Predictors of COVID-19 Vaccine Acceptance and Hesitancy among Healthcare Workers in Southern California: Not Just “Anti” vs. “Pro” Vaccine

In this study, we evaluated the status of and attitudes toward COVID-19 vaccination of healthcare workers in two major hospital systems (academic and private) in Southern California. Responses were collected via an anonymous and voluntary survey from a total of 2491 participants, including nurses, physicians, other allied health professionals, and administrators. Among the 2491 participants that had been offered the vaccine at the time of the study, 2103 (84%) were vaccinated. The bulk of the participants were middle-aged college-educated White (73%), non-Hispanic women (77%), and nursing was the most represented medical occupation (35%). Political affiliation, education level, and income were shown to be significant factors associated with vaccination status. Our data suggest that the current allocation of healthcare workers into dichotomous groups such as “anti-vaccine vs. pro-vaccine” may be inadequate in accurately tailoring vaccine uptake interventions. We found that healthcare workers that have yet to receive the COVID-19 vaccine likely belong to one of four categories: the misinformed, the undecided, the uninformed, or the unconcerned. This diversity in vaccine hesitancy among healthcare workers highlights the importance of targeted intervention to increase vaccine confidence. Regardless of governmental vaccine mandates, addressing the root causes contributing to vaccine hesitancy continues to be of utmost importance.

Download Full-text

Adenovirus and RNA-based COVID-19 vaccines’ perceptions and acceptance among healthcare workers in Saudi Arabia: a national survey

BMJ Open ◽

10.1136/bmjopen-2020-048586 ◽

2021 ◽

Vol 11 (6) ◽

pp. e048586

Author(s):

Mohamad-Hani Temsah ◽

Mazin Barry ◽

Fadi Aljamaan ◽

Abdullah Alhuzaimi ◽

Ayman Al-Eyadhy ◽

...

Keyword(s):

Saudi Arabia ◽

Healthcare Workers ◽

Online Survey ◽

Healthcare Providers ◽

Vaccine Uptake ◽

Vaccine Hesitancy ◽

Cross Sectional ◽

Validated Questionnaire ◽

Vectored Vaccine ◽

To Receive

ObjectivesThe aim of this study was to compare the perception, confidence, hesitancy and acceptance rate of various COVID-19 vaccine types among healthcare workers (HCWs) in Saudi Arabia, a nation with Middle East respiratory syndrome coronavirus experience.DesignNational cross-sectional, pilot-validated questionnaire.SettingOnline, self-administered questionnaire among HCWs.ParticipantsA total of 2007 HCWs working in the Kingdom of Saudi Arabia participated; 1512 (75.3%) participants completed the survey and were included in the analysis.InterventionData were collected through an online survey sent to HCWs during 1–15 November 2020. The main outcome measure was HCW acceptance of COVID-19 candidate vaccines. The associated factors of vaccination acceptance were identified through a logistic regression analysis and via measurement of the level of anxiety, using the Generalised Anxiety Disorder 7 scale.ResultsAmong the 1512 HCWs who were included, 62.4% were women, 70.3% were between 21 and 40 years of age, and the majority (62.2%) were from tertiary hospitals. In addition, 59.5% reported knowing about at least one vaccine; 24.4% of the participants were sure about their willingness to receive the ChAdOx1 nCoV-19 vaccine, and 20.9% were willing to receive the RNA BNT162b2 vaccine. However, 18.3% reported that they would refuse to receive the Ad5-vectored vaccine, and 17.9% would refuse the Gam-COVID-Vac vaccine. Factors that influenced the differential readiness of HCWs included their perceptions of the vaccine’s efficiency in preventing the infection (33%), their personal preferences (29%) and the vaccine’s manufacturing country (28.6%).ConclusionsAwareness by HCWs of the several COVID-19 candidate vaccines could improve their perceptions and acceptance of vaccination. Reliable sources on vaccine efficiency could improve vaccine uptake, so healthcare authorities should use reliable information to decrease vaccine hesitancy among frontline healthcare providers.

Download Full-text

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.

Download Full-text

A Community-Based Management of COVID-19 in a Mobile Container Unit

Vaccines ◽

10.3390/vaccines9111362 ◽

2021 ◽

Vol 9 (11) ◽

pp. 1362

Author(s):

Elena Petrova ◽

Timothy Farinholt ◽

Tejas P. Joshi ◽

Hannah Moreno ◽

Mayar Al Mohajer ◽

...

Keyword(s):

Healthcare Workers ◽

Vaccine Coverage ◽

The United States ◽

Vaccine Uptake ◽

Vaccine Hesitancy ◽

Air Filtration ◽

Clinical Environment ◽

Mobile Clinic ◽

Community Based ◽

Community Healthcare

Vaccine uptake is a multifactor measure of successful immunization outcomes that includes access to healthcare and vaccine hesitancy for both healthcare workers and communities. The present coronavirus disease (COVID-19) pandemic has highlighted the need for novel strategies to expand vaccine coverage in underserved regions. Mobile clinics hold the promise of ameliorating such inequities, although there is a paucity of studies that validate environmental infection in such facilities. Here, we describe community-based management of COVID-19 through a Smart Pod mobile clinic deployed in an underserved community area in the United States (Aldine, Harris County, TX, USA). In particular, we validate infection control and biological decontamination of the Smart Pod by testing surfaces and the air-filtration system for the COVID-19 virus and bacterial pathogens. We show the Smart Pod to be efficacious in providing a safe clinical environment for vaccine delivery. Moreover, in the Smart Pod, up-to-date education of community healthcare workers was provided to reduce vaccine hesitancy and improve COVID-19 vaccine uptake. The proposed solution has the potential to augment existing hospital capacity and combat the COVID-19 pandemic locally and globally.

Download Full-text

569. Characterization of COVID-19 Vaccine Breakthrough Infections in Metropolitan Detroit

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab466.767 ◽

2021 ◽

Vol 8 (Supplement_1) ◽

pp. S386-S386

Author(s):

Nicholas sturla ◽

Rita Kassab ◽

Rafa Khansa ◽

Thomas Chevalier ◽

David Allard ◽

...

Keyword(s):

Healthcare Workers ◽

Vaccine Uptake ◽

Effective Vaccine ◽

Breakthrough Infection ◽

Respiratory Sample ◽

Asymptomatic Patients ◽

The Status ◽

Henry Ford ◽

Heart Failure Exacerbation

Abstract Background Although COVID-19 vaccines are very effective, vaccine breakthrough infections have been reported, albeit rarely. When they do occur, people generally have milder COVID-19 illness compared to unvaccinated people. A total of 10,262 (0.01%) SARS-CoV-2 vaccine breakthrough infections had been reported as of April 30, 2021. The objective of this study was to evaluate the effectiveness of COVID-19 vaccines and characterize breakthrough infections in our patient population. Methods This was a retrospective review of all consecutive COVID-19 vaccine breakthrough infections at Henry Ford Health System (HFHS) in metropolitan Detroit, Michigan, from December 17, 2020 to June 7, 2021. Centers for Disease Control (CDC)'s breakthrough infection definition (detection of SARS-CoV-2 RNA or antigen in a respiratory sample ≥14 days after completion all recommended doses of COVID-19 vaccine) was used to identify cases. Vaccination status was extracted from the electronic medical records using Epic™ SlicerDicer. Results A total of 228,674 patients, including healthcare workers (HCW), were fully vaccinated in our healthcare system. We evaluate 299 patients for breakthrough infection but only 179 (0.08%) patients met the definition; 108 (60%) were female with median age of 59, 60 (33%) were HCW, and 11 (6%) were immunocompromised. The majority (92%) were asymptomatic (62 or 35%) or had mild/moderate illness (102 or 57%); 14 (8%) had severe or critical illness. The status of one patient was unknown. Of those who were symptomatic, 24 (13%) required hospitalization, and 3 (2%) required intensive unit care. One patient admitted for heart failure exacerbation died unexpectedly prior to being discharged. Nine had previous COVID-19 within 4 months but only one was symptomatic; this likely represented residual shedding in the asymptomatic patients. Conclusion COVID-19 vaccine was very effective among our patients and breakthrough infections were rare. Moreover, the vaccine reduced disease severity and mortality. Efforts should aim to increase vaccine uptake. Disclosures All Authors: No reported disclosures

Download Full-text

Spirituality and other factors associated with COVID-19 Vaccine Acceptance amongst Healthcare Workers in Cameroon

10.21203/rs.3.rs-712354/v1 ◽

2021 ◽

Author(s):

Neh Chang Ngasa ◽

Stewart Ndutard Ngasa ◽

Leticia Armelle Sani Tchouda ◽

Eugénie Tanisso ◽

Christabel Abanda ◽

...

Keyword(s):

Healthcare Workers ◽

Online Survey ◽

Vaccine Uptake ◽

Vaccine Hesitancy ◽

Microsoft Excel ◽

Cross Sectional ◽

Vaccine Acceptance ◽

Frontline Workers ◽

Factors Associated ◽

Negative Perceptions

Abstract Background: The production of the different COVID-19 vaccines has offered hope towards controlling the pandemic. Many governments around the world have been able to secure the number of doses required for the vaccination of their entire population. In Cameroon, the government’s strategy has been to secure the number of doses required to vaccinate frontline workers and other population at risk. A threat to this strategy could be vaccine hesitancy as demonstrated in previous studies. In this article we discussed the influence of spirituality on vaccine acceptance. We also examined other factors associated with vaccine acceptance amongst healthcare workers in Cameroon. Methods: This was a cross-sectional online survey of healthcare workers in Cameroon. Data was collected using Surveysparrow and then computed into Microsoft Excel. All analysis were done using Stata 14. Results: A total number of 371 healthcare workers took part in the survey and 45.38% indicated willingness to accept the vaccine if offered. The most common reason advanced for non-acceptance of the vaccine was negative perceptions about the efficacy of the vaccines. Independent factors associated with COVID-19 vaccine acceptance following a multivariate logistic regression included: being married (AOR 1.13, p< 0.01), presence of comorbidity (AOR:2.10, p<0.02), participants who had direct contact with covid patients (AOR: 3.34, p<0.01). Spirituality level was not independently associated with vaccine acceptance (AOR: 1.12, p<0.63). Conclusion: COVID-19 vaccine acceptance amongst healthcare workers in Cameroon is low. This is likely to reduce the vaccine uptake amongst healthcare workers. HCWs are in the best position to influence the uptake of these vaccines by the general population, therefore educating healthcare workers on the efficacy of these vaccines might improve their acceptance.

Download Full-text

Determinants of COVID-19 vaccine hesitancy and vaccine uptake in a national cohort of U.S. adults

10.1101/2021.05.12.21257116 ◽

2021 ◽

Author(s):

Madhura S Rane ◽

Shivani Kochhar ◽

Emily Poehlein ◽

William You ◽

McKaylee Robertson ◽

...

Keyword(s):

Public Health ◽

Healthcare Workers ◽

Vaccine Uptake ◽

Vaccine Hesitancy ◽

Lower Odds ◽

The Public ◽

National Longitudinal Study ◽

Public Health Threat ◽

National Cohort ◽

The U.S

Background Vaccine hesitancy in the U.S. may limit the potential to alleviate the public health threat caused by the COVID-19 pandemic. Methods We estimated trends in and correlates of vaccine hesitancy, and its association with subsequent vaccine uptake among 5,085 United States adults from the CHASING COVID Cohort study, a national longitudinal study. Trends in willingness to vaccinate were examined longitudinally in three rounds of interviews from September to December 2020. We assessed correlates of willingness to vaccinate in December 2020. We also estimated the association between willingness to vaccinate in December 2020 and subsequent vaccine uptake in February 2021. Results Vaccine hesitancy and resistance decreased from 51% and 8% in September 2020 to 35% and 5% in December 2020, respectively. Compared to Non-Hispanic (NH) White participants, NH Black and Hispanic participants had higher adjusted odds ratios (aOR) for both vaccine hesitancy (aOR: 3.3 [95% CI: 2.6, 4.2] for NH Black and 1.8 [95% CI: 1.5, 2.2] for Hispanic) and vaccine resistance (aOR: 6.4 [95% CI: 4.3, 9.4] for NH Black and 1.9 [95% CI: 1.3, 2.7] for Hispanic). Willingness to vaccinate was associated with lower odds of vaccine uptake among 65+ year olds (aOR: 0.4, 95% CI: 0.3, 0.6 for hesitancy; aOR: 0.1, 95% CI: 0.01, 0.6 for resistance) and healthcare workers (aOR: 0.2, 95% CI: 0.1, 0.3 for hesitancy; aOR: 0.04, 95% CI: 0.006, 0.2 for resistance). Conclusions Awareness and distribution efforts should focus on vaccine hesitant vulnerable populations.

Download Full-text

Estimating vaccine confidence levels among future healthcare workers and their trainers: A quantitative study protocol

10.1101/2021.02.03.21251068 ◽

2021 ◽

Author(s):

Elizabeth O. Oduwole ◽

Hassan Mahomed ◽

Birhanu T. Ayele ◽

Charles S. Wiysonge

Keyword(s):

Healthcare Workers ◽

Online Survey ◽

Multinomial Logistic Regression ◽

Statistical Significance ◽

Vaccine Hesitancy ◽

P Value ◽

List Type ◽

Confidence Levels ◽

Vaccine Confidence ◽

To Receive

ABSTRACTIntroductionThe outbreak of novel coronavirus disease 2019 (COVID-19) caught the world off guard in the first quarter of the year 2020. To stem the tide of this pandemic, the development, testing, and pre-licensure approval for emergency use of some COVID 19 vaccine candidates were accelerated. This led to raised public concern about their safety and efficacy, compounding the challenges of vaccine hesitancy which was already declared one of the top ten threats to global health in the year 2019. The onus of managing and administering these vaccines to a skeptical populace when they do become available rests mostly on the shoulders of healthcare workers (HCWs). Therefore, the vaccine confidence levels of HCWs becomes critical to the success of vaccination endeavors, especially COVID 19 vaccination. 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 analysisAn online survey will be distributed to current staff and students of an academic institution for HCWs. The survey questionnaire will consist of a demographic questions section consisting of six items and a vaccine confidence section comprising six items in Likert scale format.A multinomial logistic regression model will be employed to identify factors associated with vaccine confidence and intention. The strength of association will be assessed using odds ratio and its 95% confidence interval. Statistical significance will be defined at a p-value <0.05.Ethics and disseminationEthics approval has been obtained for the study from Stellenbosch University (HREC Reference # S19/01/014 (PhD)). The results will be shared with relevant health authorities, presented at conferences, and published in a peer-reviewed journal.ARTICLE SUMMARYStrengths and limitations of this study▸The proposed study will generate baseline knowledge of the vaccine confidence among future healthcare workers and their trainers in its specific context.▸It will contribute to addressing the knowledge gap about the intention to receive a COVID 19 vaccine among health care workers in Africa.▸It will enable the early identification of vaccine concerns of healthcare workers while they are still in training and assist in informing tailored measures to address them.▸A limitation of the study is the possibility of a low response rate which is an inherent challenge of online surveys.

Download Full-text

Vaccine Confidence and Hesitancy at the Start of COVID-19 Vaccine Deployment in the UK: An Embedded Mixed-Methods Study

Frontiers in Public Health ◽

10.3389/fpubh.2021.745630 ◽

2021 ◽

Vol 9 ◽

Author(s):

Chrissy h. Roberts ◽

Hannah Brindle ◽

Nina T. Rogers ◽

Rosalind M. Eggo ◽

Luisa Enria ◽

...

Keyword(s):

Mixed Methods ◽

Online Survey ◽

Vaccine Development ◽

Collective Responsibility ◽

Vaccine Uptake ◽

Vaccine Hesitancy ◽

Demographic Groups ◽

Vaccine Confidence ◽

The Uk ◽

Dominant Narratives

Background: Approval for the use of COVID-19 vaccines has been granted in a number of countries but there are concerns that vaccine uptake may be low amongst certain groups.Methods: This study used a mixed methods approach based on online survey and an embedded quantitative/qualitative design to explore perceptions and attitudes that were associated with intention to either accept or refuse offers of vaccination in different demographic groups during the early stages of the UK's mass COVID-19 vaccination programme (December 2020). Analysis used multivariate logistic regression, structural text modeling and anthropological assessments.Results: Of 4,535 respondents, 85% (n = 3,859) were willing to have a COVID-19 vaccine. The rapidity of vaccine development and uncertainties about safety were common reasons for COVID-19 vaccine hesitancy. There was no evidence for the widespread influence of mis-information, although broader vaccine hesitancy was associated with intentions to refuse COVID-19 vaccines (OR 20.60, 95% CI 14.20–30.30, p < 0.001). Low levels of trust in the decision-making (OR 1.63, 95% CI 1.08, 2.48, p = 0.021) and truthfulness (OR 8.76, 95% CI 4.15–19.90, p < 0.001) of the UK government were independently associated with higher odds of refusing COVID-19 vaccines. Compared to political centrists, conservatives and liberals were, respectively, more (OR 2.05, 95%CI 1.51–2.80, p < 0.001) and less (OR 0.30, 95% CI 0.22–0.41, p < 0.001) likely to refuse offered vaccines. Those who were willing to be vaccinated cited both personal and public protection as reasons, with some alluding to having a sense of collective responsibility.Conclusion: Dominant narratives of COVID-19 vaccine hesitancy are misconceived as primarily being driven by misinformation. Key indicators of UK vaccine acceptance include prior behaviors, transparency of the scientific process of vaccine development, mistrust in science and leadership and individual political views. Vaccine programmes should leverage the sense of altruism, citizenship and collective responsibility that motivated many participants to get vaccinated.

Download Full-text

COVID-19 Vaccine Acceptance Among Healthcare Workers in a United States Medical Center

10.1101/2021.04.29.21256186 ◽

2021 ◽

Author(s):

Michelle H. Moniz ◽

Courtney Townsel ◽

Abram L. Wagner ◽

Brian J. Zikmund-Fisher ◽

Sarah Hawley ◽

...

Keyword(s):

United States ◽

Logistic Regression ◽

Regression Models ◽

Healthcare Workers ◽

Vaccine Uptake ◽

Vaccine Hesitancy ◽

Vaccine Acceptance ◽

Logistic Regression Models ◽

Occupational Characteristics ◽

To Receive

ABSTRACTBackgroundThe Centers for Disease Control and Prevention prioritized healthcare personnel for the first phase of COVID-19 vaccination in the United States to keep critical healthcare infrastructure open and functioning, but vaccine hesitancy may limit vaccine uptake.ObjectiveTo evaluate vaccine intentions among healthcare workers eligible for COVID-19 vaccination and explore differences by sociodemographic and occupational characteristics.DesignFrom February 1-15, 2021, we conducted a cross-sectional, opt-in online survey at a Midwest U.S. academic healthcare center that began vaccinating employees in December 2020.ParticipantsThe entire employee workforce of the study site was eligible.Main MeasuresCOVID-19 vaccination intention, categorized as Received/Scheduled/ASAP, Not Now, and Not Ever. Logistic regression models to assess the relationship between demographic and occupational characteristics and intention to receive COVID-19 vaccination.Key ResultsMost participants (n=11,387, of 39,259 individual and group email accounts invited) had received or were scheduled to receive the COVID-19 vaccine (n=9081, 79.8%) or planned to receive it as soon as possible (n=546, 4.8%), while fewer were hesitant (Not Now, n=954, 8.4%; Not Ever, n=369, 3.2%). In multivariable logistic regression models predicting vaccine intention, physicians (aOR 22.2, 9.1-54.3), trainees (aOR 5.9, 3.0-11.4), and nurse practitioners/nurse midwives/physician assistants (aOR 1.9, 1.2-3.0) were significantly more likely to demonstrate vaccine acceptance, compared to nurses, whereas other clinical staff were significantly less likely (aOR 0.8, 0.6-0.9). Prior infection with COVID-19, gender, race/ethnicity, and age were all significantly associated with vaccine intention. Overall, 29.6% reported at least one concern about COVID-19 vaccination.ConclusionsIn a large, diverse sample of healthcare workers, over 11% delayed COVID-19 vaccination when it was available to them, with notable variation in vaccine hesitancy across professional roles and demographic groups. Our findings suggest immediate opportunities to empathetically engage those with COVID-19 vaccine concerns and optimize vaccine coverage across our healthcare system.

Download Full-text

Peoples’ attitude toward COVID-19 vaccine, acceptance, and social trust among African and Middle East countries

Health Promotion Perspectives ◽

10.34172/hpp.2021.21 ◽

2021 ◽

Vol 11 (2) ◽

pp. 171-178

Author(s):

Nasim Asadi Faezi ◽

Pourya Gholizadeh ◽

Moussa Sanogo ◽

Amadou Oumarou ◽

Maad Nasser Mohamed ◽

...

Keyword(s):

Higher Education ◽

Healthcare Workers ◽

Social Trust ◽

Vaccine Uptake ◽

Vaccine Hesitancy ◽

Attitudes And Beliefs ◽

Change Strategies ◽

Vaccine Acceptance ◽

Middle East Countries ◽

Study Population

Background: To end the COVID-19 pandemic, a large part of the world must be immune to the virus by vaccination. Therefore, this study aimed to gauge intent to be vaccinated against COVID-19 among ordinary people and to identify attitudes towards vaccines and barriers for vaccine acceptance. Methods: The study population comprises 1880 people residing in different countries that answer a prepared questionnaire. The questionnaire topics are demographics, historical issues, participants’ attitudes and beliefs regarding vaccines, concerns, and vaccine hesitancy. Results: Attitudes and beliefs relating to vaccines in general, and the COVID-19 vaccine, were ascertained. Overall, 66.81% of the contributors would like to be vaccinated against COVID-19, while %33.19 did not intend to be vaccinated. Reasons for COVID-19 vaccine hesitancy included concern regarding vaccine side effects, fear of getting sick from the uptake of the vaccine, and the absence of accurate vaccine promotion news. Individuals with higher education believe that India (68.6%) produces the best vaccine (P<0.001), while healthcare workers think the Chinese vaccine (44.2%) is the best (P=0.020). Individuals with higher education have not been vaccinated, not be healthcare workers, and females were the most contributors to effective of the vaccine in reducing mortality from COVID-19 disease. Conclusion: Given the degree of hesitancy against COVID-19 vaccination, a multifaceted approach to facilitate vaccine uptake that includes vaccine education, behavioral change strategies, and health promotion, is paramount.

Download Full-text