Testing persuasive messages about booster doses of COVID-19 vaccines on intention to vaccinate in Australian adults: A randomised controlled trial.

INTRODUCTION: Achieving high COVID-19 vaccine booster coverage is an ongoing global challenge. Health authorities need evidence about effective communication interventions to improve acceptance and uptake. This study aimed to test effects of persuasive messages about COVID-19 vaccine booster doses on intention to vaccinate amongst eligible adults in Australia. METHODS: In this online randomised controlled trial, adult participants received one of four intervention messages or a control message. The control message provided information about booster dose eligibility. Intervention messages added to the control message, each using a different persuasive strategy, including: emphasising personal health benefits of booster doses, community health benefits, non-health benefits, and personal agency in choosing vaccination. After the intervention, participants answered items about COVID-19 booster vaccine intention and beliefs. Intervention groups were compared to the control using tests of two proportions; differences of ≥5 percentage points were deemed clinically significant. A sub-group analysis was conducted among hesitant participants. RESULTS: Of the 487 consenting and randomised participants, 442 (90.8%) completed the experiment and were included in the analysis. Participants viewing messages emphasising non-health benefits had the highest intention compared to those who viewed the control message (percentage point diff: 9.0, 95% CI -0.8, 18.8, p = 0.071). Intention was even higher among hesitant individuals in this intervention group compared to the control group (percentage point diff: 15.6, 95% CI -6.0, 37.3, p = 0.150). Conversely, intention was lower among hesitant individuals who viewed messages emphasising personal agency compared to the control group (percentage point diff: -10.8, 95% CI -33.0, 11.4, p = 0.330), although evidence in support of these findings is weak. CONCLUSION: Health authorities should highlight non-health benefits to encourage COVID-19 vaccine booster uptake but use messages emphasising personal agency with caution. These findings can inform communication message development and strategies to improve COVID-19 vaccine booster uptake. Clinical trial registration: Registered with the Australian New Zealand Clinical Trials Registry (ACTRN12622001404718); trial webpage: https://www.anzctr.org.au/ACTRN12622001404718.aspx.

Influenza and pertussis vaccine coverage in pregnancy in Australia, 2016-2021.

Vaccination in pregnancy is the best strategy to reduce complications from influenza or pertussis infection in infants who are too young to be protected directly from vaccination. Pregnant women are also at risk of influenza complications preventable through antenatal vaccination. Both vaccines are funded under the National Immunisation Program for pregnant women in Australia, but coverage is not routinely reported nationally. We reviewed all reported Australian maternal influenza and pertussis vaccine coverage data for the period 2016-2021, to identify gaps and information needs. Maternal influenza vaccine coverage was suboptimal at < 58% for 2016-2018, with higher coverage of 62-75% reported in two states (Victoria and Western Australia) for 2019-2021. Maternal pertussis vaccine coverage from 2016 was generally higher than for influenza at > 70%, with the highest jurisdictional coverage of 89% reported in Western Australia in 2020. Vaccination rates were often suboptimal among First Nations pregnant women and up to 20% lower than among non-First Nations Australian women; while data were limited, coverage was low among culturally and linguistically diverse women and among women of lower socio-economic status. Jurisdictional perinatal data collections were the best source of information on antenatal vaccine coverage but were only available for a minority of the population; a nationally consistent systematic approach is lacking. Timely and comprehensive data are needed to provide feedback to improve maternal vaccination coverage, particularly among groups with higher risk and/or low uptake, and as new vaccines are recommended, including COVID-19 vaccination.

Effect of persuasive messaging about COVID-19 vaccines for 5- to 11-year-old children on parent intention to vaccinate.

AIM: Uptake of COVID-19 vaccines for children aged 5-11 years old in Australia has plateaued. Persuasive messaging is an efficient and adaptable potential intervention to promote vaccine uptake, but evidence for its effectiveness is varied and dependent on context and cultural values. This study aimed to test persuasive messages to promote COVID-19 vaccines for children in Australia. METHODS: A parallel, online, randomised control experiment was conducted between 14 and 21 January 2022. Participants were Australian parents of a child aged 5-11 years who had not vaccinated their child with a COVID-19 vaccine. After providing demographic details and level of vaccine hesitancy, parents viewed either the control message or one of four intervention texts emphasising (i) personal health benefits; (ii) community health benefits; (iii) non-health benefits; or (iv) personal agency. The primary outcome was parents' intention to vaccinate their child. RESULTS: The analysis included 463 participants, of whom 58.7% (272/463) were hesitant about COVID-19 vaccines for children. Intention to vaccinate was higher in the community health (7.8%, 95% confidence interval (CI) -5.3% to 21.0%) and non-health (6.9%, 95% CI -6.4% to 20.3%) groups, and lower in the personal agency group (-3.9, 95% CI -17.7 to 9.9) compared to control, but these differences did not reach statistical significance. The effects of the messages among hesitant parents were similar to the overall study population. CONCLUSION: Short, text-based messages alone are unlikely to influence parental intention to vaccinate their child with the COVID-19 vaccine. Multiple strategies tailored for the target audience should also be utilised.

Exploring the lived experience of families with a COVID-19 positive child: The journey from a critical grounded theory approach.

COVID-19 and associated public health policies have significantly disrupted the lives of both adults and children. Experiences of COVID-positive adults are well described but less is known about the experiences of families of children who receive a positive diagnosis, and the impact of public health policies on this experience. This study aimed to develop a framework to understand the lived experience of families with a child testing positive for COVID-19. We applied a qualitative study design, using grounded theory. The study took place in Melbourne, Australia between July and December 2020, during the first major Australian COVID-19 wave. Parents of children 0-18 years tested at a walk-in clinic at a paediatric tertiary referral hospital were invited to participate. Two interviewers jointly undertook in-depth interviews with parents of children who tested positive. Interviews were transcribed and two analysts used an inductive, critical realist analysis approach with NVivo and a virtual whiteboard. Results are presented incorporating a stratified reality (empirical, actual, real). Families described seven sequential stages of the COVID-19 positive testing journey: COVID-19 close to home; time to be tested; waiting for the test result; receiving the result; dealing with the diagnosis; coping with isolation; and moving forward/looking back. Our findings highlight how public health policies and messages targeting the general (adult) public were experienced by families. We provide a framework that families move through when their child tests positive for COVID-19. Within each phase, we report unmet needs and identify strategies to improve future pandemic planning for parents and children.

Empowering Health Workers to Build Public Trust in Vaccination: Experience from the International Pediatric Association's Online Vaccine Trust Course, 2020-2021.

BACKGROUND: The quality of interactions between health workers (HWs) and caregivers is key in vaccine acceptance. To optimize this, HWs need knowledge about best vaccine communication practices in person and on social media. Most pre-service curricula do not include such approaches. COVID-19 necessitated the International Pediatric Association (IPA) to shift from in-person train the trainer workshops to developing an online Vaccine Trust Course to address these gaps. METHOD: The seven-module, 8-hour Vaccine Trust Course was offered online in seven languages and promoted globally. Course outcomes for participants between September 1, 2020 and September 30, 2021 were assessed using enrollment, participation, and completion data; pre-and post-training surveys of attitudes, knowledge, and practice skills; and follow-up practice surveys 3 months post course completion. RESULTS: Of the 4,926 participants across 137 countries who registered; 2,381 (48.3 %) started the course, with 1,217 (51.1 %) completing. The majority were 25 - 39 years (57 %), female (57 %), and in pediatrics (70 %); 31 % came from India. 62 % of completers rated course structure/design as excellent, 36 % as good. Over 80 % rated the content as the most valuable aspect. Three months post training, 61 % HWs reported increased empathy towards caregivers, confidence while counseling and increased vaccine acceptance amongst their patients. 21 % identified the course as the only factor in these positive changes. CONCLUSION: Shifting from face-to-face to online training due to the COVID-19 pandemic helped increase the global reach of HWs course engagement and uptake. Trained HWs reported increased empathy towards caregivers and confidence while counseling and increased patient vaccine acceptance.

Factors impacting COVID-19 vaccine decision making in older adults and people with underlying conditions in Victoria, Australia: A cross-sectional survey.

Australia's COVID-19 vaccine rollout included prioritizing older adults and those with underlying conditions. However, little was known around the factors impacting their decision to accept the vaccine. This study aimed to assess vaccine intentions, information needs, and preferences of people prioritized to receive the COVID-19 vaccine at the start of the Australian vaccine rollout. A cross-sectional online survey of people aged ≥70 years or 18-69 with chronic or underlying conditions was conducted between 12 February and 26 March 2021 in Victoria, Australia. The World Health Organization Behavioural and Social Drivers of COVID-19 vaccination framework and items informed the survey design and framing of results. Bivariate logistic regression was used to investigate the association between intention to accept a COVID-19 vaccine and demographic characteristics. In total, 1828 eligible people completed the survey. Intention to vaccinate was highest among those ≥70 years (89.6%, n = 824/920) versus those aged 18-69 years (83.8%, n = 761/908), with 91% (n = 1641/1803) of respondents agreeing that getting a COVID-19 vaccine was important to their health. Reported vaccine safety (aOR 1.4, 95% CI 1.1 to 1.8) and efficacy (aOR 1.9, 95% CI 1.5 to 2.3) were associated with intention to accept a COVID-19 vaccine. Concerns around serious illness, long-term effects, and insufficient vaccine testing were factors for not accepting a COVID-19 vaccine. Preferred communication methods included discussion with healthcare providers, with primary care providers identified as the most trusted information source. This study identified factors influencing the prioritized public's COVID-19 vaccine decision-making, including information preferences. These details can support future vaccination rollouts.

Vaccine Champions Training Program: Empowering Community Leaders to Advocate for COVID-19 Vaccines.

Strong community engagement has been critical to support COVID-19 vaccine uptake in Australia and elsewhere. Community engagement builds trust, enables tailored information dissemination and shapes social norms. Engagement is particularly important in communities with greater vaccine hesitancy, lower health literacy and mistrust in authorities. Early in 2021, as a team of vaccine social scientists and clinicians, we developed a program to train and empower community, faith, industry and healthcare leaders to advocate for COVID-19 vaccines as "vaccine champions". We partnered with the Victorian Department of Health to deliver 91 online Vaccine Champions sessions from March 2021 to June 2022. Over 80 people who received this training were supported by the Department of Health to become formal vaccine champions, independently delivering over 100 locally tailored information sessions. Our survey evaluation of 20 sessions delivered in 2022 found most participants (94%, 118/125) felt more confident to discuss safety and effectiveness of COVID-19 vaccines and find relevant information after attending a session. We also recorded >90% participant satisfaction with training content, format and presentation. Qualitative feedback from two group interviews highlighted the value of vaccine communication role plays and opportunities for discussion. In this brief report, we present an overview of the Vaccine Champions program, evaluation and next steps.

An Australian consumer survey on COVID-19 vaccination and pregnancy

Pregnant women are more than twice as likely to require intensive care admission and invasive ventilation due to COVID-19 than non-pregnant women of childbearing age, and are a priority vaccination group. The Immunisation Coalition regularly undertakes surveys of the Australian population, to understand attitudes around immunisation, by engaging a private market research company, APMI Partners. A limited report is loaded on the Immunisation Coalition website. The aim was to examine the views of pregnant and recently pregnant women in Australia on COVID-19 vaccination during pregnancy, by conducting detailed analyses on the Immunisation Coalition’s survey data. Pregnant and recently pregnant women across Australia were surveyed in November/December 2021 by AMPI Partners, on behalf of the Immunisation Coalition. Pregnant and recently pregnant (had a baby after 17 May 2021) women were eligible for inclusion. The online survey was offered in multiple languages. Descriptive statistics were undertaken. Ethics approval was obtained to conduct detailed analyses on these data. Written consent was obtained from participants. The online survey was completed by 526 women. All states and territories were represented and the demographics were representative. Age ranged from 20-43 years, with a mean of 30.4 years. The survey was completed in a language other than English by 56 (8.6%) women. Overall, 393 (74.7%) women received a COVID-19 vaccination. Reasons for not receiving the vaccine included concerns about: the long-term effect on my baby (n=40);the vaccine was developed too quickly (n=39);the side effects of the vaccine on the baby (n=35);and my partner did not want me to (n=21). Midwives were the most trusted source of information for 31 women, with 26 (83.9%) of these women receiving the vaccine. Most women were aware that COVID-19 vaccination was recommended during pregnancy and could access the vaccine if desired. Targeted communication addressing concerns could improve uptake.

COVID-19 Vaccination in Pregnancy: Factors influencing uptake by women

Introduction COVID-19 infection in pregnancy is associated with increased morbidity and mortality for the mother as well as complications for the baby. In July 2021, the Australian Technical Advisory Group on Immunisation and the Royal Australian and New Zealand College of Obstetricians and Gynaecologists recommended that pregnant women should be prioritised for COVID-19 vaccines and routinely offered Pfizer vaccine at any stage of pregnancy. There is no evidence on the pregnant women’s perceptions and acceptance of COVID-19 vaccine after this recommendation. Aim The aim of this research was to map COVID-19 vaccination in pregnancy acceptance, hesitancy and a change in original vaccination intentions. Methods A cross-sectional, anonymous, online survey was conducted in one area health service in New South Wales, including one large tertiary referral hospital and two smaller metropolitan hospitals. Descriptive analysis was done using SPSS. Results During September 2021 to January 2022, 1103 women responded to the survey and 1,026 completed the questions, with the completion rate of 93%. Women who did not complete the survey beyond demographics (8%) or were not pregnant (3%) were excluded. The mean age of the women was 33.3 years and most were either in their second (31%) or third (49%) trimester of pregnancy. Around half of the women were having their first pregnancy (51%) and born in Australia (47%). The majority of women agreed that COVID-19 vaccine was important for their health (84%) and important to protect others in the community (81%). Although 66% of women reported that at some stage they felt unsure about having the vaccine, the majority (87%) of women had at least one dose of vaccine. Conclusion This is the largest survey of pregnant women in Australia, providing evidence that acceptance of COVID-19 vaccination in pregnancy appears to be high among Australian women living in metropolitan areas.

Association between COVID-19 restrictions and emergency department presentations for paediatric mental health in Victoria, Australia.

Objective To determine the association between coronavirus disease 2019 (COVID-19) restrictions and paediatric mental health emergency department presentations. Methods Secondary analysis of Victorian Emergency Minimum Dataset data from 38 Victorian public hospital emergency departments. Paediatric patients (birth to <18 years) attending emergency departments with an International Classification of Disease-Australian Modification (ICD-10-AM) diagnosis of a mental health problem between 1 January 2018 and 31 October 2020 were included. We compared pre-COVID-19 (1 January 2018-27 March 2020) to the COVID-19 period (28 March-26 October 2020) to examine the number of mental health presentations by patient age, socioeconomic status, location, and emergency department triage category. A Poisson regression prediction model was built for each diagnosis group to predict the presentation number in the COVID-19 period, assuming the pandemic and associated restrictions had not happened. Results There were 15 898 presentations (589 presentations/month on average) in the pre-COVID-19 period and 4747 presentations (678 presentations/month on average) in the COVID-19 period. Compared with predicted presentations, there was an increase in observed presentations for eating disorders throughout lockdown (on average, an increase of 36 presentations/month) and for anxiety (11/month) and self-harm (18/month). There were no meaningful changes for mood disorders or developmental and behavioural problems, and presentations for substance abuse mostly fell. Conclusions Pandemic restrictions were associated with increased emergency department presentations for eating disorders and, to a lesser extent, anxiety and self-harm. Given the ongoing pandemic, clinicians and policy makers must work together to find timely, accessible solutions to better manage these conditions.

SARS-CoV-2 infections and public health responses in schools and early childhood education and care centres in Victoria, Australia: An observational study.

BACKGROUND: The epidemiology of SARS-CoV-2 in children is an important consideration for control measures. To inform the safe re-opening of Victorian schools and early childhood education and care (ECEC) in late 2020, a detailed analysis of local data was undertaken. METHODS: Data on all Victorian SARS-CoV-2 confirmed cases, their close contacts, and ECEC/school events from the first case in Victoria to the end of the third school term (25/01/2020 - 18/09/2020) were analysed. We compared temporal and geographic trends in cases linked to ECEC/school events and community cases; and describe events with onward transmission by age of first case, and public health actions. FINDINGS: Victoria recorded 20,049 SARS-CoV-2 cases during the study period. In total, 1,691 cases and 18,423 contacts were linked to 339 events in ECEC/schools. Many (n=224, 66·1%) events had no evidence of onward transmission, and most (96·5%) involved <10 cases. Onward transmission was more common when the first case was older: when first case was aged 0-5 years, 14·1% events involved additional cases, compared to 30·5% (6-12 years), 33·3% (13-15 years), 42·9% (16-18 years), and 39·1% when the first case was an adult. ECEC/schools were closed within a median of one day (IQR 0-2) from laboratory notification of the first case. INTERPRETATION: Mitigation measures and rapid responses prevented most SARS-CoV-2 cases in ECEC/schools from becoming outbreaks in Victoria in 2020. As new variants emerge and vaccination coverage increases, ECEC/school mitigation strategies should be tailored to local community transmission and educational level. FUNDING: The Victorian Department of Health and Human Services.

Factors Influencing Australian Healthcare Workers' COVID-19 Vaccine Intentions across Settings: A Cross-Sectional Survey.

Healthcare workers' COVID-19 vaccination coverage is important for staff and patient safety, workforce capacity and patient uptake. We aimed to identify COVID-19 vaccine intentions, factors associated with uptake and information needs for healthcare workers in Victoria, Australia. We administered a cross-sectional online survey to healthcare workers in hospitals, primary care and aged or disability care settings (12 February-26 March 2021). The World Health Organization Behavioural and Social Drivers of COVID-19 vaccination framework informed survey design and framing of results. Binary regression results adjusted for demographics provide risk differences between those intending and not intending to accept a COVID-19 vaccine. In total, 3074 healthcare workers completed the survey. Primary care healthcare workers reported the highest intention to accept a COVID-19 vaccine (84%, 755/898), followed by hospital-based (77%, 1396/1811) and aged care workers (67%, 243/365). A higher proportion of aged care workers were concerned about passing COVID-19 to their patients compared to those working in primary care or hospitals. Only 25% felt they had sufficient information across five vaccine topics, but those with sufficient information had higher vaccine intentions. Approximately half thought vaccines should be mandated. Despite current high vaccine rates, our results remain relevant for booster programs and future vaccination rollouts.

Qualitative exploration of intentions, concerns and information needs of vaccine-hesitant adults initially prioritised to receive COVID-19 vaccines in Australia.

OBJECTIVE: Tailored communication is necessary to address COVID-19 vaccine hesitancy and increase uptake. We aimed to understand the information needs, perceived benefits and barriers to COVID-19 vaccination of people prioritised, but hesitant to receive the vaccine. METHOD: In this qualitative study in Victoria, Australia (February-May 2021), we purposively sampled hesitant adults who were health or aged/disability care workers (n=20), or adults aged 18-69 with comorbidities or aged ≥70 years ('prioritised adults'; n=19). We thematically analysed interviews inductively, then deductively organised themes within the World Health Organization Behavioural and Social Drivers of vaccination model. Two stakeholder workshops (n=12) explored understanding and preferences for communicating risks and benefits. We subsequently formed communication recommendations. RESULTS: Prioritised adults and health and aged care workers had short- and long-term safety concerns specific to personal circumstances, and felt like "guinea pigs". They saw vaccination as beneficial for individual and community protection and travel. Some health and aged care workers felt insufficiently informed to recommend vaccines, or viewed this as outside their scope of practice. Workshop participants requested interactive materials and transparency from spokespeople about uncertainty. Conclusions and public health implications: Eleven recommendations address communication content, delivery and context to increase uptake and acceptance of COVID-19 vaccines.

Parent-level barriers to uptake of childhood vaccination: a global overview of systematic reviews.

INTRODUCTION: Understanding barriers to childhood vaccination is crucial to inform effective interventions for maximising uptake. Published systematic reviews include different primary studies, producing varying lists of barriers. To make sense of this diverse body of literature, a comprehensive level of summary and synthesis is necessary. This overview of systematic reviews maps all potential parent-level barriers to childhood vaccination identified in systematic reviews. It synthesises these into a conceptual framework to inform development of a vaccine barriers assessment tool. METHODS: We applied Joanna Briggs methodology, searching the Epistemonikos review database and reference lists of included reviews to June 2020. Systematic reviews of qualitative or quantitative data on parent-level barriers to routine vaccination in preschool-aged children were included. Reviews addressing influenza, reporting non-modifiable determinants or reporting barriers not relevant to parents were excluded. Where possible, we extracted review details, barrier descriptions and the number, setting and design of primary studies. Two authors independently screened search results and inductively coded barrier descriptions. RESULTS: We screened 464 papers, identifying 30 relevant reviews with minimal overlap. Fourteen reviews included qualitative and quantitative primary studies, seven included quantitative and seven included qualitative studies only. Two did not report included study designs. Two-thirds of reviews (n=20; 67%) only included primary studies from high-income countries. We extracted 573 barrier descriptions and inductively coded these into 64 unique barriers in six overarching categories: (1) Access, (2) Clinic or Health System Barriers, (3) Concerns and Beliefs, (4) Health Perceptions and Experiences, (5) Knowledge and Information and (6) Social or Family Influence. CONCLUSIONS: A global overview of systematic reviews of parent-level barriers to childhood vaccine uptake identified 64 barriers to inform development of a new comprehensive survey instrument. This instrument will assess both access and acceptance barriers to more accurately diagnose the reasons for under-vaccination in children in different settings.