Understanding the determinants of vaccine hesitancy and vaccine confidence among adolescents: a systematic review

BackgroundVaccine hesitancy (VH) and the global decline of vaccine coverage are a major global health threat, and novel approaches for increasing vaccine confidence and uptake are urgently needed. ‘Nudging’, defined as altering the environmental context in which a decision is made or a certain behaviour is enacted, has shown promising results in several health promotion strategies. We present a comprehensive synthesis of evidence regarding the value and impact of nudges to address VH.MethodsWe conducted a systematic review to determine if nudging can mitigate VH and improve vaccine uptake. Our search strategy used Medical Subject Headings (MeSH) and non-MeSH terms to identify articles related to nudging and vaccination in nine research databases. 15 177 titles were extracted and assessed following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The final list of included articles was evaluated using the Mixed Methods Appraisal Tool and the Grading of Recommendations, Assessment, Development and Evaluations framework.FindingsIdentified interventions are presented according to a framework for behaviour change, MINDSPACE. Articles (n=48) from 10 primarily high-income countries were included in the review. Nudging-based interventions identified include using reminders and recall, changing the way information is framed and delivered to an intended audience, changing the messenger delivering information, invoking social norms and emotional affect (eg, through storytelling, dramatic narratives and graphical presentations), and offering incentives or changing defaults. The most promising evidence exists for nudges that offer incentives to parents and healthcare workers, that make information more salient or that use trusted messengers to deliver information. The effectiveness of nudging interventions and the direction of the effect varies substantially by context. Evidence for some approaches is mixed, highlighting a need for further research, including how successful interventions can be adapted across settings.ConclusionNudging-based interventions show potential to increase vaccine confidence and uptake, but further evidence is needed for the development of clear recommendations. The ongoing COVID-19 pandemic increases the urgency of undertaking nudging-focused research.PROSPERO registration numberCRD42020185817.

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Healthcare Providers’ Vaccine Perceptions, Hesitancy, and Recommendation to Patients: A Systematic Review

Vaccines ◽

10.3390/vaccines9070713 ◽

2021 ◽

Vol 9 (7) ◽

pp. 713

Author(s):

Cheryl Lin ◽

Jewel Mullen ◽

Danielle Smith ◽

Michaela Kotarba ◽

Samantha J. Kaplan ◽

...

Keyword(s):

Disease Risk ◽

Healthcare Providers ◽

Vaccine Safety ◽

Survey Study ◽

Vaccine Hesitancy ◽

Attitudes And Practices ◽

Inadequate Knowledge ◽

Vaccine Confidence ◽

And Behavior ◽

Demographic Impact

Despite vaccines’ effectiveness in reducing the rate of preventable diseases, vaccine hesitancy has threatened public health and economies worldwide. Healthcare providers’ (HCP) communications and behavior strongly influence patient receptivity and uptake. The goal of this review was to examine HCP vaccine perceptions, knowledge, and reservations and how these attitudes affect their recommendations and vaccination practices. Primary research studies published by 16 September 2020 were searched in PubMed, Web of Science, Embase, CINAHL, and PsycINFO. A 14-item scale was developed for survey study and risk of bias appraisal (SSRBA). In total, 96 papers from 34 countries were included, covering 17 vaccines (HPV and influenza vaccines the most studied). Recommendation was positively associated with provider knowledge and experience, beliefs about disease risk, and perceptions of vaccine safety, necessity, and efficacy. HCP vaccination attitudes and practices varied across specialties, vaccines, and countries; demographic impact was inconclusive. Barriers included anticipation of patient/parental concerns or refusal, lacking clear guidelines, time constraints, and cost. For HPV, vaccines were more often recommended to older, female adolescents and by physicians who discussed sexual health. HCPs are vital advocates for patients and the public, but studies indicated a prevalence of provider hesitancy pertaining to inadequate knowledge, low vaccine confidence, and suboptimal uptake themselves. Improving HCP knowledge and assuring their access to information they deem trustworthy are essential to supporting HCPs‘ role as “trusted messengers” to promote vaccine acceptance.

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Willingness of Black and White Adults to Accept Vaccines in Development: An Exploratory Study Using National Survey Data

American Journal of Health Promotion ◽

10.1177/0890117120979918 ◽

2020 ◽

pp. 089011712097991

Author(s):

Sandra Crouse Quinn ◽

Yuki Lama ◽

Amelia Jamison ◽

Vicki Freimuth ◽

Veeraj Shah

Keyword(s):

Online Survey ◽

Social Science Research ◽

Science Research ◽

Chronic Health Condition ◽

Vaccine Hesitancy ◽

Cancer Type ◽

Cross Sectional ◽

Black And White ◽

Vaccine Type ◽

Vaccine Confidence

Purpose: Explore acceptability of vaccines in development: cancer, Type II diabetes, Alzheimer’s disease, Lyme disease, Ebola, and obesity. Research questions: To what extent does acceptability vary by vaccine type? To what extent does acceptability of vaccines in development vary by race and other key demographics? To what extent are general vaccine hesitancy and key demographics associated with acceptability of vaccines in development? Design: Cross-sectional online survey administered through GfK’s KnowledgePanel in 2015. Analysis completed in 2020. Subjects: Nationally representative sample of Black and White American adults (n = 1,643). Measures: Willingness to accept a novel vaccine was measured on a 4-point Likert scale. Independent variables included demographics (e.g. age, race, gender) and measures of vaccine hesitancy, trust, and the “Three C’s” of vaccine confidence, complacency, and convenience. Analysis: Exploratory analysis including descriptive statistics and regression modeling. Results: Acceptability varied from 77% for a cancer vaccine to 55% for an obesity vaccine. White race, male gender, older age, having a chronic health condition, and higher socioeconomic status were associated with higher acceptability. Higher vaccine confidence and lower vaccine hesitancy were predictors for acceptability. Conclusion: The success of a vaccine depends on widespread public acceptance. Vaccine hesitancy may hinder acceptance of future vaccines, with significant differences by demographics. Future social science research is necessary to better understand and address vaccine hesitancy.

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COVID-19 vaccine brand hesitancy and other challenges to vaccination in the Philippines

PLOS Global Public Health ◽

10.1371/journal.pgph.0000165 ◽

2022 ◽

Vol 2 (1) ◽

pp. e0000165

Author(s):

Arianna Maever L. Amit ◽

Veincent Christian F. Pepito ◽

Lourdes Sumpaico-Tanchanco ◽

Manuel M. Dayrit

Keyword(s):

Ecological Model ◽

The Philippines ◽

Vaccine Uptake ◽

Phone Call ◽

Vulnerable Groups ◽

Vaccine Hesitancy ◽

Middle Income ◽

Political Issues ◽

Vaccination Uptake ◽

Vaccine Confidence

Effective and safe COVID-19 vaccines have been developed at a rapid and unprecedented pace to control the spread of the virus, and prevent hospitalisations and deaths. However, COVID-19 vaccine uptake is challenged by vaccine hesitancy and anti-vaccination sentiments, a global shortage of vaccine supply, and inequitable vaccine distribution especially among low- and middle-income countries including the Philippines. In this paper, we explored vaccination narratives and challenges experienced and observed by Filipinos during the early vaccination period. We interviewed 35 individuals from a subsample of 1,599 survey respondents 18 years and older in the Philippines. The interviews were conducted in Filipino, Cebuano, and/or English via online platforms such as Zoom or via phone call. All interviews were recorded, transcribed verbatim, translated, and analysed using inductive content analysis. To highlight the complex reasons for delaying and/or refusing COVID-19 vaccines, we embedded our findings within the social ecological model. Our analysis showed that individual perceptions play a major role in the decision to vaccinate. Such perceptions are shaped by exposure to (mis)information amplified by the media, the community, and the health system. Social networks may either positively or negatively impact vaccination uptake, depending on their views on vaccines. Political issues contribute to vaccine brand hesitancy, resulting in vaccination delays and refusals. Perceptions about the inefficiency and inflexibility of the system also create additional barriers to the vaccine rollout in the country, especially among vulnerable and marginalised groups. Recognising and addressing concerns at all levels are needed to improve COVID-19 vaccination uptake and reach. Strengthening health literacy is a critical tool to combat misinformation that undermines vaccine confidence. Vaccination systems must also consider the needs of marginalised and vulnerable groups to ensure their access to vaccines. In all these efforts to improve vaccine uptake, governments will need to engage with communities to ‘co-create’ solutions.

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Determinants of influenza vaccine hesitancy among pregnant women in Europe: a systematic review

European Journal of Medical Research ◽

10.1186/s40001-021-00584-w ◽

2021 ◽

Vol 26 (1) ◽

Author(s):

Gbadebo Collins Adeyanju ◽

Elena Engel ◽

Laura Koch ◽

Tabea Ranzinger ◽

Imtiaz Bin Mohammed Shahid ◽

...

Keyword(s):

Systematic Review ◽

Influenza Vaccine ◽

Influenza Vaccination ◽

Pregnant Women ◽

Healthcare Providers ◽

Primary Objective ◽

World Health ◽

Vaccine Hesitancy ◽

Cochrane Central Register ◽

Adequate Knowledge

Abstract Background Pregnant women are at high risk for severe influenza. However, maternal influenza vaccination uptake in most World Health Organization (WHO) European Region countries remains low, despite the presence of widespread national recommendations. An influenza vaccination reduces influenza-associated morbidity and mortality in pregnancy, as well as providing newborns with protection in their first months. Potential determinants of vaccine hesitancy need to be identified to develop strategies that can increase vaccine acceptance and uptake among pregnant women. The primary objective of the systematic review is to identify the individual determinants of influenza vaccine hesitancy among pregnant women in Europe, and how to overcome the hesitancy. Methods Databases were searched for peer-reviewed qualitative and quantitative studies published between 2009 and 2019 inclusive. Databases included PubMed via MEDLINE, Cochrane Central Register for Controlled Trials, PsycINFO, SAGE Journals, Taylor and Francis and Springer nature. These covered themes including psychology, medicine, and public health. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) approach, 11 studies were eligible and analyzed for significant determinants of influenza vaccine hesitancy among pregnant women in Europe. Results The most commonly reported factors were psychological aspects, for example concerns about safety and risks to mother and child, or general low risk perception of becoming ill from influenza. Doubts about the effectiveness of the vaccine and a lack of knowledge about this topic were further factors. There was also influence of contextual factors, such as healthcare workers not providing adequate knowledge about the influenza vaccine or the pregnant lady stating their antivaccine sentiment. Conclusion Health promotion that specifically increases knowledge among pregnant women about influenza and vaccination is important, supporting a valid risk judgment by the pregnant lady. The development of new information strategies for dialogue between healthcare providers and pregnant women should form part of this strategy.

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What factors influence measles, mumps and rubella vaccine hesitancy among parents? A systematic review

British Journal of Child Health ◽

10.12968/chhe.2021.2.3.143 ◽

2021 ◽

Vol 2 (3) ◽

pp. 143-152

Author(s):

Jade Stewart ◽

Lynn Sayer

Keyword(s):

Systematic Review ◽

Critical Appraisal ◽

Parental Knowledge ◽

Vaccine Hesitancy ◽

Attitudes And Beliefs ◽

Rubella Vaccine ◽

The United Kingdom ◽

Health Choices ◽

The Uk ◽

Free Status

Background The United Kingdom lost its measles free status in 2019 because of an increase in measles cases, resulting from lowered vaccination uptake. Aims This review aims to gather a deeper understanding about parents' health choices for their children related to this vaccination. Methods A systematic review was carried out with a literature search using CINHAL, MEDLINE and OVID databases to identify information published between September 2016 and February 2020. A critical appraisal of seven studies was completed and a mixed methods synthesis was used to explore the results. Results The review identified factors that contribute to a parent's decision to vaccinate their child against measles, mumps and rubella. Five themes emerged: parental knowledge, attitudes and beliefs; safety concerns; specific groups related to religion and natural lifestyles; socioeconomic factors; and the source of health information. Conclusions Ongoing health promotion is required for the UK to work towards regaining its measles free status.

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State of vaccine confidence in the European Union in 2018

European Journal of Public Health ◽

10.1093/eurpub/ckz185.374 ◽

2019 ◽

Vol 29 (Supplement_4) ◽

Cited By ~ 12

Author(s):

H Larson ◽

A de Figueiredo ◽

E Karafllakis ◽

M Rawal

Keyword(s):

European Union ◽

Czech Republic ◽

Vaccine Hesitancy ◽

The European Union ◽

Mmr Vaccine ◽

High Coverage ◽

Member States ◽

The Public ◽

Eu Member States ◽

Vaccine Confidence

Abstract Background High confidence in vaccination programmes is crucial for maintaining high coverage rates. Across the European Union (EU), however, vaccine delays and refusals are contributing to declining immunisation rates in a number of countries and are leading to increases in disease outbreaks. Methods We assessed the overall state of confidence in vaccines among the public in all 28 EU member states and among general practitioners (GP) in ten EU member states, conducting the largest ever study on attitudes to vaccines and vaccination in the EU, eliciting the views of approximately 28,000 respondents across the 28 EU member states. Results We found that a number of member states (including France, Greece, Italy, and Slovenia) have become more confident in the safety of vaccines since 2015, but that the Czech Republic, Finland, Poland, and Sweden have become less confident. While GPs generally hold higher levels of vaccine confidence than the public, the survey found that 36% of GPs surveyed in Czech Republic and 25% in Slovakia do not agree that the MMR vaccine is safe and 29% and 19% respectively do not believe it is important. Countries whose GPs hold higher confidence in vaccines tend to have a larger proportion of the public expressing positive vaccination beliefs. Conclusions Even countries with well-established vaccination programmes and high levels of confidence are not immune to rising vaccine hesitancy. There is a need for continuous monitoring, preparedness and response plans to maintain and increase confidence in the importance, effectiveness and safety of vaccines, among both the public and health professionals.

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Compulsory vaccinations for children: Balancing the competing human rights at stake

Netherlands Quarterly of Human Rights ◽

10.1177/0924051919861797 ◽

2019 ◽

Vol 37 (3) ◽

pp. 245-267

Author(s):

Francesca Camilleri

Keyword(s):

Human Rights ◽

Infectious Diseases ◽

Vaccine Safety ◽

Vaccine Hesitancy ◽

Childhood Diseases ◽

Vaccination Rates ◽

Competing Interests ◽

European Court ◽

Controversial Topic ◽

Vaccine Confidence

Vaccination for children has been a controversial topic for decades and lately it has regained particular importance. We have seen an increase in vaccine hesitancy and decrease in vaccine confidence throughout Europe, particularly due to vaccine-safety concerns by parents. Consequently, vaccination rates for children have dropped and this in turn has led to an increased spread of vaccine-preventable infectious diseases, such as measles. As a reaction to this phenomenon of vaccine hesitancy, several European countries have introduced, while others are in the process of introducing, laws making vaccinations compulsory for children for a number of vaccine-preventable childhood diseases. The introduction of such laws affects and gives rise to several competing interests of the parents, the child and the State. Against this background, this article seeks to determine how the European Court of Human Rights should balance the competing human rights that are at stake in cases concerning compulsory vaccinations for children.

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Hesitant or Not Hesitant? A Systematic Review on Global COVID-19 Vaccine Acceptance in Different Populations

Vaccines ◽

10.3390/vaccines9080873 ◽

2021 ◽

Vol 9 (8) ◽

pp. 873

Author(s):

Maria Giulia Salomoni ◽

Zeno Di Valerio ◽

Elisa Gabrielli ◽

Marco Montalti ◽

Dario Tedesco ◽

...

Keyword(s):

Systematic Review ◽

Geographical Origin ◽

Vaccine Hesitancy ◽

Vaccine Acceptance ◽

Public Health Systems ◽

Pubmed Database ◽

Collection Data ◽

Different Populations ◽

Acceptance Rates ◽

Study Setting

Vaccination currently appears to be the only strategy to contain the spread of COVID-19. At the same time, vaccine hesitancy (VH) could limit its efficacy and has, therefore, attracted the attention of Public Health Systems. This systematic review aimed at assessing anti-COVID-19 vaccine acceptance rates worldwide and at identifying populations more prone to vaccine hesitancy, for which specific interventions should be planned. PubMed database was searched using a purposely formulated string. One hundred out of the 9243 studies retrieved were considered pertinent and thus included in the analyses. VH rate was analyzed according to patient geographical origin, ethnicity, age, study setting, and method used for data collection; data from specific populations were separately analyzed. Overall, this study demonstrated significant differences in terms of VH in the general population and in the specific subgroups examined according to geographical, demographic factors, as well as associated comorbidities, underlining the need for purposely designed studies in specific populations from the different countries, to design targeted programs aimed at increasing awareness for confidence and complacency toward COVID-19 vaccines.

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Factors associated with COVID-19 vaccine hesitancy in Senegal: a mixed study

10.1101/2021.12.20.21267724 ◽

2021 ◽

Author(s):

Mouhamadou Faly Ba ◽

Adama Faye ◽

Babacar Kane ◽

Amadou Ibra Diallo ◽

Amandine Junot ◽

...

Keyword(s):

Health Professionals ◽

Vaccine Hesitancy ◽

Large Cities ◽

Quantitative Phase ◽

Factors Associated ◽

Vaccine Refusal ◽

Health Authorities ◽

Vaccine Confidence ◽

Quota Sampling ◽

Qualitative Phase

Introduction: The most effective way to control the COVID-19 pandemic in the long term is through vaccination. Two of the important components that can hinder it are vaccine hesitancy and vaccine refusal. This study, conducted before the arrival of the vaccines in Senegal, aims to assess and identify factors associated with hesitancy to the COVID-19 vaccine. Methods: This study was an explanatory, sequential, mixed-methods design. We collected quantitative data from December 24, 2020, to January 16, 2021, and qualitative data from February 19 to March 30, 2021. We conducted a marginal quota sampling nationwide. We used a structured questionnaire to collect data for the quantitative phase and an interview guide with a telephone interview for the qualitative phase. We performed descriptive, bivariate, and multivariate analyses with R software version 4.0.5 for the quantitative phase; and performed manual content analyses for the qualitative phase. Results: We surveyed 607 people for the quantitative phase, and interviewed 30 people for the qualitative phase. Individuals who hesitated or refused to be vaccinated represented 12.9% and 32.8%, respectively. Vaccine hesitancy was related to gender, living in large cities, having a poor attitude towards the vaccine, thinking that the vaccine would not help protect them from the virus, being influenced by people important to them, and lacking information from health professionals. Vaccine refusal was related to living in large cities, having a poor attitude towards the vaccine, thinking that the vaccine would not help protect them from the virus, thinking that the vaccine could endanger their health, trusting opinions of people who were important to them, and lacking information from health professionals. Conclusion: The results of the study show that the factors associated with hesitancy and refusal to be vaccinated against COVID-19 are diverse and complex. Reducing them will help to ensure better vaccination coverage if the current challenges of vaccine accessibility are addressed. Therefore, governments and health authorities should intensify their efforts to promote vaccine confidence and reduce misinformation. Keywords: Vaccine hesitancy, COVID-19, Mixed method, Senegal

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