Can psychological distress account for the associations between COVID-19 vaccination acceptance and socio-economic vulnerability?

Socially disadvantaged individuals and communities consistently showed lower COVID-19 vaccination acceptance. We aimed to examine the psychological mechanisms that could explain such vaccination disparities. This study used data from serial population-based surveys conducted since the COVID-19 vaccination programme being launched in Hong Kong (N = 28,734). We first assessed the correlations of community-level and individual-level social vulnerability with COVID-19 vaccination acceptance. Structural equation modelling (SEM) was then conducted to test whether psychological distress measured by PHQ-4 can account for the associations between participants' socio-economic vulnerability and COVID-19 vaccination acceptance. The third part analysis examined whether perceived negativity of vaccine-related news and affect towards COVID-19 vaccines accounted for the association between psychological distress and COVID-19 vaccination. Communities with higher social vulnerability scores and participants who had more vulnerable socio-economic status showed lower COVID-19 vaccination acceptance. Individuals with more vulnerable socio-economic status reported higher psychological distress, which lowered COVID-19 vaccination acceptance. Furthermore, higher psychological distress was associated with lower vaccination acceptance through its psychological mechanisms of processing vaccine-related information. We proposed a renewed focus on tackling psychological distress rather than merely increasing vaccine accessibility in more socio-economic-disadvantaged groups for promoting COVID-19 vaccination acceptance.

Community vulnerability to the COVID-19 pandemic: A narrative synthesis from an ecological perspective.

Background: We aimed to conduct a narrative synthesis of components and indicators of community vulnerability to a pandemic and discuss their interrelationships from an ecological perspective. Methods: We searched from PubMed, Embase, Web of Science, PsycINFO, and Scopus (updated to November 2021) for studies focusing on community vulnerability to a pandemic caused by novel respiratory viruses on a geographic unit basis . Studies that reported the associations of community vulnerability levels with at least one disease morbidity or mortality outcome were included. Results: Forty-one studies were included. All were about the COVID-19 pandemic. Suitable temperature and humidity environments, advanced social and human development (including high population density and human mobility, connectivity, and occupations), and settings that intensified physical interactions are important indicators of vulnerability to viral exposure. However, the eventual pandemic health impacts are predominant in communities that faced environmental pollution, higher proportions of socioeconomically deprived people, health deprivation, higher proportions of poor-condition households, limited access to preventive health care and urban infrastructure, uneven social and human development, and racism. More stringent social distancing policies were associated with lower COVID-19 morbidity and mortality only in the early pandemic phases. Prolonged social distancing policies can disproportionately burden the socially disadvantaged and racially/ethnically marginalized groups. Conclusions: Community vulnerability to a pandemic is foremost the vulnerability of the ecological systems shaped by complex interactions between the human and environmental systems. Registration: PROSPERO (CRD42021266186).

Priming with social benefit information of vaccination to increase acceptance of COVID-19 vaccines.

Vaccine hesitancy can be heightened due to increasing negative reports about vaccines. Emphasizing the social benefits of vaccination may shift individual attention from individual to social benefit of vaccination and hence promote prosocial vaccination. In six rounds of a population-based survey conducted over one major community epidemic of coronavirus disease 2019 (COVID-19) in Hong Kong from June to November 2020, we manipulated the question asking about acceptance of a COVID-19 vaccine with or without emphasizing the social benefit of vaccination against COVID-19 (prosocial priming) and monitored the changes of vaccine confidence by news media sentiment on vaccines. Population-weighted percentages of accepting COVID-19 vaccines by priming condition and vaccine confidence were compared across survey rounds. Logit regression models assessed the main effect of prosocial priming and the modification effects of vaccine confidence and perceived personal risk from COVID-19 on acceptance of COVID-19 vaccines. We found that prosocial priming significantly increased acceptance of COVID-19 vaccines across all survey rounds except for Round 3 when incidence of COVID-19 reached a peak. Vaccine confidence significantly declined in Round 6 when news media sentiment on vaccines became predominantly negative. The effect of prosocial priming on promoting vaccine acceptance was significantly greater in participants with low vaccine confidence and those perceiving the severity of COVID-19 to be mild/very mild. Our study suggests that packaging vaccination against COVID-19 as a prosocial behaviour can help overcome low vaccine confidence and promote prosocial vaccination particularly when disease incidence temporarily declines and the public perceive low severity of COVID-19.

Assessing Community Vulnerability over 3 Waves of COVID-19 Pandemic, Hong Kong, China.

We constructed a coronavirus disease community vulnerability index using micro district-level socioeconomic and demographic data and analyzed its correlations with case counts across the 3 pandemic waves in Hong Kong, China. We found that districts with greater vulnerability reported more cases in the third wave when widespread community outbreaks occurred.

Learning public engagement and government responsiveness in the communications about COVID-19 during the early epidemic stage in China: an analysis of social media data

BACKGROUND: Effective risk communication about the outbreak of a newly emerging infectious disease in the early stage is critical for managing public anxiety and promoting behavioural compliance. China has experienced the unprecedented epidemic of coronavirus disease 2019 (COVID-19) in an era when social media has fundamentally transformed information production and consumption patterns. OBJECTIVE: This study examined public engagement and government responsiveness in the communications about COVID-19 during the early epidemic stage based on analysis of data from Sina Weibo, a major social media platform in China. METHODS: Weibo data relevant to COVID-19 from December 1, 2019 to January 31, 2020 were retrieved. Engagement data (Likes, Comments, Shares and Followers) of posts from government agency accounts were extracted to evaluate public engagement with government posts online. Content analyses were conducted for a random subset of 644 posts from personal accounts of individuals, and 273 posts from 10 relatively more active government agency accounts and the National Health Commission of China to identify major thematic contents in online discussions. Latent class analysis (LCA) was employed to further explore main content patterns while Chi-square for trend examined how proportions of main content patterns changed by time within the study timeframe. RESULTS: Public response to COVID-19 seemed to follow the spread of the disease and government actions but was earlier on Weibo than the government. Online users generally had low engagement with posts relevant COVID-19 from government agency accounts. The common content patterns identified in personal and government posts included sharing epidemic situation, general knowledge of the new disease, and policies, guidelines and official actions. However, personal posts more likely showed empathy to affected people (chi-square=13.3, P<.001), attributed blame to other individuals or government (chi-square=28.9, P<.001), and expressed worry about the epidemic (chi-square=32.1, P<.001) while government posts more likely shared instrumental support (chi-square=32.5, P<.001) and praised people or organizations (chi-square=8.7, P=.003). As the epidemic evolved, sharing situation update (chi-square for trend=19.7, P<.001), and policies, guidelines and official actions (chi-square for trend=15.3, P<.001) became less frequent in personal posts but remained stable or increased significantly in government posts. Moreover, as the epidemic evolved, showing empathy and attributing blame (chi-square for trend=25.3, P<.001) became more frequent in personal posts, corresponding to a slight increase in sharing instrumental support, praising and empathy in government posts (chi-square for trend=9.0, P=.003). CONCLUSIONS: The government should closely monitor social media data to improve the timing of communications about an epidemic. As the epidemic evolves, merely sharing situation update and policies may be insufficient to capture public interest in the messages. The government may adopt a more empathic communication style as more people are affected by the disease to address public concerns. CLINICALTRIAL: Not applicable.