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Background: First Nations peoples face disproportionate vaccine-preventable risks due to social, economic, and healthcare disparities. Additionally, during the COVID-19 pandemic, there was also mistrust and hesitancy about the COVID-19 vaccines among First Nations peoples. These are rooted in factors such as colonial histories, discriminatory medical practices, and unreliable information., Objective: To examine strategies to address COVID-19 vaccine hesitancy among First Nations peoples globally., Methods: A systematic review was conducted. Searches were undertaken in OVID MEDLINE, OVID EMBASE, OVID PsycINFO, CINAHL, and Informit. Searches were date limited from 2020. Items included in this review provided primary data that discussed strategies used to address COVID-19 vaccine hesitancy in First Nations peoples., Results: We identified several key strategies across four countries - Australia, the USA, Canada, and Guatemala in seventeen papers. These included understanding communities' needs, collaborating with communities, tailored messaging, addressing underlying systemic traumas and social health gaps, and early logistics planning., Conclusion: The inclusion of First Nations-centred strategies to reduce COVID-19 vaccine hesitancy is essential to delivering an equitable pandemic response. Implementation of these strategies in the continued effort to vaccinate against COVID-19 and in future pandemics is integral to ensure that First Nations peoples are not disproportionately affected by disease.

Disparities in vaccine confidence and uptake among racial and ethnic minorities have resulted in a disproportionate burden of COVID-19 in these populations. Social media campaigns have shown promise in public health promotion and behavioral interventions. In January 2022, an academic-community partnership launched #Vax4Community, a 6-month social media campaign centered around the use of digital storytelling videos. The campaign purpose was to decrease vaccine hesitancy, combat vaccine misinformation and disinformation, and increase vaccine confidence within three distinct target communities: the justice-involved population, South Asian residents, and public housing youth in the metropolitan area of New York City (NYC). Our approach included the production and dissemination of digital storytelling videos featuring personal vaccine experiences from target populations. We evaluated key performance indicators (KPIs) of the campaign, including post impressions, reach and engagement across social media platforms, and shares from partner organizations. Overall, we received 1,910,662 post impressions, 699,722 unique users reached, and 2,880 post engagements across Instagram, Facebook, LinkedIn, and Twitter, and 147 shares from 48 partner organizations. Social media campaigns require strategic design in branding, messaging and outreach channels and could serve as an important tool to disseminate emotionally relatable content and trusted information to prime target populations to respond more optimally to public health interventions. The purpose of this paper is to describe the process of creating and disseminating these digital stories and the KPIs of the social media campaign., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Objective: South Asians represent the largest non-white ethnic group in Canada and were disproportionately impacted by the COVID-19 pandemic. We sought to determine the factors associated with vaccine hesitancy in South Asian Canadians., Methods: We conducted a cross-sectional analysis of vaccine hesitancy using data collected at the baseline assessment of a prospective cohort study, COVID CommUNITY South Asian. Participants (18 + years) were recruited from the Greater Toronto and Hamilton Area in Ontario (ON) and the Greater Vancouver Area in British Columbia (BC) between April and November 2021. Demographic characteristics and vaccine attitudes measured by the Vaccine Attitudes Examination (VAX) scale were collected. Each item is scored on a 6-point Likert scale, and higher scores reflect greater hesitancy. A multivariable linear mixed effects model was used to identify sociodemographic factors associated with vaccine hesitancy, adjusting for multiple covariates., Results: A total of 1496 self-identified South Asians (52% female) were analyzed (mean age = 38.5 years; standard deviation (SD): 15.3). The mean VAX score was 3.2, SD: 0.8 [range: 1.0‒6.0]. Factors associated with vaccine hesitancy included: time since immigration (p = 0.04), previous COVID-19 infection (p < 0.001), marital status (p < 0.001), living in a multigenerational household (p = 0.03), age (p = 0.02), education (p < 0.001), and employment status (p = 0.001)., Conclusion: Among South Asians living in ON and BC, time since immigration, prior COVID-19 infection, marital status, living in a multigenerational household, age, education, and employment status were associated with vaccine hesitancy. This information can be used to address vaccine hesitancy in the South Asian population in future COVID-19 waves or pandemics., Competing Interests: Declarations. Ethical approval: All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (Hamilton Integrated Research Ethics Board # 13323 – March 24, 2021 and British Columbia Research Ethics Board # H21-00866 – June 18, 2021) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Consent to participate: Informed consent was obtained from all individual participants included in the study. Consent for publication: Not applicable. Conflict of interest: None to declare., (© 2024. The Author(s).)

Objective: The aim of this study was to assess COVID-19 vaccination prevalence and explore whether health beliefs were associated with vaccination among firefighters., Methods: A cross-sectional online survey was distributed to Minnesota firefighters in March-April 2022. Survey questions included demographics, vaccination status, and beliefs about COVID-19 and vaccines., Results: Of the survey respondents ( n = 974, 91% male, 89% White), 76% were fully vaccinated and 53% were boosted. Firefighters were less likely to be vaccinated if they reported more perceived barriers (OR = 0.42, P < 0.001), greater decision-making ease (OR = 0.42, P < 0.001), and greater autonomy (OR = 0.65, P = 0.04). Greater perceived benefits (OR = 2.63, P < 0.001) and social norms (OR = 2.10, P < 0.001) were associated with a greater likelihood of being vaccinated. Similar results were seen predicting booster status., Conclusions: Firefighters had similar vaccination rates as the general population, despite high exposure risks. Health beliefs are strongly related to vaccination status., Competing Interests: Hooker, Ziegenfuss, Muegge, Dinh, Zabel, Dabrowski, Nadeau, and McKinney have no relationships/conditions/circumstances that present potential conflict of interest., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American College of Occupational and Environmental Medicine.)

Introduction: Understanding changes in vaccine hesitancy, overall and by sociodemographic characteristics, may highlight sub-populations for whom more intensive efforts are needed to increase vaccine uptake and confidence., Methods: We analyzed data using the CDC's Research and Development Survey (RANDS), a nationally representative survey of U.S. adults ≥18 years, collected from 17 May 2021-30 June 2021 ( n  = 5,458) and 3 November 2022-12 December 2022 ( n  = 6,821). We assessed changes in vaccine hesitancy, changes in vaccine attitudes and attitudes, and factors associated with hesitancy toward both vaccines in general and COVID-19 vaccines among a nationally representative sample of U.S. adults., Results: Although COVID-19 vaccination (≥1 dose) increased from 67.2% (2021) to 74.7% (2022), COVID-19 vaccine hesitancy increased from 40.7% to 44.6% during the same period. During the same period, hesitancy toward both COVID-19 vaccines and vaccines in general increased among those who were aged ≥65 years and who were non-Hispanic White. However, COVID-19 vaccine hesitancy decreased among non-Hispanic Black adults. Current or former smokers were more hesitant toward vaccines in general (aPR = 1.13, 95%CI: 1.03-1.24) and toward COVID-19 vaccines (aPR = 1.08, 95%CI: 1.01-1.16) compared to never smokers. Among adults who did not receive any COVID-19 vaccines, COVID-19 vaccine hesitancy increased from 86.6% in 2021 to 92.4% in 2022. Furthermore, belief in the overall social benefit of the COVID-19 vaccine decreased from 47.5% to 25.1%., Conclusion: This study highlights concerning trends in vaccine hesitancy and uptake of the COVID-19 and other recommended vaccines. We found that some high-risk groups (e.g. smokers) and population subgroups have become more vaccine hesitant, suggesting the need for improved and intensified strategies to increase vaccine confidence and uptake. Future research may focus on qualitative inquiry to understand specific concerns and determinants contributing to increased hesitancy among these groups to help inform interventions and communication campaigns to support vaccination.

Objective: The aim of the study is to provide a population-based evaluation of vaccination coverage to prevent respiratory complications from SARS-COV-2, influenza, and pneumococcus, among community-dwelling persons with spinal cord injury/disease., Design: This is a cross-sectional survey conducted in 2022, utilizing questionnaires administered to persons with spinal cord injury/disease living in Switzerland. Main outcomes were ever-vaccination rates for SARS-COV-2, influenza, and pneumococcus. Secondary outcomes included demographics, lesion and education levels, as well as respiratory and cardiovascular conditions. Vaccine hesitancy was additionally assessed for all three vaccines in nonvaccinated persons through questions on reasons for not getting vaccinated., Results: A total of 1158 persons participated in this survey. Overall vaccination rates were highest for SARS-COV-2 86.5% (95% CI = 84.4-88.3), followed by influenza 44.6 (41.7-47.6) and pneumococcus: 7.5% (6.0-9.3). The most prominent reasons for not being vaccinated were doubt on effectiveness (72.7%) and potential side effects (60%) for SARS-COV-2, patients did not feel at risk for influenza (57%) and insufficient information from the physician (52.4%) for pneumococcus vaccination., Conclusions: In individuals with spinal cord injury/disease, vaccination coverage is notably low for influenza and especially pneumococcus. Vaccine hesitancy varies between vaccination types and is associated with vaccine-specific reasons. These findings underscore the imperative for updated clinical vaccination guidelines, improved public health information, and targeted intervention programs for specific patient groups., Competing Interests: Financial disclosure statements have been obtained, and no conflicts of interest have been reported by the authors or by any individuals in control of the content of this article., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

The coronavirus disease 2019 (COVID-19) pandemic emphasized the importance of vaccinations for the prevention of life-threatening diseases and for avoiding the overburdening of the healthcare system. Despite the clear advantage of vaccinations, increasing vaccine hesitancy has been observed worldwide, especially among young people who are potential future parents. Vaccine hesitancy describes the delayed or lack of willingness to utilize recommended vaccinations and represents a substantial challenge for public health. This article analyzes the causes of vaccine hesitancy in the postpandemic period and discusses factors that could make communication successful. The role of artificial intelligence and structured evidence-based discussion techniques, such as the empathetic refutation interview, are emphasized. The aim is to provide practice-oriented recommendations to be able to provide physicians with tools that can help in the education counselling with insecure patients and can promote the acceptance of vaccinations., (© 2024. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Background: Vaccine hesitancy is an urgent public health threat. While tools have been developed to monitor vaccine hesitancy among parents and the general adult population, no such tool exists for adolescents., Methods: We modified an existing adult Vaccine Hesitancy Scale to create a teen COVID-19 Vaccine Hesitancy Scale (tVHS-COVID) for adolescents and their parents. To validate our scale, we conducted a nationally representative survey of 764 parent-teen dyads. We performed exploratory factor analysis (EFA) to determine the factor structure followed by confirmatory factor analysis (CFA) to test the factor structure validity using two random subsets. We evaluated internal consistency by Cronbach alpha values and construct validity by comparing tVHS-COVID scores to intention to receive future COVID-19 doses., Results: EFA suggested a three-factor structure with 13-items. CFA indicated good fit for adolescents (CFI = 1.00; RMSEA = 0.023; SRMR = 0.062; NNFI-TLI = 0.998) and for parents (CFI = 1.00, RMSEA = 0.031; SRMR = 0.028; NNFI-TLI = 1.00). Internal consistency exceeded 0.79 for adolescents and 0.78 for parents. As tVHS-COVID scores increased, the percent of adolescent and parent respondents who reported they were willing to receive a COVID-19 vaccine decreased., Discussion: The tVHS-COVID offers a unique tool that can be used to monitor COVID-19 vaccine hesitancy among adolescents and their parents. As adolescents take on more proactive roles in medical decision-making, monitoring vaccine hesitancy among this population becomes increasingly important., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Annette Regan reports financial support was provided by National Institutes of Health. Annette Regan reports a relationship with Moderna Inc that includes: board membership. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: The COVID-19 pandemic underscored the issue of vaccine hesitancy, leading researchers to study the determinants of people's willingness to receive the COVID-19 vaccine. This study is the first to comprehensively investigate the role of preventive practices at both the individual and contextual level, drawing on the theoretical concept of "cultural health capital"., Methods: Utilizing data from the Survey of Health, Ageing, and Retirement (SHARE), covering information from 18,454 individuals aged 50 years and above residing in 25 European countries, we examined the influence of past engagement in preventive practices and the prevalence of such practices within a country on the likelihood of COVID-19 vaccine uptake. Our analysis included (i) previous vaccination behaviors, (ii) other healthcare-related behaviors, and (iii) lifestyle factors at both the individual and contextual levels. Leveraging the longitudinal design of the SHARE, we accounted for the temporal ordering of the relationships., Results: At the individual level, almost all preventive behaviors were significantly related to people's willingness to receive the COVID-19 vaccine. Individuals who (i) had received an influenza vaccination prior to the COVID-19 outbreak and during childhood, (ii) had regularly participated in dental and blood pressure check-ups throughout their lives, and (iii) did not engage in lifestyle-related risk behaviors, were more likely to accept the COVID-19 vaccine. Notably, alcohol use was not significantly associated. At the contextual level, only the vaccination coverage rate for influenza was found to be robustly related, indicating that individuals were more inclined to receive the COVID-19 vaccine in countries with higher influenza vaccination rates prior to the pandemic., Conclusion: Active participation in preventive practices and effective implementation of vaccination campaigns can contribute to the development of (institutional) cultural health capital, which ultimately promotes a greater willingness to get vaccinated against COVID-19., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Katrijn Delaruelle reports financial support was provided by EU Framework Programme for Research and Innovation Societal Challenges. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Vaccine hesitancy, a complex behavioral phenomenon, poses a significant global health threat and has gained renewed attention amidst the COVID-19 pandemic. This paper scrutinized peer-reviewed literature on vaccine hesitancy published from 2015 to 2022, with a specific focus on behavioral perspectives, utilizing a Theories-Constructs-Variables-Contexts-Methods (TCVCM) framework. The study highlighted prominent theoretical approaches, abstract concepts, research variables, global contexts and academic techniques employed across a selected sample of 138 studies. The result is a consolidated overview of research and schematization of the factors influencing vaccine hesitancy and vaccination behaviors. These include individual-level, contextual, vaccine-specific, organizational, and public-policy-related dynamics. The findings corroborated the complexity of vaccine hesitancy and emphasized the difficulties of pursuing vaccine advocacy. The analysis also identified several directions for future research, and the need to conduct more contextual studies in low- and middle-income nations to bring out the cross-cultural nuances of vaccine hesitancy.

Vaccine hesitancy presents a significant public health challenge, particularly among Syrian refugee parents in Canada, who navigate unique barriers to vaccination. This cross-sectional study explores the determinants of vaccine hesitancy, considering socio-demographic factors, resettlement conditions, health assessments, and healthcare system interactions. The study involved 540 Syrian refugee parents residing in Ontario with at least one child under 18, interviewed from March 2021 to March 2022. Participants were asked about their willingness to take the COVID-19 vaccine, with those uncertain or unwilling categorized as "Hesitant" and others as "Non-hesitant." Stepwise multivariable logistic regression assessed various factors associated with vaccine hesitancy. Among respondents, 15.2% expressed hesitancy toward taking the COVID-19 vaccine. Findings indicated that individuals who reported very good or good mental health had decreased odds of being vaccine hesitant (OR = 0.46, 95% CI: 0.27-0.80). Also, individuals without a family doctor and those needing an interpreter but sometimes or never offered one were more likely to be hesitant (OR = 3.61, 95% CI: 1.42, 9.19; OR = 2.14, 95% CI: 1.19-3.84, respectively). These results highlight the complex interplay of factors affecting vaccine decisions, emphasizing the need for culturally sensitive public health strategies to improve vaccine uptake in this population. While vaccine acceptance is low among Syrians (36%), the higher rate among Syrian refugees in Canada (84.7%) reflects the positive impact of healthcare access and resettlement support. This contrast highlights the role of such systems in shaping vaccine attitudes among vulnerable populations, informing targeted public health efforts to boost vaccine acceptance and support the health of Syrian refugees.

Parent vaccine hesitancy (PVH) remains a significant public health concern, particularly emphasized during the COVID-19 pandemic. This study investigates PVH among parents of children with various psychiatric and neurodevelopmental conditions, such as attention deficit hyperactivity disorder (ADHD), anxiety disorders, and behavioral disturbances, extending previous research focused on autism spectrum disorder (ASD). We examined PVH in children aged 5-11 years with psychiatric and behavioral disorders excluding ASD. A cross-sectional questionnaire-based analysis was conducted in Qatar, involving 244 parents of neurodiverse children and 245 parents of neurotypical children as controls. The Parent Attitudes about Childhood Vaccines (PACV) survey assessed PVH. Results indicated a significantly higher prevalence of vaccine hesitancy among parents of children with psychiatric disorders (54.1%, 95% CI [47.8%, 60.4%], n  = 132) compared to controls (11.7%, 95% CI [7.5%, 16.0%], n  = 26), p  < .001. The PACV total score was significantly higher in parents of children with a mental disorder. Higher education among parents and lower PACV scores significantly influenced the intent to vaccinate against COVID-19. Tailored interventions by child and adolescent mental healthcare professionals, such as harnessing artificial intelligence to fight disinformation, are crucial to addressing vaccine hesitancy, enhancing acceptance, and improving outcomes for children with psychiatric disorders.

The COVID-19 pandemic highlighted Vaccine Hesitancy (VH) as an accelerating global phenomenon that must be addressed. According to the WHO, thirty to fifty percent of the world's population are VH. Motivational Interviewing (MI) is an evidence-based communication style demonstrated to significantly reduce VH. MI guides people toward change through the expression of empathy and by respecting an individual's autonomy. Healthcare providers (HCPs) are the primary implementors of vaccine policies and the most trusted advisors and influencers of vaccination intention at the individual patient level. Training HCPs in MI is one of the most effective strategies to overcome VH. Many countries are currently implementing HCP training programs and population-based MI interventions to improve vaccine uptake. MI conversations are 'the heart' of vaccine decision-making processes. Understanding individual patient-level drivers of hesitancy allows clinicians to efficiently provide tailored, accurate information that reinforces a person's own motivation and confidence in their own decision. This paper describes a 4-step practical framework designed to support HCPs in their dialogue with vaccine-hesitant patients. (1) Engaging to establish a trustful relationship and safety to freely express opinions, beliefs, and knowledge gaps; (2) Understanding what matters most to the individual; (3) Offering Information to co-build accurate knowledge in order to guide the individual toward vaccine intention (4) Clarifying and Accepting to validate an individual's decision-making autonomy. We believe that our pragmatic approach can contribute to greater acceptability of COVID-19 and other vaccines, and enable rapid deployment of practical MI skills across care systems.

COVID-19 vaccine hesitancy remains problematic among healthcare workers. Social network influences may shape vaccine decision-making, but few studies have examined this in this critical workforce. We assessed the relationship between friends' COVID-19 vaccination attitudes and personal hesitancy among Chinese healthcare personnel. In December 2022-January 2023, a cross-sectional online survey was conducted at a tertiary hospital in China using WeChat. Of the 1832 healthcare personnel who were invited to answer the structured questionnaire, 613 (33.5%) samples had valid data for data analysis. Logistic regression examined the association between friends' hesitancy and participants' own hesitancy, adjusting for confounders. Of 613 healthcare workers included, 266 (43.4%) were hesitant. Those with hesitant friends had 6.34 times higher adjusted odds of hesitating themselves versus those without hesitant friends (95% CI 2.97-13.52). Strong associations persisted across subgroups. Chinese healthcare workers' COVID-19 vaccination hesitancy was highly influenced by perceived friends' attitudes. Fostering pro-vaccine social norms through trusted peer networks could help promote vaccine acceptance in this critical workforce.

Vaccination has become the primary means for citizens to prevent severe morbidity and mortality during the pandemic. However, vaccine hesitancy poses a major threat to global public health security. Based on the data from Chinese General Social Survey in 2021, this study aims to explore the socio-political aspects of COVID-19 vaccine hesitancy, focusing on the relationship between COVID-19 risk perceptions, institutional trust and vaccine hesitancy. Among the samples, 39.8% of the respondents exhibited COVID-19 vaccine hesitancy, 48.9% had a high awareness of the risk of COVID-19, and 74.6% presented a high level of trust in institutions. The results showed that higher risk perception and institutional trust are negatively correlated with vaccine hesitancy ( p  < .001). Institutional trust had no statistically significant moderating effect on the association between risk perception and vaccine hesitancy, but the role of institutional trust in influencing vaccine hesitancy is more significant at a lower level of perceptions of COVID-19 risk. Furthermore, regional variations in the factors contributing to vaccine hesitancy were demonstrated in China. These findings have important implications for developing strategies to address vaccine hesitancy.

To investigate the dynamic evolution of vaccine hesitancy toward both COVID-19 and influenza in a context characterized by the compresence of SARS-CoV-2 pandemic and seasonal flu epidemics, a two times repeated cross-sectional exploratory design was performed at Udine Hospital (Italy) following a cohort of 479 adult patients with a previous history of SARS-CoV-2 infection in 2020. Vaccine attitude was assessed through standardized telephone interviews performed at 12 and 18 months after the acute illness. The first interview reported the success of the 2020/21 seasonal influenza immunization with 46.8% (224/479) of the participants showing a positive attitude, especially the elderly and people with comorbidities ( p  < .001), but the investigation conducted at 18 months showed a drastic drop in flu shot acceptance (30/166, 18.1%). On the other hand, a great increase in vaccinations against SARS-CoV-2 occurred after the introduction of Green Pass (26.7% vs 72.9%). The major drivers of flu vaccine skepticism were represented by the feeling of protection regardless of prevention and by concerns regarding vaccines safety and efficacy; conversely compulsory strategies seemed to play a secondary role, since only a minority of the participants identified in the restrictions induced by the certification the major incentive to get immunized against SARS-CoV-2. The focus on this peculiar historical period helps to take a step forward in the comprehension of the complexity and dynamicity of the vaccine hesitancy phenomenon. Future vaccination campaigns will need to consider the role of personal opinions and emotions, interpreted according to the social and political context.

COVID-19 vaccine hesitancy remains prevalent globally. However, national data on this issue in the general population after the termination of the zero-COVID policy in China are limited. In March 2023, we conducted a nationwide cross-sectional survey among Chinese adults using a self-administered questionnaire. Descriptive statistics and multivariate logistic regressions were employed. Among 4,966 participants, 43.8% reported COVID-19 vaccine hesitancy following the end of the zero-COVID policy in China. Higher rates of vaccine hesitancy were associated with being married (married: OR 1.36, 95%CI 1.17-1.57; other marital status: OR 1.86, 95%CI 1.36-2.55), working in healthcare (OR 1.64, 95%CI 1.38-1.96), having both minors and older adults in the household (OR 1.45, 95%CI 1.20-1.75), having no minors and older adults in the household (OR 1.44, 95%CI 1.17-1.77), having chronic diseases (OR 1.42, 95%CI 1.23-1.64), experiencing adverse events post-vaccination (OR 1.39, 95%CI 1.19-1.61), and uncertainty about previous COVID-19 infection (OR 1.45, 95%CI 1.13-1.86). Conversely, participants who had received the influenza vaccine in the past three years (OR 0.62, 95%CI 0.54-0.72), had previously taken the COVID-19 vaccine (OR 0.44, 95%CI 0.32-0.59), and had higher confidence in vaccines (OR 0.63, 95%CI 0.60-0.67) were less likely to exhibit hesitancy. Our findings indicate a significant level of vaccine hesitancy, underscoring the urgent need for tailored public health strategies to address vaccine hesitancy and improve uptake post-zero-COVID policy in China. A comprehensive understanding of public concerns and related factors is essential for developing effective vaccine communication strategies.

We sought in-depth understanding on the evolution of factors influencing COVID-19 booster dose and bivalent vaccine hesitancy in a longitudinal semi-structured interview-based qualitative study. Serial interviews were conducted between July 25th and September 1 st , 2022 (Phase I: univalent booster dose availability), and between November 21 st , 2022 and January 11 th , 2023 (Phase II: bivalent vaccine availability). Adults (≥18 years) in Canada who had received an initial primary series and had not received a COVID-19 booster dose were eligible for Phase I, and subsequently invited to participate in Phase II. Twenty-two of twenty-three (96%) participants completed interviews for both phases (45 interviews). Nearly half of participants identified as a woman ( n  = 11), the median age was 37 years (interquartile range: 32-48), and most participants were employed full-time ( n  = 12); no participant reported needing to vaccinate (with a primary series) for their workplace. No participant reported having received a COVID-19 booster dose at the time of their interview in Phase II. Three themes relating to the development of hesitancy toward continued vaccination against COVID-19 were identified: 1) effectiveness (frequency concerns; infection despite vaccination); 2) necessity (less threatening, low urgency, alternate protective measures); and 3) information (need for data, contradiction and confusion, lack of trust, decreased motivation). The data from interviews with individuals who had not received a COVID-19 booster dose or bivalent vaccine despite having received a primary series of COVID-19 vaccines highlights actionable targets to address vaccine hesitancy and improve public health literacy.

The United Nations reported that the mortality risk of Corona Virus Disease 2019 (COVID-19) is five times higher in the elderly than the global average. Although the COVID-19 vaccine effectively prevents infections and reduce mortality among the elderly, vaccine hesitancy among the Chinese elderly poses a significant threat. This study, utilizing the "Confidence, Convenience and Complacency (3 Cs)" vaccine hesitancy model, aimed to explore factors contributing to vaccine hesitancy among the Chinese elderly and assess national countermeasures and potential improvement approaches. Thirteen elderly with vaccine hesitancy and eleven vaccine-related staff participated in semi-structured interviews. Thematic analysis revealed three key determinants of vaccine hesitancy among the elderly: perceived low threat of COVID-19, lack of confidence in COVID-19 vaccine, and poor accessibility to vaccination. China has implemented strategies, including advocacy through diverse channels, joint multi-sectoral promotion vaccination, and enhancing ongoing vaccination services. Recommendations from the vaccine-related staff emphasize improving vaccine awareness among the elderly, and prioritizing the vaccination environment and process. The study underscores the importance of targeted vaccination promotion programs addressing hesitation reasons to improve vaccination rates. Furthermore, existing countermeasures can serve as a foundation for enhancing vaccination strategies, including improved publicity, administration, and management approaches.

During the COVID-19 pandemic, the vaccine hesitancy has significantly affected the vaccination. To evaluate the booster vaccine hesitancy and its influencing factors among urban and rural residents, as well as to estimate the net difference of booster vaccine hesitancy between urban and rural residents. We conducted a nationwide, cross-sectional Internet survey on 1-8 February 2023, and employed stratified random sampling technique to select participants (≥18 years old) from urban and rural areas. Multivariate logistic regression was used to determine the factors impacting booster vaccine hesitancy. Propensity Score Matching was used to estimate the net difference of COVID-19 booster vaccine hesitancy between urban and rural residents. The overall COVID-19 booster vaccine hesitancy rate of residents was 28.43%. The COVID-19 booster vaccine hesitancy rate among urban residents was found to be 34.70%, among rural residents was 20.25%. Chronic diseases, infection status, vaccination benefits, and trust in vaccine developers were associated with booster vaccine hesitancy among urban residents. Barriers of vaccination were associated with booster vaccine hesitancy among rural residents. PSM analysis showed that the urban residents have a higher booster vaccine hesitancy rate than rural residents, with a net difference of 6.20%. The vaccine hesitancy rate increased significantly, and the urban residents have a higher COVID-19 booster vaccine hesitancy than rural residents. It becomes crucial to enhance the dissemination of information regarding the advantages of vaccination and foster greater trust among urban residents toward the healthcare system.

The coronavirus disease 2019 (COVID-19) caused several impacts. Focusing on 360 participants (178 males, 182 females), this study explored the association between COVID-19 related distress, risk perception, stigma, and vaccine hesitancy and acceptance in the general population. Measures used included the Hospital Anxiety and Depression Scale (HADS) and COVID Stress Scale (CSS) to evaluate anxiety, depression, and COVID-19 related distress, the COVID-19 Risk Perception Scale and COVID-19 Stigma Discrimination Scale to assess risk perception and stigma, and the Oxford COVID-19 Vaccine Hesitancy Scale and Vaccine Acceptance Instrument to measure vaccine hesitancy and acceptance. The findings revealed that 66.9% of participants exhibited vaccine hesitancy, and stress and risk perception were significant predictors of both vaccine hesitancy and acceptance, even after controlling for demographic factors. This study highlights the importance of understanding the factors mentioned above that will contribute to vaccine hesitancy and acceptance, which will contribute to promoting vaccine acceptance.

A wide range of survey studies have explored vaccination hesitancy/resistance during the COVID-19 pandemic and provided evidence that this can be explained by several individual variables from the ideological, clinical, and socio-affective domain. However, evidence about which individual variables predict vaccine hesitancy in the post-pandemic state of COVID-19 is meager. We administered a battery of questionnaires to a group of 120 Italian participants with high and low scores on the adult vaccine hesitancy scale (aVHS) to investigate the predictive role of ideological (i.e. political orientation), clinical (i.e. anxiety, interoceptive accuracy), and socio-affective (i.e. alexithymia, disgust sensitivity/propensity, empathy) variables on vaccine hesitancy/resistance. This study provides evidence that lower interoceptive awareness and cognitive empathy are predictors of a greater hesitancy to get vaccinated in the post-pandemic COVID-19 state.

We examined the associations between the use of different types of media and COVID-19 vaccine hesitancy, as well as risk behaviors of COVID-19 infection, in Japan in late 2021. Cross-sectional surveys were conducted using rapid online surveys of residents in Iwate Prefecture from February 5 to 7, 2021, and from October 1 to 3, 2021. Each individual's risk of acquiring SARS-CoV-2 infection was calculated using a quantitative assessment tool (the microCOVID). Intention to get vaccinated for COVID-19 was assessed by self-report. Usage of five types of media for obtaining COVID-related information was assessed: (1) newspapers, (2) television or radio, (3) internet or news apps, (4) social network services (SNS) (excluding LINE, a popular messaging app), and (5) other. Reliance on SNS did not show significant associations with either intention to get vaccinated or engaging in risky behavior for acquiring COVID-19. Although users of the internet or news apps were marginally significantly less likely to engage in high-risk behavior, significant associations between vaccine hesitancy and the usage of the internet or news apps were found in the middle age and elderly groups (OR [95% confidence interval (CI)] in middle age: 1.55 [1.07-2.23]; in elderly; 9.24 [3.28-26.02]). The differential associations between different types of media use and COVID-19 prevention behaviors may assist in preparing for future pandemic outbreaks. One implication for public health risk communication is audience segmentation, such as emphasizing vaccine safety and effectiveness for older audiences.

Background: This study aims to understand factors contributing to pediatric COVID-19 vaccine hesitancy among pregnant and postpartum adults., Method: The study used targeted intercept advertising on Facebook, Twitter, and Instagram to recruit a panel of 3600 pregnant and postpartum US adults. Data were collected between December 2021 and April 2022 (i.e., before the introduction of pediatric COVID-19 vaccines in the U.S.). We used logistic regression to understand factors associated with pregnant and postpartum women's hesitancy towards getting children <5 vaccinated against COVID-19. Poststratification weights were applied to analyses to promote the representativeness of the sample. We also conducted a qualitative thematic analysis to determine the reasons for pediatric vaccine hesitancy., Results: Nearly half (45.6 %) of pregnant or postpartum women were hesitant to vaccinate their child against COVID-19. Vaccine hesitancy was lower among those who had a high perceived susceptibility to COVID-19, had increased perceived severity of COVID-19, and increased perceived benefits of the COVID-19 vaccine. Perceived barriers related to long-term side effects of vaccines were positively associated with hesitancy to vaccinate children. Older women, women in urban areas, and those born outside the US were less likely to be hesitant to vaccinate children <5 against COVID-19. Compared to respondents with a high school education or less, the odds of pediatric vaccine hesitancy were higher among respondents with some college. Pregnant and postpartum women who were hesitant about getting children <5 vaccinated cited the following reasons for hesitancy: concerns about the vaccine, lack of evidence on vaccine safety, and the COVID-19 vaccine is not necessary for children., Conclusion: Our findings suggest that public health messages to promote the COVID-19 vaccine for young children should focus on the risks and consequences of the disease and share data on the effectiveness of the vaccine in preventing severe COVID-19-related outcomes., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Background: General vaccination rates have been falling globally despite unequivocal health benefits. Noncompliance can result from access barriers and/or hesitant attitudes. Few studies have investigated the prevalence and determinants of noncompliance with COVID-19 vaccination in blood donors., Methods: We surveyed blood donors on COVID-19 infection and vaccination history, barriers and motivations for COVID-19 vaccination, and comorbidities. We estimate the prevalence of noncompliance, the prevalence of hesitancy toward COVID-19 vaccines, and investigate associated factors using multivariable models., Results: From December 2021 to December 2022, 33,610 survey respondents were included. Of these, 24% had not been vaccinated for COVID-19 or had missing vaccination information, and 99% of those who reported reasons for being unvaccinated declared at least one of three hesitant attitudes presented in the survey (safety concerns; personal/cultural/religious beliefs; being young and not worrying about being vaccinated). Among noncompliant donors, <2% reported access barriers. In the multivariable model addressing factors associated with vaccine noncompliance, younger age, male gender, White/Caucasian race, absence of comorbidities, residency in a State with less restrictive COVID-19 policies, and living in micropolitan or rural areas were identified as significant predictors. Younger age and White/Caucasian race were independently associated with vaccine hesitancy among noncompliant donors., Conclusions: We found high rates of noncompliance with COVID-19 vaccination in blood donors, mostly driven by vaccine hesitancy. Understanding vaccine adherence among blood donors-a relatively highly educated and healthy population, with good healthcare access and usually motivated by altruism-could provide key information on determinants of vaccine noncompliance that may be harder to overcome., (© 2024 AABB.)

Objective: The study tested potential factors that differentiated the COVID-19 vaccine-hesitant and -inclined college students and, based on these factors, identified subgroups of the vaccine-hesitant students. Participants: Participants were 1,183 U.S. college students attending four-year universities or community colleges recruited through Qualtrics between January 25 and March 3, 2021. Methods: Participants completed an online survey assessing their COVID-19 vaccination intention, perceived risks of COVID-19 and the COVID-19 vaccines, efficacy beliefs regarding COVID-19 and the COVID-19 vaccines, and emotions toward taking the COVID-19 vaccines. Results: Vaccine-hesitant and -inclined college students varied in their emotions, risk perceptions, and efficacy beliefs regarding the virus and the vaccines. Using these factors as indicators, vaccine-hesitant college students were classified into five latent subgroups with distinct characteristics. Conclusions: In identifying subgroups of the vaccine-hesitant college students, the study has important insights to offer regarding the design of vaccine-promotion messaging strategies targeting the college student population.

Introduction: Vaccine hesitancy poses a threat to the prevention of COVID-19 and other vaccine-controlled diseases. In 2019, the Government of Trinidad and Tobago launched a policy outlining the scope of health services in the public sector available to registered Venezuelan migrants to include access to routine immunizations. Little is understood about immunization uptake among migrants, including the uptake of COVID-19 vaccinations in Trinidad and Tobago., Method: Between July and October 2022, a survey was conducted using a sample of n  = 507 Venezuelan migrants. We examined the relationship between COVID-19 vaccine hesitancy, migrant's attitudes toward past vaccinations, their beliefs and perceptions about COVID-19 disease, and health-service related factors. Descriptive statistics summarized the characteristics of these migrants. Odds ratios with 95% confidence intervals and multivariable logistic regression was used to examine factors and attitudes associated with COVID-19 vaccine hesitancy., Results: Our findings showed that 89% of the migrants accessed publicly available health services while in Trinidad and Tobago, 72.4% reported that they did not refuse other vaccines in the past, and 23% reported being hesitant to take the COVID-19 vaccine. Females had higher odds of being COVID-19 vaccine hesitant compared to males, and participants expressing doubts about the source of vaccine information also had greater odds of vaccine hesitancy. Long waiting times at a public health clinic and costs associated with traveling to a clinic were associated with higher odds of COVID-19 vaccine hesitancy., Conclusion: A National Immunization Policy inclusive of the unmet needs of vulnerable migrant populations is needed to ensure equitable access to vaccinations., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Lyons, Bhagwandeen, Gopeechan and Edwards.)

Background: This study aimed to elucidate the prevalence and characteristics of parental vaccine hesitancy towards routine infant immunizations and COVID-19 vaccines in Japan., Methods: A web-based survey was conducted among 3,227 parents of children aged 0-11 years to assess vaccine-related hesitancy for routine infant immunizations and COVID-19 vaccines for children using the Parent Attitudes about Childhood Vaccines (PACV) questionnaire. Data were collected from January 18 to 25, 2023. Covariates included demographic characteristics, economic status, COVID-19 infection status, decisional conflict scale, and the fear of COVID-19 Scale., Results: Vaccine hesitancy was found to be 52.4% for routine infant immunizations and 73% for COVID-19 vaccines. Significant differences in parental attitudes were observed between general childhood vaccines and COVID-19 vaccines for 12 out of 13 PACV survey items. The COVID-19 vaccines showed higher hesitancy rates in 10 items; largest discrepancies were noticed in schedule adherence (22.5% vs 61%), overall hesitancy (40% vs 55.1%), and trust in pediatric doctors (37.2% vs 53.6%). Safety concerns were high for both vaccine types, exceeding 50%. Multivariable analysis identified decisional conflict (RR: 1.01 95% CI: 1.00-1.02) and COVID-19-related fear (RR: 1.04, 95% CI: 1.02-1.05) as hesitancy predictors for routine immunizations., Conclusion: Vaccine-related hesitancy for COVID-19 was significantly higher than that for routine immunizations, with decisional conflict emerging as a primary predictor for both. Fear of COVID-19 was associated with routine immunization-related hesitancy. These findings provide critical insights for future pandemic preparedness and vaccine acceptance strategies, highlighting the importance of strengthening trust between healthcare providers and parents, providing clear and reliable information, and implementing decision support tools., Competing Interests: Declarations. Ethics approval and consent to participate: This study was approved by the Institutional Review Board of Niigata University (approval no. 2022–0076). Participants' responding to the survey was considered as their consent to participate. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Background: Strategies to increase COVID-19 vaccine coverage require an understanding of the extent and drivers of vaccine hesitancy and trust in government related to COVID-19 vaccine programs, especially in low-resource communities., Methods: We conducted a cross-sectional household survey post-COVID-19 vaccine introduction among adults (n = 362) in four municipalities in Sarlahi District, Nepal from August to December 2022. The survey included modules on participant demographics and socioeconomic factors and vaccine hesitancy, information seeking, and trust in authorities related to COVID-19 vaccination., Results: Of the study participants, 38.4 % expressed hesitancy related to COVID-19 vaccination. The adjusted odds of being "vaccine hesitant" were significantly lower among the older adults (51+ years) relative to younger (<30 years) (aOR: 0.49, CI: 0.24-0.97) and among males relative to females (aOR: 0.51, CI: 0.26, 0.95). The study population highly trusted the government's handling of the COVID-19 pandemic. While for most, self-reported access to vaccination opportunities was high (88.4 %), 70.4 % of participants did not know if vaccines were in stock at their local vaccination facility. Commonly reported statements of misinformation include the vaccine being developed in a rush or too fast (21.5 %), COVID-19 infection can be effectively treated with ayurvedic medicine(16.3 %) and obtaining immunity from natural infection is better than through vaccination (19.9 %). The primary sources of information on COVID-19 programs were family and friends (98.6 %), healthcare professionals (67.7 %), Female Community Health Volunteers (FCHVs) (61.9 %), television (56.4 %), and radio (43.1 %)., Conclusion: Although many respondents expressed concerns about COVID-19 effectiveness and safety, a high proportion trusted COVID-19 information provided by healthcare workers and approved of the government's response to the pandemic. This study highlights an opportunity to design new evidence-based communication strategies to improve vaccine confidence delivered through frontline government healthcare workers. Approaches could be targeted to certain communities in the region shown to have higher vaccine hesitancy, including younger people and women., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

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.)

Importance: COVID-19 vaccine hesitancy among Black women is a critical public health concern, potentially exacerbating existing health disparities and impacting community-wide vaccination efforts., Objective: To explore the factors associated with COVID-19 vaccine hesitancy among Black women in the US and identify the specific concerns and experiences shaping hesitant attitudes toward vaccination., Design, Setting, and Participants: Qualitative study using in-depth, semistructured interviews conducted virtually between June and November 2021. Thematic analysis was used to identify key themes from the interview data. Participants were recruited through social media platforms and word-of-mouth referrals from various regions of the US. Interviews were conducted remotely via Zoom. Data were analyzed from June to October 2023., Main Outcomes and Measures: Identification of key themes associated with COVID-19 vaccine hesitancy, identified through thematic analysis of interview data., Results: Fifty-four Black women aged 21 to 66 years participated in the study. Most participants (41 [75.9%]) resided in the South. The sample was predominantly well-educated, with 41 (75.9%) holding a bachelor's degree or higher. Income levels varied, with 16 (29.6%) earning between $40 000 and $59 999 annually. Regarding family structure, 32 participants (59.3%) reported having no children, while 22 (40.7%) had 1 or more children. Three primary themes emerged as being associated with vaccine hesitancy: (1) mistrust in health care and government, rooted in past medical exploitation; (2) concerns over vaccine safety and long-term effects, particularly regarding reproductive health; and (3) ineffective and coercive vaccine communication and promotion. Participants expressed deep-rooted skepticism about being treated as "expendable" in medical research, fears about the rapid vaccine development process, and frustration with coercive vaccine advertisements. Many women desired more comprehensive education about vaccine mechanisms and criticized the use of coercive financial incentives and celebrity endorsements in vaccine promotion., Conclusions and Relevance: Addressing COVID-19 vaccine hesitancy among Black women requires a multifaceted approach that acknowledges historical traumas, provides clear and transparent safety information, and avoids coercive vaccine promotion strategies. These findings emphasize the need for health care practitioners and public health officials to prioritize trust-building, engage community leaders, and tailor interventions to address the unique concerns of Black women to improve vaccine confidence and uptake.

Vaccine hesitancy is an attitude of indecision toward vaccination that is related to but not determinative of vaccination behaviors. Although theories of vaccine hesitancy emphasize it is often vaccine-specific, we do not know the extent to which this is true across sociodemographic groups. In this study, we asked: What latent classes of vaccine hesitancy might exist when examining parents' attitudes toward vaccines in general and COVID-19 and human papillomavirus (HPV) vaccination specifically? Which sociodemographic, health access, and health-related variables are predictive of membership in those classes? To answer those questions, we analyze online survey data from parents of pediatric patients recruited through eight clinics within the University of Arkansas for Medical Sciences Rural Research Network. Data were collected between September 16, 2022 and December 6, 2022. Latent class analysis revealed three underlying classes of vaccine hesitancy, or hesitancies: The "Selectively Hesitant," the "COVID-Centric Hesitant," and the "Pervasively Hesitant." Significant predictors of class membership were age, education, health insurance status, and usual source of care. Vaccine hesitancy may be specific to certain vaccines for some parents and more generalized for others. The distinct classes of vaccine hesitancy revealed in this study suggest the need for distinct approaches to addressing vaccine hesitancy depending on the population., (© 2025 The Author(s). Clinical and Translational Science published by Wiley Periodicals LLC on behalf of American Society for Clinical Pharmacology and Therapeutics.)

This study analyzed 1432 questions asked in 19 surveys ( N  = 43,014) on COVID-19 vaccines between January 2020 and August 2022 using dimensions including (1) information sources about COVID-19 vaccine, (2) information about the access, effectiveness, and side effects of COVID-19 vaccine, (3) COVID-19 vaccine hesitancy (i.e. false perception, skepticism, and vaccine refusal), (4) motivations to get the COVID-19 vaccine (i.e. to perform routine activities, convenience, incentives, influences, and travel requirement), (5) false perceptions caused vaccine refusal, and (6) intentions to get vaccinated. Our results show that vaccine refusal was rampant throughout the pandemic and mostly attributed to the rush in the vaccine development process and perceived safety risks. Additionally, our analysis indicates that people's motivation to get vaccinated came from varied sources such as doctors, family members, and politicians. Lastly, mandating vaccines during the pandemic did not significantly increase uptake among individuals who were initially skeptical, and concerns about the rapid development of the vaccine were a major cause of vaccine hesitancy. Findings were discussed and interpreted using the information deficit model, the two-step flow theory, and the reactance theory. This research provides valuable insights and practical implications, along with significant theoretical contributions and policy recommendations.

Addressing vaccine hesitancy requires culturally adaptable tools. This study aimed to provide a better understanding of COVID-19 vaccine hesitancy in Israel's ultraorthodox Jewish community, where vaccine hesitancy is prevalent. We developed and validated a COVID-19 vaccine hesitancy questionnaire and explored correlates of intention to receive the fourth dose of the COVID-19 vaccine in this population. A mixed-methods study employing an exploratory sequential design was conducted in May-September 2022. Building on qualitative data, a questionnaire was developed and validated in a cross-sectional study when the fourth dose was recommended to all adults. Thematic analysis identified several factors influencing COVID-19 vaccine decision-making, predominantly religious authority alongside health information sources, perceived vaccine safety, effectiveness, and trust in state authorities. In the cross-sectional study, 96/106 (90.6%) participants were vaccinated against COVID-19; 5.2%, 25.0%, 65.6%, and 4.2% received 1, 2, 3, and 4 doses, respectively. Intention to receive the fourth dose (yes/maybe) was reported by 46%. A factor analysis yielded several scales expressing perceptions regarding COVID-19, with Cronbach's Alpha mostly between 0.689 and 0.887. Correlates of intention to receive the fourth dose were age ≥ 50 years: OR = 12.45 (95% CI 1.42-108.93) , male-sex: 4.97 (1.47-16.81) , perceiving the vaccine as important/effective and safe: 4.11 (1.29-13.13) , utilizing ultraorthodox communication channels: 5.86 (1.58-21.73) , and the number of previously received doses: 3.14 (1.31-7.53) . Complementary evidence emphasized the role of religious authority and information sources (ultraorthodox communication channels) and balancing perceived vaccine safety and effectiveness and disease risk in COVID-19 vaccine hesitancy in Israel's ultraorthodox Jewish population.

The HPV vaccine, which has been demonstrated to be an effective method of reducing the risk of developing cervical cancer, is still being underutilized among college students in China. To assess the current status of HPV vaccine hesitancy among college students in Guangdong Province after the COVID-19 outbreak, and to systematically analyze the influencing factors of HPV vaccine hesitancy and construct a prediction model based on the WHO 3Cs model. A cross-sectional web-based survey was conducted in June 2023 among female college students in four cities in Guangdong Province. The data were analyzed using binary logistic regression with a focus on the 3Cs model: Complacency, Convenience, and Confidence. LASSO regression was employed to analyze the variables deemed to be of significance and to construct predictive models. Out of 1399 participants, 86.5% expressed no hesitancy toward HPV vaccination. However, 11.9% exhibited hesitancy, and 1.6% refused vaccination altogether. Factors such as trust in vaccine efficacy, perception of HPV infection risk, price considerations, and constraints like distance or time were significant contributors to hesitancy. Knowledge of the HPV vaccine, socio-demographic characteristics, and the educational level of participants' mothers also played a role in vaccine hesitancy. It is recommended that targeted interventions be implemented within educational institutions with the aim of raising awareness of cervical cancer and HPV vaccines, simplifying the scheduling of vaccination appointments, and increasing affordability through the implementation of strategic purchasing measures or subsidy schemes.

The COVID-19 pandemic disproportionately affected racial and ethnic minority communities across the United States (U.S.). Despite the disproportionate burden of COVID-19 faced by communities of color, Black and Hispanic communities are less likely to be fully vaccinated than White non-Hispanic Persons. Health inequity and vaccine hesitancy are complex phenomena that require multilevel responses tailored to the unique needs of each community, a process that inherently necessitates a high level of community engagement in order to develop the most effective health interventions. Building on the principles of community based participatory research (CBPR) and with the support of the National Institutes of Health (NIH), Project 2VIDA! was born. A multidisciplinary collaborative of academic researchers, community members, and clinicians whose aim is to foster sustainable partnerships to reduce the burden of COVID-19 in Hispanic and Black communities across Southern California. Our model was designed to meet our community members where they were - whether on their lunch break or picking their children from school. This CBPR model has been well received by community members. Future health interventions focused on reducing health disparities should prioritize the role of the community, leverage the voices of key community partners, and be grounded in equitable power sharing.

Fueled by the coronavirus disease 2019 pandemic, vaccine hesitancy has become more pronounced and challenging given the increased distrust of science, pervasiveness of misinformation, and polarization of ideas. As such, pediatric providers are increasingly on the frontline of vaccine conversations with their patients, families, colleagues, and communities. To respond effectively to vaccine hesitancy, providers should employ professionalism in all aspects of their practice, including commitment to learning and growth, cultural awareness and humility, ethical responsibility to self and others, oral communication, reliability and dependability, teamwork, critical thinking and quantitative reasoning, and the engagement in public discourse around vaccines. By ensuring excellence in each professionalism domain, pediatric providers will have the best chance of enhancing vaccine positivity and minimizing vaccine hesitancy. [ Pediatr Ann . 2024;53(12):e465-e472.] .

Purpose: Parental human papillomavirus (HPV) vaccine hesitancy contributes to delays or refusals in adolescent uptake. It is unclear if COVID-19 vaccine hesitancy has further impacted the low HPV vaccine uptake trends among underrepresented minorities. This study examines the relationship between COVID-19 vaccine intent and HPV vaccine hesitancy among parents for their adolescents in communities with low vaccine uptake in Los Angeles County., Methods: Parents from a school-based academic enrichment program serving low-income, first-generation immigrant families completed an online cross-sectional survey to understand parental HPV vaccine hesitancy, adolescent HPV vaccine behavior, and attitudes towards other vaccines, including intent to receive COVID-19 vaccines. In March 2021, parents with children ages 9-17 years completed online surveys. Using multivariate logistic regression models, we examined whether low parent intent to vaccinate their adolescent against COVID-19 was associated with hesitancy to vaccinate against HPV., Results: A total of 291 surveys were completed. Among parents with high HPV vaccine hesitancy for their adolescent, 33 % did not intend to vaccinate their adolescent against COVID-19 compared to 7 % among parents with low HPV vaccine hesitancy. Low parent intention to vaccinate adolescent against COVID-19 was associated with higher HPV vaccine hesitancy (p < 0.01) after controlling for parent nativity status, medical mistrust, receiving the flu vaccination and negative HPV information., Discussion: Our findings indicate associations between low parental COVID-19 vaccine intent and higher HPV vaccine hesitancy for their adolescent. Identifying community-relevant health interventions to address parental vaccine hesitancy across multiple child and adolescent vaccines may help to achieve equitable vaccine uptake., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Objectives: This study aims to identify the factors influencing vaccine hesitancy, willingness and its variation over time in order to inform more responsive strategies for increasing vaccination uptake. The specific objectives are: (1) to describe and compare levels of COVID-19 vaccine hesitancy among the general population in rural and urban settings in West Africa over time and (2) to identify factors associated with COVID-19 vaccination willingness and hesitancy among the general population across five West African countries over time., Design: Following a baseline survey (Wave I), three serial cross-sectional surveys (Waves II-IV) were implemented., Setting: The study was conducted in Burkina Faso, Guinea, Mali, Senegal and Sierra Leone from November 2021 to July 2022., Participants: A total of 13 571 study participants were included in the study (n=4373, n=4593 and n=4605 for survey Waves II, III and IV, respectively). Inclusion criteria were being 18 years or older, living in the study area and willing to provide informed consent. A two-stage sampling strategy was used to select the sample from among the general population., Primary and Secondary Outcomes: Primary outcomes were the variability of vaccine hesitancy over time and across the five West African countries. Secondary outcomes were factors associated with vaccine willingness., Results: A small but steady increase in hesitancy to COVID-19-vaccination can be observed across countries, with an upward trend of vaccine hesitancy reported by 952 participants (33.9 %) in Wave II, 1055 (37.3%) in Wave III and 1089 (38.1%) in Wave IV. Among the countries included, Senegal shows the highest level of vaccine hesitancy ('Definitely no' and 'Probably no' ranging from 50.2% to 56.0% and 26.2 to 28.3%, respectively). At the same time, Senegal has the lowest vaccination coverage overall. Across all five countries and survey waves, the primary factor associated with vaccination willingness is fear of experiencing severe COVID-19 disease (Wave II: OR 0.42, 95% CI 0.34 to 0.51, Wave III: OR 0.48, 95% CI 0.40 to 0.59 and Wave IV: OR 0.54, 95% CI 0.44 to 0.66). Perceived improved financial status seems to influence willingness to get vaccinated negatively (OR 0.57, 95% CI 0.40 to 0.81) and unlike in Western, Educated, Industrialised, Rich and Democratic countries, men seem more reluctant to get vaccinated than women (OR 0.77, 95%, CI 0.65 to 0.93)., Conclusions: Our findings suggest that vaccine hesitancy should be monitored over time to inform communication strategies, which are responsive to changes in vaccination-related public sentiments. Additionally, a focus on social solidarity and the importance of women in vaccination advocacy can help improve COVID-19 vaccination coverage in West Africa., Trial Registration Number: The general protocol is registered on clinicaltrial.gov (protocol number: NCT04912284)., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Parent vaccine hesitancy is a sensitive topic despite the benefits associated with children's vaccination. Especially regarding the COVID-19 vaccination, parents displayed concerns about children's vaccination, questioning their effectiveness and security. Although several studies were conducted on the general population, few studies investigated this relationship on parents' intentions., Methods: An online survey was advertised from May to December 2022 on social networks, collecting data from 109 participants (90% F; mean age: 41.34 years, SD: ±6.40). The survey assessed sociodemographic characteristics, vaccine hesitancy through the Parents Attitude towards Childhood Vaccine-PAVC, trust in science through the Belief in Science Scale-BISS, and conspiracy beliefs through the Generic Conspiracist Beliefs Scale-GCBS., Results: In our sample, 29 parents (26.6%) scored more than 50 points to PAVC and, for this reason, were considered hesitant. Moreover, more than half of parents (60.6%) declared that they did not intend to vaccinate their children in the future. The path analysis model showed that parents with low education tended to have higher conspiracy beliefs (β = -0.40). Holding conspiracy beliefs (β = 0.28) and having low trust in science (β = -0.23) was associated with higher parent hesitancy and, in turn, no future intention to vaccinate their children for COVID-19 (OR = 0.83, p < 0.001)., Conclusion: The results of the current paper suggest that targeted campaigns should be aimed at parents with lower levels of education, mainly on social media, debunking the most common fake news or myths, independently from the type of vaccine, and highlighting the importance of scientific research for improving people's living conditions.

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.)

Background: Vaccine hesitancy has gained heightened relevance amid the COVID-19 pandemic, underscoring the urgency of understanding its determinants. This study explores the association between Covid-19 vaccine hesitancy, mental health variables and inflexible thinking., Methods: A convenience sample of 252 UK adults was assessed online between June 2021-July 2022 (when Covid-19 lockdown restrictions had finally eased). We assessed participants using the Oxford Covid Vaccine Hesitancy Scale (OCVHS), various aspects of mental health, using: the Obsessive-Compulsive Inventory-Revised (OCI-R), Compulsive Personality Assessment Scale (CPAS), Depression, Anxiety, and Stress scale (DASS-21), and finally, performance on a computerized version of the Wisconsin Card Sort Task (WCST). This study was preregistered at the Open Science Framework (https://osf.io/xd5wz)., Results: Multiple regression analyses showed that only cognitive inflexibility, and specifically the WCST item of perseverative errors, significantly predicted vaccine hesitancy., Conclusion: Our exploratory analysis provides the first evidence that cognitive inflexibility, measured using an objective task, is an independent risk-factor for vaccine hesitancy. Public health strategies should consider the impact of an inflexible thinking style on the decision-making of those most at risk of vaccine hesitancy and adapt interventions accordingly., Competing Interests: Declaration of competing interest Prof. Naomi Fineberg reports in the past 3 years she has held research or networking grants from the UKNIHR, COST Action, Orchard; accepted travel and/or hospitality expenses from the BAP, ECNP, RCPsych, CINP, International Forum of Mood and Anxiety Disorders, World Psychiatric Association; received payment from Elsevier for editorial duties and the Mental Health Academy for lecturing. Previously, she has accepted paid speaking engagements in various industry supported symposia and recruited patients for various industry-sponsored studies in the field of OCD treatment. She leads an NHS treatment service for OCD. She holds Board membership for various registered charities linked to OCD. She gives expert advice on psychopharmacology to the UK MHRA. She has participated in a WHO working group focusing on diagnosis and classification of obsessive compulsive or related disorders for the ICD-11. Dr Luca Pellegrini reports a relationship with European Cooperation in Science and Technology, the University of Hertfordshire, Orchard, ECNP-OCRN International College of Obsessive-Compulsive Spectrum Disorders (ICOCS), that includes: funding grants. Professor Laws and Dr. Clarke report no interest., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Vaccines remain the best strategy as the COVID-19 pandemic enters into later stages and governments begin to shed pandemic-control measures. Vaccine hesitancy continues to be a major obstacle in efforts to end the pandemic. This study reports formative evaluation research that adopted a multidimensional approach using latent profile analysis to audience segmentation and message targeting. Within the framework of the integrated behavioral model, data were collected from a US national survey to explore the dimensions in which vaccine-confident vs. -hesitant individuals differed significantly across the topics of COVID-19 and influenza. Latent profile analyses were performed to identify subgroups and establish measurement invariance between COVID-19 and influenza vaccines. Matching message strategies were proposed for the distinctive characteristics of the subgroups for both topics and to be tested in future research.

Despite widely recognised effectiveness against the spread of COVID-19, vaccine hesitancy persists. This systematic literature review aimed to clarify the definition and the operationalisation of the term 'vaccine hesitancy' and disclose the various psychosocial factors underlying this phenomenon. The results of studies conducted in European countries and in the United States after the vaccines became available were taken into account. The review was conducted according to the Preferred Reporting Items for Systematic Review and Meta-Analyses statement. Twelve studies met the inclusion criteria and were reviewed. efinitions and measures of vaccine hesitancy differed across the studies, limiting their comparison. Nonetheless, by drawing on theoretical frameworks, we were able to identify several psychosocial variables in determining vaccine hesitancy. Our findings point to the need for a transdisciplinary approach to understanding the antecedents of vaccine hesitancy. A better understanding of the phenomenon may help to develop interventions and social policies to address a complex challenge such as vaccination hesitancy., (© 2024 Wiley Periodicals LLC.)

In November 2020, North Dakota reported a higher number of cases and deaths per capita from COVID-19 than any other state in the United States. Several months later, it reported one of the country's highest rates of vaccine hesitancy, leading to the development and implementation of the state-funded and physician-led "Vaccine Champion" ("VaxChamp") program. Glossing the primary problem as one of "provider confidence," the VaxChamp program emphasized a standardized, scalable intervention that targeted healthcare providers directly, and patients only indirectly. Although the program hit its quantitative benchmarks, a qualitative inquiry into the program's history and context reveals multiple crises of confidence, many beyond the bioscientific domain of the program's focus. Drawing from work in medical and linguistic anthropology, we describe and analyze the "multiple levers of vaccine confidence" at play in the intervention and its surrounding context, as well as how these crises of confidence emerged., (© 2024 American Anthropological Association.)

Coronavirus disease 2019 (COVID-19) vaccine uptake among individuals with rheumatic conditions remains low despite heightened risk for related adverse outcomes. This is especially pronounced among historically marginalized populations who suffered disproportionately from the COVID-19 pandemic. Among the myriad of reasons for low vaccine uptake, mistrust in the healthcare system, misinformation related to the vaccine development process, fear of rheumatic disease flares, and inconsistent physician recommendations, are highlighted. Two randomized controlled trials are underway leveraging multimodal strategies and community partnerships to disseminate COVID-19 vaccine information, reduce hesitancy and hopefully improve vaccine uptake, particularly in marginalized communities., Competing Interests: Disclosure Dr N. Ezeh and Ms T. Boadi have no disclosures. Dr M.I. Danila: Research grants: NIH (P30 AR072583, P50 AR060772, R01 AI153365, R01 AR065493, R01 AR080784) Pfizer, Radius–sums paid to the Institution. Associate Editor for Arthritis Care and Research. Speaker fees <10k. Hospital for special surgery, UT Southwestern, Cedars Sinai, RheumNow. Dr R. Ramsey-Goldman: Research Grants: NIH (R01AR071091, R01 AR080089, R01 AI170938, P30AR072579, R21AI171491); DOD, United States (W81XWWH2010692); MUSC18-053-8D365; LuCIN subcontract; MP-CPI-21 to 005 OMH (subcontracts with ACR, LFA, University of Alabama); NU58DP0069080100 (subcontract with ACR); PCORI no number (subcontract with University of Alabama, Birmingham), Consulting, Honoraria, Speaking fees (all <10K): State University of New York, Syracuse; Merck; Biogen; Cabaletta; Exagen Diagnostics; Duke University, Ampel Solutions, Clarivate, Upstart Research Consulting, AstraZeneca, Georgetown University. Chair, Collaborative Initiatives Special Committee (COIN) American College of Rheumatology. Dr C.H. Feldman: Research Grants: NIH, United States (1OT2HL161841, 1P30AG064199-03, R01AR080089, 30AR072577, R03AR083661, R01MD019235, R01AR074290), the Bristol Myers Squibb Foundation, United States, the Arthritis Foundation, United States, Brigham and Women’s Hospital Health Equity Innovation Pilot. Consulting: Harvard Pilgrim, OM1, Inc., Bain Capital, LP, the American College of Rheumatology, the Lupus Foundation of America, and the University of Alabama. Speaker honorarium (<10K) from University of Texas Southwestern, University of Alabama at Birmingham, Hospital for Special Surgery, University of Washington. Conference travel reimbursement from RLITE Foundation, the Rheumatology Research Foundation, and EULAR. Associate Editor for Lupus Science and Medicine, Editorial Board for Arthritis Care and Research and Medical-Scientific Advisory Board Member for the Lupus Foundation of America. Member of the American College of Rheumatology Diversity, Equity and Inclusion Committee and the Climate Change Task Force., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Summary: The global health crisis triggered by the SARS-CoV-2 in 2019, known as the COVID-19 pandemic, prompted vaccination drives worldwide, including in India, to address the crisis. However, vaccine hesitancy remains a significant challenge to achieving vaccination goals. Hence, we conducted a systematic review and meta-analysis during 2021-2023 to estimate the prevalence of COVID-19 vaccine hesitancy among adults in India and identify associated factors. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. Quality assessment was performed using the Joanna Briggs Institute checklist. Pooled prevalence estimates were calculated using a random-effects model. A total of 265 articles were identified, of which 21 full-text articles were included in the review. The pooled estimated prevalence of COVID-19 vaccine hesitancy among adults in India was found to be 28% (95% confidence interval: 27-29). Subgroup analysis revealed variations in hesitancy rates across different states, with higher rates observed in Jammu and Kashmir (44%), West Bengal (49%), and Maharashtra (39%). Gender-based analysis indicated higher hesitancy among males (36%) compared to females (26%). Among different study populations, medical students showed the lowest hesitancy rate (13%), whereas the general population exhibited the highest (34%). The findings suggest that vaccine hesitancy remains a significant concern in India, with one in four adults expressing hesitancy toward COVID-19 vaccination. Hesitancy rates vary across states, genders, and study populations. Addressing the factors contributing to hesitancy, such as safety concerns, lack of evidence, and misinformation, is crucial to enhance vaccine acceptance., (Copyright © 2024 Indian Journal of Public Health.)

Vaccine hesitancy, a pressing global challenge in vaccination programs, was significantly amplified during the COVID-19 pandemic. The proliferation of misinformation, including false claims and rumours, and the influence of anti-vaccine movements fuelled hesitancy. This study aims to explore the socio-economic determinants that influenced vaccine hesitancy and the impact of public health information sharing in Sri Lanka during the pandemic. The study employed a comprehensive mixed-method approach for data collection, administrating a household survey (n = 3330) and 206 semi-structured interviews. The survey results indicated that 37.8% ( n = 3113) of respondents delayed or rejected vaccines for various reasons, the leading cause being the fear of side effects of the vaccine. Although fear of side effects was the prime reason for rejection ( n = 1176, 46.29%), respondents demonstrated an extremely poor understanding of the potential side effects of vaccines, which was 55.39% ( n = 3113). Notably, 84.60% ( n = 3113) were unaware of the vaccine development process. Multivariate logistic regression analysis showed that middle-income people (AOR-0.42) and females (0.65) were less likely not to make decisions based on scientific information compared to underprivileged people and males. The survey also revealed that strong belief in the use of traditional medicines and remedies and religious beliefs ( n = 1176, 3.95%) were among the main reasons for hesitancy. The findings illustrate that misinformation, lack of health knowledge, and lack of understanding to seek scientific information have fuelled vaccine hesitancy in Sri Lanka.