Change in willingness to COVID-19 vaccination in China: Two online surveys during the pandemic.

OBJECTIVE: As the variants of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) continue to emerge, periodic vaccine booster immunization may become a normal policy. This study investigated the changes and factors associated with vaccination intentions in various epidemic situations, which can provide suggestions for the construction and modification of routine vaccination program strategies. METHODS: Two cross-sectional online surveys were conducted in January and June of 2021. The willingness and confidence of the coronavirus disease 2019 (COVID-19) vaccination were measured following propensity score matching (PSM) treatment. The difference in the willingness for COVID-19 Vaccination in the two surveys was analyzed by single or multi-factor analyses. RESULTS: The willingness to accept the SARS-CoV-2 vaccine was higher in the second survey than that in the first survey (90.5% vs. 66.6%, p < 0.001). Concerns about the vaccine's safety declined (71.0% vs. 47.6%, p < 0.001), but concerns about the efficacy increased (22.4% vs. 30.9%, p < 0.001). Confidence in the SARS-CoV-2 vaccine had an important impact on the increased uptake willingness (odds ratio = 3.19, 95% confidence interval: 2.23-4.58, p < 0.001). CONCLUSIONS: There has been a significant increase in attitudes towards the SARS-CoV-2 vaccine which was associated with higher vaccine confidence. Vaccine effectiveness received more concerns from respondents rather than safety after nearly 6 months' utilization of the SARS-CoV-2 vaccine. It indicates that aggressive communication and timely disclosure of vaccine data can build vaccine confidence.

Safety of Global SARS-CoV-2 Vaccines, a Meta-Analysis.

(1) Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccines were developed in only a short amount of time and were widely distributed. We conducted this meta-analysis to understand the safety of SARS-CoV-2 vaccines. (2) Methods: We searched the corresponding literature published from 1 January 2020 to 20 October 2021. Information of adverse events (AEs) of each selected work was collected. The quality and bias of studies was evaluated, and meta-analysis was carried out by using Stata 17.0. (3) Results: Totally, 11,451 articles were retrieved, and 53 of them were included for analysis. The incidence rate of AEs was 20.05-94.48%. The incidence rate of vascular events increased after viral vector vaccination, while the incidence rate of vascular events decreased after mRNA vaccination. Viral vector vaccine had a higher AE rate compared to mRNA vaccines and inactivated vaccines. In most circumstances, the incidence of AEs was higher in older people, female and after the second dose. The sensitivity of meta-analysis was acceptable; however, the literature was subject to a certain publication bias. (4) Conclusions: The safety of SARS-CoV-2 vaccines was acceptable. The incidence of allergic symptoms and cardiovascular and cerebrovascular symptoms was low. Viral vector vaccine had a higher risk of leading to thrombosis events. The understanding of SARS-CoV-2 vaccine AEs should be enhanced, so as to promote the vaccination.

Trends and Factors Associated With Risk Perception, Anxiety, and Behavior From the Early Outbreak Period to the Controlled Period of COVID-19 Epidemic: Four Cross-Sectional Online Surveys in China in 2020.

Background: The first wave of the COVID-19 epidemic in China was brought under with 3 months-from mid-January 2020 to the end of March 2020. Less studies examined dynamic psychological effect and behaviors during COVID-19 pandemic. This study aims to examine perceived risk, anxiety, and behavioral response of the general public related to the outbreak of COVID-19 in four cross-sectional surveys conducted throughout China. Methods: In 2020, four cross-sectional, population-based online survey were conducted from January 28 to February 3, from February 10 to 12, from February 20 to 22, and from March 1 to 10, respectively. Convenience sampling was used for easy recruiting survey participants under the long-term impact of the COVID-19 epidemic. The four independent online questionnaires were sent from the same approach (WeChat and MicroBlog), and anyone who receives the questionnaire on the Internet or mobile phone and meets the inclusion criteria could fill in it. The same questionnaires repeatedly used in the four surveys. Socio-demographic information and individual protective practice were collected and the state-trait anxiety inventory (STAI) was used for measuring anxiety. Propensity score matching was used to adjust for differences in baseline characteristics among the four surveys. Wilcoxon signed ranks test was used to compare people's perceived risk, anxiety and protective behaviors changes in four stages. General linear model was used to identify associations between some demographic factors and perceived risk, anxiety scores, and protective behaviors. Results: The proportion of high perceived risk has dropped from 24.7 to 4.7%. The proportion of severe anxiety has declined from 12.2 to 1.2%. The proportion of people wore masks when they went out has increased from 97.0 to 98.3%. Women were more likely to develop anxiety (OR = 1.5, 95%CI: 1.4-1.6) and more positively adopted recommended behaviors (OR = 2.1, 95%CI: 1.3-3.4) than men. People at age 30-39 years, with high-degree education, with married status, and accompanied with poor self-rated health status were prone to have higher risk perception and anxiety. Perceived risk was significantly associated with anxiety over the entire periods. Anxiety levels had stronger associations with adoption of protective behaviors (wearing mask and avoiding crowed place) in the early epidemic periods than in the late epidemic periods. Conclusions: The levels of perceived risk and anxiety showed a trend of rising first and then falling. Gradually upward trend on initiative preventive behaviors including wearing mask and avoiding visiting crowded places also was observed through scanning data at four stages. People at age 30-39 years, with high-degree education, and accompanied with poor self-rated health status were prone to have higher risk perception and anxiety. Our findings showed that people simultaneously presented both high-level risk perception and anxiety across the four wave surveys, leading to their positive self-prevention and protective behavior.

Willingness and SARS-CoV-2 Vaccination Coverage among Healthcare Workers in China: A Nationwide Study.

Background: The SARS-CoV-2 vaccine has been widely rolled out globally in the general populations. However, specific data on vaccination confidence, willingness or coverage among health care workers (HCWs) has been less reported. Methods: A cross-sectional online survey was conducted to specify the basic data and patterns of vaccination confidence, willingness and coverage among HCWs nationwide. Results: In total, 2386 out of 2583 (92.4%) participants were enrolled for analysis, and the rates of confidence in vaccine, professional institutes and government were 75.1%, 85.2% and 85.4%, respectively. The overall vaccination coverage rate was 63.6% which was adjusted as 82.8% for participants under current medical conditions or having contraindications. Confidence in vaccine safety was shown to be the most related factor to willingness among doctors, nurses, medical technicians and hospital administrators, while confidence in vaccine effectiveness as well as trust in government played the key role in formulating public health employees' willingness. 130 (7.1% of 1833) participants reporting willingness still not been vaccinated regardless of contraindications. Multivariate analysis among willingness participants showed that males, aged over 30 years, public health employees and higher vaccination confidence had significantly higher vaccination rates with ORs (95% confidence intervals) as 1.64 (1.08-2.49), 3.14 (2.14-4.62), 2.43 (1.46-4.04) or 2.31 (1.24-4.33). Conclusions: HCWs' confidence, willingness and coverage rates to the vaccine were generally at high levels. Heterogeneity among HCWs should be considered for future vaccination promotion strategies. The population's confidence in vaccination is not only the determinant to their willingness, but also guarantees their actual vaccine uptake.

Who Is the Most Vulnerable to Anxiety at the Beginning of the COVID-19 Outbreak in China? A Cross-Sectional Nationwide Survey.

(1) Background: The COVID-19 pandemic has not only changed people's health behavior, but also induced a psychological reaction among the public. Research data is needed to develop scientific evidence-driven strategies to reduce adverse mental health effects. The aims of this study are to evaluate the anxiety reaction of Chinese people and the related determinants during the earliest phase of the COVID-19 outbreak in China. Evidence from this survey will contribute to a targeted reference on how to deliver psychological counseling service in the face of outbreaks. (2) Methods: A cross-sectional, population-based online survey was conducted from 28 January to 5 February 2020 using an open online questionnaire for people aged 18 years or above, residing in China and abroad. The socio-demographic information of the respondents was collected, and anxiety scores were calculated. A direct standardization method was used to standardize anxiety scores and a general linear model was used to identify associations between some factors (e.g., sex, age, education, etc.) and anxiety scores. (3) Results: A total of 10,946 eligible participants were recruited in this study, with a completion rate of 98.16% (10,946/11,151). The average anxiety score was 6.46 ± 4.12 (total score = 15); women (6.86 ± 4.11) scored higher than men (5.67 ± 4.04). The age variable was inversely and significantly associated with the anxiety score (ß = -2.12, 95% CI: -2.47--1.78). People possessing higher education (ß = 1.15, 95% CI: 0.88-1.41) or a higher awareness of cognitive risk (ß = 4.89, 95% CI: 4.33-5.46) reported higher levels of anxiety. There was a close association between poor subjective health and anxiety status (ß = 2.83, 95% CI: 2.58-3.09). With the increase of confidence, the anxiety of the population exhibited a gradual decline (ß = -2.45, 95% CI: -2.77--2.13). (4) Conclusion: Most people were vulnerable to anxiety during the earliest phase of the COVID-19 outbreak in China. Younger women, individuals with high education, people with high cognitive risk and subjective poor health were vulnerable to anxiety during the epidemic. In addition, increasing confidence in resisting this pandemic is a protective determinant for individuals to develop anxiety. The findings suggest that policymakers adopt psychosocial interventions to reduce anxiety during the pandemic.

The Change of Public Individual Prevention Practice and Psychological Effect From the Early Outbreak Stage to the Controlled Stage of COVID-19 in China in 2020: Two Cross-Sectional Studies.

BACKGROUND: COVID-19 broke out in China and spread rapidly in January and February 2020. Following the prevention and control measures of the Chinese government, the outbreak was gradually brought under control after March. The changes in people's attention to the epidemic, individual prevention practice and psychological effect from the early outbreak stage to the under controlled stage need to be evaluated. METHODS: Two cross-sectional, population-based online surveys were conducted from January 28 to February 1, 2020 and from February1 to March 18, 2020. Socio-demographic information and individual protective practice were collected and the State-Trait Anxiety Inventory (STAI) was used for measuring anxiety. The range of STAI score was 5-25, and the higher the score, the more anxious it was. The respondents of the two surveys were matched on a one-to-one basis according to their province, gender, age, education, and marriage. Wilcoxon signed ranks test and Mann-Whitney U test were used to compare STAI score changes in two stages and in different demographic characteristics. RESULTS: We included 9,764 individuals in the first survey and 1,669 in the second survey, covering 30 provincial administrative regions in Mainland China. COVID-19 has affected almost every aspect of people's normal life, especially lifestyle. The proportion of people who paid attention to it every day had dropped from 97.6 to 88.9%. We identified that vast majority people wore masks when they went out. The proportion has declined from 96.5 to 92.4% for hand hygiene and from 98.4 to 95.3% for not attending parties. People's anxiety (STAI score) across the country has decreased from a median of 19 in the early outbreak stage to a median of 12, including people with all demographic characteristics, but some have increased in 16 provinces. CONCLUSION: People's attention to information about the epidemic has declined slightly, but a high proportion of people maintained good practices such as wearing masks, hand hygiene, and not attending parties. People's anxiety had generally declined from the early outbreak stage to the under controlled stage, but it was still at a high level.

Vaccination willingness, vaccine hesitancy, and estimated coverage at the first round of COVID-19 vaccination in China: A national cross-sectional study.

BACKGROUND: Vaccination against coronavirus disease 2019 (COVID-19) has become an important public health solution. To date, there has been a lack of data on COVID-19 vaccination willingness, vaccine hesitancy, and vaccination coverage in China since the vaccine has become available. METHODS: We designed and implemented a cross-sectional, population-based online survey to evaluate the willingness, hesitancy, and coverage of the COVID-19 vaccine among the Chinese population. 8742 valid samples were recruited and classified as the vaccine-priority group (n = 3902; 44.6%) and the non-priority group (n = 4840; 55.4%). RESULTS: The proportion of people's trust in the vaccine, delivery system, and government were 69.0%, 78.0% and 81.3%, respectively. 67.1% of the participants were reportedly willing to accept the COVID-19 vaccination, while 9.0% refused it. 834 (35.5%) reported vaccine hesitancy, including acceptors with doubts (48.8%), refusers (39.4%), and delayers (11.8%). The current coverage was 34.4%, far from reaching the requirements of herd immunity. The predicted rate of COVID-19 vaccination was 64.9%, 68.9% and 81.1% based on the rates of vaccine hesitancy, willingness, and refusal, respectively. CONCLUSIONS: The COVID-19 vaccine rate is far from reaching the requirements of herd immunity, which will require more flexible and comprehensive efforts to improve the population's confidence and willingness to vaccinate. It should be highlighted that vaccination alone is insufficient to stop the pandemic; further efforts are needed not only to increase vaccination coverage but also to maintain non-specific prevention strategies.

Public Awareness, Individual Prevention Practice, and Psychological Effect at the Beginning of the COVID-19 Outbreak in China.

BACKGROUND: The COVID-19 has spread to more than 200 countries and territories. But less is known about the knowledge, protection behavior and anxiety regarding the outbreak among the general population. METHODS: A cross-sectional, population-based online survey was conducted in China and abroad from January 28 to February 1, 2020. Socio-demographic information was collected and knowledge scores, practice scores, anxiety scores and perceived risk were calculated. General linear model and binary logistic regression were used to identify possible associations. RESULTS: We included 9,764 individuals in this study, and 156 (1.6%) were from Hubei Province. The average knowledge score was 4.7 (standard deviation, 1.0) (scored on a 6-point scale); 96.1% maintained hand hygiene, and 90.3% of participants had varying levels of anxiety. People in Hubei Province were the most anxious, followed by those in Beijing and Shanghai. People who had experienced risk behaviors did not pay more attention to wearing masks and hand hygiene. CONCLUSIONS: The public had high awareness on knowledge of COVID-19 outbreak, and a high proportion of people practiced good hand hygiene behavior. Many people claimed anxiety, especially in heavily affected areas during pandemic, suggesting the importance of closing the gap between risk awareness and good practice and conduct psychological counseling to public and patients.