Predictors of COVID-19 Vaccine Acceptance, Intention, and Hesitancy: A Scoping Review

COVID-19 vaccine is regarded as the most promising means of limiting the spread of or eliminating the pandemic. The success of this strategy will rely on the rate of vaccine acceptance globally. The study aims to examine the factors that influence COVID-19 vaccine acceptance, intention, and hesitancy. PubMed was searched comprehensively for articles using the keyword “COVID-19 vaccine surveys.” Of the 192 records, 22 studies were eligible for the review. Eighty-two percent of these studies were conducted among the general population. Gender, age, education, and occupation were some of the socio-demographic variables associated with vaccine acceptance. Variables such as trust in authorities, risk perception of COVID-19 infection, vaccine efficacy, current or previous influenza vaccination, and vaccine safety affected vaccine acceptance. Globally, in March 2020, the average vaccine acceptance observed was 86% which dropped to 54% in July 2020 which later increased to 72% in September 2020. Globally, the average rate of vaccine hesitancy in April 2020 was 21%, which increased to 36% in July 2020 and later declined to 16% in October 2020. Large variability in vaccine acceptance and high vaccine hesitancy can influence the efforts to eliminate the COVID-19. Addressing the barriers and facilitators of vaccines will be crucial in implementing effective and tailored interventions to attain maximum vaccine coverage.

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Real-World Acceptance of COVID-19 Vaccines among Healthcare Workers in Perinatal Medicine in China

Vaccines ◽

10.3390/vaccines9070704 ◽

2021 ◽

Vol 9 (7) ◽

pp. 704

Author(s):

Biyun Xu ◽

Xuelian Gao ◽

Xinyue Zhang ◽

Yali Hu ◽

Huixia Yang ◽

...

Keyword(s):

General Population ◽

Real World ◽

Healthcare Workers ◽

Vaccine Safety ◽

Vaccine Hesitancy ◽

Present Survey ◽

Perinatal Medicine ◽

Vaccine Acceptance ◽

Questionnaire Online ◽

Convincing Data

Surveys showed that vaccine hesitancy may influence the acceptance of COVID-19 vaccines in healthcare workers (HCWs) and the general population. Currently, the actual acceptance of COVID-19 vaccination in HCWs has rarely been reported. In the present survey, we investigated the real-world acceptance of COVID-19 vaccination in HCWs in perinatal medicine during the first three-month period of vaccination in China and to identify the main reason for the decline of vaccination. HCWs (1087) who participated in a Chinese national symposium on perinatal medicine during 16–18 April 2021 were invited to answer a 27-question questionnaire online. A total of 1051 HCWs completed the questionnaire. Of them, 86.2% (906/1051) accepted the COVID-19 vaccination and 13.8% (145/1051) declined the vaccination. Because of the vaccine hesitancy, one-fourth of the vaccinated participants did not accept the vaccination until consulted with others or requested by employers. The main reason for the decline of vaccination in 145 unvaccinated HCWs was the concern about vaccine safety. The results indicate that vaccination request by employers may promote vaccine acceptance. More convincing data on the safety of COVID-19 vaccines appears to be important to increase the acceptance of vaccination.

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Vaccine Hesitancy in the Time of COVID-19: Attitudes and Intentions of Teens and Parents Regarding the COVID-19 Vaccine

Vaccines ◽

10.3390/vaccines10010004 ◽

2021 ◽

Vol 10 (1) ◽

pp. 4

Author(s):

Amy B. Middleman ◽

Judy Klein ◽

Jane Quinn

Keyword(s):

Vaccine Coverage ◽

Vaccine Safety ◽

Negative Influence ◽

Demographic Variables ◽

Vaccine Hesitancy ◽

Vaccination Rates ◽

Time Points ◽

Parental Concerns ◽

The Us ◽

Coverage Rates

To assess attitudes and intentions related to the COVID-19 vaccine during the pandemic, we surveyed adolescents aged 13–18 years and the parents of 13–18-year-olds using national research panels on three occasions or “waves”: before the COVID-19 vaccine was available, after it was available for adults, and after it was available for ages ≥12 years. Data on experiences with COVID-19, the importance of adolescent vaccines, and intentions regarding COVID-19 vaccination were analyzed across time points. We found that parental concerns about vaccine safety significantly increased from Wave 1 to 2. Social media had a negative influence on parents’ and adolescents’ opinions about vaccine safety. Demographic variables were associated with vaccination rates reported in Wave 3, consistent with known inequities related to vaccine access. Parents (70%) were supportive of concomitant COVID-19 vaccination with other adolescent vaccines for teens. It is important to address variables associated with vaccine hesitancy to increase COVID-19 vaccine coverage rates in the US.

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Early COVID-19 Vaccination of Romanian Medical and Social Personnel

Vaccines ◽

10.3390/vaccines9101127 ◽

2021 ◽

Vol 9 (10) ◽

pp. 1127

Author(s):

Loredana Sabina Cornelia Manolescu ◽

Corneliu Nicolae Zaharia ◽

Anca Irina Dumitrescu ◽

Irina Prasacu ◽

Mihaela Corina Radu ◽

...

Keyword(s):

General Population ◽

Medical Profession ◽

Geographic Area ◽

Cross Sectional Study ◽

Vaccine Virus ◽

Medical Doctor ◽

Vaccine Hesitancy ◽

Cross Sectional ◽

Vaccine Acceptance ◽

First Choice

Background: In December 2020, the first doses of COVID-19 vaccines arrived in Romania and were made available to medical and social staff. Vaccine hesitancy appeared as a barrier to effectively ending the pandemic. The opinions of medical and social staff influence the opinion of the general population. This study assesess the attitudes, knowledge, and opinion of medical and social personnel toward COVID-19 vaccines and vaccination and the influencing factors. Methods: 1025 persons participated in an online cross-sectional study from March until July 2021. Results: Out of 1021 eligible responders, 719 (70.42%) had been vaccinated: 227 with one dose (22.23%) and 492 with two doses (48.18%). There were 302 responders who were not vaccinated at all. Out of them, 188 refused vaccinations. The participants showed a good understanding and knowledge of SARScoV-2 transmission and treatment. Geographic area, medical profession, and medical experience influenced COVID-19 vaccination (p < 0.001). There were no associations between willingness to vaccinate and vaccine/virus knowledge. Most of the responders who were vaccinated or wanted to be vaccinated indicated an mRNA vaccine as their first choice. The variables that were significantly associated with reporting COVID-19 vaccine acceptance after logistic regression were: living in an urban area (Ora = 1.58, 95% CI: 0.98–2.56), being female (Ora = 1.59; 95% CI:1.03–2.44), and being a medical doctor (Ora = 3.40; 95% CI: 1.84–6.26). Conclusions: These findings show that vaccine hesitancy persists in medical and social personnel in Romania, and, hence, it may be reflected in the hesitancy of the general population toward vaccination.

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Vaccine hesitancy: evidence from an adverse events following immunization database, and the role of cognitive biases

BMC Public Health ◽

10.1186/s12889-021-11745-1 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Hossein Azarpanah ◽

Mohsen Farhadloo ◽

Rustam Vahidov ◽

Louise Pilote

Keyword(s):

Decision Making ◽

Adverse Events ◽

Cognitive Biases ◽

Vaccine Safety ◽

Vaccine Hesitancy ◽

Decision Making Process ◽

Evidence Based ◽

Vaccine Acceptance ◽

Vaccination Decision ◽

Vaccine Information

Abstract Background Vaccine hesitancy has been a growing challenge for public health in recent decades. Among factors contributing to vaccine hesitancy, concerns regarding vaccine safety and Adverse Events (AEs) play the leading role. Moreover, cognitive biases are critical in connecting such concerns to vaccine hesitancy behaviors, but their role has not been comprehensively studied. In this study, our first objective is to address concerns regarding vaccine AEs to increase vaccine acceptance. Our second objective is to identify the potential cognitive biases connecting vaccine hesitancy concerns to vaccine-hesitant behaviors and identify the mechanism they get triggered in the vaccine decision-making process. Methods First, to mitigate concerns regarding AEs, we quantitatively analyzed the U.S. Vaccine Adverse Event Reporting System (VAERS) from 2011 to 2018 and provided evidence regarding the non-severity of the AEs that can be used as a communicable summary to increase vaccine acceptance. Second, we focused on the vaccination decision-making process. We reviewed cognitive biases and vaccine hesitancy literature to identify the most potential cognitive biases that affect vaccine hesitancy and categorized them adopting the Precaution Adoption Process Model (PAPM). Results Our results show that the top frequent AEs are expected mild reactions like injection site erythema (4.29%), pyrexia (3.66%), and injection site swelling (3.21%). 94.5% of the reports are not serious and the average population-based serious reporting rate over the 8 years was 25.3 reports per 1 million population. We also identified 15 potential cognitive biases that might affect people’s vaccination decision-making and nudge them toward vaccine hesitancy. We categorized these biases based on the factors that trigger them and discussed how they contribute to vaccine hesitancy. Conclusions This paper provided an evidence-based communicable summary of VAERS. As the most trusted sources of vaccine information, health practitioners can use this summary to provide evidence-based vaccine information to vaccine decision-makers (patients/parents) and mitigate concerns over vaccine safety and AEs. In addition, we identified 15 potential cognitive biases that might affect the vaccination decision-making process and nudge people toward vaccine hesitancy. Any plan, intervention, and message to increase vaccination uptake should be modified to decrease the effect of these potential cognitive biases.

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Essential Workers COVID-19 Vaccine Hesitancy, Misinformation and Informational Needs in the Republic of North Macedonia.

10.1101/2021.12.22.21268045 ◽

2021 ◽

Author(s):

Stephen Fucaloro ◽

Vahe Yacoubian ◽

Nigel Harriman ◽

Rachael Pitch-Loeb ◽

Metodi Hadji-Janev ◽

...

Keyword(s):

Risk Perception ◽

Vaccine Hesitancy ◽

Individual Risk ◽

Informational Needs ◽

Vaccine Acceptance ◽

Health Crisis ◽

International Agencies ◽

Previous Diagnosis ◽

Increased Risk ◽

Chi Square Analysis

Introduction: The COVID-19 pandemic is a global health crisis that as of December 2021 has resulted in the death of over 5.2 million people. Despite the unprecedented development and distribution of vaccines, hesitancy to take the vaccine remains a wide-spread public health challenge, especially in Eastern European countries. In this study we focus on a sample of essential workers in North Macedonia to: 1) Describe rates of vaccine acceptance, risk perception and sources of COVID-19 information, 2) Explore predictors of vaccine hesitancy and 3) Describe informational needs of hesitant and non-hesitant essential workers. Methods: Descriptive statistics were used to present frequencies of vaccine acceptance. Logistic regression was used to explore predictors of vaccine acceptance based on sociodemographic characteristics, hesitancy to take other vaccines in the past, previous diagnosis of COVID-19, and individual risk perception of COVID-19. Chi square analysis was used to compare informational needs differences between hesitant and non-hesitant individuals across socio-demographic groups. Results: From a sample of 1003 individuals, 439 (44%) reported that they were very likely to get the vaccine, the rest reported some level of hesitancy. Older age, Albanian ethnicity, post-secondary school education, previous diagnosis of COVID-19, previous vaccine acceptance of other vaccines, and increased risk perception of COVID-19 infection were all found to be negatively associated with vaccine hesitancy. In particular hesitant individuals, compared to the non-hesitant, wanted to have more information and reassurance that all main international agencies (i.e. FDA, WHO, EMA) were all in accordance in recommending the vaccine and that they would be free to choose if getting the vaccine or not without consequences (p<0.01).

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Predictors of COVID-19 vaccine acceptability among patients living with HIV in northern Nigeria: A mixed methods study

Current HIV Research ◽

10.2174/1570162x19666211217093223 ◽

2021 ◽

Vol 19 ◽

Author(s):

Zubairu Iliyasu ◽

Aminatu A. Kwaku ◽

Amina A. Umar ◽

Fatimah Tsiga-Ahmed ◽

Nafisa S. Nass ◽

...

Keyword(s):

Mixed Methods ◽

Risk Perception ◽

Antiretroviral Treatment ◽

Antiretroviral Drugs ◽

Vaccine Uptake ◽

Vaccine Hesitancy ◽

People Living With Hiv ◽

Northern Nigeria ◽

Vaccine Acceptance ◽

Living With Hiv

Background: People living with HIV (PLHIV) are at increased risk of COVID-19 acquisition, severe disease, and poor outcomes. Yet, little is known about COVID-19 vaccine hesitancy among PLHIV in high HIV burden countries such as Nigeria. Objective: This study aims to assess the acceptability of the COVID-19 vaccine and identify predictors and reasons for vaccine hesitancy among patients living with HIV and attending a tertiary hospital in Kano, northern Nigeria. Methods: Using a mixed-methods design, structured questionnaires were administered to a clinic-based sample of patients living with HIV (n=344), followed by 20 in-depth interviews with a sub-sample. Logistic regression and the framework approach were used to analyze the data. Results: Less than half (46.2%, n=159) of the respondents were willing to take the COVID-19 vaccine. Vaccine acceptance was higher among non-Muslim PLHIV (Adjusted Odds Ratio (aOR)=1.26, 95% Confidence Interval (95%CI): 1.10-4.00), persons with high-risk perception (aOR=2.43, 95%CI:1.18-5.00), those who were not worried about infertility-related rumors (aOR=13.54, 95%CI:7.07-25.94) and persons who perceived antiretroviral drugs are protective against COVID-19 (aOR = 2.76, 95%CI: 1.48-5.14). In contrast, vaccine acceptance was lower among persons who were not more concerned about the potential effects of COVID-19-HIV co-infection (aOR=0.20, 95%CI:0.10-0.39). The most common reasons for vaccine hesitancy included doubts about the existence of COVID-19, low-risk perception, anxiety about antiretroviral treatment-vaccine interactions, safety concerns, and infertility-related rumors. Conclusion: Covid-19 vaccine acceptance was low among PLHIV. COVID-19 vaccine acceptance was associated with respondents’ faith, risk perception, perception of the protective effects of antiretroviral treatment, concerns about COVID-19-HIV co-infection, and infertility-related rumors. Vaccination counseling should be integrated into HIV treatment services to improve COVID-19 vaccine uptake among PLHIV in Kano and similar settings.

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Confidence, Acceptance and Willingness to Pay for the COVID-19 Vaccine among Migrants in Shanghai, China: A Cross-Sectional Study

Vaccines ◽

10.3390/vaccines9050443 ◽

2021 ◽

Vol 9 (5) ◽

pp. 443

Author(s):

Kaiyi Han ◽

Mark R. Francis ◽

Ruiyun Zhang ◽

Qian Wang ◽

Aichen Xia ◽

...

Keyword(s):

Willingness To Pay ◽

Migrant Workers ◽

Vaccine Safety ◽

Cross Sectional Study ◽

Vaccine Hesitancy ◽

Sectional Study ◽

Cross Sectional ◽

Vaccine Acceptance ◽

Vaccine Information ◽

Socio Demographic Factors

Understanding the public’s attitude towards COVID-19 vaccination and their acceptance could help facilitate the COVID-19 rollout. This study aimed to assess the acceptance and willingness to pay (WTP) for the COVID-19 vaccine among migrants in Shanghai, China. A cross-sectional study was conducted among 2126 migrants in Shanghai for the period 1–20 November 2020. Convenience sampling was used to recruit respondents in workplaces with large numbers of migrant workers. Multivariable (ordered) logistic regressions were used to examine factors associated with acceptance and WTP of the COVID-19 vaccine. Most (89.1%) migrants would accept COVID-19 vaccination. Over 90.0% perceived the COVID-19 vaccine as important, while only 75.0% and 77.7% perceived vaccines safe and effective. Socio-demographic factors were not significantly associated with vaccine acceptance, but confidence in the importance (OR 8.71, 95% CI 5.89–12.89), safety (OR 1.80, 95% CI 1.24–2.61) and effectiveness (OR 2.66, 95% CI 1.83–3.87) of COVID-19 vaccine was significantly positively associated with vaccine acceptance. The top reasons for vaccine hesitancy were lack of vaccine information and confidence. The proportion of those definitely willing to get the COVID-19 vaccine was 20% lower if paid by themselves than free vaccination. Migrants were willing to pay a median amount of USD 46 for the COVID-19 vaccine. Results show that a high acceptance of the COVID-19 vaccine was universal among migrants in Shanghai. Concerns about vaccine safety, effectiveness and high costs of the COVID-19 vaccine may hinder their uptake. Effective health communication to build confidence in the COVID-19 vaccine and subsidies toward the costs of these vaccines are needed to improve uptake.

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Sensitivity to COVID-19 Vaccine Effectiveness and Safety in Shanghai, China

Vaccines ◽

10.3390/vaccines9050472 ◽

2021 ◽

Vol 9 (5) ◽

pp. 472

Author(s):

Jia Lu ◽

Xiaosa Wen ◽

Qi Guo ◽

Mengdi Ji ◽

Felicia Zhang ◽

...

Keyword(s):

Side Effect ◽

Relative Income ◽

Vaccine Safety ◽

Vaccine Effectiveness ◽

Vaccine Hesitancy ◽

Cross Sectional ◽

Vaccine Acceptance ◽

Vaccine Candidates ◽

Elderly Parent

Several COVID-19 vaccines have been on the market since early 2021 and may vary in their effectiveness and safety. This study characterizes hesitancy about accepting COVID-19 vaccines among parents in Shanghai, China, and identifies how sensitive they are to changes in vaccine safety and effectiveness profiles. Schools in each township of Minhang District, Shanghai, were sampled, and parents in the WeChat group of each school were asked to participate in this cross-sectional Internet-based survey. Parents responded to questions about hesitancy and were given information about five different COVID-19 vaccine candidates, the effectiveness of which varied between 50 and 95% and which had a risk of fever as a side effect between 5 and 20%. Overall, 3673 parents responded to the survey. Almost 90% would accept a vaccine for themselves (89.7%), for their child (87.5%) or for an elderly parent (88.5%) with the most ideal attributes (95% effectiveness with 5% risk of fever). But with the least ideal attributes (50% effectiveness and a 20% risk of fever) these numbers dropped to 33.5%, 31.3%, and 31.8%, respectively. Vaccine hesitancy, age at first child’s birth, and relative income were all significantly related to sensitivity to vaccine safety and effectiveness. Parents showed a substantial shift in attitudes towards a vaccine based on its safety and effectiveness profile. These findings indicate that COVID-19 vaccine acceptance may be heavily influenced by how effective the vaccine actually is and could be impeded or enhanced based on vaccines already on the market.

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Vaccine hesitancy among healthcare providers during COVID-19 pandemic

European Journal of Public Health ◽

10.1093/eurpub/ckab164.101 ◽

2021 ◽

Vol 31 (Supplement_3) ◽

Author(s):

F Algabbani ◽

A Algabbani

Keyword(s):

Healthcare Providers ◽

Vaccine Safety ◽

Vaccine Hesitancy ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Vaccine Acceptance ◽

Web Based ◽

Global Health Issue ◽

Vaccine Confidence ◽

And Control

Abstract Public trust in vaccines is a major global health issue. This study aims to assess the vaccine acceptance among healthcare workers and their confidence and hesitancy of the COVID19 vaccine. This was a multicenter cross-sectional survey conducted among healthcare providers in Riyadh, the capital of Saudi Arabia. Data collection was carried out between October and November of 2020 through a web-based survey. COVID19 vaccine hesitancy was assessed using eight structured items adapted from the 5Cs. About 34.6% (95% CI: 27.6%-42.4%) of participants were willing to vaccinate against COVID-19 and 44% (95% CI: 36.5%-51.9%) will recommend the vaccine to their patients. About 45% of participants were neutral regarding vaccine safety and 40% were neutral regarding vaccine effectiveness. Almost 70% believe that the duration of clinical studies of the COVID-19 vaccines affects their confidence in the efficacy and safety of the vaccine. Those who never hesitated or delayed taking any of the recommended vaccination were more likely to be willing to vaccinate COVID-19 (OR 5.46, 95% CI: 2.49-11.98). Assessing the level of vaccine confidence in the population and associated factors will help implement an effective national vaccine program to enhance vaccination uptake and control COVID19 spread during this pandemic. Key messages Vaccine hesitancy is challenging vaccination goals at the national and global level. Hesitancy from the population toward vaccine and concerns regarding its safety and efficacy was observed with the development of a novel vaccine for COVID19 a newly emerged infection.

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Attitude towards childhood vaccination among parents in a rural area of Trivandrum district

International Journal of Community Medicine and Public Health ◽

10.18203/2394-6040.ijcmph20210808 ◽

2021 ◽

Vol 8 (3) ◽

pp. 1247

Author(s):

Nithya Girija ◽

Deena Divakaran Sreelatha ◽

Benny Purandaran Vasanthamani ◽

Anil Bindhu Sukumaran ◽

Regi Jose ◽

...

Keyword(s):

Rural Area ◽

Vaccine Coverage ◽

Economic Status ◽

Cross Sectional Study ◽

Childhood Vaccination ◽

Vaccine Hesitancy ◽

Modern World ◽

Cross Sectional ◽

Vaccine Acceptance ◽

Maximum Score

Background: Vaccines are simple and widely accepted as one of the most important medical strategy of modern world in the prevention of morbidity and mortality. In order to ensure the protective benefits of vaccines, it is essential that the vaccine coverage should reach between 80-100% of a population, with required coverage dependent on the concerned vaccine and the illness that it is designed to prevent. Vaccine hesitancy is defined as the reluctance to be vaccinated or have one's children vaccinated. In this study, we assess the attitude of parents towards childhood vaccinations and the prevalence of vaccine hesitancy among parents in a rural area in Thiruvananthapuram district.Methods: A cross-sectional study was carried out among parents of children below the age of 15 years, who are residents of a rural area in Thiruvananthapuram district. Data was collected using the parents’ attitude about childhood vaccination (PACV) survey, with the consent of the participants. The collected data entered into MS Excel and analysis was carried out using SPSS 20.Results: Out of 100 participating parents, 14 (14%) parents were concerned about the adverse events following immunization (AEFI). At the same time, the maximum score obtained on the PACV scale was just 24 out of 100. Further, vaccine hesitancy among the parents was found to be only 2 (2%).Conclusions: There is good vaccine acceptance among the parents residing in a rural area, even though many are from low socio-economic status.

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