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Background: Mental health and substance use challenges are highly correlated in youth and have been speculated to be associated with COVID-19 vaccine hesitancy. Literature has also suggested that mental health challenges in youth have increased during the COVID-19 pandemic. However, the longitudinal relationship between mental health challenges in youth and COVID-19 vaccine hesitancy is not well established., Objective: We examined the relationship between mental health, substance use and COVID-19 vaccine hesitancy in youth during the COVID-19 pandemic., Methods: Youth ages 14 to 29-years participated in a longitudinal survey study. Participants provided sociodemographic, mental health, and substance use data, as well as qualitative and quantitative information on their vaccine perspectives every two months between February 2021 to August 2021, and on February 2022. Generalized estimating equation logistic regression models were used to analyze the effect of mental health and substance use on vaccine hesitancy over time. Qualitative content area analyses were used to identify trends in vaccine attitudes., Results: Mental health challenges and substance use frequency were associated with vaccine hesitancy, and significantly increased the odds of vaccine hesitancy over time. Additionally, mental health challenges were associated with decreases in vaccine hesitancy (OR: 0.80 (95% CI 0.66, 0.97)) when vaccines first began to emerge, but increases in vaccine hesitancy (OR: 1.72 (95% CI 1.32, 2.26)) one year later. Participants reported perceptions regarding vaccine safety and efficacy were the primary determinants influencing hesitant, uncertain, and acceptant vaccine attitudes. Additionally, changes in vaccine attitudes over time for some participants, were associated with changes in mental health., Conclusions: Increases in mental health challenges and substance use were associated with increases in COVID-19 vaccine hesitancy in youth over the COVID-19 pandemic. Health policy agencies should be aware of the potential impact of mental health challenges and substance use in youth, when developing vaccine policy and programs., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2025 Everest et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: The World Health Organization (WHO) defines vaccine hesitancy as "a delay in acceptance or refusal of vaccines despite availability of vaccination services". Vaccine hesitancy has also been declared a top threat to global health. Some employers imposed vaccine mandates during the Covid-19 pandemic resulting in health care employees resigning or being fired rather than receive a vaccine. Healthcare paraprofessionals such as certified nursing assistants, dietary and home health aides are among the most patient facing of all health care providers. Their beliefs and attitudes about vaccines are critical to how they communicate about vaccines with their patients., Objective: The objective of this project was to survey health care paraprofessionals to explore their thoughts and opinions about vaccines in general, and Covid-19 vaccines specifically., Methods: This was a 25 question, mixed methods, cross sectional email survey. Subjects were recruited from the mailing list of a non-profit organization in the Midwest. This organization is dedicated to bringing a face and a voice to healthcare paraprofessionals engaged in direct patient care., Results: Most respondents were reasonably well informed about vaccines; had received one or more doses of indicated vaccines; used credible resources to learn about vaccines and believed physicians and pharmacists were the most trusted information sources. Qualitative results indicated that respondents expressed support for vaccines but that the support was often qualified in that a respondent may have had both pro and anti-vaccine opinions in the same response. They also expressed that communications about vaccines were often problematic. Additional vaccine-related continuing professional development for healthcare paraprofessionals appears to be indicated., Conclusions: Although attitudes towards vaccines were generally positive, respondents had concerns about the quality of vaccine information. Additional vaccine-related continuing professional development for healthcare paraprofessionals appears to be indicated., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2025 Hergott et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

This study analyzed online public discourse on Twitter (later rebranded as X) during the COVID-19 pandemic to understand key factors associated with vaccine hesitancy by employing deep-learning techniques. Text classification analysis reveals a significant association between attitudes toward vaccination and the unique socio-economic characteristics of US states, such as education, race, income or voting behavior. However, our results indicate that attributing vaccine hesitancy solely to a single social factor is not appropriate. Furthermore, the topic modeling of online discourse identifies two distinct sets of justifications for vaccine hesitancy. The first set pertains to political concerns, including constitutional rights and conspiracy theories. The second pertains to medical concerns about vaccine safety and efficacy. However, vaccine-hesitant social media users pragmatically use broad categories of justification for their beliefs. This behavior may suggest that vaccine hesitancy is influenced by political beliefs, unconscious emotions, and gut-level instinct. Our findings have further implications for the critical role of trust in public institutions in shaping attitudes toward vaccination and the need for tailored communication strategies to restore faith in marginalized communities., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Ayaz et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

The SARS-CoV-2 pandemic has generated a considerable number of infections and associated morbidity and mortality across the world. Recovery from these infections, combined with the onset of large-scale vaccination, have led to rapidly-changing population-level immunological landscapes. In turn, these complexities have highlighted a number of important unknowns related to the breadth and strength of immunity following recovery or vaccination. Using simple mathematical models, we investigate the medium-term impacts of waning immunity against severe disease on immuno-epidemiological dynamics. We find that uncertainties in the duration of severity-blocking immunity (imparted by either infection or vaccination) can lead to a large range of medium-term population-level outcomes (i.e. infection characteristics and immune landscapes). Furthermore, we show that epidemiological dynamics are sensitive to the strength and duration of underlying host immune responses; this implies that determining infection levels from hospitalizations requires accurate estimates of these immune parameters. More durable vaccines both reduce these uncertainties and alleviate the burden of SARS-CoV-2 in pessimistic outcomes. However, heterogeneity in vaccine uptake drastically changes immune landscapes toward larger fractions of individuals with waned severity-blocking immunity. In particular, if hesitancy is substantial, more robust vaccines have almost no effects on population-level immuno-epidemiology, even if vaccination rates are compensatorily high among vaccine-adopters. This pessimistic scenario for vaccination heterogeneity arises because those few individuals that are vaccine-adopters are so readily re-vaccinated that the duration of vaccinal immunity has no appreciable consequences on their immune status. Furthermore, we find that this effect is heightened if vaccine-hesitants have increased transmissibility (e.g. due to riskier behavior). Overall, our results illustrate the necessity to characterize both transmission-blocking and severity-blocking immune time scales. Our findings also underline the importance of developing robust next-generation vaccines with equitable mass vaccine deployment., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Saad-Roy et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Health communicators are faced with the challenge that people can hesitate vaccines for different reasons. Our aim was to identify and describe the qualities of distinct COVID-19 and influenza vaccine-hesitancy subgroups to facilitate the development of tailored vaccine-hesitancy communication. In two studies, we used agglomerative hierarchical cluster analysis to identify COVID-19 (N = 554) and influenza (N = 539) vaccine-hesitancy subgroups in the general population based on nine vaccine hesitancy-related variables (intent to get vaccinated, perceived vaccine safety, perceived vaccine efficacy, perceived disease threat, perceived vaccination responsibility, perceived vaccination convenience, distrust in authorities, conspiracy mentality, and reliance on anecdotal testimonies). We identified and described six distinct COVID-19 vaccine-hesitancy subgroups (the Vaccination Positive, the Ambivalent, the Fearing Skeptic, the Unconvinced, the Constrained Skeptic, and the Vaccination Opponent), and three influenza vaccine-hesitancy subgroups (the Vaccination Positive, the Complacent, and the Vaccination Opponent), with different levels of hesitancy. We discuss the implications of the results for health communicators. Our results shed light on the (dis)similarities between people who hesitate COVID-19 and influenza vaccines and suggest that there is greater variety in hesitancy concerning COVID-19 vaccinations than influenza vaccinations. These findings can be used to design and test tailored vaccination messages., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Mäki et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Introduction: The Latinx population has the second highest COVID-19 death rate among racial/ethnic groups in the United States and less than half of Latinx youth aged 5-17 years old completed their COVID-19 primary vaccination series as of September 2022. COVID-19 vaccine misinformation detrimentally impacts vaccination rates. In this study, we examined factors that predicted Latinx youth COVID-19 vaccine hesitancy and vaccination status., Methods: A community-based sample of 290 Latinx parent and adolescent dyads from a Southwestern metropolitan area of the United States who were recruited to complete an online survey at baseline at T1 (August 2020 -March 2021) and one year later. We tested a longitudinal mediation model in which we examined individual and family factors that would predict youth COVID-19 vaccine hesitancy and vaccination status over time., Results: Youth's pandemic disbelief (i.e., the belief that the COVID-19 pandemic is a conspiracy or not real) predicted greater youth's COVID-19 vaccine hesitancy, and in turn, a lower likelihood of youth's COVID-19 vaccination. Youth's pandemic disbelief also predicted greater parent's vaccination hesitancy which, in turn, predicted greater youth's vaccination hesitancy and a lower likelihood of COVID-19 vaccination. Parents' pandemic disbelief predicted their own COVID-19 hesitancy, but not youth hesitancy., Discussion: Our study findings provide initial evidence that general pandemic disbelief was a significant driver of vaccine hesitancy and vaccination among Latinx families. The study contributes to the limited research investigating COVID-19 vaccination in the Latinx community and among Latinx youth, further aiding how COVID-19 vaccine disparities can be mitigated among racial/ethnic populations., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Mantina et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Understanding and addressing the concerns of vaccine-hesitant individuals, including those with chronic diseases, is key to increasing vaccine acceptance and uptake. However, in Ethiopia, there is limited evidence on the COVID-19 vaccine hesitancy and predictor variables among diabetic patients. Hence, the study aimed to assess Covid-19 Vaccine Hesitancy and Predictor variables among Diabetic Patients on Follow-Up at Public Hospitals in Nekemte Town, Western Ethiopia., Method: Facility based cross sectional study was conducted among 422 diabetic patients attending public hospitals at Nekemte Town, Western Ethiopia between January, to February, 2023. Study participants were recruited by systematic random sampling. The data were collected interviewee administered pre-tested structured survey questioner. The collected data were entered and cleaned using Epi-Data software 4.6 version. The cleaned data were analyzed using SPSS. 25.0 Statical software. Descriptive statistics like frequency, mean and percentage, and binary logistic regression was applied to identify independent predictors of Covid-19 vaccine hesitancy and association between variables were declared at p-value of 0.05., Result: The overall magnitude of COVID-19 vaccine hesitancy was 15.2% (95% CI: 11.6-18.7). The top three listed reasons for the COVID-19 vaccine hesitancy were: negative information about the vaccine (32.90%), lack of enough information (21.80%), and vaccine safety concern (19.40%). The hesitancy of the COVID-19 vaccination uptake among diabetes patients was independently influenced by age between 40-49 (Adjusted Odd Ratio [AOR] = 4.52(1.04-19.66)), having vaccine awareness (AOR = 0.029(0.001-0.86)), having a great deal of trust on vaccine development (AOR = 0.028(0.002-0.52)), and a fear amount trust (AOR = 0.05(0.003-0.79)) on the vaccine preparation, vaccinated for COVID-19 (AOR = 0.13(0.04-0.51)), perceived exposure to COVID-19 infection after having the vaccine as strongly agree/agree (AOR = 0.03(0.01-0.17))and neither agree nor disagree (AOR = 0.07(0.02-0.30))., Conclusion: COVID-19 vaccine hesitancy among diabetic patients was relatively low. The identified independent predictors were age, vaccine awareness, COVID-19 vaccination history, awareness on vaccine preparation and exposure status to COVID-19 infection. The relevant agency should focus on efforts to translating these high levels of vaccine acceptance into actual uptake, through targeting identifying predictor variables and vaccine availability for a high-risk diabetes patient., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Olani Kuta, Dida. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

The COVID-19 pandemic prompted governments worldwide to implement a range of containment measures, including mass gathering restrictions, social distancing, and school closures. Despite these efforts, vaccines continue to be the safest and most effective means of combating such viruses. Yet, vaccine hesitancy persists, posing a significant public health concern, particularly with the emergence of new COVID-19 variants. To effectively address this issue, timely data is crucial for understanding the various factors contributing to vaccine hesitancy. While previous research has largely relied on traditional surveys for this information, recent sources of data, such as social media, have gained attention. However, the potential of social media data as a reliable proxy for information on population hesitancy, especially when compared with survey data, remains underexplored. This paper aims to bridge this gap. Our approach uses social, demographic, and economic data to predict vaccine hesitancy levels in the ten most populous US metropolitan areas. We employ machine learning algorithms to compare a set of baseline models that contain only these variables with models that incorporate survey data and social media data separately. Our results show that XGBoost algorithm consistently outperforms Random Forest and Linear Regression, with marginal differences between Random Forest and XGBoost. This was especially the case with models that incorporate survey or social media data, thus highlighting the promise of the latter data as a complementary information source. Results also reveal variations in influential variables across the five hesitancy classes, such as age, ethnicity, occupation, and political inclination. Further, the application of models to different MSAs yields mixed results, emphasizing the uniqueness of communities and the need for complementary data approaches. In summary, this study underscores social media data's potential for understanding vaccine hesitancy, emphasizes the importance of tailoring interventions to specific communities, and suggests the value of combining different data sources., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Sasse et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Despite the significant success of India's COVID-19 vaccination program, a sizeable proportion of the adult population remains unvaccinated or has received a single dose of the vaccine. Despite the recommendations of the Government of India for the two doses of the COVID-19 vaccine and the precautionary booster dose, many people were still hesitant towards the COVID-19 full vaccination. Hence, this study aimed to identify the primary behavioral and psychological factors contributing to vaccine hesitancy. Cross-sectional data was collected via a multi-stage sampling design by using a scheduled sample survey in the Gorakhpur district of Uttar Pradesh, India, between 15 July 2022 to 30 September 2022. This study has utilized three health behavior models-the Health Belief Model (HBM), the Theory of Planned Behavior (TPB), and the 5C Psychological Antecedents of vaccination, and employed bivariate and multivariable binary logistic regression model to assess the level of vaccine hesitancy and predictive health behavior of the respondents. Results indicate that among the constructs of the HBM and 5C Antecedents models, "perceived benefits", "confidence" and "collective responsibility" showed a lesser likelihood of COVID-19 vaccine hesitancy. However, in the TPB model constructs, a 'negative attitude towards the vaccine' showed a four times higher likelihood of COVID-19 vaccine hesitancy. From the future policy perspective, this study suggested that addressing the issue of 'negative attitudes towards the vaccine' and increasing the trust or confidence for the vaccine through increasing awareness about the benefits of the vaccination in India may reduce vaccine hesitancy., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Aggarwal et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Introduction: Healthcare workers play a crucial role in supporting COVID-19 vaccination as they are the most trusted source of information to the public population. Assessing the healthcare workers' hesitancy towards COVID-19 vaccination is pertinent, however, there are limited validated tools to measure their hesitancy on COVID-19 vaccines. This study aims to adapt and validate the first COVID-19 hesitancy scale among healthcare workers in Malaysia., Materials and Methods: This study adapted and translated the Vaccine Hesitancy Scale (VHS) developed by the WHO SAGE Working Group. The scale underwent a sequential validation process, including back-back translation, content, face, and construct validity for Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA). The reliability was tested using internal consistency (Cronbach's alpha composite reliability (CR) and average variance extracted (AVE))., Results: The data for EFA and CFA were completed by a separate sample of 125 and 300 HCWs, respectively. The EFA analysis of the C19-VHS-M scale was unidimensional with 10 items. A further CFA analysis revealed a uniform set of nine items with acceptable goodness fit indices (comparative fit index = 0.997, Tucker-Lewis index = 0.995, incremental fit index = 0.997, chi-squared/degree of freedom = 1.352, and root mean square error of approximation = 0.034). The Cronbach's alpha, CR and AVE results were 0.953, 0.95 and 0.70, respectively., Conclusions: The questionnaire was valid and reliable for use in the Malay language., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Zaid et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Vaccination is one of the most cost-effective public health interventions used to prevent diseases in susceptible populations. Despite the established efficacy of vaccines, there are many reasons people are hesitant about vaccination, and these reasons could be complex. This rapid survey estimated the prevalence of COVID-19 vaccine hesitancy and potentially contributing factors in Montserrado and Nimba counties in Liberia., Methods: A cross-sectional study was conducted among adults living in Liberia. The relationship between vaccine non-acceptance and sociodemographic characteristics was examined using chi-square statistics. The variables with a p-value less than 0.2 at the bivariate analysis were modelled in a binary logistic regression at a 5% level of significance. The adjusted odds ratio and 95% confidence interval are reported., Results: There were 877 participants in the study. Majority were 25-34 years of age (30.4%, 272/877), females (54.05%, 474/877), and Christians (85.2%, 747/877). Most of the participants were aware of the COVID-19 vaccine (75%, 656/877), single (41.4%, 363/877), self-employed (37.51%, 329/877), and live-in rural communities (56.1%, 492/877). Vaccine hesitancy was (29.1%, 255/877; 95% CI:26.2-32.2). Vaccine hesitancy was greater among adults living in urban areas (41%) compared to persons living in rural communities (59%) (aOR; 1.5, 95% CI: 1.1-2.1) and respondents aged 45-54 years (aOR:0.5; 95% CI: 0.2-0.9; p = 0.043) were 50% less likely to be hesitant to COVID-19 vaccination compared to those more than 55 years. The most common source of information was the media (53%, 492/877) and the main reason for being hesitant was a need for more information about the vaccine and its safety (84%, 215/255)., Conclusions: The majority of study participants were aware of the COVID-19 vaccines and their most common source of information was the media (television, radio). Vaccine hesitancy was moderate. This could pose a challenge to efforts to control the spread of the COVID-19 pandemic. Therefore, the health authorities should provide more health education on the importance of vaccines and their safety to the populace., Competing Interests: The authors have declared that no competing interests exists., (Copyright: This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication.)

COVID-19 vaccines, currently available to children over six months old, are a powerful method of reducing the risk of COVID-19-related hospitalizations and death. However, vaccination rates among Hispanic children remain suboptimal, primarily due to parental vaccine hesitancy. Health communication researchers have suggested using culturally aligned storytelling to reduce vaccine hesitancy; however, few studies have evaluated this approach for Hispanic parents of unvaccinated children. Working with community health workers, we will engage Hispanic parents who were previously hesitant to vaccinate their child(ren) against COVID-19 but currently support vaccination. We will ask them to share their stories of conversion in COVID-19 vaccine perspectives to help other parents overcome their mistrust of COVID-19 vaccines. We will then assess the feasibility and acceptability of a web-based pilot digital storytelling intervention based on these conversion stories vs. an information-only control among 80 parents and/or legal guardians of children who are not up-to-date with COVID-19 vaccines. We will also examine pre- to post-intervention changes in vaccine perceptions, hesitancy, intentions, and uptake of children's COVID-19 vaccination at two months post-intervention. If our pilot study demonstrates feasibility and acceptability while reducing COVID-19 vaccine hesitancy and increasing vaccine uptake, we will conduct a full-scale randomized controlled trial to examine the effectiveness of the DST intervention to reduce vaccine hesitancy., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Koskan et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Vaccine hesitancy is a major obstacle to the large efforts made by governments and health organizations toward achieving successful COVID-19 vaccination programs. Healthcare worker's (HCWs) acceptance or refusal of the vaccine is an influencing factor to the attitudes of their patients and general population. This study aimed to report the acceptance rates for COVID-19 vaccines among HCWs in Arab countries and identify key factors driving the attitudes of HCWs in the Arab world toward vaccines., Methods: This systematic review and meta-analysis followed the PRISMA guidelines. PubMed and Scopus databases were searched using pre-specified keywords. All cross-sectional studies that assessed COVID-19 vaccine hesitancy and/or acceptance among HCWs in Arab countries until July 2022, were included. The quality of the included studies and the risk of bias was assessed using the JBI critical appraisal tool. The pooled acceptance rate of the COVID-19 vaccine was assessed using a random-effects model with a 95% confidence interval., Results: A total of 861 articles were identified, of which, 43 were included in the study. All the studies were cross-sectional and survey-based. The total sample size was 57,250 HCWs and the acceptance rate of the COVID-19 vaccine was 60.4% (95% CI, 53.8% to 66.6%; I2, 41.9%). In addition, the COVID-19 vaccine acceptance rate among males was 65.4% (95% CI, 55.9% to 73.9%; I2, 0%) while among females was 48.2% (95% CI, 37.8% to 58.6%; I2, 0%). The most frequently reported factors associated with COVID-19 vaccine acceptance were being male, higher risk perception of contracting COVID-19, positive attitude toward the influenza vaccine, and higher educational level. Predictors of vaccine hesitancy most frequently included concerns about COVID-19 vaccine safety, living in rural areas, low monthly income, and fewer years of practice experience., Conclusion: A moderate acceptance rate of COVID-19 vaccines was reported among HCWs in the Arab World. Considering potential future pandemics, regulatory bodies should raise awareness regarding vaccine safety and efficacy and tailor their efforts to target HCWs who would consequently influence the public with their attitude towards vaccines., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Alalawi et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

While the San Francisco Bay Area counties rank very low in vaccine hesitancy and high in vaccination rates when compared to national numbers, Solano County has the most residents who are hesitant (6.3%) and the least who are fully vaccinated (51.6%) among Bay Area counties, according to the CDC. No studies to date have been able to provide the in-depth, localized information that would inform county-level public health interventions. This study aims to explore reasons and consequences for remaining unvaccinated in Solano County. Using a qualitative in-depth interview approach, we conducted 32 interviews with unvaccinated adults from Solano County. We used a grounded theory approach to our analysis. Using the socio-ecological model as a framework, we found that reasons for not getting vaccinated were primarily structural (mistrust of public information) and individual (bodily autonomy, personal choice) while consequences were primarily interpersonal (discrimination and stigma from friends, family, and employers). An overarching theme was that the vaccine rollout and messaging felt like an encroachment on personal choice and the feeling of being forced created more mistrust. Participants reported feeling like their decisions made them minorities among their colleagues, friends and family and that they were not persuaded by groupthink or by their relationships. Future public health responses to epidemics and pandemics might consider if a vaccine mandate is the best approach for reaching all county residents., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Brody et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Vaccine hesitancy remains a significant and evolving public health challenge. The COVID-19 pandemic has created a unique decision context with significant uncertainty caused by the novelty of the disease being targeted, unfamiliarity with the vaccines being offered, misinformation, and strong handed government measures. In an effort to extend our understanding of vaccine hesitancy to the high uncertainty decision environment presented by COVID-19, we present a novel taxonomy of the determinants of vaccine hesitancy, based on an inductive analysis of qualitative data gathered during the COVID-19 pandemic. We report on focus group data from a purposive sample of 18 Canadians with varying sociodemographic characteristics and COVID-19 vaccination attitudes. An inductive thematic analysis of this data reveals eight core themes related to vaccine hesitancy: values, trust, social environment, personal anecdotes, environmental fluctuation, prior knowledge, perceived risk & systems of care. We explore these core themes as well as 25 sub-themes, contrasting them with previous models of vaccine hesitancy and suggesting potential strategies for public health professionals., Competing Interests: The authors declare that they have no competing interests., (Copyright: © 2023 Krastev et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

We investigate whether an individual's information milieu-an individual's residential neighborhood and co-workers-affects the decision to get a COVID-19 vaccine. The decision to accept or refuse a vaccine is intensely personal and involves the processing of information about phenomena likely to be unfamiliar to most individuals. One can thus expect an interplay between an individual's level of education and skills and the information processing of others whom with whom she can interact and whose decision she can probe and observe. Using individual-level data for adults in Sweden, we can identify the proportion of an individual's neighborhood and workplace who are unvaccinated as indicators of possible peer effects. We find that individuals with low levels of educational attainment and occupational skills are more likely to be unvaccinated when exposed to other unvaccinated individuals at work and in the residential neighborhood. The peer effects in each of these information milieus further increases the likelihood of not getting vaccinated-with the two acting as information channels that reinforce one another., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Klaesson et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: The rapid development and rollout of COVID-19 vaccines helped reduce the pandemic's mortality burden. The vaccine rollout, however, has been uneven; it is well known that vaccination rates tend to be lower in lower income countries. Vaccine uptake, however, ultimately depends on the willingness of individuals to get vaccinated. If vaccine confidence is low, then uptake will be low, regardless of country income level. We investigated the impact on country-level COVID-19 vaccination rates of both national income and vaccine hesitancy., Methods: We estimated a linear regression model of COVID-19 vaccine uptake across 145 countries; this cross-sectional model was estimated at each of four time points: 6, 12, 18, and 24 months after the onset of global vaccine distribution. Vaccine uptake reflects the percentage of the population that had completed their primary vaccination series at the time point. Covariates include per capita GDP, an estimate of the percentage of country residents who strongly disagreed that vaccines are safe, and a variety of control variables. Next, we estimated these models of vaccine uptake by country income (countries below, and above the international median per capita GDP) to examine whether the impact of vaccine hesitancy varies by country income., Results: We find that GDP per capita has a pronounced impact on vaccine uptake at 6 months after global rollout. After controlling for other factors, there was a 22 percentage point difference in vaccination rates between the top 20% and the bottom 20% of countries ranked by per capita GDP; this difference grew to 38% by 12 months. The deleterious impact of distrust of vaccine safety on vaccine uptake became apparent by 12 months and then increased over time. At 24 months, there was a 17% difference in vaccination rates between the top 20% and the bottom 20% of countries ranked by distrust. The income stratified models reveal that the deleterious impact of vaccine distrust on vaccine uptake at 12 and 24 months is particularly evident in lower income countries., Conclusions: Our study highlights the important role of both national income and vaccine hesitancy in determining COVID-19 vaccine uptake globally. There is a need to increase the supply and distribution of pandemic vaccines to lower-income countries, and to take measures to improve vaccine confidence in these countries., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Moradpour et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background and Objectives: Vaccine hesitancy is a big obstacle for vaccination programs, as is anticipated for the COVID-19 vaccination program, resulting in low uptake of vaccines thereby hindering the process of reaching herd immunity. Bearing this in mind the current study was aimed to explore the determinants of vaccine hesitancy amongst the Pakistani population., Methodology: A cross-sectional study was carried out from November 2020 to March 2021. The conceptual framework of the study was based on the 3Cs (Confidence, Convenience, Complacency) model. The google-forms-based questionnaire was disseminated amongst the general population. Data collected were entered into SPSS version 26 and analyzed., Results: Of the 421 participants, 68.4% were women. Non-healthcare workers were 55.8% of respondents. Of vaccine-hesitant individuals, 26.13% reported they were very unlikely to get vaccinated. Perception of COVID-19 vaccine was explored, which revealed 12.6% of individuals agreed the vaccine was not safe as it came out too fast, 50.6% were worried about experiencing side-effects, 18% believed the vaccine will not offer protection and 5.9% believed the vaccine would cause death. Low Practice of standard operating procedure (SOP) in non-Healthcare workers was the strongest contributor to vaccine hesitancy (OR: 5.338, p = 0.040, 95% CI: 1.082-26.330) followed by High complacency (p = 0.026) and Moderate Complacency (OR: 0.212, p = 0.007, 95% CI: 0.069-0.654) towards COVID-19 vaccination. In Healthcare workers the strongest contributor to vaccine hesitancy was having a Moderate Confidence (OR: 0.323, p = 0.042, 95% CI: 0.109-0.958) in the vaccine followed by Moderate Convenience (OR: 0.304, p = 0.049, 95% CI: 0.093-0.993) for vaccination., Conclusion: Campaigning and communication strategies to reaffirm confidence in the COVID-19 vaccine and educating the general population about the vaccine could lead to increased perception of vaccine safety and effectiveness thereby restoring confidence in vaccine and decreasing vaccine hesitancy. Likewise, working to increase vaccine convenience and decreasing complacency towards the COVID-19 vaccine would translate into high vaccine uptake., Mesh Words: Vaccine hesitancy; vaccination intention, COVID-19 vaccine, vaccine confidence, complacency, convenience., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Sheikh et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Vaccine hesitancy remains a critical barrier in mitigating the effects of the ongoing COVID-19 pandemic. The willingness of health care workers (HCWs) to be vaccinated, and, in turn, recommend the COVID-19 vaccine for their patient population is an important strategy. This study aims to understand the uptake of COVID-19 vaccines and the reasoning for vaccine hesitancy among facility-based health care workers (HCWs) in LMICs., Methods: We conducted nationally representative phone-based rapid-cycle surveys across facilities in six LMICs to better understand COVID-19 vaccine hesitancy. We gathered data on vaccine uptake among facility managers, their perceptions of vaccine uptake and hesitancy among the HCWs operating in their facilities, and their perception of vaccine hesitancy among the patient population served by the facility., Results: 1,148 unique public health facilities participated in the study, with vaccines being almost universally offered to facility-based respondents across five out of six countries. Among facility respondents who have been offered the vaccine, more than 9 in 10 survey respondents had already been vaccinated at the time of data collection. Vaccine uptake among other HCWs at the facility was similarly high. Over 90% of facilities in Bangladesh, Liberia, Malawi, and Nigeria reported that all or most staff had already received the COVID-19 vaccine when the survey was conducted. Concerns about side effects predominantly drive vaccine hesitancy in both HCWs and the patient population., Conclusion: Our findings indicate that the opportunity to get vaccinated in participating public facilities is almost universal. We find vaccine hesitancy among facility-based HCWs, as reported by respondents, to be very low. This suggests that a potentially effective effort to increase vaccine uptake equitably would be to channel promotional activities through health facilities and HCWs.However, reasons for hesitancy, even if limited, are far from uniform across countries, highlighting the need for audience-specific messaging., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Baral et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Women planning to become pregnant, who are pregnant, and who are breastfeeding are more hesitant to take COVID-19 vaccines compared to other women globally., Aim: This study investigates COVID-19 vaccine hesitancy among women, who are planning for pregnancy, currently pregnant, and breastfeeding women in Jordan., Methods: An online cross-sectional study was conducted in the biggest three cities in Jordan, including 874 women., Results: Women who were planning for pregnancy, pregnant, or breastfeeding reported statistically significant lower levels of perception of the seriousness of COVID-19 (7.12 ± 0.72, 7.53 ± 1.80, 7.2439 ± 7296, respectively), significant lower levels of perceived benefits of the vaccine (8.92 ± 2.15, 8.73 ± 1.93, 9.09 ± 2.10, respectively), significant lower levels of motivation and causes of action (7.15 ± 1.71, 6.7524 ± 1.40, 7.27 ± 1.68, respectively), and significantly higher levels of COVID-19 vaccination hesitancy (31.32 ± 6.40, 30.11 ± 4.49, 30.27 ± 6.29, respectively) than other women. Married women, those whoe were previously infected with COVID-19, and those who had chronic diseases reported statistically significant lower levels of perception of COVID-19 seriousness, perceived benefits of COVID-19 vaccine, motivation to take COVID-19 vaccine, and causes of action, and significantly higher levels of hesitancy to take COVID-19 vaccine than unmarried women, those who have not been infected with COVID-19, and those who were medically healthy (p<0.001). There were statistically significant positive correlations between perception, perceived benefits, motivation, and cause of action with years of education; and statistically significant negative correlations between perception, perceived benefits, motivation, and cause of action with age (p<0.001)., Conclusions: Women who were planning for pregnancy, pregnant, or breastfeeding in Jordan showed miderate scores in COVID-19 vaccine hesitancy despite the current international recommendations for its safety for women and their foetuses or neonates., Competing Interests: The Authors have declared no competing interests exist., (Copyright: © 2023 Masa'deh et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Vaccine hesitancy has been around since the introduction of smallpox vaccine. Vaccine hesitancy has become more intense due to the rise of vaccine information in social media and mass adult vaccination during COVID-19 pandemic. This study investigated knowledge, perception, and reasons for rejection of the COVID-19 vaccine among Malaysian adults who refused to get free COVID-19 vaccination., Methods: An online cross-sectional survey using an embedded mixed-method study [QUAN(quali)] was conducted among Malaysian adults. The quantitative section consisted of a 49-item questionnaire, whereas the qualitative sections consisted of two open-ended questions (1) "Please state your reason why you have not registered or have no intention to register at all for COVID-19 vaccines?" and (2) "Please tell us if you have any suggestions for improvement about COVID-19 vaccine delivery". Data from respondents who were not willing to get vaccination were extracted from the overall data and further analyzed in this paper., Result: Sixty-one adults completed the online open-ended survey with a mean age of 34.28 years (SD = 10.30). Among factors that influenced them to get vaccinated was information on vaccine effectiveness (39.3%), death due to COVID-19 (37.7%), and recommendations from the Ministry of Health (36.1%). Most of the respondents (77.0%) were knowledgeable about vaccines, with half having high-perceived risks (52.5%) to COVID-19. While 55.7% and 52.5% had, high perceived barriers and benefits to COVID-19 vaccines respectively. The reasons for vaccine rejections included vaccine safety, indecisiveness, underlying medical conditions, herd immunity, non-transparent data, and use of traditional or complementary medicine., Conclusion: The study explored the multitude factors that drive perception, acceptance, and rejection. The qualitative approach with a small sample size provided more data point for interpretations and allowed participants to express themselves. This is important to develop strategies to create public awareness on vaccines not just for COVID-19 but any infectious diseases that can be curbed through vaccination., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Mohamed et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Healthcare workers (HCWs) and healthcare students display high levels of vaccine hesitancy with impact on healthcare provision, patient safety, and health promotion. The factors related to vaccine hesitancy have been reported in several systematic reviews. However, this evidence needs to be synthesised, as interventions to reduce vaccination hesitancy in this population are needed., Methods: This Umbrella Review aimed to explore the barriers and facilitators of vaccine hesitancy toward the COVID-19 vaccine for HCWs and healthcare students. The review was performed and reported in accordance with Joanna Briggs Institutes guidelines and the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. A protocol was preregistered on PROSPERO (CRD42022327354). Eight databases were searched from November 2019 to 23rd May 2022 to identify any systematic reviews that explored factors associated with hesitancy towards the COVID-19 vaccine for HCWs or healthcare students., Results: A total of 31 studies were included in the review. The majority of studies (71%) were appraised as strong or moderate quality and there was a slight degree of overlap (<5%) of primary studies between the reviews. Vaccine hesitancy was more common among HCWs and healthcare students in specific occupational roles (e.g. nurses) than others (e.g. physicians). Frequent reasons for hesitancy were related to sociodemographic factors (gender, age, ethnicity), occupational factors (COVID-19 exposure, perceived risk, mandatory vaccination), health factors (vaccination history), vaccine-related factors (concerns about safety, efficacy, side-effects, rapid development, testing, approval and distribution of the vaccine), social factors (social pressure, altruism and collective responsibility), distrust factors (key social actors, pandemic management), information factors (inadequate information and sources, exposure to misinformation)., Conclusion: The results from this Umbrella Review have wide-reaching implications for the research area, healthcare systems and institutions and governments worldwide. Designing tailored strategies for specific occupational groups is pivotal to increasing vaccine uptake and securing a safe healthcare provision worldwide., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 McCready et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Healthcare workers (HCWs) and healthcare students are at increased risk of becoming infected with and being a vector of transmission of COVID-19. Vaccination efforts amongst this group of persons have been hampered in some countries by hesitancy to uptake the COVID-19 vaccine. The factors related to vaccine hesitancy have been reported in several systematic reviews. However, a comprehensive overview of barriers and facilitators of COVID-19 vaccine hesitancy is greatly needed to address effective interventions in this population. Understanding and designing effective strategies to promote vaccination among HCWs is pivotal to secure an appropriate and safe healthcare provision. The current protocol describes the methodology for an Umbrella Review that explores the barriers and facilitators of COVID-19 vaccine hesitancy for HCWs and healthcare students. The databases that will be searched are CINAHL, MedLine, Cochrane Library, PubMed, ProQuest, Web of Science, Science Direct, IBSS, Google Scholar, and Epistemonikos. Studies will be eligible for inclusion if they: (i) conducted a systematic review (with or without meta-analysis); (ii) included primary sources utilizing a quantitative methodology; (iii) investigated factors related to COVID-19 vaccine hesitancy; (iv) and included a sub/population of HCWs or healthcare students aged 18-65. The screening processes and data extraction will be conducted independently by two reviewers. The Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Systematic Reviews and Research Syntheses will be used to assess the methodological quality of the included reviews. The degree to which the included reviews contain the same primary studies will also be assessed and reported. The outcomes of this review will have wide-reaching implications for the research area, healthcare systems and institutions, and governments worldwide., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 McCready et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Aim: Within the context of increasing mental distress noted since the beginning of the COVID19 pandemic, the study aims at analysing the relationship between mental health, vaccine distrust and vaccine hesitancy in South Africa., Subject and Methods: The study uses nationally representative panel data of 3241 individuals interviewed prior to and during the COVID19 pandemic. The study uses a range of regression techniques including logit, mediation and gradient-boosted causal mediation models to identify the causal relationship while accounting for selection bias., Results: The results of multivariate logit regression reveal that vaccine distrust is the most important predictor of vaccine hesitancy [Coeff: 3.420, CI 3.122, 3.717]. Mental distress is not found to be a significant driver in a fully specified logit model, pointing to the need to analyse the pathways through which mental distress impacts vaccine hesitancy. The mediation regression undertaken for this purpose finds that the mental distress has a positive and significant association with vaccine distrust [Coeff: 0.027, CI: 0.0029, 0.052]. The increased vaccine distrust in turn results in increased vaccine hesitancy [Coeff: 0.661, CI: 0.611, 0.711]. The results of mediation regression therefore indicate strong and significant mediation effects, whereby mental health effects vaccine hesitancy through the mediating variable of vaccine distrust. These results are robust to the gradient boosted causal mediation model which establishes strong and significant indirect effects [Coeff: 0.015, CI: 0.01, 0.019], whereby mental health effects vaccine hesitancy through the mediating variable of vaccine distrust., Conclusion: The study concludes that mental health impacts on vaccine intention through the mediating role of vaccine distrust. The findings indicate that individuals at high risk of depression are more concerned regarding the safety of vaccines, which in turn feeds into vaccine hesitancy. Therefore, depressive symptoms impact on vaccine hesitancy through the mediating factor of vaccine distrust., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Kollamparambil et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Individually tailored vaccine hesitancy interventions are considered auspicious for decreasing vaccine hesitancy. In two studies, we measured self-reported format preference for statistical vs. anecdotal information in vaccine hesitant individuals, and experimentally manipulated the format in which COVID-19 and influenza vaccine hesitancy interventions were presented (statistical vs. anecdotal). Regardless of whether people received interventions that were in line with their format preference, the interventions did not influence their vaccine attitudes or vaccination intentions. Instead, a stronger preference for anecdotal information was associated with perceiving the material in both the statistical and the anecdotal interventions as more frustrating, less relevant, and less helpful. However, even if the participants reacted negatively to both intervention formats, the reactions to the statistical interventions were consistently less negative. These results suggest that tailoring COVID-19 and influenza vaccine hesitancy interventions to suit people's format preference, might not be a viable tool for decreasing vaccine hesitancy. The results further imply that using statistics-only interventions with people who hold anti-vaccination attitudes may be a less risky choice than using only anecdotal testimonies., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Mäki et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Sporadic outbreaks of COVID-19 remain a threat to public healthcare, especially if vaccination levels do not improve. As Malaysia begins its transition into the endemic phase, it is essential to identify the key determinants of COVID-19 vaccination intention amongst the pockets of the population who are still hesitant. Therefore, focusing on a sample of individuals who did not register for the COVID-19 vaccination, the current study integrated two widely used frameworks in the public health domain-the health belief model (HBM) and the theory of reasoned action (TRA)-to examine the inter-relationships of the predictors of vaccination intention amongst these individuals., Methodology: Primary data from 117 respondents who did not register for the COVID-19 vaccination were collected using self-administered questionnaires to capture predictors of vaccination intention amongst individuals in a Malaysian context. The partial least squares structural equation modeling (PLS-SEM) technique was used to analyze the data., Results: Subjective norms and attitude play key mediating roles between the HBM factors and vaccination intention amongst the unregistered respondents. In particular, subjective norms mediate the relationship between cues to action and vaccination intention, highlighting the significance of important others to influence unregistered individuals who are already exposed to information from mass media and interpersonal discussions regarding vaccines. Trust, perceived susceptibility, and perceived benefits indirectly influence vaccination intention through attitude, indicating that one's attitude is vital in promoting behavioral change., Conclusion: This study showed that the behavioral factors could help understand the reasons for vaccine refusal or acceptance, and shape and improve health interventions, particularly among the vaccine-hesitant group in a developing country. Therefore, policymakers and key stakeholders can develop effective strategies or interventions to encourage vaccination amongst the unvaccinated for future health pandemics by targeting subjective norms and attitude., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Vaithilingam et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Vaccine hesitancy poses a significant risk to global recovery from COVID-19. To date however, there is little research exploring the psychological factors associated with vaccine acceptability and hesitancy in Iraq., Aim: To explore attitudes towards COVID-19 vaccination in Iraq. To establish the predictors of vaccine uptake and vaccine hesitancy in an Iraqi population., Methods: Using a cross-sectional design, 7,778 participants completed an online questionnaire exploring their vaccination status, likelihood of infection, perceived severity infection, benefits of vaccine, barriers to vaccine, anticipated regret, subjective norms, and trust in government., Findings: Vaccination rates increased with age and were greater in males, those who were married, divorced or widowed, those with children and those with underlying conditions. Vaccine hesitancy was widespread with 61.40% of unvaccinated individuals reported an unwillingness to receive a COVID-19 vaccine. In unvaccinated groups, vaccine hesitancy was associated with lower trust in the government, more negative social norms, greater perceived barriers to vaccination and reduced perceived benefits., Conclusions: There is significant COVID-19 vaccine hesitancy in Iraq. Public health institutions should be aware of the influence of demographic factors, as well as personal beliefs and social norms, on individuals' decisions to vaccinate. Public health messaging should therefore aim to be tailored to address the concerns of citizens., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Alatrany et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: COVID-19 hesitancy among women planning to become pregnant, who are pregnant, and who are breast-feeding is still a global phenomenon. Unfortunately, there is a lack of national educational programs that provide those groups of people with the information they need about the vaccine., Objective: This study investigated the effect of the COVID-19 vaccine tele-educational program on vaccine hesitancy and receiving the vaccine among women planning for pregnancy, pregnant and breast-feeding mothers., Methods: This study implemented a quasi-experimental pre-post design and was conducted in Jordan. It was a two-time study and had two groups of women; 220 women participated in the control group, and 205 women participated in the intervention group (those received the tele-educational program). All participating women answered the demographic characteristics sheet and the Arabic version of Hesitancy About COVID-19 Vaccination Questionnaire twice., Results: Results showed that after conducting the program the interventional group reported significantly higher vaccination rate and lower mean score of hesitancy than the control group (M = 24.67, SD = 5.11; M = 27.45, SD = 4.92; respectively) t (423) = -4.116, p-value < 0.001. Moreover, before the program, women in the intervention group reported significantly higher levels of hesitancy compared to those in the same group after the program (M = 28.35, SD = 4.91; M = 24.66, SD = 5.11; respectively) t (204) = 17.83, p-value < 0.001., Conclusions: The study concluded that awareness of pregnant women after being given the tele-education program about COVID-19 vaccination decreased their hesitancy and improved their willingness to participate in the COVID-19 vaccination. Therefore, health workers should focus on providing scientific-based information about the vaccine to reduce the doubts of pregnant women about participating in the COVID-19., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Momani et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Vaccine hesitancy is defined as a delay in acceptance of vaccines despite its availability, caused by many determinants. Our study presents the key reasons, determinants and characteristics associated with COVID-19 vaccine acceptability among students over 16 years and parents of students under 16 years and describe the COVID-19 vaccination among students in the settings of sentinel schools of Catalonia, Spain. This is a cross-sectional study that includes 3,383 students and the parents between October 2021 and January 2022. We describe the student's vaccination status and proceed a univariate and multivariate analysis using a Deletion Substitution Addition (DSA) machine learning algorithm. Vaccination against COVID-19 reached 70.8% in students under 16 years and 95.8% in students over 16 years at the end of the study project. The acceptability among unvaccinated students was 40.9% and 20.8% in October and January, respectively, and among parents was proportionally higher among students aged 5-11 (70.2%) in October and aged 3-4 (47.8%) in January. The key reason to not vaccinate themselves, or their children, were concern about side effects, insufficient research about the effect of the vaccine in children, rapid development of vaccines, necessity for more information and previous infection by SARS-CoV-2. Several variables were associated with refusal end hesitancy. For students, the main ones were risk perception and use of alternative therapies. For parents, the age of students, sociodemographic variables, socioeconomic impact related to the pandemic, and use of alternative therapies were more evident. Monitoring vaccine acceptance and refusal among children and their parents has been important to understand the interaction between different multilevel determinants and we hope it will be useful to improve public health strategies for future interventions in this population., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Ganem et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Vaccination during pregnancy has been repeatedly demonstrated to be safe and effective in protecting against infection and associated harms for the mother, developing baby, and subsequent infant. However, maternal vaccination uptake remains low compared to the general population., Objectives: An umbrella review to explore the barriers and facilitators to Influenza, Pertussis and COVID-19 vaccination during pregnancy and within 2 years after childbirth, and to inform interventions to encourage uptake (PROSPERO registration number: CRD42022327624)., Methods: Ten databases were searched for systematic reviews published between 2009 and April 2022 exploring the predictors of vaccination or effectiveness of interventions to improve vaccination for Pertussis, Influenza, or COVD-19. Both pregnant women and mothers of infants under two years were included. Barriers and facilitators were organised using the WHO model of determinants of vaccine hesitancy through narrative synthesis, the Joanna Briggs Institute checklist assessed review quality, and the degree of overlap of primary studies was calculated., Results: 19 reviews were included. Considerable overlap was found especially for intervention reviews, and the quality of the included reviews and their primary studies varied. Sociodemographic factors were specifically researched in the context of COVID-19, exerting a small but consistent effect on vaccination. Concerns around the safety of vaccination particularly for the developing baby were a main barrier. While key facilitators included recommendation from a healthcare professional, previous vaccination, knowledge around vaccination, and communication with and support from social groups. Intervention reviews indicated multi-component interventions involving human interaction to be most effective., Conclusion: The main barriers and facilitators for Influenza, Pertussis and COVID-19 vaccination have been identified and constitute the foundation for policy development at the international level. Ethnicity, socioeconomic status, concerns about vaccine safety and side effects, and lack of healthcare professionals' recommendations, are the most relevant factors of vaccine hesitancy. Adapting educational interventions to specific populations, person-to-person interaction, healthcare professionals' involvement, and interpersonal support are important strategies to improve uptake., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Nichol et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Throughout US history, chronic and infectious diseases have severely impacted minority communities due to a lack of accessibility to quality healthcare and accurate information, as well as underlying racism. These fault lines in the care of minority communities in the US have been further exacerbated by the rise of the COVID-19 pandemic. This study examined the factors associated with COVID-19 vaccine hesitancy by race and ethnicity, particularly among African American and Latinx communities in Eastern Pennsylvania (PA)., Methods: Survey data was collected in July 2021 in Philadelphia, Scranton, Wilkes-Barre, and Hazleton, PA. The 203 participants (38.7% Black, 27.5% Latinx) completed the 28-question survey of COVID-19 vaccination attitudes in either English or Spanish., Result: Out of the 203 participants, 181 participants met all the inclusion criteria, including completed surveys; of these participants, over three-fifths (63.5%) were acceptant of the COVID-19 vaccine whereas the remainder (36.5%) were hesitant. Binary logistic regression results showed that age, concern for vaccine efficacy, race, knowledge on the vaccine, and belief that the COVID-19 virus is serious significantly influenced COVID-19 vaccine hesitancy. Minorities were more likely to be hesitant toward vaccination (OR: 2.8, 95% CI: 1.1, 6.8) than non-Hispanic whites. Those who believed the COVID-19 vaccine was ineffective (OR: 8.3, 95% CI: 3.8, 18.2), and that the virus is not serious (OR: 8.3, 95% CI: 1.1, 61.8) showed the greatest odds of hesitancy., Conclusions: Minority status, age less than 45 years, misinformation about seriousness of COVID-19 illness, and concern about vaccine efficacy were contributing factors of COVID-19 vaccine hesitancy. Therefore, understanding and addressing the barriers to COVID-19 vaccination in minority groups is essential to decreasing transmission and controlling this pandemic, and will provide lessons on how to implement public health measures in future pandemics., Competing Interests: I have read the journal’s policy and the authors of this manuscript have the following competing interests: BJP had research support from Pfizer and Eli Lilly., (Copyright: © 2023 Colvin et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Introduction: This study aimed to establish pre-/post Coronavirus Disease 2019 (COVID-19) diagnosis/treatment symptoms, ownership/utilisation of face masks (FMs), as well as vaccine hesitancy (VH) amongst patients recovering from COVID-19., Methods: A cross-sectional survey was conducted from April - October 2021. Data was collected with structured self-administered questionnaires. Multinomial regression was used to determine associations between ownership/utilisation of FMs with respondents' characteristics., Results: Unproductive cough and fatigue were prevalent before and after treatment. Pre-/Post COVID-19 symptoms severity ranged from mild to moderate. There was a COVID-19 VH rate of 492 (74%). The prevalence of FM ownership and utilisation were, respectively, 613 (92.2%) and 271 (40.8%). One main factor was associated with FM ownership; respondent's sex (p; 5.5x10-2, OR; 0.5, 95%C.I; 0.3 - 1.0). The main reasons for irregular utilisation were; inability to be consistent, only used outdoors, and boredom., Conclusion: The treatment of COVID-19 does not mean immediate recovery as mild to moderate grade severity still persists. Face mask availability and ownership does not mean appreciable utilisation. This study advocates for an intensification of COVID-19 preventive practices, as well as elaborate education on the importance of vaccination., Competing Interests: The authors have declared no competing interests exist., (Copyright: © 2023 Cho et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Vaccine hesitancy is proving to be a significant impediment to COVID-19 vaccination campaigns in some developing countries. This study focuses on vaccine hesitancy and means of reducing it. Data come from a large, representative phone survey and online randomized survey experiment, both run in Papua New Guinea, a developing country with low vaccination rates. Less than 20% of relevant respondents to the phone survey were willing to be vaccinated, primarily because of fear of side effects and low trust in the vaccine. Although vaccine hesitancy was high in the online experiment, participants who received a message emphasizing that the vaccine was safe and COVID-19 dangerous were 68% more likely to state they planned to be vaccinated than those in the control group. A message appealing to social norms was also effective in reducing vaccine hesitancy, although its efficacy was limited to certain types of people., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2022 Hoy et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

At the time of writing, nearly one hundred published studies demonstrate that beliefs in COVID-19 conspiracy theories and misinformation are negatively associated with COVID-19 preventive behaviors. These correlational findings are often interpreted as evidence that beliefs in conspiracy theories and misinformation are exogenous factors that shape human behavior, such as forgoing vaccination. This interpretation has motivated researchers to develop methods for "prebunking," "debunking," or otherwise limiting the spread of conspiracy theories and misinformation online. However, the robust literatures on conspiracy theory beliefs, health behaviors, and media effects lead us to question whether beliefs in conspiracy theories and misinformation should be treated as exogenous to vaccine hesitancy and refusal. Employing U.S. survey data (n = 2,065) from July 2021, we show that beliefs in COVID-19 conspiracy theories and misinformation are not only related to COVID-19 vaccine hesitancy and refusal, but also strongly associated with the same psychological, social, and political motivations theorized to drive COVID-19 vaccine hesitancy and refusal. These findings suggest that beliefs in conspiracy theories and misinformation might not always be an exogenous cause, but rather a manifestation of the same factors that lead to vaccine hesitancy and refusal. We conclude by encouraging researchers to carefully consider modeling choices and imploring practitioners to refocus on the worldviews, personality traits, and political orientations that underlie both health-related behaviors and beliefs in conspiracy theories and misinformation., Competing Interests: The authors have declared that no competing interests exist.

Background: In response to reports of thrombosis with thrombocytopenia syndrome (TTS) post-vaccination, the Johnson & Johnson (J&J) vaccine was paused and then restarted in April 2021. Our objective was to assess whether this pause adversely impacted vaccine confidence., Methods: Two large internet-based surveys were conducted in the US among adults to measure knowledge, attitudes and perceptions of the J&J vaccine pause and rates of vaccine hesitancy among unvaccinated persons before, during and after the pause., Results: Among 66% of respondents aware of the pause, 44% identified blood clots as the reason for the pause without prompting. The impact of the pause on vaccine behavior among unvaccinated persons and perception of the vaccine safety system was mixed and modified by trust in the public health authorities. Those who were less willing to get vaccinated because of the pause were less inclined for all vaccines, not only the J&J product. Moreover, a notable proportion (22.1%) of the small number of persons (n = 30) vaccinated with the J&J vaccine after the pause reported not receiving information about the risk of TTS. The proportion of unvaccinated persons who were hesitant was increasing before and during the pause and then leveled off after the pause., Conclusions: The J&J vaccine pause is unlikely to be a major barrier to vaccine uptake. Public attitudes about vaccines may be more resilient than appreciated, especially when safety issues are investigated with transparent communication. This paper has important implications for messaging and program administration with future vaccine-specific adverse events. Efforts may be warranted to ensure all persons being offered the J&J vaccine are made aware of the risk of TTS., Competing Interests: DSS has received funding unrelated to this work including research grants from Merck and policy advisory boards for Merck and Janssen. JVL is a member of the Bioethics Advisory Council of Pfizer, Inc. WO is on the Scientific Advisory Board for Moderna and is an uncompensated member of Moderna Scientific Advisory Board (SAB). SL is an employee of and RHS is a consultant to RIWI Corp., the company that owns the technology used to conduct the surveys. No other authors have conflicts of interest to report. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

The success of mass vaccination programs against SARS-CoV-2 hinges on the public's acceptance of the vaccines. During a vaccine roll-out, individuals have limited information about the potential side-effects and benefits. Given the public health concern of the COVID pandemic, providing appropriate information fast matters for the success of the campaign. In this paper, time-trends in vaccine hesitancy were examined using a sample of 35,390 respondents from the Eurofound's Living, Working and COVID-19 (LWC) data collected between 12 February and 28 March 2021 across 28 European countries. The data cover the initial stage of the vaccine roll-out. We exploit the fact that during this period, news about rare cases of blood clots with low blood platelets were potentially linked to the Oxford/AstraZeneca vaccine (or Vaxzeveria). Multivariate regression models were used to analyze i) vaccine hesitancy trends, and whether any trend-change was associated with the link between the AstraZeneca vaccine ii) and blood clots (AstraZeneca controversy), and iii) the suspension among several European countries. Our estimates show that vaccine hesitancy increased over the early stage of the vaccine roll-out (0·002, 95% CI: [0·002 to 0·003]), a positive shift took place in the likelihood of hesitancy following the controversy (0·230, 95% CI: [0·157 to 0·302]), with the trend subsequently turning negative (-0·007, 95% CI: [-0·010 to -0·005]). Countries deciding to suspend the AstraZeneca vaccine experienced an increase in vaccine hesitancy after the suspensions (0·068, 95% CI: [0·04 to 0·095]). Trust in institutions is negatively associated with vaccine hesitancy. The results suggest that SARS-CoV-2 vaccine hesitancy increased steadily since the beginning of the vaccine roll-out and the AstraZeneca controversy and its suspension, made modest (though significant) contributions to increased hesitancy., Competing Interests: The authors have declared that no competing interests exist.

The success of the COVID-19 vaccination programme to achieve herd immunity depends on the proportion of the population inoculated. COVID-19 vaccination hesitancy is a barrier to reaching a sufficient number of people to achieve herd immunity. This study aims to determine the prevalence of COVID-19 vaccine hesitancy and to identify the reasons contributing to vaccine hesitancy using the Theory of Planned Behavior. A cross-sectional online survey was conducted between May 2021 to June 2021. Using exponential non-discriminative snowball sampling, participants were recruited via social media and telecommunication platforms. We used a questionnaire that obtained information on participant socio-demographics, vaccine hesitancy, pseudoscientific practices, conspiracy beliefs, subjective norms, perceived behavioural control, main reasons for not intending to get the COVID-19 vaccine; influential leaders, gatekeepers and anti-or pro-vaccination lobbies; and global vaccine hesitancy. A total of 354 responses (mean age = 32.5 years old ±13.6; 70.3% females) were included for analysis. The prevalence of COVID-19 vaccine hesitancy was 11.6%. COVID-19 vaccine hesitancy was significantly and positively associated with those who agreed with influential leaders, gatekeepers, and anti- or pro-vaccination lobbies (adjusted B coefficient = 1.355, p = 0.014), having a "wait and see" attitude to see if the COVID-19 vaccine is safe (adjusted B coefficient = 0. 822, p <0.001), perceiving that the vaccine will give them COVID-19 (adjusted B coefficient = 0.660, p <0.002), planned to use masks/others precautions instead (adjusted B coefficient = 0.345, p = 0.038) and having higher scores in conspiracy beliefs (adjusted B coefficient = 0.128, p <0.001). Concern about the costs associated with the vaccine (adjusted B coefficient = -0.518, p <0.001), subjective norms (adjusted B coefficient = -0.341, p <0.001), and perceived behavioural control (adjusted B coefficient = -0.202, p = 0.004) were negatively associated with vaccine hesitancy. COVID-19 vaccine hesitancy in Malaysia is low. Several factors were identified as being associated with vaccine hesitancy. Factors associated with vaccine hesitancy would be useful in tailoring specific interventions involving positive messages by influential leaders, which address vaccine misinformation and the wait-and-see attitude which may delay the uptake of COVID-19 vaccines., Competing Interests: The authors have declared that no competing interests exist.

Background: Understanding public discourse about a COVID-19 vaccine in the early phase of the COVID-19 pandemic may provide key insights concerning vaccine hesitancy. However, few studies have investigated the communicative patterns in which Twitter users participate discursively in vaccine discussions., Objectives: This study aims to investigate 1) the major topics that emerged from public conversation on Twitter concerning vaccines for COVID-19, 2) the topics that were emphasized in tweets with either positive or negative sentiment toward a COVID-19 vaccine, and 3) the type of online accounts in which tweets with either positive or negative sentiment were more likely to circulate., Methods: We randomly extracted a total of 349,979 COVID-19 vaccine-related tweets from the initial period of the pandemic. Out of 64,216 unique tweets, a total of 23,133 (36.03%) tweets were classified as positive and 14,051 (21.88%) as negative toward a COVID-19 vaccine. We conducted Structural Topic Modeling and Network Analysis to reveal the distinct topical structure and connection patterns that characterize positive and negative discourse toward a COVID-19 vaccine., Results: Our STM analysis revealed the most prominent topic emerged on Twitter of a COVID-19 vaccine was "other infectious diseases", followed by "vaccine safety concerns", and "conspiracy theory." While the positive discourse demonstrated a broad range of topics such as "vaccine development", "vaccine effectiveness", and "safety test", negative discourse was more narrowly focused on topics such as "conspiracy theory" and "safety concerns." Beyond topical differences, positive discourse was more likely to interact with verified sources such as scientists/medical sources and the media/journalists, whereas negative discourse tended to interact with politicians and online influencers., Conclusions: Positive and negative discourse was not only structured around distinct topics but also circulated within different networks. Public health communicators need to address specific topics of public concern in varying information hubs based on audience segmentation, potentially increasing COVID-19 vaccine uptake., Competing Interests: The authors have declared that no competing interests

Vaccine hesitancy is a global health challenge in controlling the virulence of pandemics. The prevalence of vaccine hesitancy will put highly vulnerable groups, such as the elderly or groups with pre-existing health conditions, at a higher risk, as seen with the outbreak of the pandemic Covid-19. Based on the trends of vaccine hesitancy in the state of Sabah, located in East Malaysia, this study seeks to identify several variables that contribute to vaccine hesitancy. In addition to this, this study also determines which groups are affected by vaccine hesitancy based on their demographics. This study is based on a sampling of 1,024 Sabahan population aged 18 and above through an online and face-to-face questionnaire. The raw data was analysed using the K-Means Clustering Analysis, Principal Component Analysis (PCA), Mann-Whitney U Test, Kruskal-Wallis Test, and frequency. The K-Means Clustering found that more than half of the total number of respondents (Cluster 2 = 51.9%) tend to demonstrate vaccine hesitancy. Based on the PCA analysis, six main factors were found to cause vaccine hesitancy in Sabah: confidence (var(X) = 21.6%), the influence of local authority (var(X) = 12.1%), ineffectiveness of mainstream media (var(X) = 8.4%), complacency (var(X) = 7.4%), social media (var(X) = 6.4%), and convenience issues (var(X) = 5.8%). Findings from both Mann-Whitney U and Kruskal-Wallis tests demonstrate that several factors of group demographics, such as employment status, level of education, religion, gender, and marital status, may explain the indicator of vaccine hesitancy. In particular, specific groups tend to become vaccine hesitancy such as, unemployed, self-employed, students, male, single, level of education, and Muslim. Findings from this empirical study are crucial to inform the relevant local authorities on the level of vulnerability among certain groups in facing the hazards of COVID-19. The main contribution of this study is that it seeks to analyse the factors behind vaccine hesitancy and identifies which groups more likely hesitant toward vaccines based on their demographics., Competing Interests: The authors have declared that no competing interests exist.

To explore the attitude towards COVID-19 vaccination among healthcare workers in the US, we surveyed three groups of individuals (essential non-healthcare workers, general healthcare workers, and correctional healthcare workers). We found surprisingly high portions of healthcare workers with COVID-19 vaccine hesitancy/resistance, with 23% of correctional healthcare workers and 17% general healthcare workers (as compared to 12%) refusing to be vaccinated against COVID-19. Multivariate regression models suggest that current season flu vaccination (aOR = 3.34), relying on employer for COVID-19 information (aOR = 3.69), and living in the Midwest (aOR = 5.04) to be strongly associated with COVID-19 vaccine acceptance among essential workers and general healthcare workers. Current season flu vaccination (aOR = 7.52) is also strongly associated with COVID-19 vaccine acceptance among correctional healthcare workers. Potential mechanisms of vaccine hesitancy/resistance among healthcare workers involves low health literacy and employer mistrust. Our findings are highly relevant as we try to reach COVID-19 vaccination goals in the US., Competing Interests: The authors have declared that no competing interests exist.

Vaccine hesitancy remains an issue in the United States. This study conducted an online survey [N = 3,013] using the Social Science Research Solution [SSRS] Opinion Panel web panelists, representative of U.S. adults age 18 and older who use the internet, with an oversample of rural-dwelling and minority populations between April 8 and April 22, 2021- as vaccine eligibility opened to the country. We examined the relationship between COVID-19 exposure and socio-demographics with vaccine intentions [eager-to-take, wait-and-see, undecided, refuse] among the unvaccinated using multinomial logistic regressions [ref: fully/partially vaccinated]. Results showed vaccine intentions varied by demographic characteristics and COVID-19 experience during the period that eligibility for the vaccine was extended to all adults. At the time of the survey approximately 40% of respondents were unvaccinated; 41% knew someone who had died of COVID-19, and 38% had experienced financial hardship as a result of the pandemic. The vaccinated were more likely to be highly educated, older adults, consistent with the United States initial eligibility criteria. Political affiliation and financial hardship experienced during the pandemic were the two most salient factors associated with being undecided or unwilling to take the vaccine., Competing Interests: The authors have declared that no competing interests exist.

Background: Vaccines are effective in preventing Coronavirus Disease 2019 (COVID-19). Vaccine hesitancy defined as delay of acceptance or refusal of the vaccine is a major barrier to effective implementation., Methods: Participants were recruited statewide through an English and Spanish social media marketing campaign conducted by a local news station during a one-month period as vaccines were becoming available in Rhode Island (from December 21, 2020 to January 22, 2021). Participants completed an online survey about COVID-19 vaccines and vaccine hesitancy with constructs and items adopted from the Health Belief Model., Results: A total of 2,007 individuals completed the survey. Eight percent (n = 161) reported vaccine hesitancy. The sample had a median age of 58 years (interquartile range [IQR]: 45, 67), were majority female (78%), White (96%), Non-Hispanic (94%), employed (58%), and reported an annual individual income of $50,000 (59%). COVID-19 vaccine hesitancy was associated with attitudes and behaviors related to COVID-19. A one unit increase in concern about COVID-19 was associated with a 69% (Adjusted Odds Ratio: 0.31, 95% CI: 0.26-0.37) decrease in vaccine hesitancy. A one-level increase in the likelihood of getting influenza vaccine was associated with a 55% (AOR: 0.45 95% CI: 0.41-0.50) decrease in vaccine hesitancy., Conclusions: COVID-19 vaccine hesitancy was relatively low in a state-wide survey in Rhode Island. Future research is needed to better understand and tailor messaging related to vaccine hesitancy., Competing Interests: The authors have declared that no competing interests exist.

Background: As the vaccination drive against the coronavirus disease (COVID-19) in Malaysia progresses rapidly, the main challenge will gradually shift from procuring and distributing vaccines to ensuring the broadest possible acceptance among all population segments. Therefore, this study used the integrated framework of the health belief model (HBM) and the theory of reasoned action (TRA) to investigate the predictors of intention to receive COVID-19 vaccines in Malaysia., Methodology: A market research company in Malaysia was engaged to collect data during June 11-20, 2021 using self-administered questionnaires via its online panel, ensuring a nationwide random sample of 804 respondents. A logistic regression was subsequently estimated to determine the significant predictors of vaccination intention., Results: The predictors that significantly affect COVID-19 vaccine hesitancy in Malaysia are age, susceptibility, religious beliefs, attitude, subjective norms, and trust in the vaccine. In particular, those who are more inclined to get vaccinated are older individuals, have a higher perceived risk of infection and social pressure to get vaccinated, have a positive attitude, and have high levels of trust in the vaccine. Individuals' who perceive that their religious beliefs are against vaccination are more likely to exhibit uncertainty toward it., Conclusion: This study showed that although a large proportion of respondents indicated that they were willing to be vaccinated against COVID-19, there are concerns about religious barriers and trust in the vaccine that the relevant stakeholders should address. Campaigns should also focus on shaping the nation's attitude toward COVID-19 vaccines, in parallel with encouraging people to use their social influence in helping those in their close circle who are unsure of vaccination to cross the line. These measures will prove to be pertinent as the nation begins to administer booster vaccines to tackle the waning effects of COVID-19 vaccines., Competing Interests: The authors have declared that no competing interests exist.

Background: As a way of minimising the devastating effects of the coronavirus disease 2019 (COVID-19) pandemic, scientists hastily developed a vaccine. However, the scale-up of the vaccine is likely to be hindered by the widespread social media misinformation. We therefore conducted a study to assess the COVID-19 vaccine hesitancy among Zimbabweans., Methods: We conducted a descriptive online cross-sectional survey using a self-administered questionnaire among adults. The questionnaire assessed willingness to be vaccinated; socio-demographic characteristics, individual attitudes and perceptions, effectiveness and safety of the vaccine. Multivariable logistic regression analysis was utilized to examine the independent factors associated with vaccine uptake., Results: We analysed data for 1168 participants, age range of 19-89 years with the majority being females (57.5%). Half (49.9%) of the participants reported that they would accept the COVID-19 vaccine. Majority were uncertain about the effectiveness of the vaccine (76.0%) and its safety (55.0%). About half lacked trust in the government's ability to ensure availability of an effective vaccine and 61.0% mentioned that they would seek advice from a healthcare worker to vaccinate. Chronic disease [vs no chronic disease-Adjusted Odds Ratio (AOR): 1.50, 95% Confidence Interval (CI)I: 1.10-2.03], males [vs females-AOR: 1.83, 95%CI: 1.37-2.44] and being a healthcare worker [vs not being a health worker-AOR: 1.59, 95%CI: 1.18-2.14] were associated with increased likelihood to vaccinate., Conclusion: We found half of the participants willing to vaccinate against COVID-19. The majority lacked trust in the government and were uncertain about vaccine effectiveness and safety. The policy makers should consider targeting geographical and demographic groups which were unlikely to vaccinate with vaccine information, education and communication to improve uptake., Competing Interests: The authors have declared that no competing interests exist.

Vaccines are highly effective for curbing the spread of SARS-CoV-2 (COVID-19). Yet, millions of Americans remain hesitant about getting vaccinated, jeopardizing our ability to end the COVID-19 pandemic by fueling the spread and development of new variants. We show that brief video-based messages of encouragement addressing specific COVID-19 vaccine concerns increase vaccination intentions, and that vaccination intentions, in turn, are predictive of future vaccine uptake. Results from our online experiment reveal that willingness to get vaccinated is driven by messages that increase confidence in COVID-19 vaccines and perceived behavioral control to get vaccinated. Importantly, messages were particularly effective among more skeptical populations including people who identify as politically conservative or moderate and those who express low trust in government institutions. Our findings corroborate the real-world behavioral significance of vaccination intentions, and devise how even short, scalable online messages can provide governments and health authorities an inexpensive, yet effective tool for increasing intentions to vaccinate against COVID-19 among populations most reluctant to get them., Competing Interests: The authors have declared that no competing interests exist.

Introduction: Despite the development of safe and highly efficacious COVID-19 vaccines, extensive barriers to vaccine deployment and uptake threaten the effectiveness of vaccines in controlling the pandemic. Notably, marginalization produces structural and social inequalities that render certain populations disproportionately vulnerable to COVID-19 incidence, morbidity, and mortality, and less likely to be vaccinated. The purpose of this scoping review is to provide a comprehensive overview of definitions/conceptualizations, elements, and determinants of COVID-19 vaccine hesitancy among marginalized populations in the U.S. and Canada., Materials and Methods: The proposed scoping review follows the framework outlined by Arksey and O'Malley, and further developed by the Joanna Briggs Institute. It will comply with reporting guidelines from the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). The overall research question is: What are the definitions/conceptualizations and factors associated with vaccine hesitancy in the context of COVID-19 vaccines among adults from marginalized populations in the U.S. and Canada. Search strategies will be developed using controlled vocabulary and selected keywords, and customized for relevant databases, in collaboration with a research librarian. The results will be analyzed and synthesized quantitatively (i.e., frequencies) and qualitatively (i.e., thematic analysis) in relation to the research questions, guided by a revised WHO Vaccine Hesitancy Matrix., Discussion: This scoping review will contribute to honing and advancing the conceptualization of COVID-19 vaccine hesitancy and broader elements and determinants of underutilization of COVID-19 vaccination among marginalized populations, identify evidence gaps, and support recommendations for research and practice moving forward., Competing Interests: The authors have declared that no competing interests exist.

Vaccination has emerged as the most cost-effective public health strategy for maintaining population health, with various social and economic benefits. These vaccines, however, cannot be effective without widespread acceptance. The present study examines the effect of media attention on COVID-19 vaccine hesitancy by incorporating fear of COVID-19 as a mediator, whereas trust in leadership served as a moderator. An analytical cross-sectional study is performed among rural folks in the Wassa Amenfi Central of Ghana. Using a questionnaire survey, we were able to collect 3079 valid responses. The Smart PLS was used to estimate the relationship among the variables. The results revealed that media attention had a significant influence on vaccine hesitancy. Furthermore, the results showed that fear of COVID-19 played a significant mediating role in the relationship between media and vaccine hesitancy. However, trust in leadership had an insignificant moderating relationship on the fear of COVID-19 and vaccine hesitancy. The study suggests that the health management team can reduce vaccine hesitancy if they focus on lessening the negative impact of media and other antecedents like fear on trust in leadership., Competing Interests: The authors have declared that no competing interests exist.

The novel coronavirus (COVID-19) is a highly contagious disease responsible for millions of deaths worldwide. Effective vaccines against COVID-19 are now available, however, an extreme form of vaccine hesitancy known as anti-vax attitudes challenge vaccine acceptance and distribution efforts. To understand these anti-vax attitudes and their associated psychological characteristics, we examined several predictors of vaccine hesitancy for COVID-19 and anti-vax attitudes generally. We surveyed 1004 adults (M = 47.0 years, SD = 17.1 years, range 18-98 years) in September-October 2020 across the United States (51% female, 49% male; 76.5% White, 23.5% non-White), prior to widespread availability of the COVID-19 vaccines. Attitudes toward vaccinations were influenced by a variety of factors, especially political attitudes. We should therefore anticipate and attempt to mitigate these challenges to achieving widespread vaccination to reduce the spread of COVID-19 and other communicable diseases., Competing Interests: The authors have declared that no competing interests exist.

Background: Medical and health science students are among the frontline health care workers who are at high risk of acquiring COVID-19 infection during their clinical attachments and future career. As health care providers, they are expected to promote and administer the COVID-19 vaccine and counsel vaccine-hesitant patients. It is, therefore, imperative to assess COVID-19 vaccine hesitancy among medical and health science students. Thus, this study aimed to assess COVID-19 vaccine hesitancy and its associated factors among medical and health science students of Wolkite University., Method: An institutional-based cross-sectional study design was conducted among 420 medical and health science students attending Wolkite University from March 1 to 30, 2021. Simple random sampling technique was used to select study participants. Self-administered and structured questionnaires were used to collect data. Data were entered into Epi-Data version 4.2.0 and exported to SPSS version 23 software package for further analysis. Bivariable and multivariable analysis was used to identify associated factors. P values <0.05 result were considered as a statistically significant association., Results: The level of COVID-19 vaccine hesitancy was 41.2% (95% CI; 35.2%-50.4%). Student age ≤23 years were 1.9 times more likely vaccine hesitant [aOR = 1.94, 95% CI; 1.14-3.28], being female were 1.7 times more likely vaccine hesitant [aOR = 1.76, 95% CI; 1.14-2.72], resided in rural area were 1.6 times more likely vaccine hesitant [aOR = 1.63, 95% CI; 1.06-2.49], source of information from social media were 2.7 times more likely vaccine hesitant [aOR = 2.68, 95% CI; 1.58-4.54], and good practice to COVID-19 mitigation measures were 47% less likely vaccine hesitant [aOR = 0.53, 95% CI; 0.34-0.83] compared to their counterpart., Conclusions: COVID-19 vaccine hesitancy is found to be high. Therefore, students are advised to receive COVID-19 vaccine information from government lead mass media (i.e. television and radio), increase awareness and adherence to COVID-19 mitigation measures is recommended., Competing Interests: The authors have declared that no competing interests exist.

Vaccination is a major strategy to prevent the coronavirus disease 2019 (COVID-19). However, information about factors associated with men and women intention to be vaccinated are scarce. To determine COVID-19 vaccine acceptance and identify factors associated vaccine hesitancy according to sex, we performed a cross-sectional population-based random survey in Salvador, Brazil between Nov/2020-Jan/2021. Participants were interviewed to obtain data on intention to receive and pay for a COVID-19 vaccine, as well as on demographics, comorbidities, influenza vaccination history, previous diagnosis of COVID-19, and exposures and perception of COVID-19 risk. Among 2,521 participants, 2,053 (81.4%) reported willingness to use a COVID-19 vaccine and 468 (18.6%) hesitated to take it. Among those intending to get vaccinated, 1,400 (68.2%) would pay for the vaccine if necessary. Sex-stratified multivariable analysis found that men who were working and who had comorbidities were less likely to hesitate about using the vaccine. Among women, higher educational level and high perception of COVID-19 risk were associated with less vaccine hesitancy. In both groups, reporting influenza vaccination in 2020 reduced the chance of COVID-19 vaccine hesitancy. COVID-19 vaccine campaigns targeting to reduce vaccine hesitancy are urgently needed. These campaigns should consider gender differences in order to be successful., Competing Interests: The authors have declared that no competing interests exist.