Freedom of Choice to Vaccinate and Covid-19 Vaccine Hesitancy in Italy (preprint)

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

Exploring the Association between Misinformation Endorsement, Opinions on the Government Response, Risk Perception, and COVID-19 Vaccine Hesitancy in the US, Canada, and Italy (preprint)

The COVID-19 pandemic has highlighted the adverse consequences created by an infodemic specifically on compliance with public health guidance and vaccine uptake. COVID-19 vaccine hesitancy is a complex construct that is related to health beliefs, misinformation exposure, and perceptions of governmental institutions. This study draws on theoretical models and current data on the COVID-19 infodemic to explore the association between perceived risk of COVID-19, levels of misinformation endorsement, and opinions about the government response on vaccine uptake. We surveyed a sample of 2,697 respondents from the US, Canada, and Italy using a mobile platform between 21-28 May, 2021. Using multivariate regression, we found that country of residence, risk perception of contracting and spreading COVID-19, perception of government response and transparency, and misinformation endorsement was associated with the odds of vaccine hesitancy. Higher perceived risk was associated with lower odds of hesitancy, while lower perceptions of government response, and higher misinformation endorsement were associated with higher hesitancy.

Essential Workers COVID-19 Vaccine Hesitancy, Misinformation and Informational Needs in the Republic of North Macedonia. (preprint)

Introduction: The COVID-19 pandemic is a global health crisis that as of December 2021 has resulted in the death of over 5.2 million people. Despite the unprecedented development and distribution of vaccines, hesitancy to take the vaccine remains a wide-spread public health challenge, especially in Eastern European countries. In this study we focus on a sample of essential workers in North Macedonia to: 1) Describe rates of vaccine acceptance, risk perception and sources of COVID-19 information, 2) Explore predictors of vaccine hesitancy and 3) Describe informational needs of hesitant and non-hesitant essential workers. Methods: Descriptive statistics were used to present frequencies of vaccine acceptance. Logistic regression was used to explore predictors of vaccine acceptance based on sociodemographic characteristics, hesitancy to take other vaccines in the past, previous diagnosis of COVID-19, and individual risk perception of COVID-19. Chi square analysis was used to compare informational needs differences between hesitant and non-hesitant individuals across socio-demographic groups. Results: From a sample of 1003 individuals, 439 (44%) reported that they were very likely to get the vaccine, the rest reported some level of hesitancy. Older age, Albanian ethnicity, post-secondary school education, previous diagnosis of COVID-19, previous vaccine acceptance of other vaccines, and increased risk perception of COVID-19 infection were all found to be negatively associated with vaccine hesitancy. In particular hesitant individuals, compared to the non-hesitant, wanted to have more information and reassurance that all main international agencies (i.e. FDA, WHO, EMA) were all in accordance in recommending the vaccine and that they would be free to choose if getting the vaccine or not without consequences (p<0.01).

COVID-19 Vaccine Concerns about Safety, Effectiveness and Policies in the United States, Canada, Sweden, and Italy among Unvaccinated Individuals (preprint)

Despite the effectiveness of the COVID-19 vaccine, global vaccination distribution efforts have thus far had varying levels of success. Vaccine hesitancy remains a threat to vaccine uptake. This study has four objectives: 1) describe and compare vaccine hesitancy proportions by country; 2) categorize vaccine-related concerns; 3) rank vaccine-related concerns; and 4) compare vaccine-related concerns by country and hesitancy status in four countries- the United States, Canada, Sweden, and Italy. Using the Pollfish survey platform, we sampled 1000 respondents in Canada, Sweden, and Italy and 750 respondents in the United States between May 21-28, 2021. Results showed vaccine related concerns varied across three topical areas- vaccine safety and government control, vaccine effectiveness and population control, and freedom. For each thematic area, the top concern was statistically significantly different in each country and among the hesitant and non-hesitant subsamples within each county. Understanding the specific concerns among individuals when it comes to the COVID-19 vaccine can help to inform public communications and identify which, if any, salient narratives, are global.

Understanding COVID-19 Vaccine Early Skepticism and Misinformation (preprint)

Recent polls report that approximately 18% of healthcare workers are still skeptical about getting vaccinated. These professionals play a key role as communicators to their patients and community members. Understanding their concerns and informational needs, as well as those of other essential workers, is important for building an effective communication strategy for the whole population. This study presents the results of a survey of 1,591 hesitant U.S. essential workers, conducted in December 2020, when they were the only group eligible for the vaccine, aiming to describe their concerns regarding the COVID-19 vaccine and related policies. Results show that freedom of choice, concerns about equal access to the vaccine and being able to live a life with no restrictions once vaccinated, were important issues since the early days of the distribution campaign. Vaccine communication campaigns and distribution policies should address both non-medical and medical concerns with the same relevance.

Development of a Codebook of Online Anti-Vaccination Rhetoric to Manage COVID-19 Vaccine Misinformation (preprint)

Vaccine hesitancy (delay in obtaining a vaccine, despite availability) represents a significant hurdle to managing the COVID-19 pandemic. Vaccine hesitancy is in part related to the prevalence of anti-vaccine misinformation and disinformation, which are spread through social media and user-generated content platforms. This study uses qualitative coding methodology to identify salient narratives and rhetorical styles common to anti-vaccine and COVID-denialist media. It organizes these narratives and rhetorics according to theme, imagined antagonist, and frequency. Most frequent were narratives centered on 'corrupt elites' and rhetorics appealing to the vulnerability of children. The identification of these narratives and rhetorics may assist in developing effective public health messaging campaigns, since narrative and emotion have demonstrated persuasive effectiveness in other public health communication settings.

Assessing knowledge, concerns, and risk perceptions among Italian medical students during the SARS-CoV-2 pandemic. (preprint)

ABSTRACT OBJECTIVE During the first phase of COVID-19 pandemic, Italian medical students transitioned from in-person to remote learning. This study was carried out to early assess students' sources of information, perceived risk of infection, knowledge and preventive practices in order to resume academic activity. The impact of training and volunteer work was also assessed. METHODS A cross-sectional online survey was conducted in May 2020 among medical students enrolled in the School of Medicine and Surgery, Bologna University. RESULTS The analysis included 537 responses. On average students used seven sources of information on COVID-19. Scientific journals were considered the most trustworthy but they ranked only 6th in the frequency of use. Perceived risk of infection was higher for academic activities, especially in the hospital than daily living activities. Less than 50% of students reported being trained on biological risk and use of PPE. Training received was significantly associated with both perceived risk of infection and confidence in the use of PPE. Students engaged in volunteer work had higher confidence in PPE usage. INTERPRETATION Accessible scientific information and students' engagement in spreading correct knowledge play an important role in challenging misinformation during the pandemic crisis. Students showed suboptimal knowledge about PPE use, calling for additional training. We found a moderate-high perceived risk of infection that could be mitigated with specific educational programs and by promoting voluntary work. Students' engagement in public health emergencies (PHE) could potentially be beneficial for their training and as well as for the healthcare system.

Examining the effect of information channel on COVID-19 vaccine acceptance (preprint)

Hesitancy towards the COVID-19 vaccine remains high among the US population. Now that the vaccine is available to priority populations, it is critical to convince those that are hesitant to take the vaccine. Public health communication about the vaccine as well as misinformation on the vaccine occurs through a variety of different information channels. Some channels of information are more commonly found to spread misinformation. Given the expansive information environment, we sought to characterize the use of different media channels for COVID-19 vaccine information and determine the relationship between information channel and vaccine acceptance. We conducted a convenience sample of vaccine priority groups (N=2,650) between December 13 and 23, 2020 and conducted bivariate chi-squared tests and multivariable multinomial logistic regression analyses to determine the relative impact of channels of information on vaccine acceptance. We found traditional channels of information, especially National TV, National newspapers, and local newspapers increased the relative risk of vaccine acceptance. Individuals who received information from traditional media compared to social media or both traditional and social media were most likely to accept the vaccine. The implications of this study suggest social media channels have a role to play in educating the hesitant to accept the vaccine, while traditional media channels should continue to promote data-driven and informed vaccine content to their viewers.

Predictors of COVID-19 Vaccine Hesitancy: Socio-demographics, Co-Morbidity and Past Racial Discrimination (preprint)

ImportanceImmunization programs are only successful when there are high rates of acceptance and coverage. While delivering billions of COVID 19 doses globally addressing vaccine hesitancy will be one of the most significant public health communication efforts ever undertaken. ObjectiveThe goal of this study is to explore predictors of COVID 19 vaccine hesitancy, including sociodemographic factors, comorbidity, risk perception, and experience of discrimination, in a sample of the U.S. population. DesignWe used a cross sectional online survey study design. The survey was implemented between Dec 13 and 23, 2020. SettingThe survey was limited to respondents over 18 years of age residing in the USA. ParticipantsRespondents were individuals belonging to priority groups for vaccine distribution. Main Outcome(s) and Measure(s)Respondents were asked how likely they would be to take a COVID 19 vaccine if offered at no cost within two months. Vaccine hesitancy was measured using a scale ranging from 1 (low hesitancy) to 6 (high hesitancy). ResultsResponses were received from 2,650 respondents (response rate 84%) from all 50 states and Puerto Rico, American Samoa, and Guam. The majority were in the age category between 25 and 44 years (66%), male (53%), and working in the healthcare sector (61%). Most were White and non-Hispanic (66%) respondents followed by Black non-Hispanic (14%) and Hispanic (8%) respondents. Experience with racial discrimination was a predictor of vaccine hesitancy. Those reporting racial discrimination having 21% increased odds of being at a higher level of hesitancy compared to those who did not report such experience (OR=1.21, 95% C.I. 1.01-1.45). Conclusions and RelevanceCommunication and logistical aspects during the COVID 19 vaccination campaign need to be sensitive to individuals past-experience of discrimination by identifying appropriate channels of communication and sites for vaccine distribution to reach those who may have sentiments of mistrust in the vaccination campaign.

Factors Associated with Access and Use of PPE during COVID-19: A Cross-sectional Study of Italian Physicians (preprint)

ObjectivesDuring the course of the Novel Coronavirus (SARS-CoV-2) pandemic, Italy has reported one of the highest number of infections. Nearly ten percent of reported coronavirus infections in Italy occurred in healthcare workers. This study aimed to understand physicians access to personal protective equipment (PPE) and to information about their use, risk perception and strategies adopted to prevent contracting the infection. MethodsWe undertook a cross-sectional, online self-reported survey implemented between March 31 and April 5 2020 of Italian physicians. ResultsResponses were received from 529 physicians, only 13% of which reported to have access to PPE every time they need them. Approximately half of the physicians reported that the information received about the use of PPE was either clear (47%) or complete (54%). Risk perception about contracting the infection was influenced by receiving adequate information on the use of PPE. Access to adequate information on the use of PPE was associated with better ability to perform donning and doffing procedures [OR=2.2 95% C.I. 1.7-2.8] and reduced perception of risk [OR=0.5, 95% C.I. 0.4-0.6]. ConclusionsResults from this rapid survey indicate that while ramping up supplies on PPE for healthcare workers is certainly of mandatory importance, adequate training and clear instructions are just as important.