Searching for the 'Trigger': An ethnographic analysis of parental beliefs regarding autism causation and vaccination in Puerto Rico.

This study examines the personal beliefs held by parents of autistic children in Puerto Rico regarding the cause of their child's autism and how these beliefs may influence parental vaccination decision-making. This study seeks to contribute towards diversifying the autism literature by focusing on an autism community living in a relatively lower income, resource-deficit context. These findings expand our understandings of how parents of autistic children may perceive vaccines and how these perceptions are informed by various sources of knowledge. This ethnographic research study was conducted between May 2017 and August 2019. Methods included 350+ hours of participant-observation and semi-structured interviewing of 35 Puerto Rican parents of autistic children. 32 of these 35 parents interviewed believed autism to be the result of genetic risks that are 'triggered' by an unknown environmental factor. Suggested 'triggers' included various environmental contaminants and vaccinations. The subject of vaccination came up in every interview; 18 interviewed parents did not believe vaccines 'triggered' autism, 3 parents attributed their child's autism entirely to vaccines, while 14 considered vaccines to be one of several possible 'triggers'. It is important to note that no parents interviewed perceived vaccinations to be inherently or universally harmful. Rather, they perceived vaccinations to be one of many possible 'triggers' for a child predisposed to develop autism. In some cases, this perception prompted parents to oppose mandatory vaccination policies on the island. Parents shared nuanced, complex understandings of autism causation that may carry implications for COVID-19 vaccine uptake within the Puerto Rican autistic community.

Positive attitudes towards COVID-19 vaccines: A cross-country analysis.

COVID-19 severely impacted world health and, as a consequence of the measures implemented to stop the spread of the virus, also irreversibly damaged the world economy. Research shows that receiving the COVID-19 vaccine is the most successful measure to combat the virus and could also address its indirect consequences. However, vaccine hesitancy is growing worldwide and the WHO names this hesitancy as one of the top ten threats to global health. This study investigates the trend in positive attitudes towards vaccines across ten countries since a positive attitude is important. Furthermore, we investigate those variables related to having a positive attitude, as these factors could potentially increase the uptake of vaccines. We derive our text corpus from vaccine-related tweets, harvested in real-time from Twitter. Using Natural Language Processing (NLP), we derive the sentiment and emotions contained in the tweets to construct daily time-series data. We analyse a panel dataset spanning both the Northern and Southern hemispheres from 1 February 2021 to 31 July 2021. To determine the relationship between several variables and the positive sentiment (attitude) towards vaccines, we run various models, including POLS, Panel Fixed Effects and Instrumental Variables estimations. Our results show that more information about vaccines' safety and the expected side effects are needed to increase positive attitudes towards vaccines. Additionally, government procurement and the vaccine rollout should improve. Accessibility to the vaccine should be a priority, and a collective effort should be made to increase positive messaging about the vaccine, especially on social media. The results of this study contribute to the understanding of the emotional challenges associated with vaccine uptake and inform policymakers, health workers, and stakeholders who communicate to the public during infectious disease outbreaks. Additionally, the global fight against COVID-19 might be lost if the attitude towards vaccines is not improved.

Communicating doctors' consensus persistently increases COVID-19 vaccinations.

The reluctance of people to get vaccinated represents a fundamental challenge to containing the spread of deadly infectious diseases1,2, including COVID-19. Identifying misperceptions that can fuel vaccine hesitancy and creating effective communication strategies to overcome them are a global public health priority3-5. Medical doctors are a trusted source of advice about vaccinations6, but media reports may create an inaccurate impression that vaccine controversy is prevalent among doctors, even when a broad consensus exists7,8. Here we show that public misperceptions about the views of doctors on the COVID-19 vaccines are widespread, and correcting them increases vaccine uptake. We implement a survey among 9,650 doctors in the Czech Republic and find that 90% of doctors trust the vaccines. Next, we show that 90% of respondents in a nationally representative sample (n = 2,101) underestimate doctors' trust; the most common belief is that only 50% of doctors trust the vaccines. Finally, we integrate randomized provision of information about the true views held by doctors into a longitudinal data collection that regularly monitors vaccination status over 9 months. The treatment recalibrates beliefs and leads to a persistent increase in vaccine uptake. The approach demonstrated in this paper shows how the engagement of professional medical associations, with their unparalleled capacity to elicit individual views of doctors on a large scale, can help to create a cheap, scalable intervention that has lasting positive impacts on health behaviour.

Acceptance rate and risk perception towards the COVID-19 vaccine in Botswana.

BACKGROUND: The COVID-19 disease burden continues to be high worldwide and vaccines continue to be developed to help combat the pandemic. Acceptance and risk perception for COVID-19 vaccines is unknown in Botswana despite the government's decision to roll out the vaccine nationally. OBJECTIVES: This study aims to assess the acceptance rate and risk perception of COVID-19 vaccines amongst the general population in Botswana. METHODS: We interviewed 5300 adults in Botswana from 1-28 February 2021 using self-administered questionnaires. The main outcomes of the study were vaccine acceptance and hesitancy rates. Demographic, experiential and socio-cultural factors were explored for their association with outcome variables. RESULTS: Two-thirds of the participants were females (3199), with those aged 24-54 making the highest proportion (61%). The acceptance rate of COVID-19 vaccine was 73.4% (95% CI: 72.2%-74.6%) with vaccine hesitancy at 31.3% (95% CI: 30.0%-32.6%). When the dependent variable was vaccine acceptance, males had higher odds of accepting the vaccine compared to females (OR = 1.2, 95% CI: 1.0, 1.4). Individuals aged 55-64 had high odds of accepting the vaccine compared to those aged 65 and above (OR = 1.2, 95% CI: 0.6, 2.5). The odds of accepting the vaccine for someone with primary school education were about 2.5 times that of an individual with post graduate level of education. Finally, individuals with comorbidities had higher odds (OR = 1.2, 95% CI: 1.0, 1.5) of accepting the vaccine compared to those without any underlying conditions. CONCLUSION: This study demonstrated a high acceptance rate for the COVID-19 vaccine and a low risk perception in Botswana. In order to achieve a high vaccine coverage and ensure a successful vaccination process, there is need to target populations with high vaccine hesitancy rates. A qualitative study to assess the factors associated with vaccine acceptance and hesitancy is recommended to provide an in-depth analysis of the findings.

People's perceptions of, willingness-to-take preventive remedies and their willingness-to-vaccinate during times of heightened health threats.

Pandemics, such as the current SARS-CoV-2 pandemic, represents a health threat to humans worldwide. During times of heightened health risks, the public's perceptions, and acceptance of evidence-based preventive measures, such as vaccines, is of high relevance. Moreover, people might seek other preventive remedies to protect themselves from getting infected (e.g., herbal remedies, nutritional supplements). A recent study on consumers' preference for naturalness showed that people put more weight on perceived naturalness of a preventive remedy compared to a curative one. This result was attributed to the increased focus on perceived effectiveness as opposed to perceived risk. This raises the question whether the current pandemic would shift people's perceptions from prevention to curing and thus, exhibit a preference for synthetic remedies because they are seen as more effective. The present online experiment (conducted in April 2021) investigated people's perceptions of vaccines and remedies within the context of the current SARS-CoV-2 pandemic. A 2x2 between-subject design with type of remedy (natural vs. synthetic) and salience of SARS-CoV-2 pandemic (high vs. low) was conducted in Switzerland in spring 2021 (N = 452). The data did not provide evidence of a curative mindset for preventive remedies, as the participants exhibited a clear preference for the natural remedy compared to the synthetic remedy. Our study stresses the importance of understanding people's mindsets on how to protect themselves from infection with a virus during an ongoing pandemic to tackle misinformation and vaccine hesitancy.

Willingness to take COVID-19 vaccination in low-income countries: Evidence from Ethiopia.

BACKGROUND: In low-income countries, vaccination campaigns are lagging, and evidence on vaccine acceptance, a crucial public health planning input, remains scant. This is the first study that reports willingness to take COVID-19 vaccines and its socio-demographic correlates in Ethiopia, Africa's second most populous country. METHODS: The analysis is based on a nationally representative survey data of 2,317 households conducted in the informal economy in November 2020. It employs two logistic regression models where the two outcome variables are (i) a household head's willingness to take a COVID-19 vaccine or not, and (ii) if yes if they would also hypothetically pay (an unspecified amount) for it or not. Predictors include age, gender, education, marital status, income category, health insurance coverage, sickness due to COVID-19, chronic illness, trust in government, prior participation in voluntary activities, urban residence. RESULTS: Willingness to take the vaccine was high (88%) and significantly associated with COVID-19 cases in the family, trust in government and pro-social behavior. All other predictors such as gender, education, income, health insurance, chronic illness, urban residence did not significantly predict vaccine willingness at the 5% level. Among those willing to take the vaccine, 33% also answered that they would hypothetically pay (an unspecified amount) for it, an answer that is significantly associated with trust in government, health insurance coverage and income. CONCLUSION: The results highlight both opportunities and challenges. There is little evidence of vaccine hesitancy in Ethiopia among household heads operating in the informal economy. The role played by trust in government and pro-social behavior in motivating this outcome suggests that policy makers need to consider these factors in the planning of COVID-19 vaccine campaigns in order to foster vaccine uptake. At the same time, as the willingness to hypothetically pay for a COVID-19 vaccine seems to be small, fairly-priced vaccines along with financial support are also needed to ensure further uptake of COVID-19 vaccines.

Potential factors influencing COVID-19 vaccine acceptance and hesitancy: A systematic review.

BACKGROUND AND AIMS: Although vaccines are considered the most effective and fundamental therapeutic tools for consistently preventing the COVID-19 disease, worldwide vaccine hesitancy has become a widespread public health issue for successful immunization. The aim of this review was to identify an up-to-date and concise assessment of potential factors influencing COVID-19 vaccine acceptance and refusal intention, and to outline the key message in order to organize these factors according to country count. METHODS: A systematic search of the peer-reviewed literature articles indexed in reputable databases, mainly Pub Med (MEDLINE), Elsevier, Science Direct, and Scopus, was performed between21stJune 2021 and10th July 2021. After obtaining the results via careful screening using a PRISMA flow diagram, 47 peer-reviewed articles met the inclusion criteria and formed the basic structure of the review. RESULTS: In total, 11 potential factors were identified, of which the greatest number of articles (n = 28) reported "safety" (34.46%; 95% CI 25.05─43.87) as the overarching consideration, while "side effects" (38.73%; 95% CI 28.14─49.32) was reported by 22 articles, which was the next common factor. Other potential factors such as "effectiveness" were identified in 19 articles (29.98%; 95% CI 17.09─41.67), followed by "trust" (n = 15 studies; 27.91%; 95% CI 17.1─38.73),"information sufficiency"(n = 12; 34.46%; 95% CI 35.87─63.07),"efficacy"(n = 8; 28.73%; 95% CI 9.72─47.74), "conspiracy beliefs" (n = 8; 14.30%; 95% CI 7.97─20.63),"social influence" (n = 6; 42.11%; 95% CI 14.01─70.21), "political roles" (n = 4; 16.75%; 95% CI 5.34─28.16), "vaccine mandated" (n = 4; 51.20%; 95% CI 20.25─82.15), and "fear and anxiety" (n = 3; 8.73%; 95% CI 0.59─18.05). The findings for country-specific influential vaccination factors revealed that, "safety" was recognized mostly (n = 14) in Asian continents (32.45%; 95% CI 19.60─45.31), followed by the United States (n = 6; 33.33%; 95% CI12.68─53.98). "Side effects" was identified from studies in Asia and Europe (n = 6; 35.78%; 95% CI 16.79─54.77 and 16.93%; 95% CI 4.70─28.08, respectively), followed by Africa (n = 4; 74.60%, 95% CI 58.08─91.11); however, public response to "effectiveness" was found in the greatest (n = 7) number of studies in Asian countries (44.84%; 95% CI 25─64.68), followed by the United States (n = 6; 16.68%, 95% CI 8.47─24.89). In Europe, "trust" (n = 5) appeared as a critical predictor (24.94%; 95% CI 2.32─47.56). "Information sufficiency" was identified mostly (n = 4) in articles from the United States (51.53%; 95% CI = 14.12─88.74), followed by Asia (n = 3; 40%; 95% CI 27.01─52.99). More concerns was observed relating to "efficacy" and "conspiracy beliefs" in Asian countries (n = 3; 27.03%; 95% CI 10.35─43.71 and 18.55%; 95% CI 8.67─28.43, respectively). The impact of "social influence" on making a rapid vaccination decision was high in Europe (n = 3; 23.85%, 95% CI -18.48─66.18), followed by the United States (n = 2; 74.85%). Finally, "political roles" and "vaccine-mandated" were important concerns in the United States. CONCLUSIONS: The prevailing factors responsible for COVID-19 vaccine acceptance and hesitancy varied globally; however, the global COVID-19 vaccine acceptance relies on several common factors related to psychological and, societal aspect, and the vaccine itself. People would connect with informative and effective messaging that clarifies the safety, side effects, and effectiveness of prospective COVID-19 vaccines, which would foster vaccine confidence and encourage people to be vaccinated willingly.

Taking a machine learning approach to optimize prediction of vaccine hesitancy in high income countries.

Understanding factors driving vaccine hesitancy is crucial to vaccination success. We surveyed adults (N = 2510) from February to March 2021 across five sites (Australia = 502, Germany = 516, Hong Kong = 445, UK = 512, USA = 535) using a cross-sectional design and stratified quota sampling for age, sex, and education. We assessed willingness to take a vaccine and a comprehensive set of putative predictors. Predictive power was analysed with a machine learning algorithm. Only 57.4% of the participants indicated that they would definitely or probably get vaccinated. A parsimonious machine learning model could identify vaccine hesitancy with high accuracy (i.e. 82% sensitivity and 79-82% specificity) using 12 variables only. The most relevant predictors were vaccination conspiracy beliefs, various paranoid concerns related to the pandemic, a general conspiracy mentality, COVID anxiety, high perceived risk of infection, low perceived social rank, lower age, lower income, and higher population density. Campaigns seeking to increase vaccine uptake need to take mistrust as the main driver of vaccine hesitancy into account.

The Vaccination Concerns in COVID-19 Scale (VaCCS): Development and validation.

Vaccines are highly effective in minimizing serious cases of COVID-19 and pivotal to managing the COVID-19 pandemic. Despite widespread availability, vaccination rates fall short of levels required to bring about widespread immunity, with low rates attributed to vaccine hesitancy. It is therefore important to identify the beliefs and concerns associated with vaccine intentions and uptake. The present study aimed to develop and validate, using the AMEE Guide, the Vaccination Concerns in COVID-19 Scale (VaCCS), a comprehensive measure of beliefs and concerns with respect to COVID-19 vaccines. In the scale development phase, samples of Australian (N = 53) and USA (N = 48) residents completed an initial open-response survey to elicit beliefs and concerns about COVID-19 vaccines. A concurrent rapid literature review was conducted to identify content from existing scales on vaccination beliefs. An initial pool of items was developed informed by the survey responses and rapid review. The readability and face validity of the item pool was assessed by behavioral science experts (N = 5) and non-experts (N = 10). In the scale validation phase, samples of Australian (N = 522) and USA (N = 499) residents completed scaled versions of the final item pool and measures of socio-political, health beliefs and outcomes, and trait measures. Exploratory factor analysis yielded a scale comprising 35 items with 8 subscales, and subsequent confirmatory factor analyses indicated acceptable fit of the scale structure with the data in each sample and factorial invariance across samples. Concurrent and predictive validity tests indicated a theoretically and conceptually predictable pattern of relations between the VaCCS subscales with the socio-political, health beliefs and outcomes, and trait measures, and key subscales predicted intentions to receive the COVID-19 vaccine. The VaCCS provides a novel measure to assess beliefs and concerns toward COVID-19 vaccination that researchers and practitioners can use in its entirety or select specific sub-scales to use according to their needs.

Factors influencing COVID-19 vaccine uptake among adults in Nigeria.

BACKGROUND: Emerging variants of Coronavirus disease 2019 (COVID-19) has claimed over 3000 lives in Nigeria and vaccination remains a means of reducing the death toll. Despite ongoing efforts by the government to ensure COVID-19 vaccination of most residents to attain herd immunity, myths and beliefs have adversely shaped the perception of most Nigerians, challenging the uptake of COVID-19 vaccine. This study aimed to assess the factors influencing the awareness, perception, and willingness to receive COVID-19 vaccine among Nigerian adults. METHODS: A cross-sectional online nationwide study was conducted from April to June 2021 among Nigerian adult population using the snowballing method. Descriptive analysis was used to summarise the data. Univariate and multivariate analysis was used to identify the predictors of COVID-19 uptake among the respondents. A p value <0.05 was considered significant. RESULTS: A total of 1058 completed forms were analysed and 63.9% were females. The mean age was 40.8 years±12.2 years. Most of the respondents (740; 69.5%) had satisfactory awareness of the vaccination exercise. The media was the main source of information. Health workers reported higher level of awareness (aOR = 1.822, 95% CI: 1.388-2.524, p<0.001). Respondents that are Christians and Muslims had better awareness compared to the unaffiliated (aOR = 6.398, 95% CI: 1.918-21.338, P = 0.003) and (aOR = 7.595, 95% CI: 2.280-25.301, p<0.001) respectively. There is average score for perception statements (566; 53.2%) towards COVID-19 vaccination. Close to half of the respondents (44.2%) found the short period of COVID-19 production worrisome. Majority of the respondents were willing to get the vaccine (856; 80.9%). Those without a prior diagnosis of COVID-19 had a lower willingness to get vaccinated (aOR = 0.210 (95% CI: 0.082-0.536) P = 0.001). CONCLUSION: The study revealed a high level of awareness, willingness to receive the vaccine and moderate perception towards the vaccination activities. Influencing factors that significantly affects awareness were religion, occupation, education and prior diagnosis of COVID-19; for perception and willingness-occupation, and prior diagnosis of the COVID-19 were influencing factors.

Barriers to COVID-19 Vaccine Uptake in the LGBTQIA Community.

Objectives. To report findings from qualitative research that describe sources of hesitancy and barriers to vaccine uptake among lesbian, gay, bisexual, transgender, queer, intersex, and asexual (LGBTQIA) populations. Methods. In March 2021, we conducted focus groups with members of the Los Angeles, California LGBTQIA community to identify barriers to becoming vaccinated. Semistructured interviews were conducted with 32 individuals in 5 focus groups. Thematic analysis was conducted to identify themes. Results. Historical and ongoing medical trauma, including misgendering, and perceived emotional violence emerged as significant barriers to LGBTQIA individuals becoming vaccinated. Fear of violence was found to be a major barrier among transgender individuals, whereas fear of an unwelcoming vaccination site was a barrier for seniors. Finally, surviving was a higher priority than becoming vaccinated. Conclusions. Participants reported vaccine hesitancy and barriers that are unique to the life experiences of LGBTQIA individuals; these include medical trauma, violence, stigma, and discrimination. Our findings highlight the need to include LGBTQIA leaders and trusted individuals in the development of vaccination education and the delivery of vaccination services. (Am J Public Health. 2022;112(3):405-407. https://doi.org/10.2105/AJPH.2021.306599).

Weighing up the risks - Vaccine decision-making in pregnancy and parenting.

BACKGROUND: Immunisation is universally accepted as one of the most significant health initiatives in recent times. However, vaccine hesitancy is increasing in Australia and other high- and middle-income countries. There is evidence to suggest that many parents, even those who elect to immunise, may have a degree of vaccine hesitancy. The recommendation of a healthcare professional is a predictor for vaccine uptake. AIM: The purpose of this study was to explore the values, beliefs and choices made by vaccine hesitant parents and pregnant women, regarding their decision not to vaccinate their child or children. The aim being to determine the factors that influence this decision making and to give a voice to vaccine hesitant parents. METHODS: A qualitative exploratory online survey of 106 vaccine hesitant parents and pregnant women was conducted in 2021. The survey utilised closed and open-ended questions. FINDINGS: Pregnant women and parents obtained most of their immunisation education from nurses, midwives, and general practitioners. Vaccine decision-making was however, influenced by multiple factors including vaccine safety concerns, the sources of information accessed, and a previous negative immunisation experience. Other influential factors included the use of alternative therapies, diet, and lifestyle factors. DISCUSSION: Along with general practitioners, nurses and midwives are a popular, respected and a vital source in the provision of accurate and timely immunisation education. However, further education is required at an undergraduate level to adequately prepare them for their role of listening to and educating vaccine hesitant pregnant women and parents.

To vax or not to vax: Predictors of anti-vax attitudes and COVID-19 vaccine hesitancy prior to widespread vaccine availability.

The novel coronavirus (COVID-19) is a highly contagious disease responsible for millions of deaths worldwide. Effective vaccines against COVID-19 are now available, however, an extreme form of vaccine hesitancy known as anti-vax attitudes challenge vaccine acceptance and distribution efforts. To understand these anti-vax attitudes and their associated psychological characteristics, we examined several predictors of vaccine hesitancy for COVID-19 and anti-vax attitudes generally. We surveyed 1004 adults (M = 47.0 years, SD = 17.1 years, range 18-98 years) in September-October 2020 across the United States (51% female, 49% male; 76.5% White, 23.5% non-White), prior to widespread availability of the COVID-19 vaccines. Attitudes toward vaccinations were influenced by a variety of factors, especially political attitudes. We should therefore anticipate and attempt to mitigate these challenges to achieving widespread vaccination to reduce the spread of COVID-19 and other communicable diseases.

COVID-19 Vaccination Acceptance among Healthcare Staff in Sudan, 2021.

Elderly and patients with comorbid conditions have higher risk of infection and complications. Vaccination hesitancy is defined as the refusal of vaccine or the delay in accepting it despite the availability of vaccines and vaccination services. This study was aimed at assessing knowledge, perception, and acceptability of healthcare staff towards different types of COVID-19 vaccination. A multicenter hospital-based descriptive cross-sectional study was implemented to study the knowledge, perception, and acceptability of healthcare staff towards COVID-19 vaccination. Multistage sampling technique was applied. Data were collected through a self-administered questionnaire filled by the participants. 400 participants were studied. 61% of the participants were females, and the most frequent age reported was between 18 and 35 years (67%). A statistically significant association (p = 0.048) was found between knowledge about vaccination and professions. The most common vaccine type known and accepted was AstraZeneca vaccine. On assessing acceptability of COVID-19 vaccination, acceptance rate was high (63.8%) and 22.7% of the participants had already got vaccinated. The rejection rate among our staff was 27.4%. This study was conducted in April, 2021. Majority of our healthcare staff believed that vaccination is the key to combat the pandemic. One of the issues and concerns about vaccination was the safety and the risk of developing acute adverse events (p = 0.001). Encouraging factor for vaccination was the fear of getting infection themselves and their families. The present study revealed the presence of good knowledge and acceptability among medical staff towards COVID-19 vaccinations in Sudan.

COVID-19 vaccine hesitancy and associated factors according to sex: A population-based survey in Salvador, Brazil.

Vaccination is a major strategy to prevent the coronavirus disease 2019 (COVID-19). However, information about factors associated with men and women intention to be vaccinated are scarce. To determine COVID-19 vaccine acceptance and identify factors associated vaccine hesitancy according to sex, we performed a cross-sectional population-based random survey in Salvador, Brazil between Nov/2020-Jan/2021. Participants were interviewed to obtain data on intention to receive and pay for a COVID-19 vaccine, as well as on demographics, comorbidities, influenza vaccination history, previous diagnosis of COVID-19, and exposures and perception of COVID-19 risk. Among 2,521 participants, 2,053 (81.4%) reported willingness to use a COVID-19 vaccine and 468 (18.6%) hesitated to take it. Among those intending to get vaccinated, 1,400 (68.2%) would pay for the vaccine if necessary. Sex-stratified multivariable analysis found that men who were working and who had comorbidities were less likely to hesitate about using the vaccine. Among women, higher educational level and high perception of COVID-19 risk were associated with less vaccine hesitancy. In both groups, reporting influenza vaccination in 2020 reduced the chance of COVID-19 vaccine hesitancy. COVID-19 vaccine campaigns targeting to reduce vaccine hesitancy are urgently needed. These campaigns should consider gender differences in order to be successful.

Knowledge, attitudes, and behavior of incarcerated people regarding COVID-19 and related vaccination: a survey in Italy.

The cross-sectional study assessed knowledge, attitudes, and preventive practices toward COVID-19 disease of incarcerated people. A total of 685 subjects were surveyed. 94% were aware that respiratory droplets are involved in the transmission of COVID-19, and 77.2% that patients with chronic conditions are at risk of a more severe disease. Overall, 92.7% of respondents considered COVID-19 a more severe disease compared to influenza, and 85.4% believed that COVID-19 could cause serious consequences in their institution. Only 22.6% were self-confident about their ability to protect themselves from SARS-CoV-2 infection. This attitude was significantly higher in those who were involved in working activities in the institution, who did not report at least one common symptom compatible with COVID-19 in the previous 3 months, who did not show generalized anxiety symptoms, and did not need additional information. 63.9% of incarcerated people expressed willingness to receive COVID-19 vaccination. Older subjects, who knew that a COVID-19 vaccination is available, believed that COVID-19 is more serious than influenza, and were self-confident about their ability to protect themselves from SARS-CoV-2 infection, were significantly more willing to undergo COVID-19 vaccination. Public health response to COVID-19 in prisons should address vaccine hesitancy to increase vaccine confidence among incarcerated people.

Changes in attitudes to vaccination as a result of the COVID-19 pandemic: A longitudinal study of older adults in the UK.

BACKGROUND: The rapid development of COVID-19 vaccines has brought an unprecedented focus on public attitudes to vaccines, with intention to accept a COVID-19 vaccine fluctuating during the pandemic. However, it is unclear how the pandemic may influence attitudes and behaviour in relation to vaccines in general. The aim of the current study is to examine older adults' changes in vaccination attitudes and behaviour over the first year of the pandemic. METHODS: In February-March 2020 (before the first COVID-19 national lockdown in the UK), 372 older adults (aged 65+) provided sociodemographic information, self-reported influenza vaccine uptake, and completed two measures of vaccination attitudes: the 5C scale and the Vaccination Attitudes Examination Scale. One-year later, following rollout of COVID-19 vaccines to older adults, participants provided information on their COVID-19 and influenza vaccine uptake in the previous 12 months, and completed the 5C and VAX scales again. Paired samples t-tests were used to examine changes in vaccination attitudes over time. RESULTS: Almost all participants (98.7%) had received at least one dose of a COVID-19 vaccine, and a significant increase in influenza uptake was identified (83.6% in 2020 to 91.6% in 2021). Complacency, mistrust of vaccine benefit, concerns about commercial profiteering, and constraints to vaccination had significantly decreased between Time 1 and Time 2, and collective responsibility had significant increased. However, calculation and worries about unforeseen future effects had increased, indicating that participants now perceived higher risks related to vaccination and were taking a more deliberative information-seeking approach. CONCLUSION: The results show significant changes in vaccination attitudes across the pandemic. These changes suggest that while older adults became less complacent about the importance of vaccines, concerns about potential risks associated with vaccination increased. It will be important for public health communication to address these concerns for all vaccines offered to this group.