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Vaccine hesitancy has become a significant issue. We aimed to elucidate the factors influencing vaccine hesitation in Chinese residents and to analyze and recommend promotional strategies and measures. In total, 92 Chinese residents from 10 provinces were interviewed using semi-structured face-to-face interviews following a predetermined survey framework in this qualitative study. We found trust in vaccine safety, access to professional advice, and vaccine price and effectiveness to be the main factors influencing vaccine hesitation. Additionally, residents in areas with a higher per capita GDP tend to receive more social support, believe that vaccination is beneficial and can prevent diseases, pay more attention to whether the vaccine is safe and has undergone various clinical trials, and are more likely to seek advice from individuals with vaccination experience as opposed to their counterparts in areas with a lower per capita GDP. Notably, as per capita GDP rises, individuals become more concerned about the price of vaccines. Measures such as clarifying vaccine safety and effectiveness, reducing self-funded vaccine prices, offering free vaccination for special groups, strengthening the publicity role of medical staff, and taking advantage of network platforms are essential to reduce vaccine hesitancy among Chinese residents.

Vaccination is currently the most effective strategy for combating COVID-19. COVID-19 vaccines were introduced to the adult population in Israel in early December 2020 and have been available for children aged 12–15 since June 2021. Our study aimed at assessing the influence of vaccine literacy, perception, hesitancy, and behavior on Israeli parents’ intentions to have their children vaccinated. Using an anonymous online questionnaire, we recruited 520 parents; 70.4% of the parents indicated that they would get their children vaccinated. The participants’ COVID-19 vaccination status was the only socio-demographic factor significantly associated with COVID-19 vaccination acceptability (OR = 32.89; 95%CI = [13.11, 82.54]). The most common sources of information regarding the COVID-19 vaccine were health-care providers and the Internet. Parents who intend to vaccinate their children had higher mean levels of vaccine literacy (2.99 ± 0.47 vs. 3.07 ± 0.44 respectively, p = 0.06), more positive perception of the vaccine (mean scores of 2.26 ± 0.75 vs. 3.44 ± 0.68 respectively, p < 0.001), and lower perceived vaccine hesitancy (7.53 ± 2.37 vs. 4.68 ± 2.71 respectively, p < 0.001) than parents who do not intend to do so. Vaccine behavior was measured using the 5C model of psychological antecedents. All 5C components were significantly correlated with parents’ willingness to vaccinate their children. Understanding of parents’ willingness to have their children receive the COVID-19 vaccine and the barriers to and facilitators of the vaccination is crucial, as vaccination of children aged 5–11 has recently been approved by the FDA. Providing the population with reliable information regarding the COVID-19 vaccine is an important measure in the attempt to increase COVID-19 vaccine acceptance.

Healthcare workers are among risk groups in the COVID-19. Even if they are not infected with the disease, they witness the effects of the pandemic. The aim of the study is to determine the factors affecting COVID-19 vaccination status and reasons for vaccine hesitancy of healthcare personnel in our hospital. Firstly, the vaccination status and demographic characteristics of all healthcare personnel was evaluated. After that, a survey was applied to 408 vaccinated and 297 nonvaccinated personnel. Within the first month after the beginning of vaccination, 66% of 3937 healthcare personnel received a COVID-19 vaccine. The number of vaccinated personnel was higher among doctors, master graduates or higher educational levels and basic science-laboratory unit workers. In the surveyed group, being under the age of 50 (OR:1.85), being nondoctor healthcare personnel (nurse/midwife OR:1.78, administrative personnel OR:3.42, patient attendant/cleaning staff OR:4.11, security guard/other OR:2.96), having had the disease before (OR:2.36), not having the flu vaccine (OR:3.24) and hesitancy about other vaccines (OR:6.61) were found to be independent risk factors for not having a COVID-19 vaccine or having it late. The three most common reasons for not getting vaccinated were doubt on the efficacy of the vaccine, distrust of its content, and fear of side effects. Taking steps by considering the main factors of hesitancy among healthcare personnel will increase the vaccine acceptance.

It is widely believed that vaccine hesitancy is prevalent in African countries, although this belief is without rigorous evidence. Our field experiment in rural northern Nigeria behaviorally measured the prevalence of vaccine hesitancy—the non-uptake of vaccines despite their availability due to non-monetary factors directly associated with vaccination. We randomly assigned two tasks to women: answering a short survey at their house vs. additionally receiving a free tetanus vaccine by submitting a voucher. The differences in their completion rates captured vaccine hesitancy, showing the rate to be about 13%. Our study reveals that absolute refusers with negative willingness to pay (WTP) for vaccines, who are likely to have strong misperceptions or a distrust of vaccines, account for about half of vaccine hesitaters, while floating refusers with zero or weakly positive WTP, who are likely to be indifferent about vaccines, account for the other half. A simple intervention, such as a door-to-door vaccination campaign, is likely to be effective for floating refusers, while interventions for absolute refusers need to effectively change their misperceptions or distrust of vaccines.

China has initiated the COVID-19 vaccination for children aged 15–17 years since late July 2020. This study aimed to determine the association between adult vaccine hesitancy and parental acceptance of childhood COVID-19 vaccines in a multi-ethnicity area of northwestern China. A web-based investigation was performed with a convenience sampling strategy to recruit the parents aged 20–49 years. In a total of 13,451 valid respondents, 66.1% had received the COVID-19 vaccination, 26.6% were intent to receive, while 7.3% were not intent, with an increasing vaccine hesitancy (p < 0.001). Moreover, vaccination uptake of four common vaccines in their children remained low (29.0% for influenza vaccine, 17.9% for pneumonia vaccine, 10.9% for rotavirus vaccine, 8.0% for Enterovirus-71 vaccine), while overall parental acceptance of childhood COVID-19 vaccines was 50.0% (32.7% for those aged 0–5, 46.6% for 6–10, 73.3% for 11–18; p < 0.001). Vaccination uptake of these four vaccines and parental acceptance of childhood COVID-19 vaccine were negatively associated with adult vaccine hesitancy. In addition, respondents mostly preferred childhood COVID-19 vaccines with weak mild common adverse events (β = 1.993) and no severe adverse events (β = 1.731), demonstrating a positive association with adult vaccine hesitancy. Thus, it warrants specific countermeasures to reduce adult vaccine hesitancy and improve strategies for childhood vaccination.

Since the declaration of the SARS-CoV-2 pandemic confirmed by World Health Organization, work on the development of vaccines has been stimulated. When vaccines are commonly available, a major problem is persistent vaccine hesitancy in many European countries. The main goal of our study was to understand the multidimensional factors inducing this phenomenon in Poland. Our study was carried out at the third wave’s peak of the pandemic, with record rates of daily cases and deaths associated with COVID-19. The results indicate that vaccine hesitancy/acceptability should always be considered in an interdisciplinary manner and according to identified factors where most negative attitudes could be altered. Our analyses included the assessment of a representative quota sample of adult Poles (N = 1000). The vaccine hesitancy in the studied group reached 49.2%. We performed stepwise logistic regression modeling to analyze variables set into six trajectories (groups) predicting the willingness to vaccinate. Apart from typical, socio-demographic and economic determinants, we identified the fear of vaccines’ side effects, beliefs in conspiracy theories and physical fitness. We were also able to establish the order of importance of factors used in a full model of all impact trajectories.

Vaccine hesitancy forms a critical barrier to the uptake of COVID-19 vaccine in high-income countries or regions. This review aims to summarize rates of COVID-19 hesitancy and its determinants in high-income countries or regions. A scoping review was conducted in Medline®, Embase®, CINAHL®, and Scopus® and was reported in accordance with the PRISMA-SCr checklist. The search was current as of March 2021. Studies which evaluated COVID-19 vaccine hesitancy and its determinants in high-income countries (US$12,536 or more GNI per capita in 2019) were included. Studies conducted in low, lower-middle, and upper-middle income countries or regions were excluded. Factors associated with vaccine hesitancy were grouped into four themes (vaccine specific, individual, group, or contextual related factors). Of 2237 articles retrieved, 97 articles were included in this review. Most studies were conducted in U.S. (n = 39) and Italy (n = 9). The rates of vaccine hesitancy across high-income countries or regions ranged from 7–77.9%. 46 studies (47.4%) had rates of 30% and more. Younger age, females, not being of white ethnicity and lower education were common contextual factors associated with increased vaccine hesitancy. Lack of recent history of influenza vaccination, lower self-perceived risk of contracting COVID-19, lesser fear of COVID-19, believing that COVID-19 is not severe and not having chronic medical conditions were most frequently studied individual/group factors associated with increased vaccine hesitancy. Common vaccine-specific factors associated with increased vaccine hesitancy included beliefs that vaccine are not safe/effective and increased concerns about rapid development of COVID-19 vaccines. Given the heterogeneity in vaccine hesitancy definitions used across studies, there is a need for standardization in its assessment. This review has summarized COVID-19 vaccine hesitancy determinants that national policymakers can use when formulating health policies related to COVID-19 vaccination.

Background: university students are believed to retain the highest levels of health literacy. They are perceived as the opinion leaders within their communities, therefore, their health-related beliefs and attitudes are deemed important for public health campaigns. This study aimed to investigate the COVID-19 vaccine hesitancy drivers among university students in the Czech Republic. Methods: a cross-sectional study using a self-administered questionnaire was carried out in the weeks before the unrestricted vaccine deployment to Czech adults. The questionnaire had 21 multiple-choice items stratified in 4 categories, demographic characteristics, COVID-19-related anamnesis and influenza vaccine experience, attitudes towards COVID-19 vaccination, and the possible drivers of COVID-19 vaccine hesitancy suggested by the WHO-SAGE. Results: out of the 1351 included students, 66.8% were females, 84.5% were Czech nationals, and 40.6% enrolled in healthcare programs. The overall COVID-19 vaccine acceptance level was 73.3%, 19.3% of participants were vaccine-resistant, and only 7.4% were vaccine-hesitant. Trust in the pharmaceutical industry, trust in healthcare providers, and perceived knowledge sufficiency predicted higher odds of vaccine acceptance. In contrast, media and social media, personal beliefs, immunity misconception, previous COVID-19 infection, and suspicions about novel vaccines and the local availability predicted higher odds of vaccine hesitancy. Conclusions: The findings of this study predict a fair probability to achieve community immunity (herd immunity) among the target population group. The primary prevention strategies in the Czech Republic need to be culturally sensitive and inclusive for foreign nationals. As one-quarter of the participating students are dependent on vaccine safety data, this study findings support the call for independent studies evaluating the side effects of COVID-19 vaccines.

General practitioners (GPs) play a critical role in patient acceptance of vaccination. Vaccine hesitancy (VH) is a growing phenomenon in the general population but also affects GPs. Few data exist on VH among GPs. The objectives of this analysis of a population of GPs in the Belgian Wallonia-Brussels Federation (WBF) were to: (1) determine the prevalence and the features of VH, (2) identify the correlates, and (3) estimate the discrepancy in vaccination’s behaviors between the GPs’ children and the recommendations made to their patients. An online survey was carried out among the population of general practitioners practicing in the WBF between 7 January and 18 March 2020. A hierarchical cluster analysis was carried out based on various dimensions of vaccine hesitancy: perception of the risks and the usefulness of vaccines as well as vaccine recommendations for their patients. A total of 251 GPs answered the survey. The average percentage of moderate to high vaccine hesitancy was 50.6%. Three factors were independently associated with increased risk of vaccine hesitancy: an age, SCOPUS: ar.j, info:eu-repo/semantics/published

Among healthcare workers (HCWs), SARS-CoV-2 vaccine hesitancy may be linked to a higher susceptibility to nocebo effects, i.e., adverse events (AEs) experienced after medical treatments due to negative expectations. To investigate this hypothesis a cross-sectional survey was performed with a self-completed questionnaire that included a tool (Q-No) for the identification of nocebo-prone individuals. A total of 1309 HCWs (67.2%women, 43.4% physicians, 28.4% nurses, 11·5% administrative staff, 16·6% other personnel) completed the questionnaires, among whom 237 (18.1%) had declined vaccination. Q-No scores were ≥15 in 325 participants (24.8%) suggesting nocebo-prone behavior. In a multivariate logistic regression model with Q-No score, age, gender, and occupation as independent variables, estimated odds ratios (ORs) of vaccination were 0.43 (i.e., less likely, p &lt, 0.001) in participants with Q-No score ≥15 vs. Q-No score &lt, 15, 0.58 in females vs. males (p = 0.013), and 4.7 (i.e., more likely) in physicians vs. other HCWs (p &lt, 0.001), independent of age, which was not significantly associated with OR of vaccination. At least one adverse effect (AE) was reported by 67.5% of vaccinees, mostly local pain and flu-like symptoms. In a multivariate logistic regression model, with Q-No score, age, gender, and occupation as independent variables, estimated ORs of AE reporting were 2.0 in females vs. males (p &lt, 0.001) and 1.47 in physicians vs. other HCWs (p = 0.017) independently of age and Q-No score, which were not significantly associated with OR of AE. These findings suggest that nocebo-prone behavior in HCWs is associated with SARS-CoV-2 vaccination hesitancy indicating a potential benefit of a campaign focused on nocebo-prone people.

Vaccination rates in Italy fell until 2015 because of unfounded safety concerns. Public education and a 2017 law on mandatory vaccination have boosted rates since then. The aim of our study is to explore how trust in the scientific community and attitudes towards vaccines have changed in the period of 2017–2019 in Italy. Data were extracted from the Italian section of the 2017 and 2019 editions of the European Social Survey (ESS). We compared the two surveys highlighting changes in public opinion on vaccines. A descriptive analysis of the socio-cultural variables according to the answers provided to key questions on the harmfulness of vaccines was conducted. Differences between percentages were tested by using the χ2 test. The association between the opinion about the harmfulness of vaccines and trust in the scientific community was analyzed through a logistic regression model. Compared to ESS8, ESS9 showed an increase in the percentage of respondents disagreeing with the harmfulness of vaccines. Trust in the scientific community raised in the period from 2017 to 2019 (59% vs. 69.6%). Higher education was significantly associated with disagreement regarding the harmfulness of vaccines (odds ratio (OR) = 2.41, 95% confidence interval (95%CI) 1.75–3.31), the strongest predictor was trust in the scientific community (OR = 10.47, 95% CI 7.55–14.52). In Italy, trust in the scientific community and in vaccinations has grown significantly in recent years, indicating a paradigm shift in public opinion compared to the past. Central actions and effective public communication strategies might reduce vaccine hesitancy and could be essential to garner public trust.

Vaccination against coronavirus disease 2019 (COVID-19) is paramount to curtailing the pandemic. However, the impact of the Non-Expanded Program on Immunization (non-EPI) and COVID-19 vaccine hesitancy on vaccine uptake among Chinese adults remain unclear. This study was an online survey performed in Eastern, Central, and Western China between February 2021 and March 2021 using proportional sampling (n = 7381). Adults aged ≥ 18 years were included, especially younger people (aged &lt, 65). Vaccine hesitancy was assessed using the 3C model and relative scales, logistic regression was used to explore the factors affecting vaccination uptake, structural equation modeling was used to evaluate the correlations between variables. Overall, 67.6% and 24.7% of adults reported vaccine hesitancy toward the non-EPI and COVID-19 vaccines, respectively. Participants (66.3%) reported taking the vaccine mainly based on recommendations from medical staff. Vaccine-hesitant participants (60.5%) reported a fear of side effects as the deciding factor in vaccine rejection. Vaccine hesitancy interacted negatively with confidence (β = −0.349, p &lt, 0.001) and convenience (β = −0.232, p &lt, 0.001), and positively with complacence (β = 0.838, p &lt, 0.001). Nonmedical personnel, adults who had previously received the influenza vaccine, and older people had lower vaccine hesitancy than their counterparts. Most Chinese adults have non-EPI but not COVID-19 vaccine hesitancy. Vaccine safety remains a concern.

The COVID-19 pandemic may have reached a turning point as the World Health Organization and the global community of nations step up plans for mass vaccination campaigns. However, the COVID-19 vaccine-related conspiracy theories (e.g., falsehoods about birth control, women infertility, surveillance, and microchip humanity, etc.) have built new momentum for vaccine hesitancy. To this end, several nations worldwide, including Pakistan, are struggling to boost public trust and enthusiasm to get vaccinated, especially in an anxious and complicated atmosphere propelled by multiple, new and the deadliest variants of COVID-19. To address this critical research gap during these intensifying conditions of vaccine hesitancy, the present study makes the first attempt to explore the potential effects of various communication strategies, including public service message (safety benefits versus fear appraisals), media types (i.e., traditional versus digital), self-efficacy, perceived benefits and threats (susceptibility and severity), on the willingness to get vaccinated for COVID-19. Importantly, the underlying effects of public skepticism (in a moderating role) on these relationships were empirically examined. Using four fictitious COVID-19 immunization campaigns in a series of experiments with 2 (media type: traditional vs. digital) X 2 (service attribute: health and safety benefits vs. fear) message frames (represented as Group one to Group four), the findings identified fear appraisal as the most viable communication strategy in combating vaccine hesitancy. Moreover, public skepticism negatively moderated the effects of media types and public service message attributes on willingness to get vaccinated in relatively high (i.e., Group two), moderate (i.e., Group one and four), and low intensities (i.e., Group three). The pioneering findings of this research offer new strategic insights for the global health authorities and vaccine promoters to proactively address the downward spiral of people’s willingness to take the COVID-19 vaccine.

The vaccine confidence index in Japan is one of the lowest worldwide. This study aimed to examine the proportion of COVID-19 vaccine hesitancy in the Japanese population using a larger sample and more robust statistical methods than previously, and to identify factors associated with vaccine hesitancy. We conducted a nationwide, cross-sectional Internet survey on 8–26 February 2021, and calculated the proportion and odds ratios for vaccine hesitancy. Among 23,142 responses analyzed, the proportion of COVID-19 vaccine hesitancy was 11.3% (10.9–11.7%). The proportion was higher among younger respondents and female respondents, and especially among younger female respondents (15.6%) compared with the lowest proportion among older male respondents (4.8%). The most cited reason for not getting vaccinated was concerns about adverse reactions in more than 70% of the respondents. The proportion of COVID-19 vaccine hesitancy in Japan was comparable to that in previous studies overseas, and the proportion among younger respondents was more than double that among older respondents. Factors associated with the hesitancy were female sex, living alone, low socioeconomic status, and presence of severe psychological distress, especially among older respondents. Thus, adequate measures should be taken to ensure that vaccines are delivered to people with these factors.

Background: Vaccine hesitancy is related to a delay in acceptance or refusal of vaccination. Aim: to perform a systematic review of clinical trials on vaccine hesitancy (2015–2020). Methods: a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria (PRISMA). Five databases were screened—PubMed, Cochrane Library, DOAJ, SciELO and b-on—which comprise multiple resources. Keywords: “Vaccine hesitancy” and (“randomized controlled trial” or “clinical trial”). Inclusion criteria: trials about “vaccine hesitancy” enrolling patients and/or health professionals (2015–2020). Exclusion criteria: studies about other topics, repeated and qualitative studies, reviews and papers written in languages other than English, Portuguese, French or Spanish. Results: a total of 35 trials out of 90 were selected (19 PubMed, 14 Cochrane Library, 0 DOAJ, 0 SciELO and 2 b-on). Selected trials were classified into five topics: children/pediatric (n = 5); online or electronic information (n = 5); vaccination against a specific disease (n = 15) (e.g., influenza or COVID-2019); miscellaneous (n = 4); and educational strategies (n = 6). Conclusion: the provision of online or electronic information (e.g., through virtual reality, social websites of experts, or apps), communication-based interventions and training of health professionals, residents or subjects seemed to improve vaccine hesitancy.

People living with HIV are a high-risk population concerning the coronavirus 19 (COVID-19) infection, with a poorer prognosis. It is important to achieve high COVID-19 vaccination coverage rates in this group as soon as possible. This project used self-reporting to assess vaccine hesitancy and acceptance among people living with HIV towards the novel COVID-19 vaccine. Sixty-eight (28.7%) participants among the 237 declared their hesitancy to be vaccinated against COVID-19. Participants who expressed concerns about their health (p &lt, 0.001), the requirement of mandatory COVID-19 vaccination (p = 0.017), and their chronic disease status (p = 0.026) were independently associated with the acceptance of vaccination. Conversely, participants presenting general vaccine refusal (p &lt, 0.001), concerns about the serious side effects of COVID-19 vaccines (p &lt, 0.001), and those already thinking having an immune status to COVID-19 (p = 0.008) were independently associated with COVID-19 vaccine hesitancy. Our results suggest that vaccine strategy would be more successful in France with a communication strategy emphasizing the collective benefits of herd immunity in the population living with HIV and reassuring patients with chronic diseases about the safety of the proposed vaccines.

The COVID-19 pandemic has led to millions of deaths and tested the capabilities of the medical and public health systems worldwide. Over the next two years as more approved vaccines are made available and supply meets or exceeds demand, medical and public health professionals will increasingly be faced with the challenge of vaccine hesitancy. There is an urgent need to create demand in groups that are either uninformed, vaccine hesitant, or actively resistant to COVID-19 vaccination. This study reviews theory, evidence, and practice recommendations to develop a vaccine demand creation strategy that has wide applicability. Specifically, we focus on key elements including supply side confidence, vaccine brand promotion strategy, service marketing as it relates to vaccine distribution, and competition strategy. We present evidence that these strategies can make a significant contribution to overcoming COVID-19 hesitancy in a high supply scenario. The paper also makes recommendations about factors that need to be considered in relation to vaccine delivery services and systems that, if done badly, may reduce uptake or result in the creation of more vaccine hesitancy. In summary, there is a need for well researched and tested demand creation strategies that integrate with brand strategy, supply side, and service delivery.

Objectives: We aimed to (1) assess parental hesitancy about category A (Expanded Program on Immunization (EPI)) and B (non-EPI) vaccines, (2) assess parental willingness for COVID-19 and influenza vaccinations, and (3) explore the association of vaccination hesitancy of parents and healthcare workers (HCWs). Methods: The study was performed in Wuxi, eastern China between 21 September 2020 and 17 October 2020. Parents of children aged &lt, 18 years and HCWs were recruited from the selected immunization clinics. Vaccine hesitancy was assessed using the Strategic Advisory Group of Experts (SAGE) vaccine hesitancy survey (VHS) by summing the total score for 10 items (maximum 50 points). Results: A total of 3009 parents and 86 HCWs were included in the analysis. The category A VHS scores were significantly higher than the category B VHS scores (p = 0.000). Overall, 59.3% and 52.4% of parents reported willingness to avail COVID-19 and influenza vaccination for their children, respectively, 51.2% of the HCWs wanted to be vaccinated against COVID-19. Parental category B VHS scores were associated with HCW category B VHS scores (r = 0.928, p = 0.008). Conclusions: In China, parents are more hesitant about category B vaccines than category A vaccines. More than 40% of parents showed hesitancy and a refusal to use COVID-19 and influenza vaccines.

Utility of vaccine campaigns to control coronavirus 2019 disease (COVID-19) is not merely dependent on vaccine efficacy and safety. Vaccine acceptance among the general public and healthcare workers appears to have a decisive role in the successful control of the pandemic. The aim of this review was to provide an up-to-date assessment of COVID-19 vaccination acceptance rates worldwide. A systematic search of the peer-reviewed English survey literature indexed in PubMed was done on 25 December 2020. Results from 31 peer-reviewed published studies met the inclusion criteria and formed the basis for the final COVID-19 vaccine acceptance estimates. Survey studies on COVID-19 vaccine acceptance rates were found from 33 different countries. Among adults representing the general public, the highest COVID-19 vaccine acceptance rates were found in Ecuador (97.0%), Malaysia (94.3%), Indonesia (93.3%) and China (91.3%). However, the lowest COVID-19 vaccine acceptance rates were found in Kuwait (23.6%), Jordan (28.4%), Italy (53.7), Russia (54.9%), Poland (56.3%), US (56.9%), and France (58.9%). Only eight surveys among healthcare workers (doctors and nurses) were found, with vaccine acceptance rates ranging from 27.7% in the Democratic Republic of the Congo to 78.1% in Israel. In the majority of survey studies among the general public stratified per country (29/47, 62%), the acceptance of COVID-19 vaccination showed a level of ≥70%. Low rates of COVID-19 vaccine acceptance were reported in the Middle East, Russia, Africa and several European countries. This could represent a major problem in the global efforts to control the current COVID-19 pandemic. More studies are recommended to address the scope of COVID-19 vaccine hesitancy. Such studies are particularly needed in the Middle East and North Africa, Sub-Saharan Africa, Eastern Europe, Central Asia, Middle and South America. Addressing the scope of COVID-19 vaccine hesitancy in various countries is recommended as an initial step for building trust in COVID-19 vaccination efforts.

Childhood vaccination has been a milestone in the control of infectious diseases. However, even in countries offering equal access to vaccination, a number of vaccine-preventable diseases have re-emerged. Suboptimal vaccination coverage has been called into question. The aim was to explore socioeconomic inequalities in vaccine hesitancy and outright refusal. Families with at least one child aged between 3 months and 7 years were involved through an online survey. Families were classified as provaccine, hesitant, or antivaccine. The association between socioeconomic determinants and hesitancy/refusal was investigated with a logistic-regression model. A total of 3865 questionnaires were collected: 64.0% of families were provaccine, 32.4% hesitant, and 3.6% antivaccine. Rising levels of perceived economic hardship were associated with hesitancy (adjusted odds ratio (AOR) from 1.34 to 1.59), and lower parental education was significantly associated with refusal (AOR from 1.89 to 3.39). Family economic hardship and parental education did not move in parallel. Economic hardship was a determinant of hesitancy. Lower education was a predictor of outright refusal without affecting hesitancy. These findings may serve as warnings, and further explanations of socioeconomic inequities are needed even in universal healthcare systems. Insight into these factors is necessary to improve convenience and remove potential access issues.

We aimed to assess the attitude towards influenza and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccinations among coronavirus disease 2019 (COVID-19) recovered patients. We performed a cross-sectional study consisting of a standardized telephone interview carried out between September and November 2020 targeting a cohort of adult in- and out-patients that had recovered from COVID-19 after the first wave (March–May 2020) at Udine Hospital (Italy). Overall, 599 people participated (320 female, median age 53 years) and most had experienced an acute COVID-19 with mild illness (409, 68.3%). The majority were hesitant or undecided towards influenza (327, 54.6%) and SARS-CoV-2 (353, 59.2%) vaccines. Older age, public work exposure, and previous 2019 flu shots were the main factors associated with a positive attitude toward both vaccinations (p &lt, 0.05). Being hospitalized during the acute COVID-19 phase was associated with the willingness to get a flu shot (94/272, 34.5%) but not SARS-CoV-2 vaccine (70/244, 28.7%). Vaccine hesitancy is diffuse and multifactorial also among COVID-19 recovered.

COVID-19 vaccines are crucial for achieving sufficient immunisation coverage to manage the pandemic, but vaccine hesitancy persists. This study aimed to investigate the prevalence and determinants of vaccine hesitancy in adults and in parents for vaccinating their children using an integrated social cognition model. A community-based cohort in Singapore [N = 1623] completed a survey (wave 25) between June and July 2021 which measured their risk perceptions, distress, trust, vaccination beliefs, and vaccine intentions/behaviours. Results indicated low rates of hesitancy (9.9%) for own vaccination, with most concerns citing side effects, safety, and hasty development. Remaining respondents were vaccinated (69%) or intended to vaccinate (21%). The multivariable model (non-vaccinated respondents) indicated that, living with people in poor health, subjective norm, moral norm, benefits, and necessity of vaccination were associated with lower vaccine hesitancy (R2 Cox & Snell: 51.4%; p < 0.001). Hesitancy rates were higher for children's vaccination (15.9%), with male gender, lower perceived vaccine benefits, high COVID-19 risk perceptions, vaccination concerns, and necessity beliefs associated with higher odds of parental vaccine hesitancy (R2 Cox & Snell = 36.4%; p < 0.001). While levels of vaccine acceptance are high, more targeted messages are needed. For adults' vaccination, more emphasis should be on benefits and social gains, while for parental hesitancy, messages related to safety should be prioritised. Published version This research was funded by estate of the late Irene Tan Liang Kheng.

A series of vaccine incidents have stimulated vaccine hesitance in China over the last decade. Many scholars have studied the institutional management of these incidents, but a qualitative study of stakeholders’ perspectives on vaccine hesitancy in China is missing. To address this lacuna, we conducted in-depth interviews and collected online data to explore diverse stakeholders’ narratives on vaccine hesitance. Our analysis shows the different perspectives of medical experts, journalists, parents, and self-defined vaccination victims on vaccination and vaccination hesitance. Medical experts generally consider vaccines, despite some flaws, as safe, and they consider most vaccine safety incidents to be related to coupling symptoms, not to vaccinations. Some parents agree with medical experts, but most do not trust vaccine safety and do not want to put their children at risk. Media professionals, online medical experts, and doctors who do not need to align with the political goal of maintaining a high vaccination rate are less positive about vaccination and consider vaccine hesitance a failure of expert–lay communication in China. Our analysis exhibits the tensions of medical expert and lay perspectives on vaccine hesitance, and suggests that vaccination experts ‘see like a state’, which is a finding consistent with other studies that have identified the over-politicization of expert–lay communication in Chinese public discourse. Chinese parents need space to express their concerns so that vaccination programs can attune to them.

Various control measures, including vaccination, have been taken to flatten the COVID-19 epidemic curve across the globe. However, in Bangladesh, many young adults, considered the asymptomatic transmitter of the disease, are waiting to get their first shot. Therefore, the potential predictors of the young adults’ vaccine uptake intention are significant to ensure their maximum vaccination when available to them. This study examined how vaccine hesitancy, eHealth literacy, and vaccine literacy are associated with young adults’ COVID-19 vaccine uptake intention in a lower-middle-income country. A total of 343 young adults participated in the study. Using ordinary least square and probit estimation, we examined the effect of the explanatory variables of interest on vaccine uptake intention. Vaccine hesitancy emerged as the strongest predictor of vaccine uptake intention. eHealth literacy shared a positive association with vaccine uptake intention, while vaccine literacy had no significant association. To make young adults feel more confident about the vaccine, transmitting the latest vaccine safety updates through authentic channels is essential. The government can aim to enhance the eHealth literacy of young adults as an increased level of eHealth literacy will enable young adults to extract reliable health-related information more efficiently than ever.

Achieving high levels of vaccination coverage against COVID-19 may be hindered by vaccine hesitancy. We quantified over time the prevalence of COVID-19 vaccine hesitancy among university students, investigated its determinants, and analyzed student attitudes, risk perceptions and compliance with preventive measures. The survey was administered online from 1 March to 30 June 2021. A multivariable logistic regression model was built to identify predictors of hesitancy. Overall, we collected 5369 questionnaires that were grouped into three survey periods (March, April–May, and May–June). The response rate ranged from 81.2% to 76.4%, whereas vaccine hesitancy ranged from 22% to 29%. Multivariable analysis showed that April–May participants had higher odds of hesitancy than March respondents. Other positive predictors were being male, not being a healthcare student, having a lower academic level, and not disclosing a political position. Conversely, higher levels of perceived COVID-19 severity, concern for the emergency, confidence in vaccine safety and effectiveness, and self-reported adherence to mask wearing indoors and outdoors were negatively associated with hesitancy. We found that vaccine hesitancy changed over time and in relation to several factors. Strategies aimed at increasing the students’ awareness and engagement, restoring confidence in health authorities, and limiting disinformation around the vaccines should be devised.

This study sought to identify individual-level determinants of COVID-19 vaccine hesitancy based on the Health Belief Model (HBM) and Theory of Planned Behavior (TPB). An online population-based survey was distributed in English and Spanish. Data were derived from 1208 U.S. adults (52% female, 38.7% minorities), 43.5% of whom reported vaccine hesitancy. Multivariable analysis revealed that unemployed individuals were more likely (OR = 1.78, 95% CI: 1.16–2.73, p = 0.009) and married (OR = 0.57, 95% CI: 0.39–0.81, p = 0.002) and higher income individuals (OR = 0.52, 95% CI 0.32–0.84, p = 0.008) were less likely to be hesitant. Individuals with greater perceived susceptibility to COVID-19 (OR = 0.82, 95% CI: 0.71–0.94, p = 0.006), who perceived vaccination as being convenient (OR = 0.86, 95% CI: 0.74–1.00, p = 0.047), and who afforded greater importance to cues to action from government (OR = 0.84, 95% CI: 0.74–0.95, p = 0.005), public health (OR = 0.70, 95% CI: 0.59–0.82, p &lt, 0.001), and healthcare experts (OR = 0.59, 95% CI: 0.50–0.69, p &lt, 0.001) were also less likely to be hesitant. Findings suggest that HBM and TPB constructs may be useful in informing strategies to improve COVID-19 vaccine uptake. Specifically, framing appeals based on perceptions of COVID-19 susceptibility, making vaccination convenient, and rebuilding trust through unified cues to action may help to overcome vaccine hesitancy.

Vaccine hesitancy is a continuum of behaviors ranging from delay in receipt to vaccination refusal. Prior studies have typically focused on high-income countries, where vaccine hesitancy is particularly prevalent in more affluent groups, but the relationship between socioeconomic status and vaccine hesitancy in Low- and Middle-Income Countries (LMICs) is less clear. The aim of this study was to describe vaccine hesitancy in five LMICs. Mothers of children in Sirajganj, Bangladesh (n = 60), Shanghai, China (n = 788), Addis Ababa, Ethiopia (n = 341), Guatemala City and Quetzaltenango, Guatemala (n = 767), and Chandigarh, India (n = 309), completed a survey between 2016 and 2018 using the WHO&rsquo, s 10-item Vaccine Hesitancy Scale. The scores of different constructs were compared across countries and by the mother&rsquo, s education level using linear regression models with generalized estimating equations. Compared to mothers in China, mothers in Bangladesh perceived less vaccination benefit (&beta, 0.56, P = 0.0001), however, mothers in Ethiopia (&beta, &minus, 0.54, P &lt, 0.0001) and Guatemala (&beta, 0.74, P = 0.0004) perceived greater benefit. Education level was not significantly linked with vaccine hesitancy. Local circumstances are important to consider when developing programs to promote vaccines. We did not find consistent associations between education and vaccine hesitancy. More research is needed to understand socio-cultural influences on vaccine decision-making.

In 2019, the World Health Organization (WHO) listed vaccine hesitancy in its top ten threats to global health. Vaccine hesitancy is a &ldquo, delay in acceptance or refusal to vaccinate despite availability of vaccination services&rdquo, Urban areas with large amounts of vaccine hesitancy are at risk for the resurgence of vaccine-preventable diseases (VPDs). Many vaccine-hesitant (VH) parents may be unfamiliar with the consequences of VPDs, and thus might be swayed when confronted with the symptoms and dangers of VPDs. As such, we sought to educate college students (future parents) in an urban vaccine-hesitant hotspot by assigning them to interview family or community members who had experienced a VPD. Student vaccine attitudes were assessed by surveys before and after the interviews. Vaccine-hesitant students who conducted a VPD interview but received no additional vaccine educational materials were significantly more likely (interaction term p &lt, 0.001) to become pro-vaccine (PV) (68%) than students who conducted an autoimmune interview and received no additional educational materials. Additionally, students whose interviewees experienced intense physical suffering or physical limitations or students who were enrolled in a course with intensive VPD and vaccine curriculum had significantly increased vaccine attitudes. This suggests that introducing students to VPDs can decrease vaccine hesitancy.

In March 2021, the coronavirus disease 2019 (COVID-19) pandemic still poses a threat to the global population, and is a public health challenge that needs to be overcome. Now more than ever, action is needed to tackle vaccine hesitancy, especially in light of the availability of effective and safe vaccines. A cross-sectional online survey was carried out on a representative random sample of 1011 citizens from the Emilia-Romagna region, in Italy, in January 2021. The questionnaire collected information on socio-demographics, comorbidities, past vaccination refusal, COVID-19-related experiences, risk perception of infection, and likelihood to accept COVID-19 vaccination. Multiple logistic regression analyses and classification tree analyses were performed to identify significant predictors of vaccine hesitancy and to distinguish groups with different levels of hesitancy. Overall, 31.1% of the sample reported hesitancy. Past vaccination refusal was the key discriminating variable followed by perceived risk of infection. Other significant predictors of hesitancy were: ages between 35 and 54 years, female gender, low educational level, low income, and absence of comorbidities. The most common concerns about the COVID-19 vaccine involved safety (54%) and efficacy (27%). Studying the main determinants of vaccine hesitancy can help with targeting vaccination strategies, in order to gain widespread acceptance—a key path to ensure a rapid way out of the current pandemic emergency.

There has been a continuous underrepresentation of minorities in healthcare research and vaccine trials, along with long-standing systemic racism and discrimination that have been fueling the distrust of the healthcare system among these communities for decades. The history and legacy of racial injustices and negative experiences within a culturally insensitive healthcare system have greatly contributed to vaccine hesitancy among ethnic minorities. COVID-19 vaccine hesitancy will impact vaccine uptake in the US, subsequently hindering the establishment of herd immunity (75–85% of the population vaccinated) to mitigate SARS-CoV-2 infection and transmission. Information targeting underserved racial/ethnic minorities in the US in a culturally competent manner has been lacking. This information is crucial for educating these communities about COVID-19 vaccines and their distribution as well as dispelling misinformation regarding vaccine trials, safety, and efficacy. This lack of education has greatly contributed to COVID-19 vaccine hesitancy and will increase disparities in vaccine uptake. Moreover, timely vaccinations are also essential to curtailing virus transmission and the emergence of SARS-CoV-2 variants that may evade the immune response produced by the three existing COVID-19 vaccines.

In 2019, vaccine hesitancy (VH), defined by the SAGE working group as “delay in acceptance or refusal of vaccination despite availability of vaccination services” appeared on the WHO list of the top 10 public health threats requiring urgent attention, along with other global issues much more covered by media, such as Ebola virus infec- tion and climate change. This has led several countries worldwide to enact, strengthen or contemplate mandatory and/or recommended infant and childhood immunization to cover this gap.

Objectives: To investigate the differences in vaccine hesitancy and preference of the currently available COVID-19 vaccines between two countries, namely, China and the United States (U.S.). Method: A cross-national survey was conducted in both China and the United States, and discrete choice experiments, as well as Likert scales, were utilized to assess vaccine preference and the underlying factors contributing to vaccination acceptance. Propensity score matching (PSM) was performed to enable a direct comparison between the two countries. Results: A total of 9077 (5375 and 3702 from China and the United States, respectively) respondents completed the survey. After propensity score matching, over 82.0% of respondents from China positively accepted the COVID-19 vaccination, while 72.2% of respondents from the United States positively accepted it. Specifically, only 31.9% of Chinese respondents were recommended by a doctor to have COVID-19 vaccination, while more than half of the U.S. respondents were recommended by a doctor (50.2%), local health board (59.4%), or friends and families (64.8%). The discrete choice experiments revealed that respondents from the United States attached the greatest importance to the efficacy of COVID-19 vaccines (44.41%), followed by the cost of vaccination (29.57%), whereas those from China held a different viewpoint, that the cost of vaccination covered the largest proportion in their trade-off (30.66%), and efficacy ranked as the second most important attribute (26.34%). Additionally, respondents from China tended to be much more concerned about the adverse effect of vaccination (19.68% vs. 6.12%) and have a lower perceived severity of being infected with COVID-19. Conclusion: Although the overall acceptance and hesitancy of COVID-19 vaccination in both countries are high, underpinned distinctions between these countries were observed. Owing to the differences in COVID-19 incidence rates, cultural backgrounds, and the availability of specific COVID-19 vaccines in the two countries, vaccine rollout strategies should be nation-dependent.

Vaccine reluctance among healthcare workers (HCW) can have widespread negative ramifications, including modeling behavior for the general population and challenges with maintaining a healthy workforce so we can respond to a resurgence of the pandemic. We previously reported that only one-third of HCW were willing to take the vaccine as soon as it became available prior to its Emergency Use Authorization (EUA). Here, we re-examine the attitude toward COVID-19 vaccines among HCW several months after the vaccines have been made widely available. In this study, only 7.9% (n = 107) of respondents were hesitant to take the first or second dose of the vaccine. Younger age (18–40 years) and lower level of education attainment (GED or less) were associated with higher vaccine hesitancy, whereas self-identified Asian racial identity was associated with greater acceptance of COVID-19 vaccination. Among the vaccine-hesitant group, more respondents noted mistrust of regulatory authorities (45.3%), government (48.6%), and pharmaceutical companies (50%) than mistrust of doctors (25.4%). Nearly two-thirds of respondents were concerned that vaccination may be ineffective against new strains and booster doses may be required, however, vaccine-hesitant respondents’ acceptance of a hypothetical booster dose was only 14.3%. Overall, vaccine hesitancy was observed to have demographic predictors similar to those previously reported, the hesitancy of some US HCW to receive booster doses may reflect a general hesitancy to receive other forms of vaccination.

Background: The immunization of large portions of populations in low/middle-income countries is considered one of the key measures to limit the development of new SARS-CoV-2 variants. However, parental vaccine hesitancy might be an important obstacle to pediatric vaccination. The aim of this survey was to study the prevalence and extent of COVID-19 vaccine hesitancy among parents of children and adolescents living in Brazil. Methods: Caregivers of children and adolescents referred to the emergency department of Hospital Estadual de Bauru, São Paulo (Brazil) were invited to fill in a validated questionnaire on vaccine hesitancy and to report their willingness for themselves and their offspring to receive a COVID-19 vaccine. Results: A total of 501 consecutive caregivers filled in the survey. Response rate was 100%. A minority (N = 14, 2.8%) of caregivers were hesitant about vaccines. Despite this, half of them declared they were willing to vaccinate their offspring against COVID-19. Conclusions: This survey identifies that vaccine hesitancy is very low among caregivers living in Brazil and that even many of the hesitant caregivers are willing to vaccinate their offspring against COVID-19. This study highlights the importance of offering the COVID-19 vaccination to the whole population, including subjects that present uncertainty about other vaccines.

Vaccines are the optimal public health strategy to prevent disease, but the growing anti-vaccine movement has focused renewed attention on the need to persuade people to increase vaccine uptake. This commentary draws on social and behavioral science theory and proposes a vaccine uptake continuum comprised of five factors: (1) awareness of the health threat; (2) availability of the vaccine; (3) accessibility of the vaccine; (4) affordability of the vaccine; and (5) acceptability of the vaccine to effectively approach this rising challenge.

Background: The current crisis created by the coronavirus pandemic is impacting all facets of life. Coronavirus vaccines have been developed to prevent coronavirus infection and fight the pandemic. Since vaccines might be the only way to prevent and stop the spread of coronavirus. The World Health Organization (WHO) has already approved several vaccines, and many countries have started vaccinating people. Misperceptions about vaccines persist despite the evidence of vaccine safety and efficacy. Objectives: To explore the scientific literature and find the determinants for worldwide COVID-19 vaccine hesitancy as reported in the literature. Methods: PRISMA Extension for Scoping Reviews (PRISMA-ScR) guidelines were followed to conduct a scoping review of literature on COVID-19 vaccine hesitancy and willingness to vaccinate. Several databases (e.g., MEDLINE, EMBASE, and Google Scholar) were searched to find relevant articles. Intervention- (i.e., COVID-19 vaccine) and outcome- (i.e., hesitancy) related terms were used to search in these databases. The search was conducted on 22 February 2021. Both forward and backward reference lists were checked to find further studies. Three reviewers worked independently to select articles and extract data from selected literature. Studies that used a quantitative survey to measure COVID-19 vaccine hesitancy and acceptance were included in this review. The extracted data were synthesized following the narrative approach and results were represented graphically with appropriate figures and tables. Results: 82 studies were included in this scoping review of 882 identified from our search. Sometimes, several studies had been performed in the same country, and it was observed that vaccine hesitancy was high earlier and decreased over time with the hope of vaccine efficacy. People in different countries had varying percentages of vaccine uptake (28–86.1%), vaccine hesitancy (10–57.8%), vaccine refusal (0–24%). The most common determinants affecting vaccination intention include vaccine efficacy, vaccine side effects, mistrust in healthcare, religious beliefs, and trust in information sources. Additionally, vaccination intentions are influenced by demographic factors such as age, gender, education, and region. Conclusions: The underlying factors of vaccine hesitancy are complex and context-specific, varying across time and socio-demographic variables. Vaccine hesitancy can also be influenced by other factors such as health inequalities, socioeconomic disadvantages, systemic racism, and level of exposure to misinformation online, with some factors being more dominant in certain countries than others. Therefore, strategies tailored to cultures and socio-psychological factors need to be developed to reduce vaccine hesitancy and aid informed decision-making.

Background: Effective public health measures in tackling the global COVID-19 pandemic necessitate understanding risk of hesitance or resistance to vaccine uptake in different populations. The Middle East and North Africa currently lacks vital representative vaccine hesitancy data. Methods: We conducted the first representative national phone survey using probability sampling among the adult population of Qatar, between December 2020 and January 2021, to identify the prevalence and potential determinants of vaccine willingness. This was categorized into: vaccine acceptance (strongly agree), vaccine resistance (strongly disagree) and vaccine hesitance (somewhat agree, neutral, somewhat disagree). Bivariate and multinomial logistic regression models estimated associations between vaccine willingness and fifteen sociodemographic, work-, and health-related variables. Findings: In the total sample, 42.7% (95%CI: 39.5-46.1) were classified as accepting, 45.2% (95%CI: 41.9-48.4) hesitant, and 12.1% (95%CI: 10.1-14.4) resistant. Those in the vaccine resistance group reported no source of endorsement will increase their confidence in accepting the vaccine (58.9% vs. 5.6% vs. 0.2%, respectively). Hesitancy and resistance were explained by female gender, Arab ethnicity, migrant status/type, and concerns about vaccine side-effects. COVID-19 related bereavement, personal infection, and quarantine status were not significantly associated with any group. Absence of or lack of concern about contracting the virus was solely associated with resistance. Interpretation: COVID-19 vaccine resistance, hesitance, and concern about side-effects is high in Qatar’s population compared with those globally. Urgent public health engagement should focus on women, Qataris (non-migrants) and those of Arab ethnicity. Funding: This study was funded by the Emergency Response Grant at Qatar University (QUERG-CAS-2020-1). Declaration of Interests: P.M.H. reports personal fees from Janssen, Lundbeck, Otsuka, New Bridge Pharmaceuticals and Sunovion, outside the submitted work. All other authors report no conflicts of interest. Ethics Approval Statement: The study was reviewed and approved by the Institutional Review Boards at Qatar University (QU-IRB 1338-EA/20) and Hamad Medical Corporation (MRC-05-089).

As COVID-19 vaccines are rolled out across the world, there are growing concerns about the roles that trust, belief in conspiracy theories, and spread of misinformation through social media play in impacting vaccine hesitancy. We use a nationally representative survey of 1476 adults in the UK between 12 and 18 December 2020, along with 5 focus groups conducted during the same period. Trust is a core predictor, with distrust in vaccines in general and mistrust in government raising vaccine hesitancy. Trust in health institutions and experts and perceived personal threat are vital, with focus groups revealing that COVID-19 vaccine hesitancy is driven by a misunderstanding of herd immunity as providing protection, fear of rapid vaccine development and side effects, and beliefs that the virus is man-made and used for population control. In particular, those who obtain information from relatively unregulated social media sources—such as YouTube—that have recommendations tailored by watch history, and who hold general conspiratorial beliefs, are less willing to be vaccinated. Since an increasing number of individuals use social media for gathering health information, interventions require action from governments, health officials, and social media companies. More attention needs to be devoted to helping people understand their own risks, unpacking complex concepts, and filling knowledge voids.

Background: The World Health Organization has recommended that individual governments identify vaccine hesitancy areas. It is proposed that the governments, with the aid of local organizations, educate and implement social insights on the vaccination so that high population levels are covered with this safe immune program. Methods: A longitudinal online survey covered 3000 adults from India. We examined the demography, behavioral (socio-economic) attitude, vaccine hesitancy, vaccine resistance for the COVID-19 vaccine. The specific reasons for the COVID-19 vaccine decline were also evaluated. Results: Our survey revealed 59% definite response, 29% low-level response, and 7% high-level response for vaccine hesitancy, while 6% had resistant views on the COVID-19 vaccine. Individuals who had higher income levels, lived in a society, maintained social distancing, had downloaded the COVID-19 update app, showed a positive attitude towards their government, and more confidence in their healthcare system were more inclined towards the vaccination. On the contrary, individuals who had overstated the risks of COVID-19 and had a religious and populistic attitude towards vaccination were more hesitant/resistant to vaccination. The respondents who declined vaccine administration were further evaluated for their specific reason for their response. The most common reasons for declining the COVID-19 vaccine were post-vaccine scare of adverse health effects and accepting the information spread by social media. Conclusions: The results in our study show that by identifying population “hot spots” that have negative or unclear information on the COVID-19 vaccination, these “hot spots” can be addressed by involving friendly organizations that can clear their strong disbeliefs and increase the percentage of vaccine-definite people within the population. The role of government-induced COVID-19 vaccine policy measures can always be beneficial to cause this shift from disbelief to confidence within the population.

Even with the availability of COVID-19 vaccines, factors associated with vaccine hesitancy and uptake among nurses are unknown. This study evaluated COVID-19 vaccine hesitancy and uptake of nursing staff during one of the first COVID-19 vaccine rollouts in the United States. A cross-sectional survey was conducted during February 2021 among nursing staff working in a large medical center in central United States. There were 276 respondents, 81.9% of participants were willing to receive the vaccine during the initial rollout, 11.2% were hesitant, and only 5.1% were unwilling. The hesitant group was likely to report having inadequate information to make an informed decision about whether to receive the vaccine (45.2%) and about vaccine expectations (32.3%). The majority (83.3%) received at least one dose of the vaccine. Having greater than 10 years’ work experience (OR 3.0, 95% CI 1.16–7.9) and confidence in vaccine safety (OR 7.78, 95% CI 4.49–13.5) were significantly associated with vaccine uptake. While our study indicates higher vaccine uptake among nursing staff during an active vaccine rollout, there remains sustained hesitancy and unwillingness to uptake. For those hesitant to receive the COVID-19 vaccine, public health efforts to provide more data on side effects and efficacy may help increase vaccine uptake.

Background: Acceleration of mass vaccination strategies is the only pathway to overcome the COVID-19 pandemic. Healthcare professionals and students have a key role in shaping public opinion about vaccines. This study aimed to evaluate the attitudes of dental students globally towards COVID-19 vaccines and explore the potential drivers for students’ acceptance levels. Methods: A global cross-sectional study was carried out in February 2021 using an online questionnaire. The study was liaised by the scientific committee of the International Association of Dental Students (IADS), and data were collected through the national and local coordinators of IADS member organizations. The dependent variable was the willingness to take the COVID-19 vaccine, and the independent variables included demographic characteristics, COVID-19-related experience, and the drivers of COVID-19 vaccine-related attitude suggested by the WHO SAGE. Results: A total of 6639 students from 22 countries, representing all world regions, responded to the questionnaire properly. Their mean age was 22.1 ± 2.8 (17–40) years, and the majority were females (70.5%), in clinical years (66.8%), and from upper-middle-income economies (45.7%). In general, 22.5% of dental students worldwide were hesitant, and 13.9% rejected COVID-19 vaccines. The students in low- and lower-middle-income (LLMI) economies had significantly higher levels of vaccine hesitancy compared to their peers in upper-middle- and high-income (UMHI) economies (30.4% vs. 19.8%, p &lt, 0.01). Conclusions: The global acceptance level of dental students for COVID-19 vaccines was suboptimal, and their worrisome level of vaccine hesitancy was influenced by the socioeconomic context where the dental students live and study. The media and social media, public figures, insufficient knowledge about vaccines, and mistrust of governments and the pharmaceutical industry were barriers to vaccination. The findings of this study call for further implementation of epidemiology (infectious diseases) education within undergraduate dental curricula.

Ending the COVID-19 pandemic requires achieving herd immunity, either by previous infection or by vaccination. However, concerns about the COVID-19 vaccine are growing around the globe. The current study was conducted to investigate young the adult population’s hesitancy towards the vaccine. The study used a prospective cross-sectional design. Data was collected using an online self-administered questionnaire. A total of 862 Saudi adults participated. Information was gathered on the participants’ perspectives towards the severity and susceptibility of the COVID-19 infection, reasons for their hesitancy to receive the vaccine, perceived benefits, and reasons for action. Just under a quarter (19.6%) of respondents had previously tested positive for COVID-19. A small minority of the participants had already received the vaccine (2.1%), while 20.3% had registered in the Sehaty app (application) to receive the vaccine. Just under half of them (48%) will take the vaccine when mass vaccination is achieved and approximately the same number (46.7%) will only take it if it is made mandatory. Vaccine reluctance is highly prevalent among the general public in Saudi Arabia during the COVID-19 pandemic. While many are aware of a high likelihood of getting the infection, the efficacy and safety of the COVID-19 vaccine were reported as barriers to vaccination.

Despite the well-developed Chinese National Immunization Program, vaccine hesitancy in China is rising. As part of the response, Chinese scholars have studied determinants and proposed solutions to vaccination hesitancy. We performed a scoping review of Chinese literature (2007–2019), drawn from four Chinese databases. We mapped relevant information and presented a systemic account of the proposed determinants and responses to vaccine hesitancy in China. We identified 77 relevant studies that reveal four approaches to vaccine hesitancy. Most Chinese studies define vaccine hesitancy as a problem of vaccine safety and vaccine incident response and place accountability on the level of governance, such as regulation deficits and inappropriate crisis management. A first minority of studies tied vaccination hesitancy to unprofessional medical conduct and called for additional resources and enhanced physician qualifications. A second minority of studies positioned vaccination hesitancy as a problem of parental belief and pointed to the role of media, proposing enhanced communication and education. Chinese literature ties vaccine hesitancy primarily to vaccine safety and medical conduct. Compared to international research, parental concerns are underrepresented. The Chinese context of vaccination scandals notably frames the discussion of vaccination hesitancy and potential solutions, which stresses the importance of considering vaccination hesitancy in specific social and political contexts.

The success of large-scale COVID-19 vaccination campaigns is contingent upon people being willing to receive the vaccine. Our study explored COVID-19 vaccine hesitancy and its correlates in eight different countries around the globe. We analyzed convenience sample data collected between March 2020 and January 2021 as part of the iCARE cross-sectional study. Univariate and multivariate statistical analyses were conducted to explore the correlates of vaccine hesitancy. We included 32,028 participants from eight countries, and observed that 27% of the participants exhibited vaccine hesitancy, with increases over time. France reported the highest level of hesitancy (47.3%) and Brazil reported the lowest (9.6%). Women, younger individuals (≤29 years), people living in rural areas, and those with a lower perceived income were more likely to be hesitant. People who previously received an influenza vaccine were 70% less likely to report COVID-19 vaccine hesitancy. We observed that people reporting greater COVID-19 health concerns were less likely to be hesitant, whereas people with higher personal financial concerns were more likely to be hesitant. Our findings indicate that there is substantial vaccine hesitancy in several countries, with cross-national differences in the magnitude and direction of the trend. Vaccination communication initiatives should target hesitant individuals (women, younger adults, people with lower incomes and those living in rural areas), and should highlight the immediate health, social and economic benefits of vaccination across these settings. Country-level analyses are warranted to understand the complex psychological, socio-environmental, and cultural factors associated with vaccine hesitancy.

In this study, we evaluated the status of and attitudes toward COVID-19 vaccination of healthcare workers in two major hospital systems (academic and private) in Southern California. Responses were collected via an anonymous and voluntary survey from a total of 2491 participants, including nurses, physicians, other allied health professionals, and administrators. Among the 2491 participants that had been offered the vaccine at the time of the study, 2103 (84%) were vaccinated. The bulk of the participants were middle-aged college-educated White (73%), non-Hispanic women (77%), and nursing was the most represented medical occupation (35%). Political affiliation, education level, and income were shown to be significant factors associated with vaccination status. Our data suggest that the current allocation of healthcare workers into dichotomous groups such as “anti-vaccine vs. pro-vaccine” may be inadequate in accurately tailoring vaccine uptake interventions. We found that healthcare workers that have yet to receive the COVID-19 vaccine likely belong to one of four categories: the misinformed, the undecided, the uninformed, or the unconcerned. This diversity in vaccine hesitancy among healthcare workers highlights the importance of targeted intervention to increase vaccine confidence. Regardless of governmental vaccine mandates, addressing the root causes contributing to vaccine hesitancy continues to be of utmost importance.

Vaccine hesitancy remains a major public health concern in the effort towards addressing the COVID-19 pandemic. This study analyzed the effects of indicators of compliance with preventive practices on the willingness to take COVID-19 vaccines in Kenya. The data were from the COVID-19 Rapid Response Phone Surveys conducted between January and June 2021 during the fourth and fifth waves. The data were analyzed with the random-effects endogenous Probit regression model, with estimated parameters tested for robustness and stability. The results showed that willingness to take vaccines increased between the fourth and fifth waves. Compliance with many of the preventive practices also improved, although the utilizations of immune system-promoting practices were very low. The panel Probit regression results showed that compliance indicators were truly endogenous and there was existence of random effects. Immune system-boosting and contact-prevention indicators significantly increased and decreased the willingness to take vaccines, respectively (p &lt, 0.01). The experience of mental health disorders in the form of nervousness and hopelessness also significantly influenced vaccine hesitancy (p &lt, 0.10). Willingness to take vaccines also significantly increased among older people and those with a formal education (p &lt, 0.01). Different forms of association exist between vaccine hesitancy and the prevention compliance indicators. There is a need to properly sensitize the people to the need to complement compliance with COVID-19 contact-prevention indicators with vaccination. Addressing mental health disorders in the form of loneliness, nervousness, depression, hopelessness and anxiety should also become the focus of public health, while efforts to reduce vaccine hesitancy should focus on individuals without formal education, males and youths.

Background: Incomplete childhood immunization against communicable diseases is a major concern and vaccine hesitancy remains a hurdle to overcome in primary vaccination programs. This study was to examine the parents’ vaccine knowledge, awareness and hesitancy in relation to their children’s immunization status. Methods: A cross-sectional questionnaire study design was used. The parents who brought their children for immunization visit or follow-up at four public health clinics located in Sandakan district were invited to participate in this survey. Informed consent was obtained before each participant completed a hard copy of self-administered questionnaire in either English or Malay versions. Results: Of 405 parents responded, they generally had good knowledge and awareness of vaccines, only a small percentage (6.8%) of parents were found vaccine hesitant. There were significant differences in vaccine knowledge and awareness in those from different education levels and employment status, similarly, these two factors also significantly affected the vaccine hesitancy among the parents. The parents’ knowledge score was found to be moderately associated with their awareness (r = 0.551, p &lt, 0.01) and inversely correlated to vaccine hesitancy (r = −0.397, p &lt, 0.01). Most of the children (n = 376, 92.8%) in the study were immunized. The children’s immunization status was significantly associated with the parents’ education level (p = 0.025). There was also a significant difference in the total vaccine knowledge scores between the groups of parents with different child immunization status (p = 0.05). Conclusion: This study revealed that parents with higher education had a better knowledge of vaccinations, were less vaccine hesitant and were more likely to ensure that their children complete the recommended course of immunization. It is crucial to ensure parents are well-informed about the safety and efficacy of vaccines so that the children are protected from communicable diseases by the child vaccination program.

Vaccine hesitancy has been considered one of the most severe threats to global health, as it represents an obstacle to achieving adequate vaccination coverage. Recent research studies aimed at investigating the propensity for anti-COVID vaccination among adults have found a high prevalence of vaccine hesitancy, but few data are available on parental vaccine hesitancy. We therefore built an anonymous online survey to investigate the factors related to the vaccine hesitancy of parents of adolescents between 12 and 17 years of age, with a special focus on demographic factors and the domains of confidence and complacency. The online survey was conducted by using the Crowd Signal platform from 15 July to 16 August 2021, in Italy. A total of 1799 analyzable questionnaires were analyzed. Overall, Favorable and Doubtful parents declared a higher level of confidence on safety and efficacy of pediatric vaccines and on confidence in health institutions than Hesitant/Reluctant ones (p-values &lt, 0.001). The univariate multinomial logistic regression analysis and the multivariate multinomial logistic regression analysis showed that the Hesitant/Reluctant parents were younger than 40 years of age, with a secondary-school or three-year degree, free-lance, with a family income below € 28,000, with an erroneous perception of the risk of COVID-19 as disease and with fear of anti-COVID vaccination. These results, which should be confirmed in a larger population and in different geographical areas, should lead Institutions and stakeholders to identify targeted communication tools to improve trust in health institutions, especially by younger parents.

Vaccine hesitancy (VH) is known to play a relevant role in thwarting the efforts toward reaching satisfactory influenza vaccination coverage, and has caused similar difficulties during the COVID-19 pandemic. This study aims to describe the phenomenon and produce insights on the reasons behind VH. A survey was administered between December 2020 and February 2021 to adults living in the cities of Bologna and Palermo. Of the 443 subjects enrolled, 47.3% were likely to get the influenza vaccination, while 75.6% were willing to receive the COVID-19 vaccination. The most frequent determinants that motivated the willingness to get the COVID-19 vaccine were trust in the safety of vaccines and belief that the vaccine is an effective tool. As for people’s unwillingness to be vaccinated, being exposed to information that produced doubts about the vaccine and lack of trust in a newly developed vaccine were the most frequently involved determinants. Statistically significant positive associations were found between the willingness to be vaccinated and postgraduate education and the propensity towards influenza vaccination. A negative association with being over 40 years old and of female gender was also found. These results might have an impact in better understanding individual reasons behind VH, identifying which categories are more exposed to it and which strategies should be implemented.

As the COVID-19 pandemic rages unabated, and with more infectious variants, vaccination may offer a way to transit out of strict restrictions on physical human interactions to curb the virus spread and prevent overwhelming the healthcare system. However, vaccine hesitancy threatens to significantly impact our progress towards achieving this. It is thus important to understand the sentiments regarding vaccination for different segments of the population to facilitate the development of effective strategies to persuade these groups. Here, we surveyed the COVID-19 vaccination sentiments among a highly educated group of graduate students from the National University of Singapore (NUS). Graduate students who are citizens of 54 different countries, mainly from Asia, pursue studies in diverse fields, with 32% expressing vaccine hesitancy. Citizenship, religion, country of undergraduate/postgraduate studies, exposure risk and field of study are significantly associated with vaccine sentiments. Students who are Chinese citizens or studied in Chinese Universities prior to joining NUS are more hesitant, while students of Indian descent or studied in India are less hesitant about vaccination. Side effects, safety issues and vaccine choice are the major concerns of the hesitant group. Hence, this study would facilitate the development of strategies that focus on these determinants to enhance vaccine acceptance.