scholarly journals Vaccine refusal/hesitancy—the ethical point of view

2021 ◽  
Vol 31 (Supplement_2) ◽  
Author(s):  
João Gentil

Abstract Background In 2019, WHO classified vaccine hesitancy as one of the top 10 threats to global health. Vaccination is an area of excellence in nursing that has gained a new focus and has become a challenge in the provision of care and in the management field. Vaccine hesitation raises questions about mandatory vaccination, individual versus collective freedom that are highlighted in the current context due to the emergence of new vaccines. In this paper, we want to analyze and update knowledge about vaccines hesitancy from an ethical and bioethical perspective. Methods A combination of literature reviews on vaccine refusal/hesitancy, ethics and COVID-19 vaccine confidence, accessed on SciELO and PubMed databases and analysis of documents from General Directorate of Health and Ordem dos Enfermeiros (National Nurses Association). Results Vaccination programs aim is a collective protection. The desirable effects at individual level do not have the same ethical value at collective level, leading to cost-benefit imbalances. Moral conflicts between the individual and the collective, cost-benefit imbalances and the insufficiency of bioethics principles, lead us to the use of other moral values and principles, such as responsibility, solidarity and social justice, as a tool for ethical reflection problems related to COVID-19 vaccines. Conclusions There are no perfect solutions to ethical dilemmas and some optimal solutions could depend the context. In a pandemic situation, one of the most relevant ethical issues is the herd immunity since it leaves public health at risk. Equity and the principle of justice in vaccination campaign are shown daily in the nursing profession.

Vaccines ◽  
2021 ◽  
Vol 9 (4) ◽  
pp. 366
Author(s):  
Marco Montalti ◽  
Flavia Rallo ◽  
Federica Guaraldi ◽  
Lapo Bartoli ◽  
Giulia Po ◽  
...  

In the near future, COVID-19 vaccine efficacy trials in larger cohorts may offer the possibility to implement child and adolescent vaccination. The opening of the vaccination for these strata may play a key role in order to limit virus circulation, infection spreading towards the most vulnerable subjects, and plan safe school reopening. Vaccine hesitancy (VH) could limit the ability to reach the coverage threshold required to ensure herd immunity. The aim of this study was to investigate the prevalence and determinants of VH among parents/guardians toward a potentially available COVID-19 vaccination for children and adolescents. An online survey was performed in parents/guardians of children aged <18 years old, living in Bologna. Overall, 5054 questionnaires were collected. A vast majority (60.4%) of the parents/guardians were inclined to vaccinate, while 29.6% were still considering the opportunity, and 9.9% were hesitant. Highest vaccine hesitancy rates were detected in female parents/guardians of children aged 6–10 years, ≤29 years old, with low educational level, relying on information found in the web/social media, and disliking mandatory vaccination policies. Although preliminary, these data could help in designing target strategies to implement adherence to a vaccination campaign, with special regard to web-based information.


2021 ◽  
Author(s):  
Daniela Toro-Ascuy ◽  
Nicolas Cifuentes-Munoz ◽  
Andrea Avaria ◽  
Camila Pereira-Montecinos ◽  
Gilena Cruzat ◽  
...  

Control of the COVID-19 pandemic largely depends on the effectiveness of the vaccination. Several factors including vaccine hesitancy can affect the vaccination process. Understanding the factors that underlie the willingness to accept vaccination brings pivotal information to control the pandemic. We analyzed the association between the willingness level to accept the COVID-19 vaccine, and vaccine determinants amidst the Chilean vaccination process. Individual-level survey data was collected from nationally representative samples of 744 respondents, and multivariate regression models used to estimate the association between outcome and explanatory variables. Trust in the COVID-19 vaccine, scientists, and medical professionals were found to increase the willingness to: accept the vaccine, a booster dose, annual vaccination, and children vaccination. Our results are critical to understanding the acceptance of COVID-19 vaccines in the context of a country with one of the highest vaccination rates in the world. We provide information for decision-making, policy design and communication of vaccination programs.


2021 ◽  
Author(s):  
Xiao Chen ◽  
Hanwei Huang ◽  
Jiandong Ju ◽  
Ruoyan Sun ◽  
Jialiang Zhang

Abstract Governments worldwide are implementing mass vaccination programs in an effort to end the novel coronavirus (COVID-19) pandemic. Here, we evaluated the effectiveness of the COVID-19 vaccination program and predicted the path to herd immunity in the U.S. We estimated that vaccination reduced the total number of new cases by 4.4 million (from 33.0 to 28.6 million), prevented approximately 0.12 million hospitalizations (from 0.89 to 0.78 million), and decreased the population infection rate by 1.34 percentage points (from 10.10–8.76%). We built a Susceptible-Infected-Recovered (SIR) model with vaccination to predict herd immunity. Our model predicts that the U.S. can achieve herd immunity by the last week of July 2021, with a cumulative vaccination coverage of 60.2%. Herd immunity could be achieved earlier with a faster vaccination pace, lower vaccine hesitancy, and higher vaccine effectiveness. These findings improve our understanding of the COVID-19 vaccination and can inform future public health policies.


Author(s):  
Serhat Sirekbasan

I would like to mention an issue discussed constantly these days in the light of scientific data. It would be best to start by answering a question everyone is curious about before we start the main topic. Will this virus go away? The answer is simply “No”. The virus will probably continue to exist together with us; however, one day, the pandemic will end. The only answer we can give to the question of how this pandemic will end is “scientific and social fight”. All countries throughout the entire world are fighting to control the spread of SARS-CoV-2. The most important among these global fights is proper medical treatment in addition to an early, rapid and accurate diagnosis. Besides, another aspect that will crown this fight is the vaccination programs. The success of this fight depends on people’s accepting the vaccines. A total of 10 of the vaccine candidates, which numbered more than 165 developed within a record time period, have achieved approval after their final stages of effectiveness tests on a large scale as of March when the whole world mobilized to produce vaccines to stop the pandemic. Unfortunately; however, a vaccine against COVID-19 is unlikely to provide full protection. Also, even if a safe and effective vaccine comes to be known, it will not be possible to reach adequate distribution worldwide within a short time period. It is estimated that the time for the distribution of a safe and effective vaccine to the population will be between the end of 2020 and early 2022. However, even in the presence of adequate vaccines, vaccination of a sufficient number of population cannot be guaranteed due to hesitations, indecisiveness, and oppositions to the vaccine. Although vaccination is considered to be one of the most successful public health measures, an increasingly growing number of people perceive it as unsafe and unnecessary. The lack of trust in vaccines comes before us as a threat to the success of vaccination programs. Hesitation, indecision, and opposition to vaccines is an extremely important issue and requires to be dealt with. As a matter of fact, vaccines, which save approximately 2-3 million lives each year, are among the greatest achievements of the past two centuries. Vaccines, which eliminated the smallpox disease successfully, also reduced the prevalence of many important diseases greatly, such as polio and measles. Today, more than 30 infectious diseases can be controlled on a worldwide scale with the existing licensed vaccines; and it is prevented that the limited public healthcare resources are spent in vain by decreasing the burden of infectious diseases that are preventable with vaccines on the healthcare system. The way to eliminate the detrimental effects of this pandemic depends on the implementation of effective and safe vaccines as soon as possible, and on maintaining this at high rates. An overall “herd immunity”, which will be achieved with high vaccination rates, will also limit the ability of the virus to spread. Of course, how long the protective immunity to vaccines will last will determine our future regarding the virus; however, it must be kept in mind that the uncertainty we are experiencing now regarding the condition of the pandemic stems from our attitudes about vaccine rejection rather than the immune response. In conclusion, the potential of vaccines to prevent diseases and save lives has never been more remarkable throughout history. However, the magnitude of the hesitations regarding the vaccines was not at such dimensions. As misinformation about vaccines spreads, public confusion also increases, and various hesitations occur against the vaccine. These hesitations prevent the success of scientists and the attempts to spread the vaccine. Attention should be paid not to spread misguiding information regarding the safety and effectiveness of immunization, explanations that may be misunderstood of especially those who do not know about the subject should be prevented, and necessary information should be provided regularly regarding the concerns of the public. In any case, the potential benefit of the existing effective vaccines depends on the adequate acceptance of them by society. For this reason, the most important task that stands out before us is to raise public awareness by informing society to eliminate hesitations regarding the vaccines to increase vaccine adaptation rates in the entire population.


2021 ◽  
Author(s):  
Shohei Okamoto ◽  
Kazuki Kamimura ◽  
Kohei Komamura

Objectives: While the development of vaccines against the novel coronavirus (COVID-19) brought the hope of establishing herd immunity, which might help end the global pandemic, vaccine hesitancy can hinder the progress towards herd immunity. In this study, we assess the determinants of vaccine hesitancy, reasons for hesitation, and effectiveness of vaccine passports in relaxing public health restrictions. Methods: Through an online survey that includes a conjoint experiment of a demographically representative sample of 5,000 Japanese adults aged 20-74, we assess the determinants of vaccine hesitancy, reasons for hesitation, and effectiveness of hypothetical vaccine passports. Results: We found that about 30% of respondents did not intend to vaccinate or have not yet decided, with major reasons for vaccine hesitancy being related to concerns about the safety and side effects of the vaccine. In line with previous findings, younger age, lower socioeconomic status, and psychological factors such as weaker COVID-19 fear were associated with vaccine hesitancy. The easing of public health restrictions such as travel, wearing face masks, and dining out at night was associated with an increase in vaccine acceptance by 4-10%. Conclusion: Vaccine hesitancy can be reduced by mitigating the concerns about vaccine safety and side effects, as well as by relaxing public health restrictions. However, the feasibility of vaccine passports needs to be sufficiently assessed, taking the ethical issues of passports and the public health impacts of the relaxation of restrictions into careful consideration.


2021 ◽  
Author(s):  
Naveen Siddique Sheikh ◽  
Mumtaz Touseef ◽  
Riddah Sultan ◽  
Kanwal Hassan Cheema ◽  
Sidra Shafiq Cheema ◽  
...  

Background and objectives: Vaccine hesitancy is a big obstacle for vaccination programs, as is anticipated for the COVID-19 vaccination program, resulting in low uptake of vaccines thereby hindering the process of reaching herd immunity. Bearing this in mind the current study was aimed to explore the determinants of vaccine hesitancy amongst the Pakistani population. Methodology: A cross-sectional study was carried out from the 23rd-31st January 2021. The conceptual framework of the study was based on the 3Cs (Confidence, Convenience, Complacency) model. Google-forms-based questionnaire was disseminated amongst the general population. Data collected were entered into SPSS version 26 and analyzed. Results: Of the 421 participants, 68.4% were females. Non-healthcare workers were 55.8% of respondents. Vaccine hesitant individuals, 26.13% reported they were very unlikely to get vaccinated. Vaccine was not safe as it came out too fast was agreed upon by 12.6% individuals, 50.6% were worried about experiencing side-effects, 18% believed vaccine will not offer protection and 5.9% believed vaccine would cause death. Low Practice of SOP in non-Healthcare workers was the strongest contributor to vaccine hesitancy (OR: 5.338, p=0.040, 95% CI: 1.082-26.330) followed by High complacency (p=0.026) and Moderate Complacency (OR: 0.212, p=0.007, 95% CI: 0.069-0.654) towards COVID-19 vaccination. In Healthcare workers the strongest contributor to vaccine hesitancy was having a Moderate Confidence (OR: 0.323, p=0.042, 95% CI: 0.109-0.958) in the vaccine followed by Moderate Convenience (OR: 0.304, p=0.049, 95% CI: 0.093-0.993) for vaccination Conclusion: Campaigning and communication strategies to reaffirm confidence in the COVID-19 vaccine and educating the general population about the vaccine could lead to increased perception of vaccine safety and effectiveness thereby restoring confidence in vaccine and decreasing vaccine hesitancy. Likewise, working to increase vaccine convenience and decreasing complacency towards the COVID-19 vaccine would translate into high vaccine uptake.


Author(s):  
KASI VISWANATH ◽  
HIREMATH RN ◽  
SHARANJIT SINGH BASRA ◽  
NIRAJ CHOUREY

Objective: Coronavirus disease 2019 (COVID-19) infection evolved as a worst nightmare across entire humanity especially for health care workers along with all stakeholders of the society ever since the beginning of year 2020. Vaccination campaign is one of the most successful public health interventions and a cornerstone for the prevention of communicable infectious diseases. To have a baseline data and to form the basis for further vaccination drive, we carried out this study with an objective to understand the perception and COVID-19 vaccine hesitancy among health care workers (HCWs). Methods: A correctional study was carried out at one of the multispecialty hospital in North India where COVID-19 vaccination for HCWs was planned and 675 HCWs were taken into the study. Data were collected by means of personal interview using pretested semi-structured questionnaire and Epi Info version 6 was used for analysis. Results: The mean age of the participants was 32.78 years. Majority were male (89.48%), working in government sector (87.7%) and paramedic (88.15%). While 94.67% were accepting vaccine voluntarily while remaining were not confident enough on their own, only 26.96% were ready to take vaccine even on payment. The overall awareness scores of study participants were calculated and found that 79.56% of them had poor awareness level while only 20.44% had satisfactory awareness level. The association of awareness score was statistically significant with job profile (designation), gender, and prior COVID-19 positivity of study participants. Conclusion: The decision of vaccine prioritization to HCWs and frontline workers will boost the morale and spirit of warriors high in future. This study was a preliminary attempt to check any vaccine hesitancy factors among HCWs and act accordingly. Although almost all had volunteered for vaccine, the knowledge about vaccine was poor in majority of HCWs as the time period was recent to vaccine rollout and detailed research findings were not yet out about vaccine. All measures to be taken including intensive information education and communications activities targeting HCWs and general population on regular basis to upgrade the knowledge on vaccine issues. A strong communicating policy in an era of misinformation is highly recommended as social media plays an important role in spreading true as well as false messages jeopardizing the entire gains of successful vaccination and attainment of herd immunity. HCWs to act as role model for general public and patients which would in turn increase the vaccine acceptance among them.


Author(s):  
Farrukh Ansar ◽  
Hira Naveed ◽  
Mudasir Khan ◽  
Almas Khattak

COVID-19 pandemic has caused global healthcare and economic crises and mass vaccination to acquire herd immunity seem to be the only solution. Present study aimed to evaluate the intent of Pakistani population towards vaccination and to uncover the barriers associated with vaccine reluctance. This cross-sectional study included responses of 855 Pakistani residents. Respondents’ knowledge of COVID-19 infection, intent of vaccination and barriers towards vaccine refusal were evaluated. Participants were categorized on the basis of knowledge score, risk of disease and other demographic characteristics. Descriptive statistics were used for calculating frequencies and percentages, means and Chi-square test was utilized for cross-tabulation. A multinomial logistic regression model was executed to identify the predictors of vaccination intention. Significance level was set at the p-value of ? 0.05. Prevalence of vaccine refusal was 40%. COVID-19 vaccine is not Halal, negative propaganda on social media against the vaccine, discouraging advice from social circle and clerics, concerns regarding efficacy, fear of immediate and late adverse reactions were the major barriers identified towards vaccine hesitancy. Around one-third of the study population did not consider COVID-19 as a serious disease and associate it with conspiracy theory. The mean score of participants towards COVID-19 knowledge was 5.5±1.6 (range: 0-9). Having a college degree, living in an urban area, working in a healthcare field and being in a higher risk category increases the chances of vaccine acceptability.


Author(s):  
Francesc López ◽  
Martí Català ◽  
Clara Prats ◽  
Oriol Estrada ◽  
Irene Oliva ◽  
...  

(1) Background: in epidemiological terms, it has been possible to calculate the savings in health resources and the reduction in health effects of COVID vaccines. From the point of view of economic evaluation, some studies have estimated its cost-effectiveness with the vaccination showing highly favorable results, which in some cases is cost-saving; (2) Methods: a cost-benefit analysis of the vaccination campaign in the North Metropolitan Health Region (Catalonia). An epidemiological model based on observational data and before and after comparison is used. The information on the doses used and the resources assigned (conventional hospital beds, ICU, number of tests) has been extracted from administrative data from the largest Primary Care provider in the region (Catalan Institute of Health). A distinction is made between the social perspective and the health system; (3) Results: the costs of vaccination are estimated at 137 million euros (€48.05/dose administered). This figure is significantly lower than the positive impacts of the vaccination campaign, which are estimated at 470 million euros (€164/dose administered). Of these, 18% corresponds to the reduction of ICU discharges, 16% to the reduction in conventional hospital discharges, 5% to the reduction in PCR tests and 1% to the reduction of RAT tests. Monetization of deaths and cases with sequelae avoided account for 53% and 5% of total savings, respectively. The benefit/cost ratio is estimated at 3.4 from a social perspective and 1.2 from a health system perspective. The social benefits of vaccination are estimated at €116.67 per dose of vaccine given (€19.93 from the point of view of the health system); (4) Conclusions: the mass vaccination campaign against COVID is cost-saving. From a social perspective, most of these savings come from the monetization of the reduction in mortality and cases with sequelae, although the intervention is equally widely cost-effective from the point of view of the health system thanks to the reduction in the use of resources. It is concluded that, from an economic perspective, the vaccination campaign has high social returns.


Vaccines ◽  
2021 ◽  
Vol 9 (4) ◽  
pp. 302
Author(s):  
Alexandre Vallée ◽  
Erwan Fourn ◽  
Catherine Majerholc ◽  
Pauline Touche ◽  
David Zucman

People living with HIV are a high-risk population concerning the coronavirus 19 (COVID-19) infection, with a poorer prognosis. It is important to achieve high COVID-19 vaccination coverage rates in this group as soon as possible. This project used self-reporting to assess vaccine hesitancy and acceptance among people living with HIV towards the novel COVID-19 vaccine. Sixty-eight (28.7%) participants among the 237 declared their hesitancy to be vaccinated against COVID-19. Participants who expressed concerns about their health (p < 0.001), the requirement of mandatory COVID-19 vaccination (p = 0.017), and their chronic disease status (p = 0.026) were independently associated with the acceptance of vaccination. Conversely, participants presenting general vaccine refusal (p < 0.001), concerns about the serious side effects of COVID-19 vaccines (p < 0.001), and those already thinking having an immune status to COVID-19 (p = 0.008) were independently associated with COVID-19 vaccine hesitancy. Our results suggest that vaccine strategy would be more successful in France with a communication strategy emphasizing the collective benefits of herd immunity in the population living with HIV and reassuring patients with chronic diseases about the safety of the proposed vaccines.


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