Ethical Dilemma in Global Vaccine Cooperation and Its Countermeasures: Taking the Global Eradication of Smallpox as an Example / 中国医学伦理学

Vaccine cooperation is an important means to deal with global infectious diseases. However, the cooperation cannot be achieved overnight. Ethical dilemma is one of the obstacles that hinders vaccine cooperation. Reviewing the history, the most successful vaccine collaboration to date has been the global smallpox eradication program. In the process of eradicating smallpox, there were also many ethical dilemmas, including the international pattern of the US-Soviet hegemony, which impacted the mutual help between countries, the ethical disputes of the vaccine itself hindering solidarity and cooperation among actors, and the vaccine coercion adopted to overcome vaccine hesitancy undermining the principle of proportionality among the freedom, equality and efficacy. The ethical dilemmas of vaccine cooperation were resolved by shaping professional and scientific consensus among medical professional groups, reaching consensus on cooperation between leading countries and developing countries, and integrating local culture to improve vaccination methods. Finally, in 1980, the world successfully eradicated smallpox. The case of smallpox eradication provides us lessons for vaccine cooperation against COVID-19 and the construction of a community of common health for mankind today.

Psychometric properties and reliability of the Brazilian version of Parent Attitudes about Childhood Vaccine (PACV-BR) / Propriedades psicométricas e confiabilidade da versão brasileira do Parent Attitudes about Childhood Vaccine (PACV-BR)

ABSTRACT Objective: To evaluate the psychometric properties and reliability of the Brazilian version of the tool Parent Attitudes about Childhood Vaccine (PACV-BR). Methods: The sample included 110 parents of children up to two years old served by Family Health Basic Units. The tool's internal consistency and factor validity were respectively assessed by Cronbach's alpha and exploratory factor analysis (EFA). The test-retest reliability was assessed by the intraclass correlation coefficient (ICC). Results: The EFA results indicated a proper structural adequacy of the PACV-BR (15 items and two factors). The reliability generated Cronbach's alpha values between 0.715 and 0.854 for the items, of 0.918 for the tool as a whole, of 0.877 for factor 1 and of 0.825 for factor 2, in addition to an ICC of 0.984. Conclusions: The PACV-BR showed evidence of construct validity and reliability.

RESUMO Objetivo: Avaliar as propriedades psicométricas e a confiabilidade da versão brasileira do instrumento Parent Attitudes about Childhood Vaccine (PACV-BR). Métodos: A amostra incluiu 110 pais de crianças de até dois anos atendidas em Unidades Básicas de Saúde da Família. A consistência interna e a validade fatorial do instrumento foram avaliadas, respectivamente, pelo alfa de Cronbach e pela análise fatorial exploratória (EFA). A confiabilidade teste-reteste foi avaliada pelo coeficiente de correlação intraclasse (ICC). Resultados: Os resultados da AFE indicaram adequação estrutural do PACV-BR (15 itens e dois fatores). A confiabilidade indicou valores de alfa de Cronbach entre 0,715 e 0,854 para os itens, de 0,918 para o instrumento como um todo, de 0,877 para o fator 1 e de 0,825 para o fator 2, além de ICC de 0,984. Conclusões: O PACV-BR apresentou evidências de validade de construto e confiabilidade.

Hesitação vacinal infantil e COVID-19: uma análise a partir da percepção dos profissionais de saúde / Childhood vaccine hesitancy and COVID-19: an analysis based on the perception of health professionals / La reticencia vacunal infantil y la COVID-19: un análisis a partir de la percepción de los profesionales de la salud

Resumo: Este artigo apresenta os resultados de uma pesquisa sobre a percepção dos profissionais de saúde sobre a hesitação vacinal infantil relacionada à COVID-19. Baseado no constructo teórico da hesitação vacinal, foi realizada uma pesquisa qualitativa com 86 trabalhadores da atenção primária à saúde (APS) em quatro municípios de quatro estados brasileiros e no Distrito Federal. A análise temática foi realizada e obtiveram-se três categorias: medo, desinformação em vacina e papel dos profissionais de saúde. O medo como motivo de hesitação vacinal gerou reflexões sobre a condução da pandemia pelo Governo Federal, principalmente no que tange à governabilidade por meio desse afeto, e sobre as consequências do uso das plataformas digitais na população. O medo relacionou-se ao fato de a vacina ainda ser percebida como experimental; às possíveis reações adversas; à ausência de estudos de longo prazo; à falsa percepção de risco reduzido da COVID-19 em crianças; e às condutas do Governo Federal geradoras de insegurança nos efeitos da vacina. A desinformação em vacina relacionou-se às fake news sobre a vacina e suas reações; ao fenômeno da infodemia e desinformação; e à ausência de orientação e conhecimento sobre vacinas. Por fim, o trabalho discute o papel fundamental dos profissionais de saúde da APS no aumento da cobertura vacinal devido à confiabilidade perante a população e à proximidade com os territórios, fatores que possibilitam reverter o medo e a desinformação diante das vacinas. Ao longo do trabalho, buscou-se apresentar as convergências entre o conteúdo dos temas delineados e os determinantes da hesitação vacinal e refletir sobre possibilidades para a reconstrução da alta adesão às vacinas infantis.

Abstract: This article presents the results of a study on health professionals' perceptions of childhood vaccine hesitancy related to COVID-19. Based on the theoretical construct of vaccine hesitancy, a qualitative study was conducted with 86 primary health care (PHC) workers in four municipalities in four Brazilian states and in the Federal District. A thematic analysis was performed and three categories were obtained: fear, misinformation about vaccines, and the role of health professionals. Fear as a reason for vaccine hesitancy has led to reflections on the Brazilian Federal Government's management of the pandemic, especially regarding governability and the consequences of the use of digital platforms on the population. Fear was related to the vaccine still being perceived as experimental; to the adverse reactions it may cause; to the lack of long-term studies; to the false perception of reduced risk of COVID-19 in children; and to the Federal Government's behavior, which creates uncertainty about the effects of the vaccine. Vaccine misinformation was related to fake news about the vaccine and its reactions; the phenomenon of infodemic and misinformation; and the lack of guidance and knowledge about vaccines. Finally, the article discusses the fundamental role of PHC workers in increasing vaccination coverage due to the trust among the population and proximity to the territories, factors that enable the reversal of fear and misinformation about vaccines. Throughout the study, authors' sought to show the convergences between the content of the themes outlined and the determinants of vaccine hesitancy and to consider possibilities for rebuilding high adherence to childhood vaccines.

Resumen: Este artículo presenta los resultados de una encuesta sobre la percepción de los profesionales de la salud acerca de la reticencia vacunal infantil relacionada con la COVID-19. Con base en el constructo teórico de la reticencia vacunal, se realizó una encuesta cualitativa con 86 trabajadores de la atención primaria de salud (APS) en 4 municipios de 4 estados brasileños y en el Distrito Federal. Se realizó un análisis temático y se obtuvieron tres categorías: miedo, desinformación sobre vacunas y papel de los profesionales de la salud. El miedo como motivo de reticencia vacunal dio lugar a reflexiones sobre el manejo de la pandemia por parte del Gobierno Federal, sobre todo en lo que respecta a la gobernabilidad por medio de esta afección y las consecuencias del uso de plataformas digitales en la población. El temor se relacionó con el hecho de que la vacuna todavía se percibe como experimental; con las reacciones adversas que puedan provocar; con la ausencia de estudios a largo plazo; con la falsa percepción de riesgo reducido de COVID-19 en niños y con las conductas del Gobierno Federal que generan inseguridad sobre los efectos de la vacuna. La desinformación sobre las vacunas se relacionó con noticias falsas sobre la vacuna y sus reacciones; el fenómeno de la infodemia y la desinformación; y la ausencia de orientación y conocimiento sobre las vacunas. Finalmente, el trabajo discute el papel fundamental de los profesionales de la salud de la APS en el aumento de la cobertura vacunal debido a su confiabilidad entre la población y cercanía a los territorios, factores que permiten revertir el miedo y la desinformación respecto a las vacunas. A lo largo del trabajo, se buscó presentar las convergencias entre el contenido de los temas delineados y los determinantes de la reticencia vacunal y reflexionar sobre las posibilidades para la reconstrucción de una alta adhesión a las vacunas infantiles.

COVID-19 vaccine hesitancy in KwaZulu-Natal, South Africa: A survey of unvaccinated adults

Background: Concerns and misconceptions surrounding coronavirus disease 2019 (COVID-19) vaccines may account for vaccine hesitancy and low uptake. Aim: To determine prevalence of COVID-19 vaccine hesitancy, vaccine-related misconceptions, and predictors of vaccine hesitancy among South Africans. Setting: Community setting in five districts in KwaZulu- Natal province. Methods: Between August 20, 2021, and September 27, 2021, we conducted a cross-sectional survey, interviewing 300 unvaccinated adults amid the national vaccination campaign. Predictors of hesitancy were identified through multivariable logistic regression analysis. Results: Participants had a median age of 29 years (IQR: 23­39), 86.7% were Black African, 63.2% were male, 53.3% resided in rural communities, and 59.3% (95% CI: 53.8% ­ 64.9%) were classified as vaccine hesitant. The primary reason for not vaccinating was a lack of trust in the vaccine (62.1%). Factors associated with reduced vaccine hesitancy included age (participants aged 35­49 years: OR: 0.28, 95% CI: 0.18­0.64, p = 0.003; participants over 50 years: OR: 0.18, 95% CI: 0.07­0.47, p = 0.0004), previous COVID-19 infection (OR: 0.31, 95% CI: 0.11­0.87, p = 0.03), and receiving vaccine information from healthcare workers (OR: 0.32, 95% CI: 0.10­1.0, p = 0.05). Unemployed (OR: 2.14, 95% CI: 1.1­4.2, p = 0.03) and self-employed individuals (OR: 2.98, 95% CI: 1.27­7.02, p = 0.01) were more likely to be vaccine hesitant. Conclusion: COVID-19 vaccine hesitancy rates are high in KwaZulu-Natal. Uptake could be enhanced by healthcare workers leading information campaigns with messages targeting younger individuals, the unemployed, and the self-employed. Contribution: This survey provides evidence to improve COVID-19 vaccination uptake in South Africa.

Aceptación y reticencia a las vacunas contra COVID-19 en ingresantes a una universidad pública peruana durante la tercera ola pandémica

Introducción. Los estudiantes universitarios influyen en las decisiones de su familia y comunidad a favor de la vacunación. Objetivo. Identificar las principales razones para la aceptación o reticencia vacunal contra COVID-19 en ingresantes a una universidad pública. Métodos. Estudio transversal en una muestra de 408 estudiantes. Se preguntó si había completado las tres dosis de vacuna contra COVID-19 y la principal razón para la aceptación o reticencia vacunal. Se realizó un análisis descriptivo, se aplicó la prueba chi cuadrado y exacta de Fisher. Resultados. El 85,5% aceptó la vacuna principalmente por no querer contagiar a familiares (38,1%) y no querer enfermarse (27,8%). El 14,5% fue reticente, especialmente por prolongados tiempos de espera en vacunatorios (37,3%) y lejanía de los centros de vacunación (13,6%). Conclusiones. En los universitarios estudiados, el temor a la enfermedad impulsó la aceptación de la vacuna contra COVID-19 y la inaccesibilidad a los servicios de salud generó la reticencia.

Introduction. University students influence their family and community decisions in favor of vaccination. Objective. To identify the main reasons for COVID-19 vaccine acceptance or hesitancy among university entrants. Methods. A cross-sectional study in a sample of 408 students. We asked whether the student had completed the three doses the COVID-19 vaccine and the main reason for vaccine acceptance or hesitancy. A descriptive analysis was performed, the chi-square test and Fisher's exact were applied. Results. 85.5% accepted vaccination mainly because they did not want to infect family members (38.1%) and did not want to get sick (27.8%). 14.5% were hesitancy especially due to long waiting times in vaccination centers (37.3%) and distance from vaccination centers (13.6%). Conclusions. In the university students studied, the fear of disease drove COVID-19 vaccine acceptance and inaccessibility to health services generated vaccine hesitancy among university entrants.

Implementação da Prática Avançada de Enfermagem no enfrentamento do atraso vacinal: um relato de experiência / Implementation of Advanced Practice Nursing in coping with vaccine delay: an experience report

OBJETIVO: Descrever a implementação de práticas avançadas de enfermagem para abordar o atraso na imunização em crianças menores de dois anos de idade. MÉTODO: Trata-se de um relato de experiência que monitorou a situação vacinal de crianças menores de dois anos e descreveu práticas avançadas de enfermagem para melhorar a adesão à vacinação. RESULTADOS: Foi monitorado o estado vacinal das crianças e realizadas ações e intervenções individuais e coletivas, como consultas individuais, buscas ativas, ligações telefônicas e mensagens via aplicativo de celular, educação continuada e produção de materiais educativos para conscientização entre a comunidade, pais/responsáveis e profissionais de saúde sobre a importância de manter o calendário vacinal atualizado, conforme proposto pelo Programa Nacional de Imunizações. CONCLUSÃO: As intervenções neste relatório demonstraram implicações importantes para a saúde pública e podem sugerir que as práticas avançadas de enfermagem têm um impacto positivo na melhoria da cobertura vacinal.

OBJECTIVE: To describe the implementation of advanced practice nursing to address delayed immunization in children under two years of age. METHOD: This experience report monitored the immunization status of children under two years of age and described advanced practice nursing to improve immunization compliance. RESULTS: The immunization status of children was monitored, and individual and collective actions and interventions were carried out, such as individual consultations, active searches, telephone calls and messages via a mobile phone application, ongoing education, and the production of educational materials to raise awareness among the community, parents/guardians and health professionals about the importance of keeping the immunization schedule up to date, as proposed by the Brazilian National Immunization Program. CONCLUSION: The interventions in this report have demonstrated important public health implications and may suggest that advanced nursing practices positively impact improving immunization coverage.

Cobertura vacinal e taxa de abandono nas capitais do nordeste brasileiro entre 2018 e 2022 / Vaccination coverage and abandonment rate in Northeastern Brazilian capitals between 2018 and 2022 / Cobertura de vacunación y tasa de abandono en las capitales del Noreste Brasileño entre 2018 y 2022

Introdução: O Programa Nacional de Imunizações presente na Atenção Primária à Saúde coordena o processo de imunização e o torna mais eficaz, porém esse sistema enfrenta problemas como a falta de acesso à internet e desabastecimento de imunizantes, que prejudicam a cobertura vacinal da população e dificultam o registro eletrônico dos dados indicadores, além de aumentar a taxa de abandono vacinal. Objetivo:Analisar os indicadores de Cobertura Vacinal e Taxa de Abandono nas capitais do Nordeste nos últimos cinco anos. Metodologia:Estudo epidemiológico, quantitativo e descritivo. As nove capitais do Nordeste do Brasil foram selecionadas para o estudo. A temática abordada é a Taxa de Abandono Vacinal e a Cobertura Vacinal nos últimos cinco anos nas capitais. Os dados foram coletados através doSistema de Informação do Programa Nacional de Imunização e armazenadosno Microsoft Excel. Resultados:Quanto às taxasde cobertura vacinal, Fortaleza teve o maior percentual, com 74,87%. Maceió obteve o segundo maior índice, com 66,12%. Em relação às taxas de abandono vacinal, Salvador registrou o maior número,com 27,39% nos últimos cinco anos. Não obstante, João Pessoaobteve a menor taxa, com 16,08%. Conclusões:Verificou-se que Fortaleza teve a maiorCobertura Vacinal e Salvador teve a maiorTaxa de Abandono Vacinal.Algumas capitais tiveram redução naCobertura Vacinal e aumento na Taxa de Abandono Vacinalno período pandêmico, indicando a necessidade de mais pesquisas sobre o impacto da Covid-19 e a circulação de informações equivocadas sobre vacinação. Logo, a atuação da atenção primária à saúde é crucial para reverter essa tendência, trabalhando na implementação de campanhas de imunização e na educação em saúde (AU).

Introduction: The National Immunization Program present in Primary Health Carecoordinates the immunization process and makes it more effective, but this system faces problems such as lack of internet access and shortages of immunizers, which underminethe population's vaccination coverage and hinderthe electronic recording of indicator data, besides increasing the vaccination abandonment rate.Objective: To analyze the Vaccination Coverage and AbandonmentRate indicators in theNortheasterncapitalsover the last five years.Methodology: Epidemiological, quantitative and descriptive study. The nine capitals of NortheasternBrazil were selected for the study. The themesaddressed arethe VaccinationAbandonment Rate andtheVaccinationCoverage overthe last five years in the capitals. The data was collected through the National Immunization Program Information System and stored in Microsoft Excel.Results:As for vaccination coverage rates, Fortaleza had the highest percentage, with 74.87%. Maceió obtainedthe second highest index, with 66.12%. Regardingvaccinationabandonment rates, Salvador recordedthe highest number,with 27.39% over the last five years. Nonetheless, João Pessoa obtainedthe lowest rate, with 16.08%. Conclusions:It was found that Fortaleza had the highest Vaccination Coverage and Salvador had the highest VaccinationAbandonment Rate.Some capitals had a reduction in Vaccination Coverage and an increase in the VaccinationAbandonment Rate in the pandemic period, indicating the need for more research aboutthe impact of Covid-19 and the circulation of misinformation about vaccination. Therefore, the role of primary health care is essential forreversing this trend, working on the implementation of immunization campaignsand health education (AU).

Introducción:El Programa Nacional de Inmunizaciónpresente en la Atención Primariade Saludcoordina el proceso de inmunización y lo hace más eficaz, pero este sistema se enfrenta a problemas como la falta de acceso a internet y la escasez de inmunizadores, queperjudicanla cobertura de vacunación de la población y dificultan el registro electrónico de los datos de los indicadores, además de aumentar la tasa de abandono de vacunación.Objetivo:Analizar los indicadores de Cobertura de Vacunación y Tasa de Abandono en las capitales del Nordeste en los últimos cinco años.Metodología:Estudio epidemiológico, cuantitativo y descriptivo. Fueron seleccionadas para el estudio las nueve capitales del Nordeste de Brasil. LostemasabordadossonlasTasa de Abandono deVacunacióny la Cobertura de Vacunación en los últimos cinco años en las capitales. Los datos se recogieron a través del Sistema de Información del Programa Nacional de Inmunización y se almacenaron en Microsoft Excel.Resultados:En cuanto a las tasas de cobertura de vacunación, Fortaleza tuvo el porcentaje más elevado, con un74,87%. Maceióobtuvo lasegunda tasa más alta, con un66,12%. En cuanto a las tasas de abandono de vacunación, Salvador registró la cifra más alta, con un27,39% en los últimos cinco años. Sin embargo, João Pessoa obtuvola tasa más baja, con un16,08%.Conclusiones:Se notó queFortaleza tuvo la mayor Cobertura de Vacunación y Salvadortuvola mayor Tasa de Abandono de Vacunación. Algunas capitales tuvieron una reducción de la Cobertura de Vacunacióny un aumento de la Tasa de Abandono de Vacunacióndurante el período pandémico, indicandola necesidad de más investigaciones sobre el impacto de laCovid-19 y la circulación de información errónea sobre la vacunación. Por lo tanto, el rolde la atención primaria de salud es crucial para revertiresta tendencia, trabajando en la implementación de campañas de inmunización y educación sanitaria (AU).

Decisão de profissionais de saúde sobre sua vacinação anti-Covid-19: revisão integrativa / Decision of health professionals about their anti-COVID-19 vaccination: integrative review

RESUMO A decisão vacinal de profissionais de saúde tem sido observada em diferentes países, devido ao seu comportamento de hesitação frente à vacinação contra a Covid-19, que pode interferir no controle da pandemia. Pretendeu-se identificar os fatores associados à decisão vacinal de profissionais de saúde contra a Covid-19 em publicações de julho de 2020 a julho de 2022. Foi realizada uma revisão integrativa da literatura nas bases de dados PubMed, Scopus, Web of Science e Cinahl. Das 439 publicações, foram escolhidos 35 artigos para análise. As características sociodemográficas da decisão vacinal revelaram que profissionais não médicos, principalmente enfermeiros, apresentaram maior hesitação. O estudo revelou fatores associados à hesitação vacinal, tais como: dúvidas sobre a eficácia das vacinas e o processo de produção, insegurança pela escassez de estudos, medo dos efeitos colaterais e informações veiculadas em mídias sociais. Em relação à aceitação e à recomendação vacinal, ressaltam-se a vacinação prévia contra a influenza, a confiança na eficácia das vacinas e o receio pelo risco de contágio por Covid-19. A identificação dos fatores associados à decisão vacinal de profissionais de saúde contra a Covid-19 foi estratégica em relação à ampliação da cobertura vacinal, tanto para a proteção da saúde dos profissionais quanto para a da população.

ABSTRACT The vaccine decision of health professionals has been observed in different countries, due to their hesitation behavior in the face of vaccination against COVID-19, which can interfere with the control of the pandemic. It was intended to identify the factors associated with the vaccination decision of health professionals against COVID-19 in publications from July 2020 to July 2022. An Integrative Literature Review was carried out in PubMed, Scopus, Web of Science and CINAHL databases. Of the 439 publications, 35 articles were chosen for analysis. The sociodemographic characteristics of the vaccine decision revealed that non-medical professionals, mainly nurses, had greater vaccine hesitancy. The study revealed factors associated with vaccine hesitancy, such as: doubts about the effectiveness of vaccines and the production process, insecurity due to lack of studies, fear of side effects and information conveyed on social media. Regarding vaccine acceptance and recommendation, prior vaccination against influenza, confidence in the effectiveness of vaccines and fear of the risk of contagion by COVID-19 stand out. Identifying the factors associated with the vaccination decision of health professionals against COVID-19 was strategic in relation to expanding vaccination coverage, both to protect the health of professionals and the population.

Desordens informativas: análise de pronunciamentos de Jair Bolsonaro contra a vacinação de covid-19 / Information disorders: analysis of statements by Jair Bolsonaro against covid-19 vaccination / Trastornos de la información: análisis de las declaraciones de Jair Bolsonaro contra la vacunación contra la covid-19

Baseando-se nos conceitos de "desordens informativas" propostos por Claire Wardle e Hossein Derakhshan, este trabalho propõe-se a observar o fenômeno de hesitação vacinal e a opinião pública em relação à vacina CoronaVac contra a covid-19, a partir da análise de falas públicas do presidente Jair Bolsonaro sobre esse imunizante produzido pelo Instituto Butantan em parceria com a biofarmacêutica chinesa Sinovac. As falas em questão foram proferidas no período de julho de 2020 a janeiro de 2021. Através de uma pesquisa de abordagem qualitativa, com finalidades exploratórias e descritivas, o trabalho analisou o conteúdo de dez pronunciamentos do então presidente sobre as vacinas no contexto do primeiro ano da pandemia de covid-19 no Brasil e observou desordens informativas dos seguintes tipos: má informação (17,6%), informação incorreta (47,1%) e desinformação (35,3%) em todas as falas. As desordens informativas propagadas contribuíram para os sentimentos de desconfiança e as posturas coletivas de hesitação vacinal relacionadas à covid-19, principalmente em relação à CoronaVac

Using the concepts of "informational disorder" proposed by Claire Wardle and Hossein Derakhshan, this paper observes the phenomenon of vaccine hesitancy and the public opinion towards the CoronaVac vaccine against covid-19, from the analysis of public speeches by President Jair Bolsonaro about this immunizer produced by Instituto Butantan in partnership with the Chinese biopharmaceutical company Sinovac. The speeches in question were delivered in the period from July 2020 to January 2021. Through a qualitative approach research, with exploratory and descriptive purposes, the work analyzed the content of ten pronouncements of the president about vaccines in the context of the first year of the covid-19 pandemic in Brazil and observed informational disorders of the following types: bad information (17.6%), incorrect information (47.1%) and misinformation (35.3%) in all speeches. The propagated informational disorders contributed to feelings of distrust and collective postures of vaccine hesitancy related to covid-19, especially in relation to CoronaVac

Utilizando los conceptos de "desórdenes informativos" propuestos por Claire Wardle y Hossein Derakhshan, este trabajo observa el fenómeno de la vacilación a la vacunación y la opinión pública hacia la vacuna CoronaVac contra el covid-19, a partir del análisis de los discursos públicos del presidente Jair Bolsonaro sobre este inmunizante producido por el Instituto Butantan en asociación con la biofarmacéutica china Sinovac. Los discursos en cuestión se pronunciaron en el periodo comprendido entre julio de 2020 y enero de 2021. A través de una investigación de abordaje cualitativo, con fines exploratorios y descriptivos, el trabajo analizó el contenido de diez pronunciamientos del presidente sobre vacunas en el contexto del primer año de la pandemia de covid-19 en Brasil y observó trastornos informativos de los siguientes tipos: mala información (17,6%), información incorrecta (47,1%) y desinformación (35,3%) en todos los discursos. Los trastornos informativos propagados contribuyeron a los sentimientos de desconfianza y a las posturas colectivas de indecisión vacunal relacionadas con el covid-19, especialmente en relación con CoronaVac

Hesitação da vacina da febre amarela e sua relação com influências contextuais, individuais ou de grupo e questões específicas da vacina: uma revisão de escopo / Yellow fever vaccine hesitancy and its relationship with contextual, individual, or group influences and vaccine-specific issues: a scoping review

Resumo A hesitação vacinal é um fenômeno com potencial para reduzir as taxas de cobertura vacinal, como observado na vacina contra febre amarela (VFA), propiciar epidemias e a reintrodução de doenças imunopreveníveis controladas. O objetivo deste estudo é mapear junto à literatura científica a relação entre a falta de informação, a segurança da vacina e os eventos adversos e a hesitação vacinal da VFA. Foi realizada uma revisão de escopo nas bases Biblioteca Virtual em Saúde (BVS), National Library of Medicine (PubMed), SCOPUS, Embase e Web of Science utilizando descritores controlados (DeCS/MeSH) e não controlados. Foram selecionados 11 artigos publicados nos idiomas inglês, espanhol e português, sem delimitação de tempo e que atenderam aos critérios de inclusão. Estiveram relacionados à hesitação vacinal da VFA informações falsas, conhecimento inadequado sobre o imunizante, falta de tempo para se vacinar, aceitação da vacina, insegurança na vacina e medo dos eventos adversos. Este estudo reforça a importância do acesso a informações adequadas, orientações sobre a segurança e os eventos adversos da VFA e pode auxiliar na elaboração de estratégias de saúde pública para mitigar a hesitação vacinal.

Abstract Vaccine hesitancy is a phenomenon with the potential to reduce vaccination coverage rates, as observed with the yellow fever vaccine (YFV), leading to epidemics and the reintroduction of controlled immunopreventable diseases. This study, together with the scientific literature, aims to map the relationship among the lack of information, vaccine safety and adverse events, and vaccine hesitancy concerning YFV. A scoping review was conducted in the Virtual Health Library (VHL), National Library of Medicine (PubMed), SCOPUS, Embase, and Web of Science databases, using controlled (DeCS/MeSH) and uncontrolled descriptors. In this work, we selected eleven articles, published in English, Spanish, and Portuguese, with no time limits, which met the inclusion criteria. False information, inadequate knowledge about the immunizer, lack of time to take a vaccination, acceptance of the vaccine, vaccine safety, and fear of adverse events were related to vaccine hesitancy. This study reinforces the importance of access to adequate information, provides guidance on YFV safety and adverse events, and can aid in the development of public health strategies to mitigate hesitancy.

Are Parents Willing to Vaccinate Their 6- To 11-Year-Old Children Against COVID-19? A Community Based Study in Murshidabad, India

Context/Background: The future of Corona virus disease is still uncertain due to viral mutations. Immuniza-tion against COVID-19 has not yet been introduced for children aged 6-11 years. Parents are instrumental for the success of any immunization programme, being the chief decision makers for their wards. The study aims to assess the perceptions of parents regarding COVID 19 vaccination among children aged 6-11 years in an urban slum of Murshidabad and identify the factors influencing such perceptions among them. Methodology: A cross sectional study was conducted among 106 parents in a slum area of Murshidabad, West Bengal. Participants were interviewed using a validated WHO Vaccine Hesitancy Scale (VHS). Bivariate and multivariable analysis were done using Chi square test and binary logistic regression respectively. Results: Majority of the study subjects instead of parents were unlikely to vaccinate their children against COVID-19. The major concern centered around the safety (73.5%) of the vaccine. Higher level of education (p=0.003), previous history of COVID-19 infection in the family (p=0.004) and having a children aged between 6-8 years (p=0.006), influenced such perceptions, with the latter being the single most important predictor (AOR 4.126, P=0.007). Conclusions: The likelihood of parents to vaccinate their child was found to be low. This underscores the im-portance of an effective communication strategy when such programme will be rolled out.

Research progress of vaccine hesitancy in China in recent years / 上海预防医学

The 2030 Immunization Agenda of the World Health Organization （WHO） states that everyone in the world should fully benefit from vaccines to achieve good health and well-being. With the ever-changing disease spectrum and the improvement of residents' health literacy， relying solely on vaccines included in the National Immunization Program （NIP） is insufficient to meet the current requirements for disease prevention and control. Non-NIP vaccines play an important role in meeting people's diverse needs. Vaccine hesitancy is a global issue and an important factor affecting vaccine uptake. By reviewing relevant studies on vaccine hesitancy in recent years， this paper summarized different vaccination situations， current situation of vaccine hesitancy， measuring tools of vaccine hesitancy， and major influencing factors. It aims to provide references for the development of scientific and effective vaccine education strategies， which can increase public knowledge and understanding of vaccines， enhance healthcare professional's willingness and behavior in recommending vaccines， improve public vaccine literacy， and reduce vaccine hesitancy. At the same time， the supervision and guidance of media discourse should be strengthened to enhance the protective role of non-NIP vaccines in immunization barriers.

Malaysian Newspapers’ Coverage of Anti-vaxxers: Implication on Vaccine Intakes

@#Introduction: The World Health Organization (WHO) named anti-vaxxers as one of the top ten public health hazards in 2019. Anti-vaxxers are a health danger since they are mostly responsible for the re-emergence of deadly contagious diseases such as measles, which has increased in recent years. The media such as newspapers, are responsible for disseminating messages and public knowledge about health issues, particularly health hazards. To particularly combat anti-vaccine views online, newspaper must provide critical information, such as scientific and verifiable facts. Newspapers need to also take a clear stand against anti-vaccine sentiments. Method: A quantitative content analysis was conducted on four newspapers (Harian Metro, Berita Harian, New Straits Times, and The Star) over a three-year period beginning 1 January 2019 and ending 30 September 2021. The 43-month period offered adequate data for analysing reporting trends. Result: The findings suggested that newspapers do significantly report about the antivaxxers with 247 news were focused on them. Conclusion: However, the newspapers tend to only publish generic information about the antivaxxers and rarely make compelling arguments against them.

The influence of information sources on intention changes to receive COVID-19 vaccination: A prospective cohort study in Japan

BACKGROUND@#Before the COVID-19 vaccine became available, many Japanese people were undecided about whether or not to receive them. Their decisions were keys to achieving herd immunity. The impact of the type of information source on the COVID-19 vaccine uptake decision-making process remains unclear. We aimed to investigate the association between information source usage on COVID-19 and subsequent vaccine uptake status among those who have yet to decide whether to receive vaccines from non-prioritized people for vaccination.@*METHODS@#Prospective cohort online self-administered surveys were conducted in February 2021 (T1), before the start of the mass vaccination program, and September-October 2021 (T2), when the vaccines were available to all citizens. The survey's target population was registered monitors of an Internet research company. Participants who answered "I want to get vaccinated after waiting to see how it goes." at T1 were eligible for analysis. The outcome variable was the COVID-19 vaccine uptake status in T2, and the predictors were 20 types of information sources, categorized based on people (family members, etc.), institutions (governments, etc.), or media (TV news, etc.). Adjusted odds ratio and 95% confidence intervals were estimated using logistic regression adjusted for possible confounders.@*RESULTS@#The 5,139 respondents, mean age and standard deviation was 42.8 ± 12.5, 55.7% female, were eligible for analysis. 85.7% completed vaccination (including reserved/intended people) in T2. In the multivariate logistic analysis, odds ratios (95% confidence interval) for vaccine uptake were 1.49 (1.18-1.89) for workplaces/schools, 1.81 (1.33-2.47) for LINE, 0.69 (0.55-0.86) for Internet news and 0.62 (0.48-0.82) for video sharing sites.@*CONCLUSIONS@#The type of information source usage played an important role in the decision to vaccinate against COVID-19. Although caution is needed in interpreting the results, obtaining information from workplaces/schools and LINE was influential in promoting immunization.

COVID-19 vaccine hesitancy in ASEAN: Insights from a multi-wave survey database from July 2020 to March 2021

Objectives@#Early studies on COVID-19 vaccine hesitancy showed varied intensity across countries, which was linked to various factors such as socio-economic conditions, information sources, and issues of trust in government, scientific experts, and the health sector. This study aims to evaluate the determinants of vaccine hesitancy to offer insights into the strategies that may be successful in designing communications campaigns for enhanced vaccination uptake. @*Methods@#Through logistic regression, this study examines correlates of survey data from five Southeast Asian countries, namely Indonesia (ID), Malaysia (MY), Philippines (PH), Thailand (TH), Vietnam (VN) collected by the Massachusetts Institute of Technology Initiative on Digital Economy and Facebook between July 2020 and March 2021.@*Results@#Some significant determinants at the 5% or 1% level of significance of COVID-19 vaccine hesitancy in the countries of interest include gender [ID: 1.17 (1.01, 1.15), MY: 1.35 (1.2,1.53), PH: 1.92 (1.68,2.19), VN: 1.28 (1.04,1.58)], age [MY:1.11 (1.06,1.17), PH: 0.92 (0.88, 0.97), TH: 1.17 (1.11, 1.23)], knowing someone who tested positive for COVID-19 [ID: 0.75 (0.65,0.88), MY: 0.82 (0.71,0.95), PH: 0.76 (0.67, 0.87), TH: 0.76 (0.59, 0.99), VN: 0.72 (0.54,0.97)], and perceived effectiveness of mask wearing [ID: 0.83 (0.74, 0.94), MY: 0.86 (0.79, 0.95), TH: 0.88 (0.8,0.98)]. Vaccine hesitancy is particularly strong among women in 3 countries—peaking at 52% in Indonesia, 42% in Malaysia, and 56% in the Philippines.@*Conclusion@#Results from the survey highlight the significance of a targeted vaccine education and research campaign. This study calls for streamlining of communications campaigns towards messages that promote vaccine uptake in the region, while better targeting those groups most vulnerable guided by the empirical findings herein.

Addressing vaccine hesitancy during the COVID-19 pandemic: Learning from the past and moving forward

Excerpt@#Anong hirap ang kailangan niyong maranasan para kayo ay magpabakuna na? How much suffering are you willing to risk experiencing to persuade you to go for COVID-19 vaccination? @*@#Working at a COVID-19 Referral Center, we probably saw a lot more critically ill COVID-19 patients than in other hospitals in the Philippines. During the height of the Delta surge in 2021, our intensive care units (ICUs) for adults and pediatric critical COVID-19 were always full with a long waiting line. The typical medical history of the patients would be a senior retiree, usually a Lolo (grandfather) or a Lola (grandmother), who needed urgent support to be hooked to a mechanical ventilator because they could not breathe on their own anymore. When asked about their COVID-19 vaccination status, Lolo and Lola were often not vaccinated. Other times, the patient may not yet be old enough to be considered a Lolo or Lola but may have illnesses like heart failure, diabetes, hypertension, or on dialysis. They too were often not vaccinated. And occasionally, we admitted small children who would seemingly be out of place in the sea of adult patients in the Emergency Room. One would think that because the very young have not yet been allowed to get vaccinated, the people around them would strive to be vaccinated to protect these little ones. On the contrary, though, we saw many young patients whose exposures to COVID-19 came from their unvaccinated parents. This heartbreaking situation continued despite the intensive COVID-19 vaccination program of our government. When one thinks about it, it is possible that some of the many deaths and sufferings of patients and the anguish of grieving families, as well as the lonely exits of beloved ones dying alone amidst CPR machines and teams, may have been avoided had unvaccinated patients opted to be vaccinated. Now over 2 ½ years into the pandemic with many cases said to be mild, we continue to have a continuous flow of admissions for COVID-19 which fall into the moderate, severe, and even critical COVID-19, and some of them are because they have remained unvaccinated. Where and how can we improve the situation?

Attitudes, hesitancy, concerns, and inconsistencies regarding vaccines reported by parents of preschool children / Atitudes, hesitações, preocupações e inconsistências relacionadas a vacinas relatadas por pais de crianças pré-escolares

Abstract Objective: This study aimed to assess attitudes, concerns, information and knowledge about vaccines among parents of preschool children attending kindergartens in a city in the interior of São Paulo, Brazil, using a self-administered questionnaire. Methods: Cross-sectional, questionnaire-based study of knowledge and attitudes regarding vaccination among parents of children aged up to 72 months from public and private schools, between 2018 and 2019. Results: Among the 2,528 questionnaires, 1,261 were answered and grouped by respondents' educational level. According to information, 96.6% of the children were up to date with vaccines. The prevalence of vaccine hesitancy was 5.0%. The lower the educational level, the lower was the income, the larger the number of household members, and the greater the lack of knowledge about vaccines. The higher the educational level, the lower was the vaccine hesitancy, and the greater the dissatisfaction with the information received. Conclusions: Generally, parents consider vaccines to be important for preventing diseases and to be safe, with their benefits outweighing the risks. Positive comments were accompanied by doubts, concerns, hesitancy, and inconsistencies. The level of educational attainment makes a difference in the access to information, medical care provided by pediatricians, and the feeling of obligation to vaccinate. Parents have vaccinated and still intend to vaccinate their children, but ensuring adequate levels of vaccination coverage will be a post-pandemic challenge.

RESUMO Objetivo: Este estudo procurou avaliar atitudes, preocupações, informações e conhecimentos sobre vacinas por parte de responsáveis por crianças em idade pré-escolar que frequentam instituições de ensino infantil em um município do interior de São Paulo, Brasil, por meio de questionário autoaplicável. Métodos: Estudo transversal com o uso de questionário dirigido aos pais de crianças de até 72 meses, em escolas públicas e privadas, sobre conhecimentos e atitudes quanto à vacinação das crianças entre 2018 e 2019. Resultados: Entre 2.528 questionários entregues, 1.261 foram respondidos e agrupados conforme a escolaridade dos entrevistados. De acordo com as informações, 96,6% das crianças estavam com vacinas em dia. A prevalência de hesitação vacinal foi de 5,0%. Quanto menor a escolaridade, menor a renda, maior o número de habitantes na casa e maior o desconhecimento sobre vacinas. Quanto maior a escolaridade, menor hesitação e maior insatisfação com as informações recebidas. Conclusões: Em geral, os pais consideram as vacinas importantes para prevenir doenças, como proteção, e dizem que os benefícios superam os riscos. Manifestações positivas foram acompanhadas por dúvidas, preocupações, hesitações e inconsistências. O nível de escolaridade faz diferença no acesso a informações, no atendimento médico por pediatras e no sentimento de obrigatoriedade em vacinar. Os pais têm vacinado e ainda pretendem vacinar, mas garantir níveis de cobertura vacinal adequados será um desafio pós-pandemia.

Facilitators of and barriers to COVID-19 vaccination in Grenada: a qualitative study / Factores que facilitan u obstaculizan la vacunación contra la COVID-19 en Granada: estudio cualitativo / Facilitadores e barreiras para a vacinação contra a covid-19 em Granada: um estudo qualitativo

ABSTRACT Objectives. To identify the factors contributing to coronavirus disease 2019 (COVID-19) vaccine hesitancy in Grenada. Methods. A phenomenological study was conducted using semi-structured interviews at vaccination and pop-up testing clinics during a spike in COVID-19 cases on the island. Interview questions were developed using the health belief model related to perceived threat of COVID-19, perceived benefits of and barriers to COVID-19 vaccination, and cues to action. Data were analyzed using a deductive approach to identify themes, categories, and subcategories. Results. Twenty-five interviews were transcribed and coded. In all, 68% of participants were unvaccinated, 12% were partially vaccinated, and 20% were fully vaccinated. Data analysis revealed two main themes: facilitators and barriers. Factors more likely to encourage vaccination (facilitators) included trust in medical advice and vaccine efficacy, social responsibility, and vaccine mandates for travel, employment, and social activities. Factors hindering vaccination (barriers) included: perceived low threat of COVID-19; preference for natural remedies; concerns about contraindications because of underlying health conditions; fear; mistrust of vaccines and related messaging; vaccine accessibility; and the many different information sources. Conclusions. Overcoming vaccine hesitancy is key to combating the detrimental effects of COVID-19 in Grenada. Public health interventions and policies that address barriers and capitalize on facilitators can increase vaccine uptake.

RESUMEN Objetivos. Determinar cuáles son los factores que contribuyen con la reticencia a la vacunación contra la enfermedad por el coronavirus del 2019 (COVID-19) en Granada. Métodos. Se realizó un estudio fenomenológico utilizando entrevistas semiestructuradas realizadas en puestos transitorios de prueba y vacunación durante un aumento en el número de casos de COVID-19 en la isla. Se elaboraron las preguntas de la entrevista según el modelo de creencias de salud en relación con la amenaza percibida respecto de la COVID-19, los obstáculos y los beneficios percibidos respecto de la vacunación contra la COVID-19 y los incentivos para la acción. Los datos se analizaron mediante un enfoque deductivo con el fin de determinar los principales temas, categorías y subcategorías. Resultados. Se transcribieron y codificaron veinticinco entrevistas. En total, el 68% de los participantes no estaban vacunados, el 12% estaban parcialmente vacunados y el 20% tenían el esquema completo de vacunación. El análisis de los datos reveló dos temas principales: los factores facilitadores y los obstáculos. Entre los factores con mayores probabilidades de incentivar la vacunación (factores facilitadores) se encuentran la confianza en el asesoramiento médico y la eficacia de la vacuna, la responsabilidad social y los mandatos de vacunación para viajes, empleo y actividades sociales. Entre los factores que obstaculizan la vacunación (obstáculos) se encuentran la percepción de que la COVID-19 no es una amenaza grave; la preferencia por los remedios naturales; las preocupaciones por las contraindicaciones debido a afecciones de salud subyacentes; el miedo; la desconfianza en las vacunas y los mensajes relacionados; la accesibilidad a las vacunas; y las muy diferentes fuentes de información. Conclusiones. Es necesario superar la reticencia a la vacunación para combatir los efectos nocivos de la COVID-19 en Granada. Las políticas e intervenciones de salud pública que abordan los obstáculos y capitalizan los factores facilitadores pueden aumentar el uso efectivo de las vacunas.

RESUMO Objetivos. Identificar os fatores que contribuem para a hesitação em relação à vacina contra a doença por coronavírus 2019 (covid-19) em Granada. Métodos. Realizou-se um estudo fenomenológico com entrevistas semiestruturadas em clínicas de vacinação e testagem rápida durante um pico de casos de covid-19 na ilha. As perguntas da entrevista foram elaboradas com base no modelo de crenças em saúde relacionado à percepção de ameaça da covid-19, à percepção de benefícios e barreiras relativos à vacinação contra a covid-19, e aos estímulos para ação. Os dados foram analisados por um método dedutivo para identificar temas, categorias e subcategorias. Resultados. Vinte e cinco entrevistas foram transcritas e codificadas. No total, 68% dos participantes não eram vacinados, 12% eram parcialmente vacinados e 20% eram totalmente vacinados. A análise dos dados evidenciou dois temas principais: facilitadores e barreiras. Os fatores mais propensos a incentivar a vacinação (facilitadores) foram confiança na orientação médica e na eficácia da vacina, responsabilidade social e exigência de vacinação em viagens, no emprego e em atividades sociais. Entre os fatores que impediam a vacinação (barreiras) estavam: percepção de baixa ameaça da covid-19; preferência por remédios naturais; preocupação com contraindicações em razão de problemas de saúde preexistentes; medo; desconfiança das vacinas e mensagens relacionadas; acessibilidade da vacina; e as muitas diferentes fontes de informação. Conclusões. Superar a hesitação vacinal é imprescindível para combater as consequências negativas da covid-19 em Granada. As intervenções e políticas de saúde pública que afastam barreiras e promovem facilitadores podem aumentar a aceitação da vacina.

Prediction and reasons for COVID-19 second dose vaccine hesitation: a cross-sectional study in a municipality of Brazil

ABSTRACT BACKGROUND: Hesitation and refusal to take a second dose of the vaccine for coronavirus disease 19 (COVID-19) are prevalent. OBJECTIVES: We aimed to identify predictive factors for hesitation or refusal and describe groups with higher rates of vaccine hesitancy. DESIGN AND SETTING: A cross-sectional study in Assis City, Brazil. METHODS: The study included adults who passed the due date for taking the COVID-19 second dose vaccine. Participants were recruited in December 2021 using a mobile-based text message. Sociodemographic and clinical data and reasons for hesitance were collected. The outcome was the attitude towards completing the recommended second dose of the vaccine. Bivariate and multivariate Poisson analyses were performed to determine the adjusted predictors. RESULTS: Participants between 30-44 years of age had a 2.41 times higher prevalence of hesitation than those aged 18-29 years. In addition, people who had adverse events or previously had COVID-19 had 4.7 and 5.4 times higher prevalences of hesitation, respectively (P value < 0.05). CONCLUSION: We found a significant group of adults aged between 30-44 years who refused the second dose of the COVID-19 vaccine. Furthermore, those who reported adverse effects after the first dose and those who had COVID-19 previously were a significant group for refusal.

Percepção, conhecimento e satisfação do paciente em relação ao processo vacinal: revisão integrativa / Perception, knowledge and satisfaction of patients in relation to the vaccination process: an integrative review / Percepción, conocimiento y satisfacción del paciente en relación con el proceso de vacunación: revisión integradora

Objetivo: Analisar as evidências cientificas disponíveis na literatura acerca da percepção, o conhecimento e a satisfação do paciente em relação ao processo vacinal mediante a assistência recebida. Metodologia: Foi feita uma busca das referências nas bases PubMed, Scientific Electronic Library Online (SciELO) e Biblioteca Virtual em Saúde (BVS). Resultados: A busca permitiu a identificação de quatro estudos com os descritores de Vaccination AND Patient Care AND Perception, sete com os descritores Vaccination AND Patient Care AND Knowledge e um com os descritores Vaccination AND Patient Care AND Satisfaction. Considerações finais: Os estudos evidenciaram que o foco principal das pesquisas se enquadrou nos grupos de pais devido os mesmos acompanharem seus filhos no processo vacinal, gestantes, puérperas e pessoas com comorbidades. Constatou-se que houve maior declínio em relação a vacina influenza com as gestantes e HPV entrevistando pais. Os principais motivos de atraso e da não aceitação vacinal foi o desconhecimento vacinal, crença excessiva na imunidade natural, julgar que as vacinas são desnecessárias, medo das reações adversas e pouca satisfação quanto as informações recebidas. Quanto as possíveis lacunas na assistência o principal foi a carência de orientações ofertadas pelos profissionais da saúde, sendo assim, para que o repasse de informações aos pacientes seja efetivo e esses tenham melhores conhecimentos é de extrema importância que os profissionais da saúde estejam sempre atualizados, qualificando assim o repasse de informação, promovendo orientações de forma mais clara e consequentemente absorção de mais conhecimentos pelos usuários.

Objective: To analyze the scientific evidence available in the literature about the perception, knowledge and patient satisfaction regarding the vaccination process through the assistance received. Methodology: A search was performed for references in PubMed, Scientific Electronic Library Online (SciELO) and Virtual Health Library (BVS). Results: The search allowed the identification of four studies with the descriptors Vaccination AND Patient Care AND Perception, seven with the descriptors Vaccination AND Patient Care AND Knowledge and one with the descriptors Vaccination AND Patient Care AND Satisfaction. Final considerations: The studies showed that the main focus of the research was framed in the groups of parents because they accompany their children in the vaccination process, pregnant women, postpartum women and people with comorbidities. It was found that there was a greater decline in relation to influenza vaccine with pregnant women and HPV interviewing parents. The main reasons for delay and non-acceptance of the vaccine were lack of vaccine knowledge, excessive belief in natural immunity, judging that vaccines are unnecessary, fear of adverse reactions and little satisfaction with the information received. As for the possible gaps in care, the main one was the lack of guidelines offered by health professionals, so, for the transfer of information to patients to be effective and for them to have better knowledge, it is extremely important that health professionals are always up to date, thus qualifying the transfer of information, promoting clearer guidelines and consequently absorbing more knowledge by users.

Objetivo: Analizar la evidencia científica disponible en la literatura sobre la percepción, conocimiento y satisfacción del paciente en relación al proceso de vacunación a través de la atención recibida. Metodología: Se realizaron búsquedas de referencias en las bases de datos PubMed, Scientific Electronic Library Online (SciELO) y Virtual Health Library (BVS). Resultados: La búsqueda permitió la identificación de cuatro estudios con los descriptores de Vaccination AND Patient Care AND Perception, siete con los descriptores Vaccination AND Patient Care AND Knowledge y uno con los descriptores Vaccination AND Patient Care AND Satisfaction. Consideraciones finales: Los estudios mostraron que el foco principal de la investigación fue en los grupos de padres porque acompañan a sus hijos en el proceso de vacunación, embarazadas, puérperas y personas con comorbilidades. Se encontró que hubo una mayor disminución en relación con la vacuna contra la influenza con mujeres embarazadas y VPH entrevistando a los padres. Las principales razones para el retraso y la no aceptación de las vacunas fueron la falta de conocimiento de estas, la creencia excesiva en la inmunidad natural, juzgar que las vacunas son innecesarias, el miedo a las reacciones adversas y la poca satisfacción con la información recibida. En cuanto a las posibles brechas en la atención, la principal fue la falta de orientación ofrecida por los profesionales de la salud, para que la transferencia de información a los pacientes sea efectiva y tengan un mejor conocimiento, es extremadamente importante que los profesionales de la salud estén siempre actualizados, calificando así la transferencia de información, promoviendo la orientación más claramente y, en consecuencia, la absorción de más conocimiento por parte de los usuarios.