Vaccine/Vaccination Hesitancy: Challenging Science and Society

Conflict deeply affects human experiences, frequently testing individual resilience to its breaking point and leaving enduring psychological and societal wounds. The current conflict in Ukraine, initiated by Russia's invasion in 2022, illustrates this phenomenon by altering regional relationships and triggering a major humanitarian crisis marked by extensive displacement, loss of life, and emotional turmoil. This study explores the factors influencing hope and distress in Ukraine alongside six nearby European countries during the ongoing conflict. A cross-sectional survey collected data primarily via internet panel samples from the Czech Republic, Georgia, Lithuania, Poland, Romania, Slovakia, and Ukraine in the second year since the war's initiation. The current study utilised validated instruments, collecting data on levels of hope, distress, individual resilience, community resilience, societal resilience, morale, sense of danger, perceived security threats, and demographic characteristics. Hope and distress levels differ across countries, with Ukraine exhibiting the highest levels of both (3.74±1.02 and 2.89±0.87, respectively). Overall, average scores of hope were higher than average distress levels. Across the regression models for the seven countries, hope showed strong associations with individual (between β=0.089 and β=0.327) and societal resilience (between β=0.206 and β=0.514), while morale (between β=-0.104 and β=-0.479) and individual resilience (between β=-0.077 and β=-0.335) displayed a protective relationship against distress (all β values were significant, p<0.01). Monitoring hope and distress is crucial during the Russian-Ukrainian war and other adversities, as these factors give insight into the current and future psychological states of affected populations. The results offer valuable information that can guide the development of tailored strategies to enhance hope and buffer distress in war-impacted countries, as well as those experiencing its broader effects. Fostering individual and societal resilience, alongside enhancing morale, may strengthen hope and mitigate distress amid adversity. Developing targeted interventions that address each population's unique needs, as well as their sociocultural and geopolitical contexts can enhance efficacy.

Background: Incomplete childhood immunization against communicable diseases is a major concern and vaccine hesitancy remains a hurdle to overcome in primary vaccination programs. This study was to examine the parents’ vaccine knowledge, awareness and hesitancy in relation to their children’s immunization status. Methods: A cross-sectional questionnaire study design was used. The parents who brought their children for immunization visit or follow-up at four public health clinics located in Sandakan district were invited to participate in this survey. Informed consent was obtained before each participant completed a hard copy of self-administered questionnaire in either English or Malay versions. Results: Of 405 parents responded, they generally had good knowledge and awareness of vaccines, only a small percentage (6.8%) of parents were found vaccine hesitant. There were significant differences in vaccine knowledge and awareness in those from different education levels and employment status; similarly, these two factors also significantly affected the vaccine hesitancy among the parents. The parents’ knowledge score was found to be moderately associated with their awareness (r = 0.551, p < 0.01) and inversely correlated to vaccine hesitancy (r = −0.397, p < 0.01). Most of the children (n = 376, 92.8%) in the study were immunized. The children’s immunization status was significantly associated with the parents’ education level (p = 0.025). There was also a significant difference in the total vaccine knowledge scores between the groups of parents with different child immunization status (p = 0.05). Conclusion: This study revealed that parents with higher education had a better knowledge of vaccinations, were less vaccine hesitant and were more likely to ensure that their children complete the recommended course of immunization. It is crucial to ensure parents are well-informed about the safety and efficacy of vaccines so that the children are protected from communicable diseases by the child vaccination program.

BackgroundA vital stakeholder in the successful management of the COVID-19 pandemic is the public. The degree of involvement of the population in managing the pandemic, and the leadership perception of the public, had a direct impact on the resilience of the population and level of adherence to the issued protective measures.Main bodyResilience refers to the ability to ‘bounce back’ or ‘bounce forward’ following adversity. Resilience facilitates community engagement which is a crucial component of combating the COVID-19 pandemic. The article highlights six insights recognized in studies conducted in Israel during and following the pandemic concerning the resilience of the country’s population. (1) Contrary to varied adversities in which the community serves as an important support system to the individuals, this type of support was substantially impaired during the COVID-19 pandemic, due to the need to maintain isolation, social distancing, and lockdowns. (2) Policy-making during the pandemic should be based on evidence-based data, rather than on assumptions made by decision-makers. This gap led the authorities during the pandemic to adopt measures that were ineffective, such as risk communication based on ‘scare tactics’ concerning the virus, when the highest risk perceived by the public was political instability. (3) Societal resilience is associated with the public’s behavior, such as with vaccine hesitancy and uptake. (4) Factors that affect the levels of resilience include, among others, self-efficacy (impacts individual resilience); social, institutional, and economic aspects as well as well-being (impact community resilience); and hope and trust in the leadership (impact societal resilience). (5) The public should be perceived as an asset in managing the pandemic, thus becoming a vital part of the ‘solution’. This will lead to a better understanding of the needs and expectations of the population and an applicable ‘tailoring’ of the messages that address the public. (6) The gap between science and policymaking must be bridged, to achieve optimal management of the pandemic.ConclusionsImproving preparedness for future pandemics should be based on a holistic view of all stakeholders, including the public as a valued partner, connectivity between policymakers and scientists, and strengthening the public’s resilience, by enhancing trust in authorities.

Overcrowding and limited ability to social distance contribute to high rates of COVID-19 outbreaks in correctional facilities. Despite the Centers for Disease Controls' recommendations, incarcerated persons and correctional staff report a high prevalence of vaccine-hesitance. We sought to identify reasons underlying COVID-19 vaccine hesitation and refusal in correctional systems. We used Preferred Reporting Items for Systematic Reviews (PRISMA) guidelines to design the review. We searched PubMed abstracts and reviewed literature relevant to COVID-19 vaccine uptake and hesitancy in correctional systems of the United States (n = 23). Reasons for vaccine hesitancy among incarcerated people and correctional staff include efficacy, safety concerns, lack of information, and distrust. Findings reveal higher vaccine hesitancy among young and Black residents whereas facilities in close collaborations with state health departments exhibited higher vaccination rates. Correctional facilities must prioritize communication and education to improve the current state of vaccine hesitancy.

Background & ObjectivesGrowing data on the impact of herd immunity and susceptibility of unvaccinated persons to chronic COVID sequelae requires deeper understanding of vaccine stigma and hesitancy to facilitate population needs. Reproductive-aged women (18–45 years) were at a “vaccine paradox” during COVID-19 – hesitant to receive the vaccine, yet at increased risk for COVID infection. In this study, we sought to: identify demographic predictors, reasons, geographic location of vaccine hesitancy, and COVID-specific attributes that predict future vaccination willingness. We hypothesized that high COVID risk perception and high COVID stress would be predictors of willingness.MethodsStudy Design: Cross-sectional survey of women across the United States. Main Outcomes and Measures: Vaccine hesitancy was defined as responding “No/Not Sure” to the question “Have you received any of the COVID-19 vaccines?” The COVID-Risk scale evaluate perceived COVID Risk, and the COVID-19 Perceived Stress Scale (PSS-10-c) evaluated COVID stress. Open ended questions inquired about participants’ vaccine concerns.ResultsOf the 1,037 women who accessed the survey, 948 (91%) consented and completed. Predictors of vaccine hesitancy included younger aged parents (p=0.005), non-white race (p=0.003), and having high school or lower educational attainment (p<0.0001). Using smoking as a proxy measure of “health behavior”, we found long-term smokers or quitters were more hesitant than those who never smoked (p=0.03). Geographic analyses showed the most vaccine hesitant women resided in Southeast and Midwest US. Hesitancy reasons included side effects (21%) and fertility/pregnancy concerns (4%). High COVID risk perception (p=0.0004) and high COVID stress (p=0.01) significantly predicted future willingness to get vaccinated.Conclusions and RelevanceThis research provides insights for managing the “vaccine paradox” in reproductive age women, and identifying factors that influence COVID-19 vaccine hesitancy and future vaccination willingness. Public health and policy advocates could target messaging around COVID risk and stress in Southeastern and Midwestern regions; as well as address women’s concerns around fertility and other side effects.

COVID-19 vaccine perceptions and hesitancy amongst parents of school-aged children during the pediatric vaccine rollout

The development and dissemination of vaccines has made immunization possible and has led to the successful control and eradication of various infectious diseases in many parts of the world. However, even when vaccines that are said to be "effective" are offered, a certain number of people do not receive them, and this has become a problem known as "vaccine hesitancy". Why is vaccine hesitancy a problem? It has been pointed out that the reason is not only because of the risk of contracting infectious diseases if they are not vaccinated, but also because of the lack of a collective immunity system. Vaccines are an effective means of acquiring immunity, but no matter how highly effective vaccines are developed, if the vaccination rate does not exceed a certain number, herd immunity cannot be acquired. Therefore, it is said that how to increase the vaccination rate of the population is a major public health challenge. Hence, the large number of people who do not receive vaccinations due to "vaccine hesitancy" is problematic. This paper reviews previous studies on "vaccine hesitancy" in Japan and analyzes people's hesitancy in terms of negative "rumors" about vaccines, risk perception of vaccine side effects, and sense of burden when receiving vaccinations. Then, I will examine that the background of "vaccine hesitancy" is not only distrust of vaccines and risk perception of side effects, but also distrust of those who provide and promote vaccinations, such as medical professionals, government, and public administration. By using medical uncertainty and trans-scientific theory, this paper argues that the problem of "vaccine hesitancy" can be reduced if medical professionals and governments show sincere empathy and attitude toward victims of adverse vaccine reactions and those who hesitate to vaccinate.

Background: The World Health Organization (WHO) warns that vaccine hesitancy is an ongoing major global health threat. While vaccination against severe acute respiratory syndrome coronavirus (SARS-CoV-2) proves to be an effective strategy in protecting against the disease, vaccine hesitancy represents a major barrier to stopping the spread of the virus. Willingness for vaccination can be influenced by several factors, including education level and health literacy. Although several studies demonstrate the value of video educational programs in improving coronavirus disease 2019 (COVID-19) vaccine knowledge and acceptance, no studies to date have evaluated if race, gender, and other demographic factors impact the influence of an educational video on COVID-19 vaccine knowledge and hesitancy among university students in the United States (U.S.). Aims: This study was conducted to determine the impact of an educational video on U.S. university undergraduate students’ COVID-19 vaccine perception and acceptance. It also aims to evaluate whether demographic factors affect the influence of the video. Methods: An online survey was used to measure perceived understanding and acceptance of COVID-19 vaccines before and after viewing a video regarding the effectiveness and safety of COVID-19 vaccinations. The impact of demographic factors on the Video Influence Score was analyzed. Key results: After viewing the video, respondents’ (n = 285) perceived awareness and acceptance of COVID-19 vaccines significantly increased (p < 0.05). In addition, gender, political party affiliation, age, study major, and influenza vaccination history did not significantly impact the Video Influence Score (p > 0.05). However, African American/Black respondents (3.81 ± 4.24) were significantly more influenced by the video compared to respondents of other races (p < 0.05), such as White/Caucasian (1.91 ± 3.75), Hispanic/Latino (0.17 ± 3.67), Asian (0.29 ± 1.53), and Indigenous American (0.64 ± 2.52). Conclusions: This study suggests the potential impact of an educational video on COVID-19 vaccine perception and acceptance among university students. Despite limitations such as a modest survey response rate, this study provides valuable insight concerning the influential factors affecting vaccine acceptance in diverse student populations. Future studies are warranted to explore how student response to vaccine educational videos may vary depending on students’ racial and cultural backgrounds. Implications: A targeted educational video to promote vaccine acceptance is a valuable tool for public health campaigns to combat vaccine hesitancy. The study also highlights the importance of tailoring interventions to specific demographic groups such as considering racial factors to maximize the impact of educational interventions on vaccine attitudes.

Hesitancy remains one of the major hurdles to vaccination, regardless of the fact that vaccines are indisputable preventive measures against many infectious diseases. Nevertheless, vaccine hesitancy or refusal is a growing phenomenon in the general population as well as among healthcare workers (HCWs). Many different factors can contribute to hesitancy to COVID-19 vaccination in the HCWs population, including socio-demographic characteristics (female gender, low socio-economical status, lower age), individual beliefs regarding vaccine efficacy and safety, as well as other factors (occupation, knowledge about COVID-19, etc.). Understanding the determinants of accepting or refusing the COVID-19 vaccination is crucial to plan specific interventions in order to increase the rate of vaccine coverage among health care workers. We conducted a cross-sectional online survey on HCWs in seventeen Italian regions, between 30 June and 4 July 2021, in order to collect information about potential factors related to vaccine acceptance and hesitancy. We found an overall vaccine uptake rate of 96.4% in our sample. Acceptance was significantly related to job task, with physicians showing the highest rate of uptake compared to other occupations. At univariate analysis, the HCWs population's vaccine hesitancy was significantly positively associated with fear of vaccination side effects (p &lt; 0.01), and negatively related to confidence in the safety and efficacy of the vaccine (p &lt; 0.01). Through multivariate analysis, we found that only the fear of possible vaccination side effects (OR: 4.631, p &lt; 0.01) and the confidence in vaccine safety and effectiveness (OR: 0.35 p &lt; 0.05) remained significantly associated with hesitancy. Action to improve operator confidence in the efficacy and safety of the vaccine should improve the acceptance rate among operators.

The arrival of the COVID-19 vaccine has been accompanied by increased discussion of vaccine hesitancy. However, it is unclear if there are shared patterns between general vaccine hesitancy and COVID-19 vaccine rejection, or if these are two different concepts. This study characterized rejection of a hypothetical COVID-19 vaccine, and compared patterns of association between general vaccine hesitancy and COVID-19 vaccine rejection. The survey was conducted online March 20-22, 2020. Participants answered questions on vaccine hesitancy and responded if they would accept the vaccine given different safety and effectiveness profiles. We assessed differences in COVID-19 rejection and general vaccine hesitancy through logistic regressions. Among 713 participants, 33.0% were vaccine hesitant, and 18.4% would reject a COVID-19 vaccine. Acceptance varied by effectiveness profile: 10.2% would reject a 95% effective COVID-19 vaccine, but 32.4% would reject a 50% effective vaccine. Those vaccine hesitant were significantly more likely to reject COVID-19 vaccination [odds ratio (OR): 5.56, 95% confidence interval (CI): 3.39, 9.11]. In multivariable logistic regression models, there were similar patterns for vaccine hesitancy and COVID-19 vaccine rejection by gender, race/ethnicity, family income, and political affiliation. But the direction of association flipped by urbanicity (P=0.0146, with rural dwellers less likely to be COVID-19 vaccine rejecters but more likely to be vaccine hesitant in general), and age (P=0.0037, with fewer pronounced differences across age for COVID-19 vaccine rejection, but a gradient of stronger vaccine hesitancy in general among younger ages). During the COVID-19 epidemic’s early phase, patterns of vaccine hesitancy and COVID-19 vaccine rejection were relatively similar. A significant minority would reject a COVID-19 vaccine, especially one with less-than-ideal effectiveness. Preparations for introducing the COVID-19 vaccine should anticipate substantial hesitation and target concerns, especially among younger adults.

Reviewed by: Anti/Vax: Reframing the Vaccination Controversy by Bernice L. Hausman José Luis Quintero Ramírez (bio) Bernice L. Hausman. Anti/Vax: Reframing the Vaccination Controversy. Ithaca, NY: Cornell University Press, 2019. 294 pp. Hardcover, $29.95. At the heart of Bernice Hausman's Anti/Vax is a call to take vaccination skeptics at their word, to take their stories seriously. Drawing from her experience at Virginia Tech's Vaccination Research Group (VRG) interviewing people who do not vaccinate or only partially vaccinate, Hausman argues that while vaccination controversy is understood within popular discourses to be a problem of science denial, it is in fact a problem of social and political disagreement. She proposes that "vaccine skepticism is linked to various beliefs and practices that are actually not unusual in American society, and that such skepticism is sustained by popular suspicions of government, sponsored scientific research, and pharmaceutical companies" (13). This reality, however, is buried under a stalemate in public debates that is only further entrenched by contemporary media and popular literature that groups vaccine skeptics together with climate change deniers and conspiracy theorists. Anti/Vax is Hausman's attempt at moving beyond this impasse, offering a varied history of the particular material conditions that result in the modern vaccine skeptic, alongside a focus on narrative storytelling that highlights the centrality of individual health experience in understanding such subjects. The book's ten chapters are an expansive study that start by summarizing the long history of vaccination controversies in the United States, and then delve into the contemporary media's take on the modern controversy; the role of parental responsibility in understanding vaccine skepticism; science denialism; poststructuralism and alternative facts; biomedicalization and anti-medicine practices; and even cinematic representations of zombie epidemics. Throughout, Hausman is careful to remain neutral in the debate: her intention is not to "proclaim which side is right, but investigate the controversy [End Page 214] itself" (2). She does this tactfully and precisely, wonderfully illustrating how the scientific establishment has failed to address the fears of its skeptics. At the end of Anti/Vax, however, Hausman feels the need to clearly state that she is, despite the book she has written, on the side of vaccination and science. Listening to the stories of health and illness told by those interviewed at the VRG has led her to understand that, when it comes to appeasing vaccination skepticism, "the answer is science and something else" (219; original emphasis). Anti/Vax is a fantastic start in figuring out what that something else might be. The first chapter offers a quick but detailed history of vaccination concerns in the twentieth century, focusing on concerns brought up since the 1980s. From the start, Hausman clarifies that "there was never a golden age of vaccine acceptance," demonstrating that vaccination skepticism is not entirely linked to the contemporary moment (16). What the chapter truly centers around, however, is demonstrating that there is a wide array of reasons vaccination has become a national issue. Vaccine shortages, inaccessible prices, rumors about the spreading of HIV in Africa, and Gulf War syndrome have all previously caused people to raise concerns about the use of vaccines; these concerns are why governmental policy has been put in place to make vaccination a required practice. Parental belief, however, is what characterizes the contemporary vaccination controversy, and Hausman argues that this is only possible because "other concerns about vaccination were stripped of their authority or believability, or simply stopped being reported on" (34). This chapter's conclusion sets the stage for chapters 2 and 3, which explore how news media and nonfiction books on vaccination written for the general public single out parental disregard of scientific discourse as the root of the vaccination controversy. Hausman (and her well-acknowledged team of researchers) survey a vast archive of news media in chapter 2 in order to track how the tone of vaccination reporting has changed in the last decade. She concludes that "the narrowing of vaccination concern to the issue of autism causation does not necessarily reflect the range of vaccination worries in the United States" (47). The governmental mandate to vaccinate children for HPV, for example, was contentious specifically...

Introduction: Scaling up vaccination against COVID-19 is central to controlling the COVID-19 epidemic in the United States. Several vaccines are now approved for the prevention of COVID-19, but public concerns over safety and efficacy have heightened distrust and vaccine hesitancy. This is particularly concerning among people with HIV (PWH) who may be vulnerable to more severe COVID-19 disease. Here, we aimed to identify and understand COVID-19 vaccine hesitancy in a sample of PWH in the U.S. Methods: We conducted a cross-sectional online survey among PWH in the U.S. between 6 December 2020 and 8 January 2021. Measures included demographics, participants’ HIV and health-related attributes, COVID-19 history and experiences, COVID-19 vaccine-related concerns, and standardized measures of attitudes towards COVID-19 vaccines. Multivariate linear regression was used to identify factors associated with vaccine hesitancy in this sample. Results: Among the 1030 respondents, most were male (89.7%), White (66.0%), and identified as gay or lesbian (84.5%). Participants’ mean time living with HIV was 17.0 years (standard deviation (SD) = 11.1). The mean score for vaccine hesitancy was 1.5 (SD = 0.5; range: 1–5); 935 participants (90.8%) had a score greater than 1.0, indicating most participants had some degree of vaccine hesitancy. The final multivariate linear regression showed that greater vaccine hesitancy was associated with being Black (b = 0.149, p = 0.005), single (b = 0.070, p = 0.018), politically conservative (b = 0.157, p = 0.010), “anti-vaxxer” (b = 1.791, p < 0.001), concern about side effects (b = 0.226, p < 0.001), concern about safety (b = 0.260, p < 0.001), and being worried that the vaccine will not be effective (b = 0.169, p = 0.008) and they were being experimented on (b = 0.287, p < 0.001). Participants who were male White (b = −0.093, p = 0.008) and university graduates (b = −0.093, p < 0.001) and had a CD4 count of 200 cells/mm3 (b = −0.082, p = 0.048) and a liberal political orientation (b = −0.131, p < 0.001) were associated with lower vaccine hesitancy. Conclusions: Our findings provide important insights regarding COVID-19 vaccine hesitancy among PWH. Further efforts are required to understand how various social, political, and psychological factors contribute to COVID-19 vaccine hesitancy among key populations.

Background: Vaccine hesitancy is the next great barrier for public health. Arab Americans are a rapidly growing demographic in the United States with limited information on the prevalence of vaccine hesitancy. We therefore sought to study the attitudes towards the coronavirus disease 2019 (COVID-19) vaccine amongst Arab American health professionals living in the United States. Methods: This was a cross sectional study utilizing an anonymous online survey. The survey was distributed via e-mail to National Arab American Medical Association members and Arab-American Center for Economic and Social Services healthcare employees. Respondents were considered vaccine hesitant if they selected responses other than a willingness to receive the COVID-19 vaccine. Results: A total of 4000 surveys were sent via e-mail from 28 December 2020 to 31 January 2021, and 513 responses were received. The highest group of respondents were between the ages of 18–29 years and physicians constituted 48% of the respondents. On multivariable analysis, we found that respondents who had declined an influenza vaccine in the preceding 5 years (p < 0.001) and allied health professionals (medical assistants, hospital administrators, case managers, researchers, scribes, pharmacists, dieticians and social workers) were more likely to be vaccine hesitant (p = 0.025). In addition, respondents earning over $150,000 US dollars annually were less likely to be vaccine hesitant and this finding was significant on multivariable analysis (p = 0.011). Conclusions: Vaccine hesitancy among health care providers could have substantial impact on vaccine attitudes of the general population, and such data may help inform vaccine advocacy efforts.

Introduction A majority of otolaryngologists have not had direct experience with many vaccine-preventable diseases since the creation of national vaccination programs. Despite the elimination of endemic transmission of some of these diseases in the United States, outbreaks can occur anywhere and still pose a threat to public health around the world. Recent outbreaks and changing trends in exemption rates indicate that it is important for physicians to maintain a working knowledge of how these diseases present and of the recommended treatment guidelines.Objectives This review will evaluate the current state of vaccination rates, vaccine exemption rates and disease incidence in the United States and in the world. It will also examine the clinical presentation and treatment recommendations of these diseases.Data Synthesis United States estimated vaccination rates, vaccine exemption rates and vaccine-preventable disease incidences were obtained from data compiled by the Centers for Disease Control and Prevention. World vaccination rates and disease incidences were obtained from the World Health Organization databases, which compile official figures reported by member states. A PubMed literature review provided information on the current state of vaccination exemptions and outbreaks in the United States.Conclusion Vaccination and vaccine exemption rates continue to put the United States and many areas of the world at risk for outbreaks of vaccine-preventable diseases. Clinical guidelines should be reviewed in the event of a local outbreak.

Understanding how vaccine hesitancy relates to online behavior is crucial for addressing current and future disease outbreaks. We combined survey data measuring attitudes toward the COVID-19 vaccine with Twitter data in two studies (N1 = 464 Twitter users, N2 = 1,600 Twitter users) with preregistered hypotheses to examine how real-world social media behavior is associated with vaccine hesitancy in the United States (US) and the United Kingdom (UK). In Study 1, we found that following the accounts of US Republican politicians or hyper-partisan/low-quality news sites were associated with lower confidence in the COVID-19 vaccine—even when controlling for key demographics such as self-reported political ideology and education. US right-wing influencers (e.g. Candace Owens, Tucker Carlson) had followers with the lowest confidence in the vaccine. Network analysis revealed that participants who were low and high in vaccine confidence separated into two distinct communities (or “echo chambers”), and centrality in the more right-wing community was associated with vaccine hesitancy in the US, but not in the UK. In Study 2, we found that one's likelihood of not getting the vaccine was associated with retweeting and favoriting low-quality news websites on Twitter. Altogether, we show that vaccine hesitancy is associated with following, sharing, and interacting with low-quality information online, as well as centrality within a conservative-leaning online community in the US. These results illustrate the potential challenges of encouraging vaccine uptake in a polarized social media environment.