Predictors of intention to vaccinate against COVID-19: Results of a nationwide survey

BackgroundPublic polling indicates that vaccine uptake will be suboptimal when COVID-19 vaccines become available. Formative research seeking an understanding of weak vaccination intentions is urgently needed.MethodsNationwide online survey of 804 U.S. English-speaking adults. Compensated participants were recruited from the U.S. through an internet survey panel of 2.5 million residents developed by a commercial survey firm. Recruitment was based on quota sampling to produce a U.S. Census-matched sample representative of the nation with regard to region of residence, sex, and age.ResultsCOVID-19 vaccination intentions were weak, with 14.8% of respondents being unlikely to get vaccinated and another 23.0% unsure. Intent to vaccinate was highest for men, older people, individuals who identified as white and non-Hispanic, the affluent and college-educated, Democrats, those who were married or partnered, people with pre-existing medical conditions, and those vaccinated against influenza during the 2019–2020 flu season.In a multiple linear regression, significant predictors of vaccination intent were general vaccine knowledge (β = 0.311, p < .001), rejection of vaccine conspiracies (β = ?0.117, p = .003), perceived severity of COVID-19 (β = 0.273, p < .001), influenza vaccine uptake (β = 0.178, p < .001), having ≥ 5 pre-existing conditions (β = 0.098, p = .003), being male (β = 0.119, p < .001), household income of ≥ $120,000 (β = 0.110, p = .004), identifying as a Democrat (β = 0.075, p < .029), and not relying upon social media for virus information (β = -0.090, p 〈0 0 2). Intent to vaccinate was lower for Fox News (57.3%) than CNN/MSNBC viewers (76.4%) (χ2 (1) = 12.68, p < .001). Political party differences in threat appraisals and vaccine conspiracy beliefs are described.ConclusionsDemographic characteristics, vaccine knowledge, perceived vulnerability to COVID-19, risk factors for COVID-19, and politics likely contribute to vaccination hesitancy.     

Factors associated with parents' willingness to vaccinate their children against COVID-19: The LA pandemic surveillance cohort study

BackgroundChildren age 5–11 became eligible for COVID-19 vaccination in November 2021 in the United States, but vaccine uptake in this age group remains low. Understanding reasons why parents are hesitant to vaccinate their children may provide critical insights to help protect children from COVID-19 infection. This study examines factors associated with parents'' willingness to vaccinate their children.MethodsWe conducted a cross-sectional survey focusing on the Los Angeles County adult residents between March and June 2021. Our analytic sample focused on a subgroup of participants who self-report having a child. Predictors included parents'' vaccination status and beliefs about COVID-19. We used multivariable logistic regression analysis and calculated the predicted probabilities of parents'' willingness to vaccinate their children.ResultsParents (n = 401) who worried about catching the virus, had trust in vaccine development and the COVID-19 vaccine approval process, and vaccinated against COVID-19 were more likely to be willing to vaccinate their children. Socio-economic, racial and ethnic differences were no longer statistically significant in the adjusted model. Predicted probabilities of parents who were willing to vaccine their children were 55% among the vaccinated and 36% among the unvaccinated.ConclusionsParents'' intent to vaccinate their children is influenced by their perceived severity of the pandemic, trust in the vaccine development process, and their vaccination status, which can be the potential drivers of hesitancy to vaccinate their children.     

Understanding COVID-19 vaccination willingness among youth: A survey study in the Netherlands

Vaccination of youth could be key to preventing future outbreaks of SARS-CoV-2. Given the limited direct health benefit for young people, it is important to understand how youth themselves perceive obtaining a vaccination. This survey study in a representative sample of Dutch youth aged 12–18 showed that 73% were willing to get vaccinated against COVID-19. In regression analyses, vaccination willingness was strongly related to age, perceived personal (protect own health) and societal benefits (to get rid of restrictive policies), and their peers’ and parents’ vaccination uptake. Negative associations with vaccination willingness were perceived side-effects and potential unknown long term consequences. On-going and transparent communication with up-to-date information about safety and risks, delivered by independent and trusted experts (as perceived by the recipients) seems important for addressing questions and concerns. Local information sessions for youth and parents where a vaccination can be obtained without appointment could have merit in addition to mass media communication.     

Hesitation of the Tunisian population to COVID-19 vaccination,and its associated factors

Background: Many people are reluctant to be vaccinated against COVID-19. Aim: To determine the intention to accept COVID19 vaccine and its associated factors among Tunisians. Methods: We conducted a cross-sectional study among Tunisians from December 2020 to January 2021 using an online questionnaire. Factors associated with intention to accept coronavirus vaccine were analysed using multinomial logistic regression. Results: In total, 169 Tunisians participated in our study. The majority were female (85.2%). The mean age was 48.3 ± 11.8 years. Only 33.1% intended to accept to be vaccinated when COVID-19 vaccine will be available in Tunisia and 22.5% were still hesitant. In multinomial logistic regression, participants having high or very high perceived personal risk of COVID-19 infection (aOR:3.257, 95% CI :1.204 – 8.815) were more prone to hesitate to accept COVID-19 vaccine rather than those being willing to accept it. Respondents undergoing seasonal influenza vaccination (aOR: 0.091, 95% CI : 0.019 – 0.433)were less prone to refuse COVID-19 vaccine rather than those being willing to accept it. Young ones aged less than 40 years (aOR: 4.324, 95% CI: 1.180 – 15.843) were more prone to refuse COVID-19 vaccine rather than those being willing to accept it. Conclusion: The acceptance rate of coronavirus vaccination was moderate. Therefore, a good communication and health education at a community level are needed.     

COVID-19 vaccine perceptions and hesitancy amongst parents of school-aged children during the pediatric vaccine rollout

BackgroundThe United States has the highest number of total cases and deaths due to coronavirus disease 2019 (COVID-19) worldwide (Johns Hopkins COVID Dashboard, 2021). Despite COVID-19 vaccine availability, uptake in the United States has been slow and vaccine hesitancy has been a significant barrier to achieving widespread vaccine uptake. Understanding determinants of vaccine acceptance is essential to implement successful population health interventions to increase COVID-19 vaccination.MethodsWe developed an anonymous cross-sectional parent survey to assess factors associated with parent and child COVID-19 vaccine acceptance and hesitancy during the initial pediatric vaccine rollout amongst adolescents 16 years +. The survey was sent via email to 25,308 parents registered to the Alachua County Public School System in May 2021 and remained active until July 2021.FindingsThere were a total of 2,620 survey responses. Overall, 31.5 % of parents with children ages 16 years + reported their child had received the COVID-19 vaccine, 65.2 % reported their (eligible) child had not received the vaccine, and 3.3 % reported their child was scheduled for the vaccine. A majority of parents (60.9 %) reported they planned to vaccinate all of their children once the COVID-19 vaccine was available for their children’s age. COVID-19 vaccine uptake in adolescents ages 16 + reported by Hispanic and White parents was two times higher than that reported by Black parents. Parent COVID-19 and influenza vaccine uptake were associated with increased child COVID-19 vaccination. The most commonly reported reasons why parents chose not to have their child vaccinated against COVID-19 were concerns about long–term negative side effects (75.7 %) and a negative reaction (56.5 %). Medical providers were reported as the most trusted source of information.ConclusionOur study provides insight into determinants of vaccine acceptance, vaccine hesitancy, and trusted sources of information that may be helpful to develop targeted interventions to increase youth COVID-19 vaccination.     

Characteristics associated with the willingness to receive a COVID-19 vaccine and an exploration of the general public's perceptions: A mixed-methods approach

Demographics and media discourse impact vaccine hesitancy. We explored the New Zealand public's perceptions of COVID-19 vaccines and associated media portrayal, and determined predictive factors associated with willingness to receive vaccines. A community cohort (N = 340) completed online surveys. A logistic regression explored whether characteristics predict willingness to receive the vaccine. Textual data were analysed thematically. Willingness to receive the vaccine was high (90%). Having a postgraduate degree (p =.026), trying to receive an influenza vaccine (p <.001) and fewer concerns (p <.001) predicted willingness. Health keyworkers (p <.001) were less willing. Participants wanted the vaccine for protection and returning to normality. Reasons against receiving vaccines regarded safety, efficacy, and an unclear roll-out plan. The media was reported to generally provide good/positive coverage, but also engage in unbalanced reporting and spreading misinformation. Education strategies should include collaborations between media and scientists and focus on distributing easy-to-access information. Health keyworkers should be reassured of testing/safety.     

The public health response to the COVID-19 pandemic for people with disabilities

With the rapidly changing landscape of the COVID-19 outbreak, how to best address the needs and continue to protect the health and well-being of people with disabilities (PwDs) is a global public health priority. In this commentary we identify three public health areas of ongoing need and offer possible strategies to address each. These areas include: the types of data that would help clarify risks for PwDs and help assure their safety long term; the prevention, treatment and mitigation measures for PwDs that are needed through the duration of the outbreak; and the issues of equity in access to and quality of medical care for PwDs. Because of the rapid nature of the public health response, it is critical to reassess and readjust our approach to best address the needs of PwDs in the months and years to come and to incorporate these new practices into future emergency preparedness responses.     

Willingness to vaccinate children against COVID-19 declined during the pandemic

ObjectivesTo document the level of vaccine hesitancy in caregivers’ of children younger than 12 years of age over the course of the pandemic in Pediatric Emergency Departments (ED).Study designOngoing multicenter, cross-sectional survey of caregivers presenting to 19 pediatric EDs in the USA, Canada, Israel, and Switzerland during first months of the pandemic (phase1), when vaccines were approved for adults (phase2) and most recently when vaccines were approved for children (phase3).ResultsWillingness to vaccinate rate declined over the study period (59.7%, 56.1% and 52.1% in the three phases). Caregivers who are fully vaccinated, who have higher education, and those worried their child had COVID-19 upon arrival to the ED, were more likely to plan to vaccinate in all three phases. Mothers were less likely to vaccinate early in the pandemic, but this hesitancy attenuated in later phases. Older caregivers were more willing to vaccinate, and caregivers of older children were less likely to vaccinate their children in phase 3. During the last phase, willingness to vaccinate was lowest in those who had a primary care provider but did not rely on their advice for medical decisions (34%). Those with no primary care provider and those who do and rely on their medical advice, had similar rates of willingness to vaccinate (55.1% and 52.1%, respectively).ConclusionsCOVID-19 vaccine hesitancy is widespread and growing over time, and public health measures should further try to leverage identified factors associated with hesitancy in order to enhance vaccination rates among children.     

Vaccine hesitancy comes in waves: Longitudinal evidence on willingness to vaccinate against COVID-19 from seven European countries

AimThis paper investigates the prevalence and determinants of three main states of people’s willingness to be vaccinated (WTBV) against COVID-19 – willing, unwilling and hesitant – and the occurrence and predictors of shifts between these states over time. Understanding the dynamics of vaccine intentions is crucial for developing targeted campaigns to increase uptake and emergency response preparedness.Study designA panel survey consisting of 9 quarterly waves of data collected between April 2020 and January 2022. Baseline data included 24 952 adults from Germany, UK, Denmark, the Netherlands, France, Portugal, and Italy recruited from online panels to construct census-matched nationally representative samples.Methods and measuresSelf-reported COVID-19 vaccine intention was the main outcome. Multinomial logit random effects models were used to analyze the relationships of interest. All results reported as relative risk ratios (RRR).ResultsHesitancy to get vaccinated was the most unstable vaccine intention, with on average 42% of ever hesitant respondents remaining in this state through future waves, followed by the ‘unwilling’ (53%) and ‘willing (82%). Following COVID-19 news, trust in information from the government, GPs and the WHO, risk preferences, risk perceptions, and confidence in vaccines (or lack thereof) predicted vaccination intention reversals. Risk preferences acted both as an impediment and as a facilitator for the vaccine uptake depending on the initial vaccine intention.Conclusions and relevanceThis study revealed the dynamic nature of COVID-19 vaccine intentions and its predictors in 7 European countries. The findings provide insights to policymakers for designing more effective communication strategies, particularly targeted at hesitant and unwilling to vaccinate population groups, to increase vaccine uptake for future public health emergencies.     

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.     

Trust in government,intention to vaccinate and COVID-19 vaccine hesitancy: A comparative survey of five large cities in the United States,United Kingdom,and Australia

BackgroundThere is widespread hesitancy towards COVID-19 vaccines in the United States, United Kingdom, and Australia.ObjectiveTo identify predictors of willingness to vaccinate against COVID-19 in five cities with varying COVID-19 incidence in the US, UK, and Australia.DesignOnline, cross-sectional survey of adults from Dynata’s research panel in July-September 2020.Participants, settingAdults aged 18 and over in Sydney, Melbourne, London, New York City, or Phoenix.Main outcomes and measuresWillingness to receive a COVID-19 vaccine; reason for vaccine intention.Statistical methodsTo identify predictors of intention to receive a COVID-19 vaccine, we used Poisson regression with robust error estimation to produce prevalence ratios.ResultsThe proportion willing to receive a COVID-19 vaccine was 70% in London, 71% NYC, 72% in Sydney, 76% in Phoenix, and 78% in Melbourne. Age was the only sociodemographic characteristic that predicted willingness to receive a COVID-19 vaccine in all five cities. In Sydney and Melbourne, participants with high confidence in their current government had greater willingness to receive the vaccine (PR = 1.24; 95% CI = 1.07–1.44 and PR = 1.38; 95% CI = 1.74–1.62), while participants with high confidence in their current government in NYC and Phoenix were less likely to be willing to receive the vaccine (PR = 0.78; 95% CI = 0.72–0.85 and PR = 0.85; 95% CI = 0.76–0.96).LimitationsConsumer panels can be subject to bias and may not be representative of the general population.ConclusionsSuccess for COVID-19 vaccination programs requires high levels of vaccine acceptance. Our data suggests more than 25% of adults may not be willing to receive a COVID-19 vaccine, but many of them were not explicitly anti-vaccination and thus may become more willing to vaccinate over time. Among the three countries surveyed, there appears to be cultural differences, political influences, and differing experiences with COVID-19 that may affect willingness to receive a COVID-19 vaccine.     

Influenza vaccination among infection control teams: A EUCIC survey prior to COVID-19 pandemic

We aimed to describe the influenza vaccination rate and its determinants among infection control team (ICT) across different countries. Online multilingual survey consisting of 23 items, between 17 May −15 July of 2019 targeting the opinions and practices of ICTs regarding the 2018–2019 influenza season was employed. Participants were reached via European Society of Clinical Microbiology and Infectious Diseases (ESCMID) and European Union Certificate for Infection Control (EUCIC) newsletters, social media, and national societies. In total, 899 participants from 56 countries responded to the survey. The overall vaccination rate was 76%, being the highest in Finland, Portugal, Norway, and Israel (100%), whereas the lowest in Italy (68%) and Turkey (39%). Influenza vaccination rate was 86% among IC physicians and 52% among IC nurses. The most significant factors affecting participants’ decision were personal influenza vaccine experience (49%) and attitude of the scientific authorities (48%). In multivariate analysis, vaccination of the ICT head (OR: 16.04, 95%CI: 8.4–30.8, p < 0.001) and having free vaccine (OR: 7.56, 95%CI: 2.1–27.4, p = 0.02) were found to be the strongest predictors for influenza vaccination, whereas working in Turkey (OR: 0.41, 95%CI: 0.22–0.77, p = 0.006) and being an IC nurse (OR:0.43, 95%CI: 0.24–0.80, p = 0.007) were significantly associated with not having been vaccinated. In conclusion, COVID-19 pandemic increased the importance of protection against respiratory viruses including influenza. Vaccination strategies should have a special emphasis on IC nurses, who have a relatively lower vaccination rate, should enhance the vaccination of the ICT leaders, and put effort to provide free availability of the influenza vaccine.     

Social inequalities in COVID-19 vaccine acceptance and uptake for children and adolescents in Montreal,Canada

BackgroundThe success of current and prospective COVID-19 vaccine campaigns for children and adolescents will in part depend on the willingness of parents to accept vaccination. This study examined social determinants of parental COVID-19 vaccine acceptance and uptake for children and adolescents.MethodsWe used cross-sectional data from an ongoing COVID-19 cohort study in Montreal, Canada and included all parents of 2 to 18-year-olds who completed an online questionnaire between May 18 and June 26, 2021 (n = 809). We calculated child age-adjusted prevalence estimates of vaccine acceptance by parental education, race/ethnicity, birthplace, household income, and neighbourhood, and used multinomial logistic regression to estimate adjusted prevalence differences (aPD) and ratios (aPR). Social determinants of vaccine uptake were examined for the vaccine-eligible sample of 12 to 18 year-olds (n = 306).ResultsIntention to vaccinate children against COVID-19 was high, with only 12.4% of parents unlikely to have their child vaccinated. Parents with younger children were less likely to accept vaccination, as were those from lower-income households, racialized groups, and those born outside Canada. Children from households with annual incomes <$100,000 had 18.4 percent lower prevalence of being vaccinated/very likely vaccinated compared to household incomes ≥$150,000 (95% CI: 10.1 to 26.7). Racialized parents reported greater unwillingness to vaccinate vs. White parents (aPD = 10.3; 95% CI: 1.5, 19.1). Vaccine-eligible adolescents from the most deprived neighbourhood were half as likely to be vaccinated compared to those from the least deprived neighbourhood (aPR = 0.48; 95% CI: 0.18 to 0.77).Interpretation.This study identified marked social inequalities in COVID-19 vaccine acceptance and uptake for children and adolescents. Efforts are needed to reach disadvantaged and marginalized populations with tailored strategies that promote informed decision making and facilitate access to vaccination.     

Adverse events of the Pfizer-BioNTech COVID-19 vaccine in Korean children and adolescents aged 5 to 17 years

ObjectivesThis study aimed to identify potential safety signals and adverse events following the primary Pfizer-BioNTech coronavirus disease 2019 (COVID-19) vaccination series among children and adolescents aged 5 to 17 years in the Republic of Korea.Methods Adverse events reported through the COVID-19 vaccination management system (CVMS, a web-based passive vaccine safety surveillance system) and adverse events and health conditions collected from a text message-based survey were analyzed.Results A total of 14,786 adverse events among 5 to 17-year-old children and adolescents were reported in the CVMS; 14,334 (96.9%) were non-serious and 452 (3.1%) were serious, including 125 suspected cases of acute cardiovascular injury and 101 suspected cases of anaphylaxis. The overall reporting rate was lower in 5 to 11-year-old children (64.5 per 100,000 doses) than in 12 to 17-year-old adolescents (300.5 per 100,000 doses). The text message survey identified that local and systemic adverse events after either dose were reported less frequently in 5 to 11-year-old children than in 12 to 17-year-old adolescents (p<0.001). The most commonly reported adverse events were pain at the injection site, myalgia, headache, and fatigue/tiredness.Conclusion The overall results are consistent with the results of controlled trials; serious adverse events were extremely rare among 5 to 17-year-old children and adolescents following Pfizer-BioNTech COVID-19 vaccination. Adverse events were less frequent in children aged 5 to 11 years than in adolescents aged 12 to 17 years.     

COVID-19 differentiated measures for unvaccinated individuals: The need for clear goals and strong justifications

Numerous countries and jurisdictions have implemented differential COVID-19 public health restrictions based on individual vaccination status to mitigate the public health risks posed by unvaccinated individuals. Although it is scientifically and ethically justifiable to introduce such vaccination-based differentiated measures as a risk-based approach to resume high-risk activities in an ongoing pandemic, their justification is weakened by lack of clarity on their intended goals and the specific risks or potential harms they intend to mitigate. Furthermore, the criteria for the removal of differentiated measures may not be clear, which raises the possibility of shifting goalposts without clear justification and with potential for unfairly discriminatory consequences. This paper seeks to clarify the ethical justification of COVID-19 vaccination-based differentiated measures based on a public health risk-based approach, with focus on their deployment in domestic settings. We argue that such measures should be consistent with the principal goal of COVID-19 vaccination programmes, which is to reduce the incidence of severely ill patients and associated healthcare burdens so as to protect a health system. We provide some considerations for the removal of vaccination-based differentiated measures based on this goal.     

COVID-19 vaccination hesitancy among Americans with disabilities aged 18-65: An exploratory analysis

BackgroundIt is important for people with disabilities to be vaccinated against COVID-19 because, as a group, they are at increased risk of severe outcomes. While there are multiple vaccines available to prevent COVID-19, a considerable proportion of Americans report some hesitancy to becoming vaccinated, including people with disabilities.ObjectiveWe conducted a study to explore what factors may contribute to COVID-19 vaccination hesitancy among Americans with disabilities.MethodsWe used Amazon's Mechanical Turk to survey 439 people with disabilities (ages 18+) about their concerns of the COVID-19 disease, vaccines, and hesitancy toward vaccination to learn more about factors that influence vaccination hesitancy. Concerns about vaccines were analyzed as a composite variable representing different dimensions such as: side effects, too new, developed too quickly, influenced by politics, and effectiveness.ResultsResults from a logistic regression indicate that concern about vaccines was the most significant predictor of hesitancy, even after considering demographic, economic, and geographic factors. Concerns about getting COVID-19, getting tested for COVID-19, trust in experts, education, and being a Democrat were negatively associated with hesitancy.ConclusionsThese findings indicate that some groups of individuals may be more vaccination hesitant because they are more concerned about vaccine safety than COVID-19 infection. Public health messaging that focuses on the risks of vaccines relative to the risks of COVID-19 might be one strategy to reduce hesitancy and increase vaccination uptake. Messaging should also be tailored to specific disabilities (i.e. physical, mental, sensory), written in plain language, and disseminated in accessible formats.