Cross-national vaccine concerns and predictors of vaccine hesitancy in not-fully vaccinated individuals: findings from USA, Canada, Sweden, and Italy

Vaccine hesitancy is a key contributor to reduced COVID-19 vaccine uptake and remains a threat to COVID-19 mitigation strategies as many countries are rolling out the campaign for booster shots. The goal of our study is to identify and compare the top vaccine concerns in four countries: Canada, Italy, Sweden, and the USA and how these concerns relate to vaccine hesitancy. While most individuals in these countries are now vaccinated, we expect our results to be helpful in guiding vaccination efforts for additional doses, and more in general for other vaccines in the future. We sought to empirically test whether vaccine related concerns followed similar thematic issues in the four countries included in this study, and then to see how these themes related to vaccine hesitancy using data from a cross-sectional survey conducted in May 2021. We applied CFA and created vaccine concern scales for analysis. We then utilized these results in regression-based modeling to determine how concerns related to vaccine hesitancy and whether there were similar or different concerns by country. The results quantitatively highlight that the same vaccine related concerns permeated multiple countries at the same point in time. This implies that COVID-19 vaccination communications could benefit from global collaboration

Freedom of choice to vaccinate and COVID-19 vaccine hesitancy in Italy

Despite the availability of effective vaccines that lower mortality and morbidity associated with COVID-19, many countries including Italy have adopted strict vaccination policies and mandates to increase the uptake of the COVID-19 vaccine. Such mandates have sparked debates on the freedom to choose whether or not to get vaccinated. In this study, we examined the people's belief in vaccine choice as a predictor of willingness to get vaccinated among a sample of unvaccinated individuals in Italy. An online cross-sectional survey was conducted in Italy in May 2021. The survey collected data on respondents' demographics and region of residence, socioeconomic factors, belief in the freedom to choose to be vaccinated or not, risk perception of contracting and transmitting the disease, previous vaccine refusal, opinion on adequacy of government measures to address the pandemic, experience in requesting and being denied government aid during the pandemic, and intent to accept COVID-19 vaccination. The analysis employed binary logistic regression models using a hierarchical model building approach to assess the association between intent to accept vaccination and belief in the freedom to choose to vaccinate, while adjusting for other variables of interest. 984 unvaccinated individuals were included in the study. Respondents who agreed that people should be free to decide whether or not to vaccinate with no restrictions on their personal life had 85% lower odds of vaccine acceptance (OR = 0.15; 95% CI, 0.09,0.23) after adjusting for demographic and socioeconomic factors and their risk perception of contracting and transmitting COVID-19. Belief in the freedom to choose whether or not to accept vaccinations was a major predictor of COVID-19 vaccine acceptance among a sample of unvaccinated individuals in Italy in May 2021. This understanding of how individuals prioritize personal freedoms and the perceived benefits and risks of vaccines, when making health care decisions can inform the development of public health outreach, educational programs, and messaging

The Use of a Scenario-Based Nominal Group Technique to Assess P/CVE Programs: Development and Pilot Testing of a Toolkit

Preventing and countering violent extremism (P/CVE) requires coordination among multiple agencies, stakeholders and systems. The complexity of this task (compounded by the variety of P/CVE programming around the world) creates a  challenge for those hoping to develop these initiatives. The purpose of this project was to develop a replicable process and corresponding toolkit to engage multiple stakeholders in consensus building around the efficacy and improvement of nascent, developing or mature systems-level P/CVE programs. As a method, we adapted the process of nominal group technique (NGT), a structured-brainstorming tool that provides an orderly procedure for obtaining qualitative and ranked information from heterogenous participant pools. The technique we developed is based on a case-study approach (“scenario”) which we then tested in three countries (USA, Sweden, and North Macedonia) with existing P/CVE initiatives at different stages of development. We conducted scenario-based NGT sessions in each location and then systematically analyzed the results using iterative qualitative coding based on a common framework. Results were analyzed to achieve consensus on the most common system-level challenges and system-level functions, necessary to overcome those challenges, in each location. Practitioners in each local jurisdiction were then able to utilize the results derived from the NGT for their own purposes, such as advocacy to policy makers, strategic regional P/CVE planning, and ongoing stakeholder engagement. Acknowledgments: This project was funded by the NATO Science for Peace and Security Programme under the award entitled "Evaluation Support for CVE at the Local Level" SPS.MYPG5556, the Swedish Contingency Agency (MSB), and the U.S. Department of Homeland Security (DHS), Science and Technology Directorate (Cooperative Agreement Number: 2015-ST-108-FRG005). The content of this manuscript as well as the views and discussions expressed are solely those of the authors and do not necessarily represent the official views of any of the above institutions, nor does mention of trade names, commercial practices, or organizations imply endorsement by the U.S. government

COVID-19 vaccine uptake, confidence and hesitancy in rural KwaZulu-Natal, South Africa between April 2021 and April 2022: A continuous cross-sectional surveillance study

High COVID-19 vaccine hesitancy in South Africa limits protection against future epidemic waves. We evaluated how vaccine hesitancy and its correlates evolved April 2021-April 2022 in a well-characterized rural KwaZulu-Natal setting. All residents aged >15 in the Africa Health Research Institute's surveillance area were invited to complete a home-based, in-person interview. We described vaccine uptake and hesitancy trends, then evaluated associations with pre-existing personal factors, dynamic environmental context, and cues to action using ordinal logistic regression. Among 10,011 respondents, vaccine uptake rose as age-cohorts became vaccine-eligible before levelling off three months post-eligibility; younger age-groups had slower uptake and plateaued faster. Lifetime receipt of any COVID-19 vaccine rose from 3.0% in April-July 2021 to 32.9% in January-April 2022. Among 7,445 unvaccinated respondents, 47.7% said they would definitely take a free vaccine today in the first quarter of the study time period, falling to 32.0% in the last. By March/April 2022 only 48.0% of respondents were vaccinated or said they would definitely would take a vaccine. Predictors of lower vaccine hesitancy included being male (adjusted odds ratio [aOR]: 0.70, 95% confidence interval [CI]: 0.65-0.76), living with vaccinated household members (aOR:0.65, 95%CI: 0.59-0.71) and knowing someone who had had COVID-19 (aOR: 0.69, 95%CI: 0.59-0.80). Mistrust in government predicted greater hesitancy (aOR: 1.47, 95%CI: 1.42-1.53). Despite several COVID-19 waves, vaccine hesitancy was common in rural South Africa, rising over time and closely tied to mistrust in government. However, interpersonal experiences countered hesitancy and may be entry-points for interventions

Safety, Efficacy, and Ill Intent: Examining COVID-19 Vaccine Perceptions among the New Undervaccinated Moveable Middle in a U.S. Cohort, October 2022

Individuals who received their primary vaccine series only (with no subsequent booster) may be a new type of “moveable middle” given their receipt of the original COVID-19 vaccination. One population within the moveable middle for whom tailored interventions may be needed is individuals with common mental disorders (CMD). The purpose of this paper is to understand the vaccine perceptions among this new moveable middle—the undervaccinated—and within the undervaccinated to examine the extent to which COVID-19 vaccine perceptions and motivations differ among those with and without symptoms of CMD. Using data from the CHASING COVID Cohort, we examine the relationship between vaccination status, CMD, and vaccine perceptions in the undervaccinated. Among 510 undervaccinated participants who had completed the primary vaccine series but were not boosted, the most common reasons for undervaccination focused on efficacy (not seeing a need for an additional dose, 42.4%; there not being enough evidence that a booster dose is effective, 26.5%; already having had COVID-19, 19.6%). Other concerns were related to safety (long-term side effects, 21.0%; short-term side effects, 17.6%) and logistics (plan to get a booster but haven’t had time yet, 18.8%). Overall, the greatest vaccine concerns (over 30%) for the undervaccinated focused on efficacy and safety issues. Symptoms of depression or anxiety were associated with lower levels of vaccine efficacy and greater safety concerns in adjusted models. The implications of our study are that campaigns that are hoping to maximize vaccination uptake should consider focusing on and emphasizing messaging on efficacy and safety issues

Crossâ Sectional Psychological and Demographic Associations of Zika Knowledge and Conspiracy Beliefs Before and After Local Zika Transmission

Perceptions of infectious diseases are important predictors of whether people engage in diseaseâ specific preventive behaviors. Having accurate beliefs about a given infectious disease has been found to be a necessary condition for engaging in appropriate preventive behaviors during an infectious disease outbreak, while endorsing conspiracy beliefs can inhibit preventive behaviors. Despite their seemingly opposing natures, knowledge and conspiracy beliefs may share some of the same psychological motivations, including a relationship with perceived risk and selfâ efficacy (i.e., control). The 2015â 2016 Zika epidemic provided an opportunity to explore this. The current research provides some exploratory tests of this topic derived from two studies with similar measures, but different primary outcomes: one study that included knowledge of Zika as a key outcome and one that included conspiracy beliefs about Zika as a key outcome. Both studies involved crossâ sectional data collections that occurred during the same two periods of the Zika outbreak: one data collection prior to the first cases of local Zika transmission in the United States (Marchâ May 2016) and one just after the first cases of local transmission (Julyâ August). Using ordinal logistic and linear regression analyses of data from two time points in both studies, the authors show an increase in relationship strength between greater perceived risk and selfâ efficacy with both increased knowledge and increased conspiracy beliefs after local Zika transmission in the United States. Although these results highlight that similar psychological motivations may lead to Zika knowledge and conspiracy beliefs, there was a divergence in demographic association.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/153206/1/risa13369_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/153206/2/risa13369.pd

What were the information voids? A qualitative analysis of questions asked by Dear Pandemic readers between august 2020-august 2021

In the current infodemic, how individuals receive information (channel), who it is coming from (source), and how it is framed can have an important effect on COVID-19 related mitigation behaviors. In light of these challenges presented by the infodemic, Dear Pandemic (DP) was created to directly address persistent questions related to COVID-19 and other health topics in the online environment. This is a qualitative analysis of 3806 questions that were submitted by DP readers to a question box on the Dear Pandemic website between August 30, 2020 and August 29, 2021. Analyses resulted in four themes: the need for clarification of other sources; lack of trust in information; recognition of possible misinformation; and questions on personal decision-making. Each theme reflects an unmet informational need of Dear Pandemic readers, which may be reflective of the broader informational gaps in our science communication efforts.This study highlights the role of an ad hoc risk communication platform in the current environment and uses questions submitted to the Dear Pandemic question box to identify informational needs of DP readers over the course of the COVID-19 pandemic. These findings may help clarify how organizations addressing health misinformation in the digital space can contribute to timely, responsive science communication and improve future communication efforts

The Hurricane Sandy Place Report: Evacuation Decisions, Housing Issues and Sense of Community

Hurricane Sandy was one of the largest storms on record, sweeping through the eastern seaboard of the United States with a massive diameter twice the size of Hurricane Katrina. Although wind speeds did not match those of Katrina, the combination of high tide at landfall and the lunar phase resulted in exceptionally high storm surges. Catastrophic storms such as Hurricane Sandy can have devastating effects on many aspects of human life and the environment, undermining economic activity, crippling critical infrastructure, and disrupting hundreds of thousands of lives for weeks, months, or even years. The Sandy Child and Family Health (S-CAFH) Study was designed to describe and analyze the impacts of the storm on the residents of New Jersey, identifying those needs which emerged and those which are still pressing. The research team – a partnership of faculty and research staff from Rutgers University, New York University, Columbia University, and Colorado State University – randomly selected and surveyed 1,000 residents of New Jersey’s “Disaster Footprint,” representing the experiences of 1 million New Jersey residents living in or near those coastal areas of the state most directly exposed to the storm. The primary focus of this Briefing Report, the first in a series of four thematic reports, is to document the storm’s impact on PLACE in New Jersey residents’ lives, with a particular emphasis on Sandy’s effect on people’s homes and housing decisions

The Hurricane Sandy Person Report: Disaster Exposure, Health Impacts, Economic Burden, and Social Well-Being

The impact a disaster has on the health of a population can be described as having a “dose-response” relationship: the larger the “dose” of the disaster, the greater the health impact or “response” among those individuals and communities exposed. This PERSON Briefing Report describes the impact of Hurricane Sandy (the dose) on the health and well-being of adults and children exposed to the storm (the response). Data for the report are drawn from the baseline survey of the Sandy Child and Family Health (S-CAFH) Study, an observational cohort study of nearly 1,000 randomly-selected New Jersey residents who were living in areas of the state exposed to the storm in 2012. Participants in the study represent over 1 million people living in Sandy’s “Disaster Footprint,” the hurricane-exposed portions of the state. This report describes and examines several critical aspects of individual health and well-being that may be associated with the storm, including: 1. Physical health of adults; 2. Psychological and emotional health of adults; 3. Social and economic health of adults; 4. Health and well-being of children; and 5. The association between disaster exposure and individual outcomes

What Were the Information Voids? A Qualitative Analysis of Questions Asked by Dear Pandemic Readers between August 2020-August 2021

In the current infodemic, how individuals receive information (channel), who it is coming from (source), and how it is framed can have an important effect on COVID-19 related mitigation behaviors. In light of these challenges presented by the infodemic, Dear Pandemic (DP) was created to directly address persistent questions related to COVID-19 and other health topics in the online environment. This is a qualitative analysis of 3806 questions that were submitted by DP readers to a question box on the Dear Pandemic website between August 30, 2020 and August 29, 2021. Analyses resulted in four themes: the need for clarification of other sources; lack of trust in information; recognition of possible misinformation; and questions on personal decision-making. Each theme reflects an unmet informational need of Dear Pandemic readers, which may be reflective of the broader informational gaps in our science communication efforts. This study highlights the role of an ad hoc risk communication platform in the current environment and uses questions submitted to the Dear Pandemic question box to identify informational needs of DP readers over the course of the COVID-19 pandemic. These findings may help clarify how organizations addressing health misinformation in the digital space can contribute to timely, responsive science communication and improve future communication efforts