Priming with social benefit information of vaccination to increase acceptance of COVID-19 vaccines

Vaccine hesitancy can be heightened due to increasing negative reports about vaccines. Emphasizing the social benefits of vaccination may shift individual attention from individual to social benefit of vaccination and hence promote prosocial vaccination. In six rounds of a population-based survey conducted over one major community epidemic of coronavirus disease 2019 (COVID-19) in Hong Kong from June to November 2020, we manipulated the question asking about acceptance of a COVID-19 vaccine with or without emphasizing the social benefit of vaccination against COVID-19 (prosocial priming) and monitored the changes of vaccine confidence by news media sentiment on vaccines. Population-weighted percentages of accepting COVID-19 vaccines by priming condition and vaccine confidence were compared across survey rounds. Logit regression models assessed the main effect of prosocial priming and the modification effects of vaccine confidence and perceived personal risk from COVID-19 on acceptance of COVID-19 vaccines. We found that prosocial priming significantly increased acceptance of COVID-19 vaccines across all survey rounds except for Round 3 when incidence of COVID-19 reached a peak. Vaccine confidence significantly declined in Round 6 when news media sentiment on vaccines became predominantly negative. The effect of prosocial priming on promoting vaccine acceptance was significantly greater in participants with low vaccine confidence and those perceiving the severity of COVID-19 to be mild/very mild. Our study suggests that packaging vaccination against COVID-19 as a prosocial behaviour can help overcome low vaccine confidence and promote prosocial vaccination particularly when disease incidence temporarily declines and the public perceive low severity of COVID-19.     

Negative sentiments toward novel coronavirus (COVID-19) vaccines

Addressing negative vaccine sentiments is paramount to COVID-19 prevention efforts. However, assessing population sentiments is challenging due to the desirability bias that can emerge when directly asking respondents for their opinions on vaccination. Social media data, containing people’s unfiltered thoughts, have the potential to offer valuable insights that could guide vaccine promotion messaging. We extracted one week’s (4/5–4/11, 2020) worth of COVID-19 vaccine posts on Twitter (tweets) from the U.S. (N = 208,973) and segmented tweets with negative sentiments toward COVID-19 vaccines (n = 14,794). We imputed location based on Twitter users’ self-reported state of residence. We found that states in the South had significantly higher prevalence of negative tweets compared to states in other parts of the country, and higher-income states reported lower prevalence of negative tweets. Our findings suggest the existence of negative vaccine sentiments and geographic variability in these opinions, warranting tailored vaccine promotion efforts, particularly for the southern U.S.     

Hesitancy towards COVID-19 vaccines on social media in Canada

To effectively end the pandemic, the acceptance of effective vaccines against COVID-19 is critical. Comments posted in online platforms act as a barometer for understanding public concerns regarding vaccination and can be used to inform communication strategies for the ‘moveable middle’. The aim of this exploratory study was to identify online dialogue regarding the nature of vaccine hesitancy related to COVID-19 vaccine(s). We analyzed user comment threads in response to news reports regarding COVID-19 vaccines on the Canadian Broadcasting Corporation national news website (with as many as 9.4 million unique visitors per day). User comments (n = 1145) were extracted from 19 articles between March 2020 and June 15th, 2020. Comments were then coded inductively for content to establish a coding framework that was subsequently applied to the dataset. Our data provide empirical support for misrepresentation as a form of misinformation and further demonstrate the utility of social media content as data for social research that informs public health communication materials. The data point to the need for, and value of, rapid communication interventions to foster vaccine acceptance. False information will continue to create challenges for delivering COVID-19 vaccines. Communication strategies to get ahead of the pace of misinformation are critical, particularly in light of boosters and the possibility of COVID-19 vaccination on an annual basis.     

A cross-sectional analysis of the association between social capital and willingness to get COVID-19 vaccine in Ontario,Canada

ObjectiveWe examine the role of social capital in intention to take the vaccine at the end of the first wave of the COVID-19 pandemic.MethodsThis study uses observational, cross-sectional data from the Ontario sample of the fall 2020 Canadian Community Health Survey (CCHS), a representative sample of the population with added questions relative to symptoms of COVID-19 and intentions to get vaccinated. Questions on social capital were asked to respondents from Ontario only, yielding a sample of 6516. Odds ratios (OR) and marginal effects at sample mean of an index of social capital (at the individual or aggregated level) on changes in intentions to get vaccinated are estimated from logistic regression models.ResultsIndividual-level social capital is associated with greater willingness to get vaccinated against COVID-19 (OR 1.09). Associations with aggregated-level social capital are less precisely estimated. Associations are the same for both males and females but vary across age categories: individual-level social capital is associated with higher willingness to get vaccinated among working-age respondents, but aggregate-level social capital is associated with higher willingness to get vaccinated among older adults.ConclusionVaccine hesitancy is not a random phenomenon, nor is it explained by individual characteristics such as education or income only. It also reflects the state of the social environment in which individuals live and public health messaging should take this into account if it is to be successful.Supplementary InformationThe online version contains supplementary material available at 10.17269/s41997-023-00746-9.     

Association between social vulnerability and COVID-19 vaccination hesitancy and vaccination in pregnant and postpartum individuals

ObjectiveTo evaluate the association of community-level social vulnerability with COVID-19 vaccine hesitancy and vaccination among pregnant and postpartum individuals.MethodsProspective cohort study assessing COVID-19 vaccine hesitancy among pregnant and postpartum individuals. We performed a baseline survey on COVID-19 vaccine hesitancy from 03/22/21 to 04/02/21, and a follow-up survey on COVD-19 vaccination status 3- to 6-months later. The primary exposure was the Centers for Disease Control and Prevention SVI (Social Vulnerability Index), measured in quartiles. Higher SVI quartiles indicated greater community-level social vulnerability with the lowest quartile (quartile 1) as the referent group. The primary outcome was COVID-19 vaccine hesitancy on the baseline survey (uncertainty or refusal of the vaccine), and the secondary outcome was self-report of not being vaccinated (unvaccinated) for COVID-19 on the follow-up survey.ResultsOf 456 assessed individuals, 46% reported COVID-19 vaccine hesitancy on the baseline survey; and of 290 individuals (290/456, 64%) who completed the follow-up survey, 48% (140/290) were unvaccinated. The frequency of baseline vaccine hesitancy ranged from 25% in quartile 1 (low SVI) to 68% in quartile 4 (high SVI), and being unvaccinated at follow-up ranged from 29% in quartile 1 to 77% in quartile 4. As social vulnerability increased, the risk of COVID-19 vaccine hesitancy at baseline increased (quartile 2 aRR (adjusted relative risk): 1.46; 95% CI:0.98 to 2.19; quartile 3 aRR: 1.86; 95% CI:1.28 to 2.71; and quartile 4 aRR: 2.24; 95% CI:1.56 to 3.21), as did the risk of being unvaccinated at follow-up (quartile 2 aRR: 1.00; 95% CI:0.66 to 1.51; quartile 3 aRR: 1.68; 95% CI:1.17 to 2.41; and quartile 4 aRR: 1.82; 95% CI:1.30 to 2.56).ConclusionsPregnant and postpartum individuals living in an area with higher community-level social vulnerability were more likely to report COVID-19 vaccine hesitancy and subsequently to be unvaccinated at follow-up.     

Intention to participate in a COVID-19 vaccine clinical trial and to get vaccinated against COVID-19 in France during the pandemic

IntroductionThe world is facing the COVID-19 pandemic. The development of a vaccine is challenging. We aimed to determine the proportion of people who intend to get vaccinated against COVID-19 in France or to participate in a vaccine clinical trial.MethodsWe conducted an anonymous on-line survey from the 26th of March to the 20th of April 2020. Primary endpoints were the intention to get vaccinated against COVID-19 if a vaccine was available or participate in a vaccine clinical trial.ResultsThree thousand two hundred and fifty nine individuals answered the survey; women accounted for 67.4% of the respondents. According to their statements, 2.512 participants (77.6%, 95% CI 76.2–79%) will certainly or probably agree to get vaccinated against COVID-19. Older age, male gender, fear about COVID-19, being a healthcare worker and individual perceived risk were associated with COVID-19 vaccine acceptance. Vaccine hesitancy was associated with a decrease in COVID-19 vaccine acceptance. One thousand and five hundred and fifty respondents (47.6% 95% CI 45.9–49.3%) will certainly or probably agree to participate in a COVID-19 vaccine clinical trial. Older age, male gender, being a healthcare worker and individual perceived risk were associated with potential acceptance to participate in a COVID-19 vaccine clinical trial. Vaccine hesitancy was associated with refusal for participation in a COVID-19 vaccine clinical trial.ConclusionsNearly 75% and 48% of the survey respondents were respectively likely to accept vaccination or participation in a clinical trial against COVID-19. Vaccine hesitancy will be the major barrier to COVID-19 vaccine uptake.     

Preferences for COVID-19 vaccination information and location: Associations with vaccine hesitancy,race and ethnicity

This study examined the association between preferences for being informed about the COVID-19 vaccine and where to receive it with vaccination intent and race/ethnicity. We conducted an online survey, oversampling Black and Latino panel members. The 1668 participants were 53.2% female, 34.8% White, 33.3% Black, and 31.8% Latino. Participants who were vaccine hesitant (answered “not sure” or “no” to vaccination intent) were more likely to prefer a conversation with their doctor compared to those who answered “yes” (25.0% and 23.4% vs 7.8%, P < .001, respectively). Among participants who responded “not sure”, 61.8% prefer to be vaccinated at a doctor’s office, compared with 35.2% of those who responded “yes” (P < .001). Preferred location differed by race/ethnicity (P < .001) with 67.6% of Black “not sure” participants preferring a doctor’s office compared to 60.2% of Latino and 54.9% of White “not sure” participants. These findings underscore the need to integrate healthcare providers into COVID-19 vaccination programs.     

Christian nationalism and COVID-19 vaccine hesitancy and uptake

Understanding COVID-19 vaccine hesitancy and uptake is vital for informing public health interventions. Prior U.S. research has found that religious conservatism is positively associated with anti-vaccine attitudes. One of the strongest predictors of anti-vaccine attitudes in the U.S. is Christian nationalism—a U.S. cultural ideology that wants civic life to be permeated by their particular form of nationalist Christianity. However, there are no studies examining the relationship between Christian nationalism and COVID-19 vaccine hesitancy and uptake. Using a new nationally representative sample of U.S. adults, we find that Christian nationalism is one of the strongest predictors of COVID-19 vaccine hesitancy and is negatively associated with having received or planning to receive a COVID-19 vaccine. Since Christian nationalists make up approximately 20 percent of the population, these findings could have important implications for achieving herd immunity.     

Conditionality of COVID-19 vaccine acceptance in European countries

The COVID-19 vaccine rollout has offered a powerful preventive measure to help control SARS-CoV-2 transmission. Nevertheless, long-standing public hesitation around vaccines heightened concerns that vaccine coverage would not achieve desired public health impacts, particularly in light of more contagious variants. This cross-sectional survey was conducted online just before the European vaccine rollout in December 2020 among 7000 respondents (aged 18–65) in Belgium, France, Germany, Italy, Spain, Sweden, and Ukraine. The survey included open text boxes for fuller explanation of responses. Overall, 56.9% of respondents would accept a COVID-19 vaccine, 19.0% would not, and 24.1% did not know or preferred not to say. By country, between 44% (France) and 66% (Italy) of respondents would accept a COVID-19 vaccine. Respondents expressed conditionality in open responses, voicing concerns about vaccine safety and mistrust of authorities. We highlight lessons learned about the dynamism of vaccine conditionality and persistence of safety concerns.     

COVID-19 vaccine acceptance and its socio-demographic and emotional determinants: A multi-country cross-sectional study

BackgroundMultiple COVID-19 vaccines have now been licensed for human use, with other candidate vaccines in different stages of development. Effective and safe vaccines against COVID-19 have been essential in achieving global reductions in severe disease caused by severe acute respiratory coronavirus 2 (SARS-CoV-2), but multiple factors, including vaccine supply and vaccine confidence, continue to impact global uptake of COVID-19 vaccines. In this study, we explore determinants of COVID-19 vaccination intent across17 countries worldwide.MethodsIn this large-scale multi-country study, we explored intent to accept a COVID-19 vaccine and the socio-demographic and emotional determinants of uptake for 17 countries and over 19,000 individuals surveyed in June and July 2020 via nationally representative samples. We used Bayesian ordinal logistic regressions to probe the relationship between intent to accept a COVID-19 vaccine and individuals’ socio-demographic status, their confidence in COVID-19 vaccines, and their recent emotional status. Gibbs sampling was used for Bayesian model inference, with 95% Bayesian highest posterior density intervals used to capture uncertainty.FindingsIntent to accept a COVID-19 vaccine was found to be highest in India, where 77?8% (95% HPD, 75?5 to 80?0%) of respondents strongly agreeing that they would take a new COVID-19 vaccine if it were available. The Democratic Republic of Congo (15?5%, 12?2 to 18?6%) and France (26?4%, 23?7 to 29?2%) had the lowest share of respondents who strongly agreed that they would accept a COVID-19. Confidence in the safety, importance, and effectiveness of COVID-19 vaccines are the most widely informative determinants of vaccination intent. Socio-demographic and emotional determinants played a lesser role, with being male and having higher education associated with increased uptake intent in five countries and being fearful of catching COVID-19 also a strong determinant of uptake intent.InterpretationBarriers to COVID-19 vaccine acceptance are found to be country and context dependent. These findings highlight the importance of regular monitoring of COVID-19 vaccine confidence to identify groups less likely to vaccinate.     

Misinformation and COVID-19 vaccine hesitancy

BackgroundCOVID-19 vaccine hesitancy has emerged as a major public health challenge. Although medical and scientific misinformation has been known to fuel vaccine hesitancy in the past, misinformation surrounding COVID-19 seems to be rampant, and increasing evidence suggests that it is contributing to COVID-19 vaccine hesitancy today. The relationship between misinformation and COVID-19 vaccine hesitancy is complex, however, and it is relatively understudied.MethodsIn this article, we report qualitative data from two related but distinct studies from a larger project. Study 1 included semi-structured, open-ended interviews conducted in October–November 2020 via phone with 30 participants to investigate the relationship between misinformation and COVID-19 vaccine hesitancy. Study 1′s results then informed the design of open-ended questions for Study 2, an online survey conducted in May–June 2021 to consider the relationship between misinformation and vaccine hesitancy further. The data were examined with thematic analysis.ResultsStudy 1 led to the identification of positive and negative themes related to attitudes toward COVID-19 vaccines. In Study 2, responses from vaccine-hesitant participants included six categories of misinformation: medical, scientific, political, media, religious, and technological. Across both Study 1 and Study 2, six vaccine hesitancy themes were identified from the data: concerns about the vaccines’ future effects, doubts about the vaccines’ effectiveness, commercial profiteering, preference for natural immunity, personal freedom, and COVID-19 denial.ConclusionsThe relationship between misinformation and vaccine hesitancy is complicated. Various types of misinformation exist, with each related to a specific type of vaccine hesitancy-related attitude. Personal freedom and COVID-19 denial are vaccine attitudes of particular interest, representing important yet understudied phenomena. Medical and scientific approaches may not be sufficient to combat misinformation based in religion, media, or politics; and public health officials may benefit from partnering with experts from those fields to address harmful misinformation that is driving COVID-19 vaccine hesitancy.     

Factors associated with COVID-19 vaccination intentions among adults in the deep South

The recent approval of several COVID-19 vaccines signals progress toward controlling the pandemic. Although social distancing and masking have been effective, vaccines are an important additional measure of protection to reduce COVID-19 spread. Adequate uptake is essential to reach herd immunity, estimated to be approximately 67%. However, vaccine hesitancy, the fast-tracked nature of the COVID-19 vaccines, and misinformation circulating through various forms of media have contributed to lower vaccination intention than desired. The current research study developed an online survey conducted via Facebook to explore the attitudes and perceptions of adult Alabama residents about COVID-19 and the COVID-19 vaccines. Of the 3,781 respondents, only 44.3% reported intent to receive a vaccine, with a large proportion reporting they were unsure (28.1%). Lack of intention to vaccinate was associated with low educational attainment, low COVID-19 knowledge levels, low income, and African American race. The current survey also explored participants’ influenza vaccine behavior as this information can also be used to inform successful COVID-19 vaccine distribution. Of the respondents, 56% report receiving the yearly influenza vaccine and the majority receive it at a pharmacy or healthcare provider office. This informs likely successful locations for COVID-19 vaccine distribution. Appropriate education targeted to populations most likely to refuse COVID-19 vaccination is essential to promote uptake. The information collected from the current study should be utilized to inform effective and efficient vaccine distribution strategies.     

Vaccine hesitancy against COVID-19 vaccine over time in Nigeria

IntroductionWhile COVID-19 pandemic is an ongoing threat for our lives, the rapid development of effective vaccines against COVID-19 provided us hopes for manageable disease control. However, vaccine hesitancy across the globe is a concern which could attenuate efforts of disease control. This study examined the extent and trend of vaccine hesitancy in Nigeria.MethodsThe COVID-19 National Longitudinal Phone Survey conducted between 2020 and 2021 was used for the analysis. The extent and trend of vaccine hesitancy across different zones within Nigeria, over time, as well as reasons of the hesitancy were evaluated.ResultsVaccine hesitancy was more prevalent in southern zones, which on average have better socioeconomic status than northern zones. Overtime, vaccine hesitancy became more prevalent, and respondents became more resistant to the COVID-19 vaccine across the country.ConclusionWhile the nature of interventions to improve the uptake of COVID-19 vaccine should differ by regions due to differential barriers to vaccination, it might be important to prebunk and debunk any misinformation related to COVID-19 vaccine to mitigate the vaccine hesitancy across the country.     

The correlates and dynamics of COVID-19 vaccine-specific hesitancy

Most work on COVID-19 vaccine hesitancy has focused on its attitudinal and demographic correlates among individuals, but the characteristics of vaccines themselves also appear to be important. People are more willing to take vaccines with higher reported levels of efficacy and safety. Has this dynamic sparked comparative hesitancy towards specific COVID-19 vaccines? We conduct a series of cross-sectional survey experiments to test for brand-based differences in perceived effectiveness, perceived safety, and vaccination intention. Examining more than 6,200 individuals in a series of cross-sectional surveys, we find considerably more reluctance to take the AstraZeneca and Johnson & Johnson vaccines compared to those from Pfizer and Moderna if offered, despite all vaccines being approved and deemed safe and effective by a federal regulator. Comparative hesitancy towards these vaccines grew over the course of fielding as controversy arose over their link to extremely rare, but serious side effects. Comparative vaccine-specific hesitancy is strongest among people who are usually most open to mass vaccination efforts. Its effects are substantial: most respondents reported a willingness to wait months for their preferred vaccine rather than receive either the AstraZeneca or Johnson & Johnson vaccine immediately. Our findings call for additional research on the determinants and consequences of COVID-19 vaccine-specific hesitancy and communication strategies to minimize this challenge.     

COVID-19 vaccine intentions in the United States,a social-ecological framework

BackgroundCOVID-19 vaccine hesitancy is a major obstacle for pandemic mitigation. As vaccine hesitancy occurs along multiple dimensions, we used a social-ecological framework to guide the examination of COVID-19 vaccine intentions.MethodsUsing an online survey in the US conducted in July 2020, we examined intentions to obtain a COVID-19 vaccine, once available. 592 respondents provided data, including measures of demographics, vaccine history, social norms, perceived risk, and trust in sources of COVID-19 information. Bivariate and multivariate multinomial models were used to compare respondents who intended to be vaccinated against COVID-19 to respondents who did not intend or were ambivalent about COVID-19 vaccination.ResultsOnly 59.1% of the sample reported that they intended to obtain a COVID-19 vaccine. In the multivariate multinomial model, those respondents who did not intend to be vaccinated, as compared to those who did, had significantly lower levels of trust in the CDC as a source of COVID-19 information (aOR = 0.29, CI = 0.17–0.50), reported lower social norms of COVID-19 preventive behaviors (aOR = 0.67, CI 0.51–0.88), scored higher on COVID-19 Skepticism (aOR = 1.44, CI = 1.28–1.61), identified as more politically conservative (aOR = 1.23, CI = 1.05–1.45), were less likely to have obtained a flu vaccine in the prior year (aOR = 0.21, CI = 0.11–0.39), were less likely to be female (aOR = 0.51, CI = 0.29–0.87), and were much more likely to be Black compared to White (aOR = 10.70, CI = 4.09–28.1). A highly similar pattern was observed among those who were ambivalent about receiving a COVID-19 vaccine compared to those who intended to receive one.ConclusionThe results of this study suggest several avenues for COVID-19 vaccine promotion campaigns, including social network diffusion strategies and cross-partisan messaging, to promote vaccine trust. The racial and gender differences in vaccine intentions also suggest the need to tailor campaigns based on gender and race.     

Effect of the suspension of the J&J COVID-19 vaccine on vaccine hesitancy in the United States

On April 13, 2021, U.S. authorities announced an investigation into potential adverse events associated with the Johnson & Johnson (Janssen, J&J) COVID-19 vaccine and recommended “a pause in the use of this vaccine out of an abundance of caution.” We examined whether public attitudes toward COVID-19 vaccination shifted after this recommended suspension using an interrupted time series with data from the Census Bureau’s Household Pulse Survey, which was fielded bi-weekly between January 6 and April 26, 2021. We found no significant changes in trends of the proportion of the U.S. adult population hesitant about getting a COVID-19 vaccine, but a significant increase in concerns about safety and efficacy of COVID-19 vaccines among the already hesitant population.     

Compliance,procrastination and refusal: American COVID-19 vaccination trust and value orientation

IntroductionCOVID-19 vaccine hesitancy studies, most of which were completed prior to the release of the vaccine, speculated on factors that might influence inoculation intention when a vaccine was introduced. This paper examines actual vaccination decisions among US residents after COVID-19 vaccines were approved, with a focus on trust in vaccine effectiveness, increased trust in government pandemic response, and individual-versus-collective value orientation.MethodThe data set was from the Kaiser Family Foundation COVID-19 Vaccine Monitor, a nationally representative sample reflecting the opinions of 1519 American adults aged 18 and above. Data were collected in September 2021—approximately nine months after the first COVID-19 vaccines were approved for distribution. Indicators of trust in vaccine effectiveness included individual opinions regarding breakthrough infections and vaccine boosters. Increased trust in government indicated approval of official COVID-19 responses, and value orientation denoted respondent emphasis on personal choice versus protecting the health of others. We established three categories of a vaccine hesitancy dependent variable: none, some, and full rejection. A multinomial regression analysis was employed to compare vaccine hesitancy in three pairs of contrasting groups.ResultsWhile we noted distinct patterns in decision-making factors for each of the contrasting pairs, we also observed strong effects for trust in vaccine effectiveness and value orientation on vaccine decisions across all three. Both effects were more substantial than those associated with three control variables—social-demographic characteristics, political party affiliation, and health risk.ConclusionOur findings suggest that in order to increase vaccination rates, policymakers and influencers should focus on reducing individual scepticism over breakthrough infections and vaccine boosters, and on influencing a value orientation shift from personal choice to social responsibility.     

COVID-19 booster vaccination in rural community pharmacies

This study assessed rural community pharmacists’ attitudes about COVID-19 vaccine booster doses and explored whether rural pharmacies offered these booster doses. Of the 80 rural Southeastern U.S. pharmacists who completed the online survey, the majority (n = 68, 85 %) offered boosters and 42 (52.5 %) had received the booster themselves. Alabama and Mississippi offered boosters less often than other states, and pharmacists who had foregone receiving COVID-19 vaccination or booster doses were less likely to offer the booster to their patients. Additionally, many pharmacists reported that they and their patients felt the booster was not needed. Community pharmacies provide access points for the COVID-19 booster in rural areas. Interventions for both pharmacists and patients are needed to address hesitancy and improve booster uptake in these communities.