Vaccine refusal risk factors among parents of children with autism spectrum disorders.

BACKGROUND: Vaccine refusal is a global trend and was announced as one of the top ten health threats in recent years. The rate of vaccine refusal (VR) among children with autism spectrum disorders (ASD) has also increased in parallel with the global trend but their vaccination behavior may differ from that of the normal population. This study aims to determine the VR rates among parents of children with ASD, to define the risk factors for developing VR, and to evaluate the parental concerns for childhood vaccinations in this susceptible population. METHODS: We conducted a 4-part survey questionnaire among parents of children with ASD, evaluating the vaccination status for both the child with ASD and their younger sibling. The vaccination uptake of the first child was accepted as the `baseline` behavior, while the following sibling`s uptake was suggested as the `current` behavior. The risk factors of VR were determined with logistic regression analysis. RESULTS: The study group included 110 parents of children with ASD (M/F:76/34) and their younger siblings (M/F:57/53). The rate of `baseline VR` was 12.7 % whereas the `current VR` was 40% (p=0.001). High socioeconomic status (relative risk [RR]: 4.4; 95% confidence interval [CI]: 1.01-16.6; p=0.04), using social media as the main source of information (RR: 7; 95% CI: 1.5-32; p= 0.01) and lack of regular well-child visits of the sibling (RR: 25; 95% CI 4.1-166; p=0.001) were determined as risk factors for VR. CONCLUSIONS: The vaccination behavior of parents changed after having a child with ASD, and thus, the younger siblings may constitute a risk group for VR. In clinical practice, pediatricians should be aware of this risk and evaluate the vaccination uptake of the younger siblings of children with ASD more carefully. Regular well-child visits and improving media literacy may be the key points to prevent VR in this susceptible population.

Post-truth epistemic beliefs rooted in the Dark Factor of Personality are associated with higher COVID-19 vaccination refusal.

A substantial number of people refused to get vaccinated against COVID-19, which prompts the question as to why. We focus on the role of individual worldviews about the nature and generation of knowledge (epistemic beliefs). We propose a model that includes epistemic beliefs, their relationship to the Dark Factor of Personality (D), and their mutual effect on the probability of having been vaccinated against COVID-19. Based on a US nationally representative sample (N = 1268), we show that stronger endorsement of post-truth epistemic beliefs was associated with a lower probability of having been vaccinated against COVID-19. D was also linked to a lower probability of having been vaccinated against COVID-19, which can be explained by post-truth epistemic beliefs. Our results indicate that the more individuals deliberately refrain from adhering to the better argument, the less likely they are vaccinated. More generally, post-truth epistemic beliefs pose a challenge for rational communication.

Vaccine hesitancy among healthcare professionals and the general population: Second important step in the fight against COVID-19.

INTRODUCTION: This study aims at finding valuable information for predicting vaccination intentions against COVID-19 to guide future interventions to address hesitation. METHODOLOGY: This observational study consists of 1010 volunteer health workers from the state hospitals in Bursa, and 1111 volunteers from the non-healthcare group, unvaccinated against COVID-19. In the study, the participants were asked about their sociodemographic information and reasons for refusing the COVID-19 vaccine by face-to-face interview. RESULTS: We classified the unvaccinated healthcare worker group as group 1, and the unvaccinated non-health workers group as group 2. Between groups 1 and 2, vaccination refusal, education level, income level, and pregnancy status were statistically significant (p < 0.001). The groups differed in the reasons for vaccine refusal and recommending vaccination to the relatives of those who refused vaccination (p < 0.001). CONCLUSIONS: Healthcare workers have priority among high-risk groups considered candidates for early vaccination. Therefore, it is important to consider health professionals' attitudes towards COVID-19 vaccination to better address barriers to widespread vaccination. The role of healthcare professionals is also important, as it encourages the entire community to be vaccinated with role-modeling behavior and advises patients and communities.

Attitudes of French adults toward COVID-19 vaccination.

Reticence toward COVID-19 vaccination is more prevalent among women, people with low income, people who feel close to parties on the Far Right and Far Left and people who feel close to no party at all. It illustrates a mistrust of state institutions and policy-makers in general. The arguments in favor of Covid vaccine refusal are safety concern, and the contention that COVID is a mild disease. That said, vaccine hesitancy is vaccine-specific, with a major difference between Pfizer/Moderna and Oxford-AstraZeneca vaccines. Aside from vaccine hesitancy, vaccination intention rate has approached 80%.

Motherhood and vaccine refusal in the United Kingdom: A new examination of gender, identity and the journey to contemporary non-vaccination.

INTRODUCTION: Contemporary research into non-vaccination has highlighted some of the attitudes, beliefs and characteristics of non-vaccinating parents with recent research also beginning to examine the journey to non-vaccination. However, the interaction between gender, identity and non-vaccination is less well understood, as well as the non-vaccination journey for parents in the United Kingdom. METHODS: Using purposive sampling, we recruited mothers who have rejected some or all of their child's routine vaccinations in the last 5-10 years. Semi- structured interviews were conducted by phone in late 2020 and analysed using thematic analysis. RESULTS: Ten mothers were interviewed. They differed in socio-economic, educational and cultural backgrounds, yet all wanted the same thing: to have happy and healthy children, a goal which they saw as their responsibility and within their control and did not include vaccination. Within this shared parenting priority, identities varied considerably. Most mothers strongly rejected the label or identity of 'anti-vaxxer', preferring alternative terms with less negative social connotations. The decision not to vaccinate was predominantly made by mothers, describing a dynamic where mothers (rather than fathers/partners) were clearly responsible for their children's health, but this largely appeared to be internalized as the mother's role. CONCLUSIONS: The heterogeneity of mother's identities within the non-vaccination movement and the pressures on mothers to raise children with 'optimum health' explored in this study suggest that non-vaccination is a largely individual choice that requires nuanced and compassionate engagement to understand the root causes behind this decision.

A COVID-19 elleni oltóanyagot elutasítók az aktív korú felnott magyar lakosság körében 2021 decemberében.

INTRODUCTION: In 2021, vaccines against COVID-19 became widely available in Hungary, but a part of the population refuses to be vaccinated, which hinders the control of the pandemic. OBJECTIVE: To explore the sociodemographic characteristics of the Hungarian vaccination-refusing population and to preliminarily explore the reasons behind their refusal. METHODS: In December 2021, survey data were collected online using quota-sampling among the Hungarian population aged 18-65 years with internet access. Sociodemographic variables, individual variables, and reasons for refusal were asked. 1905 completed questionnaires were included in this analysis. After variable selection using LASSO regression, binary logistic regression was used to identify the influencing variables. Reasons for rejection were examined both descriptively and using hierarchical classification. RESULTS: Respondents with lower income, lower education, females, younger age, people living in smaller municipalities and who perceived their own health as better were more likely to refuse vaccination. No similar associations were found with marital status, household size, life satisfaction and loneliness. Distrust of vaccination, safety concerns (especially side effects) and efficacy concerns are the main reasons for refusal, and to a lesser extent, the belief of immunity. CONCLUSIONS: Vaccination refusal is higher in vulnerable groups, which further increases their health risks. Alongside a well-designed health communication campaign, restoring trust in scientific and health institutions, transparent communication and a community-based approach appear to be important to increase vaccination uptake in Hungary. Orv Hetil. 2022; 163(29): 1135-1143.

[How to Defend Mandatory Immunization Against Vaccine Hesitancy and Vaccine Refusal? An Ethical Assessment]. / Asi Kararsizligi ve Asi Reddi Olgusu Karsisinda Zorunlu Bagisiklama Nasil Savunulmali? Etik Açisindan Bir Degerlendirme.

One of the basic ethical principles in medical practice is to respect personal autonomy. However, it is a widely accepted view that when it comes to health problems that concern not only the individual but also the society, especially in epidemics of infectious diseases, individual autonomy can be violated by prioritizing the benefit of the community. This view is based on the scientific fact that epidemics can only be controlled by immunizing all susceptible individuals. However, whether all susceptible individuals can be compelled to be immunized remains a matter of debate around the world. Especially in the last three years, during the worldwide Coronavirus disease-2019 (COVID-19) pandemic, a significant part of the society has been hesitant about being vaccinated, and some have argued that vaccines should be rejected altogether. In the face of the situation outlined above, the question of "should immunization be mandatory?" has become more important than ever to be able to answer the question in a way that will ensure as broad consensus as possible. In this review article; it was discussed under which conditions mandatory immunization could be justified in terms of ethics and thus, it was aimed to contribute to the solution of the vital problem created by the phenomenon of vaccine hesitancy and rejection in terms of public health. To this aim, first of all, the need to clarify some concepts was mentioned. Afterwards, the arguments "must be compulsory", "should be optional", and "should not be done to anyone" were evaluated with their justifications and it was determined that the argument that immunization should be mandatory could be justified in terms of ethics. In the article, it was argued that the conflicts of "individual freedom X community benefit" and "personal autonomy X community benefit" did not exist in today's actual conditions, but it was stated that an individual with the knowledge of reality experiences a tension in the face of not putting this knowledge into practice. It was emphasized that in order to overcome this tension, consolidation of the theoretical background and also consideration of the macro determinants of vaccine hesitancy and rejection in practice were necessary. What needs to be done to re-establish trust in the medical institution was listed, and it was argued that the question of how to implement mandatory immunization could only be answered in a healthy way through a transformation process that will be implemented through a social dialogue.

Global state of education-related inequality in COVID-19 vaccine coverage, structural barriers, vaccine hesitancy, and vaccine refusal: findings from the Global COVID-19 Trends and Impact Survey.

BACKGROUND: COVID-19 vaccine coverage and experiences of structural and attitudinal barriers to vaccination vary across populations. Education-related inequality in COVID-19 vaccine coverage and barriers within and between countries can provide insight into the hypothesised role of education as a correlate of vaccine access and acceptability. We aimed to characterise patterns of within-country education-related inequality in COVID-19 vaccine indicators across 90 countries. METHODS: This study used data from the University of Maryland Social Data Science Center Global COVID-19 Trends and Impact Survey. Data from 90 countries (more than 14 million participants aged 18 years and older) were included in our analyses. We assessed education-related inequalities globally, across country-income groupings, and nationally for four indicators (self-reported receipt of COVID-19 vaccine, structural barriers to vaccination, vaccine hesitancy, and vaccine refusal) for the study period June 1-Dec 31, 2021. We calculated an absolute summary measure of inequality to assess the latest situation of inequality and time trends and explored the association between government vaccine availability policies and education-related inequality. FINDINGS: Nearly all countries had higher self-reported receipt of a COVID-19 vaccine among the most educated respondents than the least educated respondents. Education-related inequality in structural barriers, vaccine hesitancy, and vaccine refusal varied across countries, and was most pronounced in high-income countries, overall. Low-income and lower-middle-income countries reported widespread experiences of structural barriers and high levels of vaccine hesitancy alongside low levels of education-related inequality. Globally, vaccine hesitancy in unvaccinated people was higher among those with lower education and vaccine refusal was higher among those with higher education, especially in high-income countries. Over the study period, education-related inequalities in self-reported receipt of a COVID-19 vaccine declined, globally and across all country income groupings. Government policies expanding vaccine availability were associated with lower education-related inequality in self-reported receipt of vaccine. INTERPRETATION: This study serves as a baseline for continued inequality monitoring and could help to inform targeted actions for the equitable uptake of vaccines. FUNDING: Gavi, the Vaccine Alliance.

Discriminatory attitudes against unvaccinated people during the pandemic.

During the COVID-19 pandemic, sizeable groups of unvaccinated people persist even in countries with high vaccine access1. As a consequence, vaccination became a controversial subject of debate and even protest2. Here we assess whether people express discriminatory attitudes in the form of negative affectivity, stereotypes and exclusionary attitudes in family and political settings across groups defined by COVID-19 vaccination status. We quantify discriminatory attitudes between vaccinated and unvaccinated citizens in 21 countries, covering a diverse set of cultures across the world. Across three conjoined experimental studies (n = 15,233), we demonstrate that vaccinated people express discriminatory attitudes towards unvaccinated individuals at a level as high as discriminatory attitudes that are commonly aimed at immigrant and minority populations3-5. By contrast, there is an absence of evidence that unvaccinated individuals display discriminatory attitudes towards vaccinated people, except for the presence of negative affectivity in Germany and the USA. We find evidence in support of discriminatory attitudes against unvaccinated individuals in all countries except for Hungary and Romania, and find that discriminatory attitudes are more strongly expressed in cultures with stronger cooperative norms. Previous research on the psychology of cooperation has shown that individuals react negatively against perceived 'free-riders'6,7, including in the domain of vaccinations8,9. Consistent with this, we find that contributors to the public good of epidemic control (that is, vaccinated individuals) react with discriminatory attitudes towards perceived free-riders (that is, unvaccinated individuals). National leaders and vaccinated members of the public appealed to moral obligations to increase COVID-19 vaccine uptake10,11, but our findings suggest that discriminatory attitudes-including support for the removal of fundamental rights-simultaneously emerged.

COVID­19 vaccine hesitancy among pregnant women and their reported reasons for vaccine refusal - A prospective study in Tehran, Iran.

OBJECTIVE: Evaluation of covid­19 vaccine hesitancy among pregnant women and their reported reasons for vaccine refusal. METHODS: This prospective study was performed in Arash women's Hospital, Tehran, Iran, between December 1, 2021 and January 1, 2022. All pregnant women who were attended to prenatal care unit were considered eligible for inclusion. A validated questionnaire was used for data gathering. Written informed consent was obtained from all participants. RESULTS: Finally, 477 pregnant women were recruited and were divided into two groups according the status of vaccine acceptance (237 accepted and 240 women refused vaccination). The mean age of accepted participants was higher (31.65 ± 5.69 vs 30.39 ± 5.5; P = 0.01). There was a significant statistical difference between the groups regarding education level. Access to internet and social media were also significantly different between the two groups (94.8% in accepted vs 86.6% in refused group; P = 0.002). There was more rate of severe COVID-19 infection in friends or relatives of accepted group (50% vs 38%). we did not find any statistically significant differences in obstetric characteristics and the rate of obstetric complications between the two groups. The most common reasons reported by participants for vaccine refusal, was fear of vaccination side effects on the fetus (86.5%), and the less common reported reasons were husband's disagreement (9.7%), use of traditional medicine (5.6%), religious beliefs (3.7%), and information obtained from social media (2.8%). After advices from medical staff, most of these mothers (86.5%) still refused vaccination. CONCLUSION: Based on the results of the present study,rate of COVID-19 vaccine hesitancy was about 50% and its most common reported reason was fear of probable side effects of vaccine on the fetus.

COVID-19 vaccination refusal trends in Kenya over 2021.

BACKGROUND: Vaccination refusal exacerbates global COVID-19 vaccination inequities. No studies in East Africa have examined temporal trends in vaccination refusal, precluding addressing refusal. We assessed vaccine refusal over time in Kenya, and characterized factors associated with changes in vaccination refusal. METHODS: We analyzed data from the Kenya Rapid Response Phone Survey (RRPS), a household cohort survey representative of the Kenyan population including refugees. Vaccination refusal (defined as the respondent stating they would not receive the vaccine if offered to them at no cost) was measured in February and October 2021. Proportions of vaccination refusal were plotted over time. We analyzed factors in vaccination refusal using a weighted multivariable logistic regression including interactions for time. FINDINGS: Among 11,569 households, vaccination refusal in Kenya decreased from 24 % in February 2021 to 9 % in October 2021. Vaccination refusal was associated with having education beyond the primary level (-4.1[-0.7,-8.9] percentage point difference (ppd)); living with somebody who had symptoms of COVID-19 in the past 14 days (-13.72[-8.9,-18.6]ppd); having symptoms of COVID-19 in the past 14 days (11.0[5.1,16.9]ppd); and distrusting the government in responding to COVID-19 (14.7[7.1,22.4]ppd). There were significant interactions with time and: refugee status and geography, living with somebody with symptoms of COVID-19, having symptoms of COVID-19, and believing in misinformation. INTERPRETATION: The temporal reduction in vaccination refusal in Kenya likely represents substantial strides by the Kenyan vaccination program and possible learnt lessons which require examination. Going forward, there are still several groups which need specific targeting to decrease vaccination refusal and improve vaccination equity, including those with lower levels of education, those with recent COVID-19 symptoms, those who do not practice personal COVID-19 mitigation measures, refugees in urban settings, and those who do not trust the government. Policy and program should focus on decreasing vaccination refusal in these populations, and research focus on understanding barriers and motivators for vaccination.

Emergence of Vaccine-Preventable Diseases: The Perfect Storm of Hesitancy, Refusal, a Pandemic, and War.

The landscape of pediatric vaccination has changed dramatically due to changing attitudes toward immunizations and recent world events. The rise of vaccine hesitancy and refusal related to the concurrent rise of social media and anti-vaccination messages with misinformation campaigns have led to populations of children being unimmunized or under-immunized. These populations have been left vulnerable to the rapid spread of vaccine-preventable infection. Additionally, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and the clinical syndrome known as coronavirus disease 2019 (COVID-19) resulted in the emergence of a worldwide pandemic. Control measures to mitigate the spread of COVID-19 resulted in numerous reports of children missing routine vaccines along with the stopping of many public health immunization programs. Finally, armed conflicts and war have led to large family migrations from their homelands to various countries and regions leading to increased risk for missed maternal and child immunization as well as difficulty in keeping vaccination records. [Pediatr Ann. 2022;51(11):e426-e430.].

Are Conspiracy Theories Harmless?

In recent years, there has been an increasing interest in the consequences of conspiracy theories and the COVID-19 pandemic raised this interest to another level. In this article, I will outline what we know about the consequences of conspiracy theories for individuals, groups, and society, arguing that they are certainly not harmless. In particular, research suggests that conspiracy theories are associated with political apathy, support for non-normative political action, climate denial, vaccine refusal, prejudice, crime, violence, disengagement in the workplace, and reluctance to adhere to COVID-19 recommendations. In this article, I will also discuss the challenges of dealing with the negative consequences of conspiracy theories, which present some opportunities for future research.

Associations Between Social Media Engagement and Vaccine Hesitancy.

There has been a surge in vaccine hesitancy following the Coronavirus pandemic. This study measured the prevalence of and identified factors associated with vaccine hesitancy and social media use. An online survey was administered (n = 1050) between May and July 2021. Chi-square tests were used to examine bivariate associations with vaccine hesitancy (partially vaccinated and unvaccinated participants). Logistic regression was used to identify associations between social media use and vaccine hesitancy. Chi-square tests showed women (69.7% vs 28.2% men, padjusted = .002), African American participants (52.3% vs 17.8% white, padjusted < .001), high school diploma (54.4% vs 38.6% college degree, padjusted < .001), political unaffiliated (15.8% vs 14.5% republican, padjusted < .001), Muslim (10.0% vs 0% Jewish, padjusted < .001), and never married/single (53.9% vs 17.0% married, padjusted < .001) were more likely to be vaccine hesitant. Controlling for all demographic variables (age, race, gender, and education), more frequent use of social media for reading news was associated with lower vaccine hesitancy (OR 0.35, 99% CI 0.20, 0.63, p < 0.001). However, using social media as a source of vaccine information without any other trusted source (health department, doctor, CDC,) was associated with higher odds of being vaccine hesitant (OR 2.00, 99% CI 1.15, 3.46, p = 0.001). People who use social media without referencing trusted sources may be particularly vulnerable to disinformation or vaccine hesitant persons are more likely exposed to non-trusted social media sites as their only information source.

COVID-19 Vaccine in Inherited Metabolic Disorders Patients: A Cross-Sectional Study on Rate of Acceptance, Safety Profile and Effect on Disease.

BACKGROUND: Vaccines for COVID-19 have had a significant impact on the spread of COVID-19 infection, reducing the incidence and mortality of the infection in several countries. However, hesitancy toward this vaccine is a global health issue for the general population The Vaccine acceptance rate among patients affected with inherited metabolic disorders (IMD), as well as safety profile, has not been described. METHODS: We conducted a cross-sectional study, based on a telephone survey, investigating the COVID-19 vaccination rate, the incidence and type of adverse effects (AEs), the reasons for vaccine refusal and the effects on the underlying disease in a cohort of IMD patients followed at a single center and invited directly to vaccination by specialistic team. RESULTS: Seventy-four patients were included in the study, the median age was 23.4 years (min 12.1-max 61.7), 47% (n = 85) were females and 61% (107) were affected from impaired metabolism of phenylalanine. By October 2021, 94% (n = 163) of them had received at least one dose of the vaccine, which was, in 98% of cases, mRNA-based vaccine, given at the referral hospital in 65% of cases. Overall, 72% of patients with IMD reported AE to the vaccine: 60% after the first dose, 81% after the second. The highest rate of adverse events at the first dose was reported in patients with amino acids related disorders other than impaired phenylalanine metabolism (PKU/HPA) (88%). For the second dose, the PKU/HPA group reported the highest rate of AEs (89% of cases). There was no effect on the underlying disease or acute decompensation after the vaccine. Eleven patients (6%) were not vaccinated because they considered it dangerous. CONCLUSION: Among individuals with IMD, the vaccination rate was high, the incidence and severity of AEs were comparable to those in the general population with no effects on the disease. Direct contact with the specialist medical team, has proven to reassure patients and effectively contrast hesitancy.

Assessment of COVID-19 vaccination refusal among healthcare workers in Ethiopia.

Background: Even though the emergence of the coronavirus disease 2019 (COVID-19) vaccine and the increasing vaccination rates are promising, there are reports of refusal to get vaccinated in a different segment of the population, including health care workers. Objective: This study determines the acceptance/refusal of the COVID-19 vaccination and its predictors among health care workers in Ethiopia. Methods: A cross-sectional survey was conducted among a group of health care workers at different health facilities in Ethiopia. Data were collected from 1 to 30 July 2020. Data were collected from 403 participants through an online Google submission form. Data were entered into Epi-info 7 and exported to SPSS version 20 for analysis. Results: Approximately 38.5% of the health care workers in the study had refused COVID-19 vaccination. Younger age groups vs. 40 and above years (age 20-24 year [AOR: 0.03, 95% CI (0.00, 0.48)], age 25-29 year [AOR: 0.02, 95% CI (0.00, 0.49)], and age 30-34 year [AOR: 0.04 (0.00, 0.49)] and medical doctors vs. Nurses [AOR: 0.06, 95% CI, (0.01, 0.42)] were reported as risk factors; also, academic working staff vs. hospital staff [AOR: 4.42, 95% CI (1.85, 10.54)] was reported as a protective factor toward refusal of COVID-19 vaccination. Conclusion: Two-fifths of health care workers in Ethiopia were indicated to refuse COVID-19 vaccination, implying a significant barrier to achieving WHO's a target of 70% double vaccination rate by mid-2022.

Hesitant adopters: An examination of hesitancy among adults in Arkansas who have taken the COVID-19 vaccine.

Recent research suggests people who report vaccine hesitancy may still get vaccinated; however, little is known about hesitancy among those who chose to vaccinate. The current study focused on individuals who received the coronavirus disease 2019 (COVID-19) vaccine despite their hesitancy, whom we refer to as "hesitant adopters." With the understanding that vaccine attitudes and vaccine behaviors may or may not be correlated, we examined the prevalence of COVID-19 vaccine hesitancy among those who have been vaccinated, how COVID-19 vaccine hesitancy varies across sociodemographic groups, and how COVID-19 vaccine hesitancy relates to other factors (prior health care access and influenza vaccination behavior over the past 5 years). Random digit dialing of telephone landlines and cell phones was used to contact potential survey respondents, rendering a sample of 1500 Arkansan adults. Approximately one-third of those who received a COVID-19 vaccine also reported some level of hesitancy. Among hesitant adopters, 5.3% said they were "very hesitant," 8.8% said they were "somewhat hesitant," and 17.1% said they were "a little hesitant." Black/African American and Hispanic/Latinx respondents reported more hesitancy than White respondents, and female respondents reported greater hesitancy compared to male respondents. Greater hesitancy was associated with non-metro/rural residence, forgoing health care due to cost, and lower influenza vaccination rates over the past 5 years. Findings suggest those who are hesitant may get vaccinated despite their hesitancy, illustrating the complexity of vaccination behaviors. Prevalence of hesitancy among the vaccinated has implications for communication strategies in vaccine outreach programs and may help to reduce stigmatization of hesitant adopters.