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

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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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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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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Factors Influencing the COVID-19 Vaccine Hesitancy Across Diverse Participants Across Patients, Healthcare Providers And Common Public – A Cross Sectional Questionnaire-Based Perception Mapping Survey (Preprint)

10.2196/preprints.27219 ◽

2021 ◽

Author(s):

Sagar Redkar

Keyword(s):

Research Work ◽

Healthcare Providers ◽

Target Population ◽

Rural Setting ◽

Vaccine Hesitancy ◽

Scientific Uncertainty ◽

Time Duration ◽

Cross Sectional ◽

Inaccurate Information ◽

Vaccine Confidence

BACKGROUND Vaccine hesitancy is refusal or reluctance in the acceptance of vaccination despite the availability of vaccination services OBJECTIVE Understanding determinants of vaccine hesitancy for early identification of vaccine concerns to analyse acceptance behaviour in public and in healthcare providers for recommendation behaviour. Target population would be across multiple cities in India, Indonesia, UAE and UK METHODS Questions for survey would be corroborative with existing tools for vaccine hesitancy, based on PICO statement incorporating public health mistrust scale, perceived COVID-19 societal stigma scale - adapted from perceived external stigma of Ebola-related stigma questionnaire, COVID-19-related prosocial behaviors adapted from two scales: empathic responding to SARS scale and pro socialness scale. Time duration from first whatsapp communication, three reminders and execution per targeted individual participant would be for 10 days. Target population include, patients visiting multi-specialty hospital in urban and rural setting in India, physicians in clinical practice across country including corona warriors involved in front-end, university students in medical school, pharmacists in pharmaceutical trade RESULTS We would identify sources of vaccine misinformation, analyse patterns of spread of inaccurate information and help flatten the curve of infodemic. This would enable to define a vaccine confidence index for determining customised educational intervention to support percolation of evidence-based information for COVID-19 vaccine to remove unscientific barriers preventing the uptake and acceptance of the COVID-19 vaccine. This would enhance health care provider's confidence in recommending vaccination and thus increasing coverage rates. We plan to submit research work to speciality conferences and plan to conduct workshops to develop educational materials which to mitigate the COVID-19 vaccine hesitancy CONCLUSIONS We would explore gaps to build scientific trust in era of scientific uncertainty when politicians rather than the medical experts have become the public faces of crisis management CLINICALTRIAL NA

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Parent attitudes about childhood vaccines: a vaccine hesitancy point prevalence study.

10.1101/2021.07.26.21261018 ◽

2021 ◽

Author(s):

Sarah Marshall ◽

Anne C Moore ◽

Laura J Sahm ◽

Aoife Fleming

Keyword(s):

Side Effects ◽

Vaccine Safety ◽

Vaccination Schedule ◽

Survey Study ◽

Vaccine Hesitancy ◽

Parent Attitudes ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Number Of Children ◽

Childhood Vaccines

Abstract Objectives The aim of this study was to measure the prevalence of vaccine hesitancy using Parent Attitudes about Childhood Vaccines (PACV) survey regarding paediatric vaccines for their children, in a population of parents attending a STEM (Science, Technology, Engineering and Mathematics) outreach event in Cork, Ireland. Study design Cross-sectional survey study. Methods This study was conducted in November 2018 at the Community Festival of Science STEM event. Eligible attendees were invited to read the participant information leaflet, provide written informed consent, and complete the validated Parent Attitudes about Childhood Vaccines (PACV) survey. Each of the 15 PACV survey items was scored. A score ≥50 identified vaccine hesitant parents. Results A total of 105 parents participated in the study. A small number of participants (6.7%, n = 7) were identified as vaccine hesitant. There were no statistically significant differences between the vaccine hesitant and non-hesitant groups based on age, education, or number of children. Parents had concerns around vaccine side effects (36.2%, n=38) and vaccine safety (20%, n=21). Parents trusted the information they received on vaccines (85.6%, n=90) and 81.9% (n=86) believed that the vaccine schedule was good for their child. Conclusions The findings of this research indicate the presence of vaccine hesitancy in parents in Ireland regarding paediatric vaccines. Parents had concerns regarding vaccine side effects and the number of vaccines on the paediatric immunisation schedule. Further research is necessary to understand how these issues may contribute to vaccine hesitancy, and to develop evidence-based interventions to build on parents existing trust in the vaccination schedule.

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Physicians’ Experience with COVID-19 Vaccination: A Survey Study

Healthcare ◽

10.3390/healthcare9121746 ◽

2021 ◽

Vol 9 (12) ◽

pp. 1746

Author(s):

Alina Dima ◽

Ciprian Jurcut ◽

Daniel Vasile Balaban ◽

Valeriu Gheorghita ◽

Ruxandra Jurcut ◽

...

Keyword(s):

Side Effects ◽

Safety Profile ◽

Vaccine Dose ◽

Vaccine Safety ◽

Survey Study ◽

Vaccine Hesitancy ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Vaccination Rates ◽

Additional Information

Background: COVID-19 vaccine hesitancy remains high in the general population and is the main determinant of low vaccination rates and of the fourth pandemic wave severity in Romania. Additional information is needed to raise awareness over vaccine efficiency and the safety profile. Objective: To assess self-reported experience related to COVID-19 vaccination in Romanian physicians. Design, Setting, and Participants: A cross-sectional, self-administered questionnaire-based survey, distributed online in the period 24 March to 24 May 2021. The survey included 30 cascade questions with skip logic filters. All physicians included filled in the questionnaire voluntarily and anonymously. Not all respondents filled in all questions. Main outcome and measure: Primary outcomes addressed were related to the COVID-19 vaccine safety profile. Results: 407/467 (87.15%) of the respondents’ physicians were fully vaccinated, mostly with the Pfizer—BioNTech (Comirnaty)—BNT162b2 vaccine, with the peak of immunization in January 2021, with almost four-fifths of the study participants. Regarding COVID-19, almost 20% physicians had the infection and one declared COVID-19 re-infection. A number of 48/420 (11.42%) and 47/419 (11.22%) of the vaccinated physicians did not report any side effects after the first or second vaccine dose. However, most of the side effects reported were minor. Only 50/360 (13.88%) physicians reported the vaccine side effects on the dedicated online national platform. Approximately 40% respondents checked the anti-spike SARS-CoV2 antibodies’ titer after complete vaccination, of which two cases reported indeterminate levels. Lower anti-spike SARS-CoV2 antibodies’ titer of 100–1000 times the laboratory limit was more frequent in naive physicians (36.95% versus 14.28%, p = 0.012), moderate titers were similar, while very high levels, more than 10,000 times laboratory limit, were more frequent in physicians with previous COVID-19 infection (2.17% versus 42.85%, p < 0.001). Conclusions and relevance: In this cross-sectional survey study on the COVID-19 vaccination among Romanian physicians, we describe a safety vaccination profile among Romanian physicians.

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Assessing the level and determinants of COVID-19 Vaccine Confidence in Kenya

10.1101/2021.06.11.21258775 ◽

2021 ◽

Author(s):

Stacey Orangi ◽

Jessie Pinchoff ◽

Daniel Mwanga ◽

Timothy Abuya ◽

Mainga Hamaluba ◽

...

Keyword(s):

Public Health ◽

Economic Loss ◽

Vaccine Safety ◽

Cross Sectional Study ◽

Vaccine Hesitancy ◽

Cross Sectional ◽

Major Barrier ◽

The Government ◽

Vaccine Confidence ◽

Context Specific

The government of Kenya has launched a phased rollout of COVID-19 vaccination. A major barrier is vaccine hesitancy; the refusal or delay of accepting vaccination. This study evaluated the level and determinants of vaccine hesitancy in Kenya. We conducted a cross-sectional study administered through a phone-based survey in February 2021 in four counties of Kenya. Multivariate logistic regression was used to identify individual perceived risks and influences, context-specific factors, and vaccine-specific issues associated with COVID-19 vaccine hesitancy. COVID-19 vaccine hesitancy in Kenya was high: 60.1%. Factors associated with vaccine hesitancy included: older age, lower education level, perceived difficulty in adhering to government regulations on COVID-19 prevention, less adherence to wearing of face masks, not having ever been tested for COVID-19, no reported socio-economic loss as a result of COVID public-health restriction measures, and concerns regarding vaccine safety and effectiveness. There is a need for the prioritization of interventions to address vaccine hesitancy and improve vaccine confidence as part of the vaccine roll-out plan. These messaging and/or interventions should be holistic to include the value of other public health measures, be focused and targeted to specific groups, raise awareness on the risks of COVID-19 and effectively communicate the benefits and risks of vaccines.

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COVID-19 Vaccine Hesitancy in the LGBTQ+ Population: A Systematic Review

Infectious Disease Reports ◽

10.3390/idr13040079 ◽

2021 ◽

Vol 13 (4) ◽

pp. 872-887

Author(s):

Ishan Garg ◽

Hamza Hanif ◽

Nismat Javed ◽

Ramsha Abbas ◽

Samir Mirza ◽

...

Keyword(s):

Public Health ◽

Healthcare Providers ◽

Common Factors ◽

Vaccine Safety ◽

Health Policies ◽

Vaccine Hesitancy ◽

Public Health Policies ◽

Building Trust ◽

Factors Influencing ◽

History Of

The coronavirus 2019 (COVID-19) pandemic has disproportionately impacted lesbian, gay, bisexual, transgender, queer (LGBTQ+) people. Despite developing safe and effective COVID-19 vaccines, LGBTQ+ communities still faces challenges due to inequitable access and vaccine hesitancy. Vaccine hesitancy is a delay in the acceptance or refusal of vaccines despite the availability of vaccination services. Various studies have explored and tried to address factors influencing vaccine hesitancy. However, the LGBTQ+ population remains under- and misrepresented in many of these studies. According to the few studies that have focused on the LGBTQ+ population, several factors influencing vaccine hesitancy have been identified, with the most common factors in studies being concern about vaccine safety, vaccine efficacy, and history of bad experiences with healthcare providers. In order to rebuild the confidence of LGBTQ+ people in vaccines, governments, healthcare policymakers, and healthcare providers need to start by acknowledging, and then resolving, these disparities; building trust; dismantling systemic suppression and discrimination; and prioritizing the inclusion of LGBTQ+ people in research studies and public health policies.

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Assessing the Level and Determinants of COVID-19 Vaccine Confidence in Kenya

Vaccines ◽

10.3390/vaccines9080936 ◽

2021 ◽

Vol 9 (8) ◽

pp. 936 ◽

Cited By ~ 1

Author(s):

Stacey Orangi ◽

Jessie Pinchoff ◽

Daniel Mwanga ◽

Timothy Abuya ◽

Mainga Hamaluba ◽

...

Keyword(s):

Vaccine Safety ◽

Cross Sectional Study ◽

Vaccine Hesitancy ◽

Cross Sectional ◽

Major Barrier ◽

Perceived Difficulty ◽

Specific Factors ◽

The Government ◽

Vaccine Confidence ◽

Context Specific

The government of Kenya has launched a phased rollout of COVID-19 vaccination. A major barrier is vaccine hesitancy; the refusal or delay of accepting vaccination. This study evaluated the level and determinants of vaccine hesitancy in Kenya. We conducted a cross-sectional study administered through a phone-based survey in February 2021 in four counties of Kenya. Multilevel logistic regression was used to identify individual perceived risks and influences, context-specific factors and vaccine-specific issues associated with COVID-19 vaccine hesitancy. COVID-19 vaccine hesitancy in Kenya was high: 36.5%. Factors associated with vaccine hesitancy included: Rural regions, perceived difficulty in adhering to government regulations on COVID-19 prevention, no perceived COVID-19 infection risk, concerns regarding vaccine safety and effectiveness, and religious and cultural reasons. There is a need for the prioritization of interventions to address vaccine hesitancy and improve vaccine confidence as part of the vaccine roll-out plan. These messaging and/or interventions should be holistic to include the value of other public health measures, be focused and targeted to specific groups, raise awareness on the risks of COVID-19 and effectively communicate the benefits and risks of vaccines.

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Estimating vaccine confidence levels among healthcare students and staff of a tertiary institution in South Africa: protocol of a cross-sectional survey

BMJ Open ◽

10.1136/bmjopen-2021-049877 ◽

2021 ◽

Vol 11 (5) ◽

pp. e049877

Author(s):

Elizabeth O Oduwole ◽

Hassan Mahomed ◽

Birhanu T Ayele ◽

Charles Shey Wiysonge

Keyword(s):

South Africa ◽

Statistical Significance ◽

Cape Town ◽

Survey Study ◽

Vaccine Hesitancy ◽

P Value ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Confidence Levels ◽

Vaccine Confidence

IntroductionThe outbreak of novel COVID-19 caught the world off guard in the first quarter of 2020. To stem the tide of this pandemic, there was acceleration of the development, testing and prelicensure approval for emergency use of some COVID-19 vaccine candidates. This led to raised public concern about their safety and efficacy, compounding the challenges of vaccine hesitancy. The onus of managing and administering these vaccines to a sceptical populace when they do become available rests mostly on the shoulders of healthcare workers (HCWs). Therefore, the vaccine confidence levels of HCWs become critical to the success of vaccination endeavours. This proposed study aims to estimate the level of vaccine confidence and the intention to receive a COVID-19 vaccine among future HCWs and their trainers at a specific university in Cape Town, South Africa, and to identify any vaccination concerns early for targeted intervention.Methods and analysisThis proposed study is a cross-sectional survey study. An online questionnaire will be distributed to all current staff and students of the Faculty of Medicine Health Sciences of Stellenbosch University in Cape Town, South Africa. No sampling strategy will be employed. The survey questionnaire will consist of demographic questions (consisting of six items) and vaccine confidence questions (comprising six items in Likert scale format). Log binomial models will be employed to identify factors associated with vaccine confidence and intention. The strength of association will be assessed using the OR and its 95% CI. Statistical significance will be defined at a p value <0.05.Ethics and disseminationEthics approval has been obtained for the study from Stellenbosch University (Human Research Ethics Committee reference number S19/01/014 (PhD)). The results will be shared with relevant health authorities, presented at conferences and published in a peer-reviewed journal.

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Factors affecting vaccine hesitancy among families with children 2 years old and younger in two urban communities in Manila, Philippines

Western Pacific Surveillance and Response ◽

10.5365/wpsar.2019.10.2.006 ◽

2020 ◽

Vol 11 (2) ◽

pp. 20-26

Author(s):

Julius Migriño, Jr. ◽

Billy Gayados ◽

Karen Rachel Joyce Birol ◽

Lorelie De Jesus ◽

Christopher Willis Lopez ◽

...

Keyword(s):

Urban Communities ◽

Vaccine Safety ◽

Sociodemographic Factors ◽

Cross Sectional Study ◽

Vaccine Hesitancy ◽

Cross Sectional ◽

Factors Affecting ◽

Media Reports ◽

Vaccine Confidence ◽

Families With Children

Objective: The study aimed to determine the factors that influence vaccine hesitancy among parents and caregivers of children 2 years old and younger in selected urban communities in Manila, Philippines. Methodology: The study used a cross-sectional study design with a modified questionnaire adapted from the SAGE Working Group on Vaccine Hesitancy. Self-administered surveys were conducted in two highly urbanized barangays (smallest administrative divisions) in Manila, Philippines. Results: The survey was completed by 110 respondents, comprised mostly of 20–39-year-old mothers. Most respondents (95.5%) believed that vaccines are protective however vaccine hesitancy rates among the respondents reached 36.4%. Respondents who believed in the protective nature of vaccines were less likely to report vaccine hesitancy and were nine times less likely to refuse vaccination for their children because of negative media exposure. The main reasons identified for vaccine hesitancy were exposure to negative media information and concerns about vaccine safety. The main negative media information identified by the respondents was related to the dengue vaccine, Dengvaxia®. Health-care workers and political leaders were the main supporters of vaccination in the community. Discussion: The recent events surrounding the Dengvaxia® controversy contributed to a decrease in vaccine confidence. The role of mass media in vaccine hesitancy was highlighted in this study, supporting previous evidence that vaccine hesitant parents tend to be more susceptible to media reports. The lack of association between sociodemographic factors and vaccine hesitancy implies that the determinants of vaccine hesitancy can be highly varied depending on context and setting.

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