ABSTRACT
Background Maternal vaccinations against Influenza, Pertussis, and Covid-19 are recommended in the UK, and vaccines against further infections may become available soon. However, many pregnant women, especially in socially and ethnically diverse areas, have low vaccine uptake. Qualitative studies on the reasons and possible solutions are needed that are inclusive of disadvantaged and minority ethnic groups. We therefore aimed to understand the complex interplay between structural and behavioural factors contributing to the low maternal vaccine uptake in socially and ethnically diverse areas in England in the Covid-19 context.Methods In 2022, we conducted semi-structured interviews and a focus group discussion among a purposive sample of 38 pregnant/recently pregnant women and 20 health service providers, including 12 midwives. Participants were recruited in ethnically diverse London boroughs. We followed a critical realist paradigm and used a thematic analysis approach.Results The sample included participants who took all, some or none of the maternal vaccines, with some participants unsure whether they had taken or been offered the vaccines. Decision-making was passive or active, with the expectation for pregnant women to do their 'own research'. Participants described various individual, social and contextual influences on their decision-making as they navigated the antenatal care system. Missing or conflicting information from providers meant knowledge gaps were sometimes filled with misinformation from unreliable sources that increased uncertainties and mistrust. Both pregnant women and providers described structural and organisational factors that hindered access to information and vaccinations, including lack of training, time and resources, and shortcomings of health information systems and apps. Some participants described factors that facilitated vaccination uptake and many made recommendations for improvements.Conclusions Our study showed how structural and organisational factors can compound uncertainties around maternal vaccination among socially and ethnically diverse populations. Results highlight the need for more reliable resources, streamlined workflows, improved electronic information systems and training in their use. Roles and responsibilities should be clarified with potential greater involvement of nurses and pharmacists in vaccine provision. Education and communication should consider individual (language/digital) skills and needs for information and reassurance. Further research is needed to co-produce solutions with service users and providers.
Subject(s)
COVID-19ABSTRACT
Background The success of vaccination programs often depends on the effectiveness of the vaccine messages, particularly during emergencies such as the COVID-19 pandemic. The current suboptimal uptake of COVID-19 vaccines across many parts of the world highlights the tremendous challenges in overcoming vaccine hesitancy and refusal even in the context of a world-devastating pandemic. Methods We conducted a randomized controlled trial in Hong Kong to evaluate the impact of seven vaccine messages on COVID-19 vaccine uptake (with the government slogan as the control). The participants included 127,000 individuals who googled COVID-19-related information during July-October 2021. Results The impact of vaccine messages on uptake varied substantially over time and among different groups of users. For example, the message that emphasized the indirect protection of vaccination on family members (i) increased overall uptake by 30% (6-59%) in July but had no effect afterwards for English language users; and (ii) had no effect on overall uptake for Chinese language users throughout the study. Such volatility and heterogeneity in message effectiveness highlight the limitations of one-size-fits-all and static vaccine communication. Conclusions Epidemic nowcasting should include real-time monitoring of vaccine hesitancy and message effectiveness, in order to adapt messaging appropriately. This dynamic dimension of surveillance has so far been underinvested. Trial registration The study was registered at ClinicalTrials.gov (NCT05499299).
Subject(s)
COVID-19ABSTRACT
Background: COVID-19 vaccination has faced a range of challenges from supply-side barriers such as insufficient vaccine supply and negative information environment and demand-side barriers centring on public acceptance and confidence in vaccines. This study assessed global spatiotemporal trends in demand- and supply-side barriers to vaccine uptake using COVID-19-related social media data and explored the country-level determinants of vaccine acceptance. Methods: We accessed a total of 13,093,406 tweets sent between November 2020 and March 2022 about the COVID-19 vaccine in 90 languages from 135 countries using Meltwater (a social listening platform). Based on 8,125 manually-annotated tweets, we fine-tuned multilingual deep learning models to automatically annotate all 13,093,406 tweets. We present spatial and temporal trends in four key spheres: (1) COVID-19 vaccine acceptance; (2) confidence in COVID-19 vaccines; (3) the online information environment regarding the COVID-19 vaccine; and (4) perceived supply-side barriers to COVID-19 vaccination. Using univariate and multilevel regressions, we evaluated the association between COVID-19 vaccine acceptance on Twitter and (1) country-level characteristics regarding governance, pandemic preparedness, trust, culture, social development, and population demographics; (2) country-level COVID-19 vaccine coverage; and (3) Google search trends on adverse vaccine events. Findings: COVID-19 vaccine acceptance was high among Twitter users in Southeast Asian, Eastern Mediterranean, and Western Pacific countries, including India, Indonesia, and Pakistan. In contrast, acceptance was relatively low in high-income nations like South Korea, Japan, and the Netherlands. Spatial variations were correlated with country-level governance, pandemic preparedness, public trust, culture, social development, and demographic determinants. At the country level, vaccine acceptance sentiments expressed on Twitter predicted higher vaccine coverage. We noted the declining trend of COVID-19 vaccine acceptance among global Twitter users since March 2021, which was associated with increased searches for adverse vaccine events. Interpretation: In future pandemics, new vaccines may face the potential low-level and declining trend in acceptance, like COVID-19 vaccines, and early responses are needed. Social media mining represents a promising surveillance approach to monitor vaccine acceptance and can be validated against real-world vaccine uptake data. Keywords: COVID-19, vaccine confidence, vaccine acceptance, vaccine hesitancy, social media, machine learning
Subject(s)
COVID-19 , Learning DisabilitiesABSTRACT
BackgroundMultiple COVID-19 vaccines have now been licensed for human use, with other candidate vaccines in different stages of development. Effective and safe vaccines against COVID-19 are essential to achieve global control of the pandemic caused by severe acute respiratory coronavirus 2 (SARS-CoV-2), but multiple factors, including vaccine supply and vaccine confidence, will be key for high rates of global uptake. Confidence in COVID-19 vaccines, socio-demographic status, and recent emotional status are likely to be key drivers of COVID-19 vaccine acceptance. In this study, we explore these determinants of COVID-19 vaccination intent across17 countries worldwide. MethodsIn this large-scale multi-country study, we explore intent to accept a COVID-19 vaccine and the socio-demographic and emotional determinants of uptake for 17 countries and over 19,000 individuals surveyed in June and July 2020 via nationally representative samples. We used Bayesian ordinal logistic regressions to probe the relationship between intent to accept a COVID-19 vaccine and individuals socio-demographic status, their confidence in COVID-19 vaccines, and their recent emotional status. Gibbs sampling was used for Bayesian model inference, with 95% Bayesian highest posterior density intervals used to capture uncertainty. FindingsIntent to accept a COVID-19 vaccine is highest in India, where 77.8% (95% HPD, 75.5 to 80.0%) of respondents strongly agreeing that they would take a new COVID-19 vaccine if it were available. The Democratic Republic of Congo (15.5%, 12.2 to 18.6%) and France (26.4%, 23.7 to 29.2%) have the lowest share of respondents who strongly agree that they would accept a COVID-19. Confidence in the safety, importance, and effectiveness of COVID-19 vaccines are the most widely informative determinants of vaccination intent. Socio-demographic and emotional determinants played a lesser role, with being male and having higher education was associated with increased uptake intent in five countries and being fearful of catching COVID-19 also a strong determinant of uptake intent. InterpretationBarriers to COVID-19 vaccine acceptance will be highly country and context dependent. These findings highlight the importance of regular monitoring of COVID-19 vaccine confidence to identify groups less likely to vaccinate and to monitor the impact of vaccination policies on uptake behaviour.
Subject(s)
COVID-19ABSTRACT
Background: While vaccines ensure individual protection against COVID-19 infection, delay in receipt or refusal of vaccines will have both individual and community impacts. The behavioral factors of vaccine hesitancy or refusal are a crucial dimension that need understanding to implicate appropriate interventions. The aim of this study was to assess the behavioral determinants of COVID-19 vaccine acceptance and to provide recommendations to increase the uptake of COVID-19 vaccines in Bangladesh. Methods: We employed a Barrier Analysis (BA) approach to examine twelve potential behavioral determinants (drawn from the Health Belief Model and Theory of Reasoned Action [TRA]) of intended vaccine acceptance. We conducted 45 interviews with those who intended to take the vaccine (Acceptors) and another 45 interviews with those who did not have that intention (Non-acceptors). We performed data analysis to find statistically significant differences and to identify which beliefs were most highly associated with acceptance and non-acceptance with COVID-19 vaccines. Results: COVID-19 vaccine Acceptors in Dhaka were different from Non-acceptors in terms of many of their beliefs and responses. The behavioral determinants associated with the behavior included perceived social norms, perceived safety of COVID-19 vaccines and trust in them, perceived risk/susceptibility, perceived self-efficacy, perceived positive and negative consequences, perceived action efficacy, perceived severity of COVID-19, access, and perceived divine will. In line with the Health Belief Model, beliefs about the disease itself were highly correlated with vaccine acceptance, although not the only determinant. Other responses of Acceptors provide clues such as providing vaccination through government health facilities, schools, and kiosks, and having vaccinators maintain proper COVID-19 health and safety protocols as to ways to make it easier to boost acceptance. Conclusion: An effective behavior change strategy for COVID-19 vaccines uptake will need to address multiple beliefs and behavioral determinants, reducing barriers and leveraging enablers identified in this study. The national plans on COVID-19 vaccination should adopt culturally and community label acceptable and appropriate evidence-based behavior change interventions strategies to promote high vaccination coverage and acceptance in all societal structures across the country.
Subject(s)
COVID-19ABSTRACT
The successful development and widespread acceptance of a SARS-CoV-2 vaccine will be a major step in fighting the pandemic, yet obtaining high uptake will be a challenging task, worsened by online misinformation. To help inform successful COVID-19 vaccination campaigns in the UK and US, we conducted a survey to quantify how online misinformation impacts COVID-19 vaccine uptake intent and identify socio-economic groups that are most at-risk of non-vaccination and most susceptible to online misinformation. Here, we report findings from nationally representative surveys in the UK and the US conducted in September 2020. We show that recent misinformation around a COVID-19 vaccine induces a fall in vaccination intent among those who would otherwise "definitely" vaccinate by 6.4 (3.8, 9.0) percentages points in the UK and 2.4 (0.1, 5.0) in the US, with larger decreases found in intent to vaccinate to protect others. We find evidence that socio-econo-demographic, political, and trust factors are associated with low intent to vaccinate and susceptibility to misinformation: notably, older age groups in the US are more susceptible to misinformation. We find evidence that scientific-sounding misinformation relating to COVID-19 and vaccines COVID-19 vaccine misinformation lowers vaccination intent, while corresponding factual information does not. These findings reveal how recent COVID-19 misinformation can impact vaccination rates and suggest pathways to robust messaging campaigns.
Subject(s)
COVID-19ABSTRACT
A number of COVID-19 vaccines are under development, with one or more possibly becoming available in 2021. We conducted a global survey in June 2020 of 13,426 people in 19 countries to determine potential acceptance rates of a COVID-19 vaccine and factors influencing acceptance. We ran univariate logistic regressions to examine the associations with demographic variables. 71.5% reported they would be very or somewhat likely to take a COVID-19 vaccine; 61.4% reported they would accept their employer's recommendation to take a COVID-19 vaccine. Differences in acceptance across countries ranged from almost 9 in 10 (China) to fewer than 6 in 10 (Russia). Respondents reporting higher levels of trust in information from government sources were more likely to accept a vaccine, and take their employer's advice to do so. Targeted interventions addressing age, sex, income, and education level are required to increase and sustain public acceptance of a COVID-19 vaccine.