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

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.

Attitudes towards vaccines and intention to vaccinate against COVID-19: a cross-sectional analysis—implications for public health communications in Australia

ObjectiveTo examine SARS-CoV-2 vaccine confidence, attitudes and intentions in Australian adults as part of the iCARE Study.Design and settingCross-sectional online survey conducted when free COVID-19 vaccinations first became available in Australia in February 2021.ParticipantsTotal of 1166 Australians from general population aged 18–90 years (mean 52, SD of 19).Main outcome measuresPrimary outcome: responses to question ‘If a vaccine for COVID-19 were available today, what is the likelihood that you would get vaccinated?’.Secondary outcome: analyses of putative drivers of uptake, including vaccine confidence, socioeconomic status and sources of trust, derived from multiple survey questions.ResultsSeventy-eight per cent reported being likely to receive a SARS-CoV-2 vaccine. Higher SARS-CoV-2 vaccine intentions were associated with: increasing age (OR: 2.01 (95% CI 1.77 to 2.77)), being male (1.37 (95% CI 1.08 to 1.72)), residing in least disadvantaged area quintile (2.27 (95% CI 1.53 to 3.37)) and a self-perceived high risk of getting COVID-19 (1.52 (95% CI 1.08 to 2.14)). However, 72% did not believe they were at a high risk of getting COVID-19. Findings regarding vaccines in general were similar except there were no sex differences. For both the SARS-CoV-2 vaccine and vaccines in general, there were no differences in intentions to vaccinate as a function of education level, perceived income level and rurality. Knowing that the vaccine is safe and effective and that getting vaccinated will protect others, trusting the company that made it and vaccination recommended by a doctor were reported to influence a large proportion of the study cohort to uptake the SARS-CoV-2 vaccine. Seventy-eight per cent reported the intent to continue engaging in virus-protecting behaviours (mask wearing, social distancing, etc) postvaccine.ConclusionsMost Australians are likely to receive a SARS-CoV-2 vaccine. Key influencing factors identified (eg, knowing vaccine is safe and effective, and doctor’s recommendation to get vaccinated) can inform public health messaging to enhance vaccination rates.

Predictors of COVID-19 Vaccine Confidence: Findings from Slums of Four Major Metro Cities of India

There are limited studies on COVID vaccine confidence at the household level in urban slums, which are at high risk of COVID-19 transmission due to overcrowding and poor living conditions. The objective was to understand the reasons influencing COVID-19 vaccine confidence, in terms of barriers and enablers faced by communities in urban slums and informal settlements in four major metro cities in India. A mixed method approach was adopted, where in field studies were conducted during April–May 2021. First, a survey of at least 50 subjects was conducted among residents of informal urban settlements who had not taken any dose of the COVID-19 vaccine in Mumbai, Bengaluru, Kolkata and Delhi; second, a short interview with five subjects who had taken at least one dose of the vaccine in each of the four cities to understand the factors that contributed to positive behaviour and, finally, an in-depth interview of at least 3 key informants in each city to ascertain the vaccination pattern in the communities. The reasons were grouped under contextual, individual/group and vaccine/vaccination specific issues. The most frequent reason (27.7%) was the uncertainty of getting the vaccine. The findings show the need for increasing effectiveness of awareness campaigns, accessibility and the convenience of vaccination, especially among vulnerable groups, to increase the uptake.

COVID-19 Vaccine Acceptance is associated with Vaccine Hesitancy, Perceived Risk and Previous Vaccination Experiences

Objective: This study examines the factors associated with the willingness to get the coronavirus vaccine among individuals aged 18 and above. Methods: This cross-sectional study was conducted in Turkey. The participants aged 18 and older were recruited between December 2020 and January 2021 through conventional social media sites. Snowball sampling was used. An anonymous questionnaire consisted of demographics, vaccination experiences, and perceived risk of coronavirus disease. Results: 1202 women and 651 men were included in the data analysis. Findings showed that demographics, vaccinations experience, and perceived risk of getting COVID-19 were explained 37% of the variance in people’s willingness to get the COVID-19 vaccination according to hierarchical logistic regression. Furthermore, increasing age, being male, acquiring positive information about COVID-19 vaccines, having a lower level of vaccine hesitancy, the high level of worry about the COVID-19 and low level of perceptions of the possibility of becoming infected by the COVID-19 were the main predictors of COVID-19 vaccine willingness. Conclusions: Factors affecting adults’ willingness to be inoculated with COVID-19 vaccines were related to demographics, vaccination experiences, and perceived risk of getting COVID-19. We recommend that public health authorities and practitioners should consider these multiple factors regarding vaccine confidence to achieve herd immunity.

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

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

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.

Assessing Acceptability of COVID-19 Vaccine Booster Dose among Adult Americans: A Cross-Sectional Study

Given the emergence of breakthrough infections, new variants, and concerns of waning immunity from the primary COVID-19 vaccines, booster shots emerged as a viable option to shore-up protection against COVID-19. Following the recent authorization of vaccine boosters among vulnerable Americans, this study aims to assess COVID-19 vaccine booster hesitancy and its associated factors in a nationally representative sample. A web-based 48-item psychometric valid survey was used to measure vaccine literacy, vaccine confidence, trust, and general attitudes towards vaccines. Data were analyzed through Chi-square (with a post hoc contingency table analysis) and independent-sample t-/Welch tests. Among 2138 participants, nearly 62% intended to take booster doses and the remaining were COVID-19 vaccine booster hesitant. The vaccine-booster-hesitant group was more likely to be unvaccinated (62.6% vs. 12.9%) and did not intend to have their children vaccinated (86.1% vs. 27.5%) compared to their non-hesitant counterparts. A significantly higher proportion of booster dose hesitant individuals had very little to no trust in the COVID-19 vaccine information given by public health/government agencies (55% vs. 12%) compared to non-hesitant ones. The mean scores of vaccine confidence index and vaccine literacy were lower among the hesitant group compared to the non-hesitant group. Compared to the non-hesitant group, vaccine hesitant participants were single or never married (41.8% vs. 28.7%), less educated, and living in a southern region of the nation (40.9% vs. 33.3%). These findings underscore the need of developing effective communication strategies emphasizing vaccine science in ways that are accessible to individuals with lower levels of education and vaccine literacy to increase vaccination uptake.

An ethical analysis of vaccinating children against COVID-19: benefits, risks, and issues of global health equity

COVID-19 vaccination of children has begun in various high-income countries with regulatory approval and general public support, but largely without careful ethical consideration. This trend is expected to extend to other COVID-19 vaccines and lower ages as clinical trials progress. This paper provides an ethical analysis of COVID-19 vaccination of healthy children. Specifically, we argue that it is currently unclear whether routine COVID-19 vaccination of healthy children is ethically justified in most contexts, given the minimal direct benefit that COVID-19 vaccination provides to children, the potential for rare risks to outweigh these benefits and undermine vaccine confidence, and substantial evidence that COVID-19 vaccination confers adequate protection to risk groups, such as older adults, without the need to vaccinate healthy children. We conclude that child COVID-19 vaccination in wealthy communities before adults in poor communities worldwide is ethically unacceptable and consider how policy deliberations might evolve in light of future developments.

Pay-it-forward to improve influenza vaccine uptake and public engagement among children and older adults in China: A three-arm quasi-experimental study

China has low seasonal influenza vaccination rates among children and older adults. This quasi-experimental pragmatic trial examined the effectiveness of a pay-it-forward intervention on influenza vaccination compared to standard of care (user-paid vaccination) and free vaccination strategies among children and older people in China (ChiCTR2000040048). In pay-it-forward, people receive a free influenza vaccine from a local group and are offered an opportunity to donate financially to support vaccination among future individuals. The primary outcome was pre-specified as influenza vaccine uptake. Secondary outcomes included vaccine confidence and associated costs. Among 450 participants enrolled, 55/150 (36.7%) in the standard of care arm, 111/150 (74.0%) in the pay-it-forward arm, and 114/150 (76.0%) in the free vaccination arm received an influenza vaccine. The pay-it-forward arm had significantly higher vaccine confidence when compared to the standard of care arm. In the pay-it-forward arm, 107/111 (96.4%) of participants donated money for subsequent vaccinations and 19 of 60 invited (31.7%) created postcard messages.