I want to be safe: understanding the main drivers behind vaccination choice throughout the pandemic.

BACKGROUND: Despite being a major advancement in modern medicine, vaccines face widespread hesitancy and refusal, posing challenges to immunization campaigns. The COVID-19 pandemic accentuated vaccine hesitancy, emphasizing the pivotal role of beliefs in efficacy and safety on vaccine acceptance rates. This study explores the influence of efficacy and safety perceptions on vaccine uptake in Italy during the pandemic. METHODS: We administered a 70-item questionnaire to a representative sample of 600 Italian speakers. Participants were tasked with assessing the perceived effectiveness and safety of each vaccine dose, along with providing reasons influencing their vaccination choices. Additionally, we conducted an experimental manipulation, exploring the effects of four framing messages that emphasized safety and/or efficacy on participants' willingness to receive a hypothetical fourth vaccine dose. Furthermore, participants were asked about their level of trust in the scientific community and public authorities, as well as their use of different information channels for obtaining COVID-19-related information. RESULTS: Our study reveals a dynamic shift in vaccine efficacy and safety perceptions throughout the COVID-19 pandemic, potentially influencing vaccination compliance. Initially perceived as more effective than safe, this assessment reversed by the time of the third dose. Beliefs regarding safety, rather than efficacy, played a significant role in anticipating future vaccinations (e.g., the booster dose). Safety-focused messages positively affected vaccination intent, while efficacy-focused messages showed limited impact. We also observed a changing trend in reasons for vaccination, with a decline in infection-related reasons and an increase in social related ones. Furthermore, trust dynamics evolved differently for public authorities and the scientific community. CONCLUSIONS: Vaccine perception is a dynamic process shaped by evolving factors like efficacy and safety perceptions, trust levels, and individual motivations. Our study sheds light on the complex dynamics that underlie the perception of vaccine safety and efficacy, and their impact on willingness to vaccinate. We discuss these results in light of bounded rationality, loss aversion and classic utility theory.

Acceptance and expectations of healthcare workers and community during the COVID-19 vaccine rollout in Bhavnagar city, western India: a qualitative exploration.

BACKGROUND: COVID-19 vaccine was launched in India on January 16, 2021. There is a paucity of robust evidence from qualitative studies on the acceptability and expectations of potential recipients from the COVID-19 vaccine around the time of its rollout in India. We conducted this study to explore the acceptance and expectations of the COVID-19 vaccine among the healthcare workers and community in Bhavnagar, India. METHODS: During January 2021, in-depth interviews were conducted with potential vaccine recipients in Bhavnagar city-health care workers, people over the age of 50, and people of any age with comorbidities. A total of 28 in-depth interviews were performed, including 16 healthcare workers and 12 community beneficiaries. An in-depth interview guide was developed based on the constructs of the health belief model. Following written informed consent from all participants, all interviews were audio-recorded, transcribed in English and codes were generated using thematic analysis. Qualitative qualifiers were used due describe our study findings. RESULTS: Most of healthcare workers and a majority of people from the community have shown willingness to be vaccinated with COVID-19 vaccine as they had trust on the results of the clinical trials and on the government. Some participants showed hesitancy, which was attributed to concerns regarding safety and efficacy, negative news reports in the media and lack of awareness regarding benefits of vaccine. Some healthcare workers were hesitant due to a lack of transparency in sharing the results of clinical trials. Very few showed refusal in getting vaccinated due to their belief that they won't be infected with SARS-CoV-2 virus as they might have developed immunity against it. Most of the participants expected good efficacy, minimal/no side effects, rapid and wide coverage of vaccine and a perception of getting back to pre-COVID life sooner. CONCLUSIONS: Most of the potential recipients were willing to take the COVID-19 vaccine around the time of its initial roll out. Future vaccine rollout campaigns could reduce refusals by timely demand generation activities on vaccine safety/efficacy, involving leaders/influencers, addressing grievances, and minimizing misinformation.

Implications of information heard about Dengvaxia on Filipinos' perception on vaccination.

Issues that arose from the Dengvaxia vaccination program in the Philippines in 2017 were followed by a remarkable decline in immunization coverage in the country. This study intended to describe the Filipinos' perceptions about vaccination after hearing about the Dengvaxia vaccine and the vaccination program and determine its potential relationship with selected demographic factors and other variables such as: health literacy, sources of information on Dengvaxia, information heard about the vaccine, healthcare visits, and perceived health status. The study utilized secondary data derived from a national health literacy survey in the Philippines. A total of 1992 respondents were included in the analysis. Majority were females, had reached college, residing in urban areas, and were unemployed. Most obtained information about Dengvaxia from media, particularly the television and heard that it caused death and prevents dengue. Seventy-one per cent had negative vaccination perception upon obtaining information about Dengvaxia. Sex, residence type, and income were found to be associated with vaccination perception. Females and those living in rural areas were more likely to have a negative vaccination perception while those with the highest income were less likely to have negative vaccination perception. Respondents who heard that Dengvaxia prevents dengue, those who obtained Dengvaxia information from health professionals, and those who visited both public and private health facilities in the last 12 months were less likely to have negative vaccination perception. On the other hand, those with inadequate functional health literacy were more likely to have negative vaccination perception. The study presents the implications of information heard about Dengvaxia on Filipinos' perception on vaccination through selected variables and other factors. The findings are important in designing strategies in communicating health information, building public trust, and in reinforcing policies to improve vaccination uptake.

Melioidosis Vaccines (MeVa): Attitudes to vaccines, melioidosis and clinical trials in key stakeholders in Ubon Ratchathani, Thailand.

Background: Melioidosis is a bacterial infection which kills an estimated 89,000 people per year in tropical and sub-tropical regions, chiefly affecting the poorest. Diabetes is the primary risk factor, conferring a 12-fold increase in risk. Despite limited funding compared to other neglected tropical diseases, melioidosis vaccine development has generated several candidates for clinical development. CPS-CRM 197/Hcp1 is a promising vaccine candidate developed at the University of Nevada, Reno which is due to enter a Phase I clinical trial in Oxford, UK in 2024. As we move closer to the possibility of field trials of a melioidosis vaccine, it is critical to work in parallel to understand perceptions toward a vaccine among those living where melioidosis rates are high. Reasons for vaccine acceptance versus hesitancy are complex, and include perceived risk of the target disease, concern about side effects, and above all trust in government, scientists, the pharmaceutical industry and other authorities. Methods: We will carry out a qualitative study in Ubon Ratchathani, Thailand, an endemic region for melioidosis, as groundwork for a potential future melioidosis vaccine efficacy study, and in the longer-term vaccine introduction. This study seeks to explore knowledge and attitudes in three main areas; 1) melioidosis disease, 2) vaccines, and 3) participation in clinical vaccine trials. In-depth interviews and focus group discussions will take place in five participant groups of different risks and exposure to melioidosis. Purposive, convenience sampling will be used, also snowball sampling to reach some participant groups. Sample size will be based on participant's experience, to inform the line of enquiries of study, or until data saturation, expecting 66-90 participants across all groups. Discussion: The findings of this study will be written up and published in an open access journal, and will be valuable to inform future design of clinical trials as well as engagement and communications associated with future vaccine rollout.

Perceptions towards COVID-19 Vaccines and Willingness to Vaccinate in Nepal.

Vaccination is the most effective preventive measure of COVID-19 available at present, but its success depends on the global accessibility of vaccines and the willingness of people to be vaccinated. As the vaccination rollouts are increasing worldwide, it is important to assess public perception and willingness towards vaccination, so that the aim of mass vaccination will be successful. This study aimed to understand public perception towards COVID-19 vaccines and their willingness to get vaccinated in Nepal. This cross-sectional online survey was conducted among 1196 residents of Nepal in August 2021; most of the participants of this online survey were young adults (18-47 years) with university-level education. A total of 64.5% (771/1196) of the participants perceived COVID-19 vaccines to be safe and risk-free, while 68.6% (820/1196) agreed that vaccination would be efficient in the fight against this pandemic. Most of the participants (841/1196, 70.3%) disagreed that people are getting COVID-19 vaccines easily in Nepal, while they agree with the prioritization of older adults and healthcare workers for vaccination. A total of 61.1% (731/1196) of the participants had received at least one dose of the vaccine. Among the unvaccinated, 93.3% (434/465) were willing to get vaccinated when their turn came. The higher confidence of younger adults in vaccines and the vaccination process is encouraging, as that can help educate others who are hesitant or are not positive towards the idea of receiving vaccines. Dissemination of correct and current information, acquisition of enough doses of vaccines, and equitable distribution of vaccines will be required to achieve successful completion of the COVID-19 vaccination campaign in Nepal.

"When did you decide to receive the Covid-19 vaccine?" Survey in a high-volume vaccination center.

Highly efficient and safe Covid-19 vaccines are available in Europe in amounts that theoretically allow for a high immune coverage. However, a notable proportion of the population is reluctant toward immunization. We aimed to determine, among people who chose to be vaccinated, when they made the decision and whether they would have preferred an earlier vaccination. A survey was conducted in a high-volume Covid-19 vaccination center in France from 28 May to 9 July 2021 through an anonymous questionnaire. The 2519 participants (54.1% males; median age 39 years) attributed lower efficacy and safety to Covid-19 vaccines than to vaccines in general. When asked when they decided to receive the vaccine, 15.5% and 16.0% answered "less than one month ago" and "less than one week ago," respectively; age <40 and female sex were independently associated with these responses. When asked whether they would have preferred to have been vaccinated earlier, 57.6% answered "definitely no," "rather no," or "neither yes nor no"; female sex (independently from age) was associated with these answers. When asked whether they would have preferred to receive the vaccine as early as January 2021, 65.2% answered "definitely no," "rather no," or "neither yes nor no"; age <40 and female sex were independently associated with these responses. In conclusion, one-third people had made the decision to be vaccinated only recently, while more than half would not have preferred an earlier vaccination, in particular women and those aged <40 years. Vaccine campaigns should take such short-term decision-making processes into account.

The prospective COVID-19 vaccine: willingness to pay and perception of community members in Ibadan, Nigeria.

BACKGROUND: The introduction of the COVID-19 vaccine necessitates the assessment of individual perception regarding the vaccine. This study aimed to assess the perception of community members and willingness to pay for the prospective COVID-19 vaccine in Ibadan, Nigeria. METHODS: A descriptive cross-sectional study design was used. Data were collected using an interviewer-administered questionnaire in September 2020. We studied community members aged 15 years and above using a multi-stage sampling technique. The perceptions of respondents about the COVID-19 vaccine were assessed on eight questions using the five-point Likert scale with a score point of "1" assigned for "Strongly Agree", "2" for "Agree", "3" for "Not decided", "4" for "Disagree", and "5" for "Strongly disagree". During analysis, we reverse-coded the options by assigning a point of "1" for "Strongly disagree", "2" for "Disagree", "3" for "Not decided", "4" for "Agree", and "5" for "Strongly disagree". However, questions asked in the negative directions were not reverse-coded during analysis. Eight questions were used to assess the perception of community members regarding the prospective COVID-19 vaccine, and overall, the maximum point was 40. Points greater than or equal to 32 points (80%) implied positive perception. Descriptive statistics were done. Chi-square tests were used for the assessment of associations between sociodemographic characteristics and willingness to pay for the prospective COVID-19 vaccine. We conducted logistic regression tests on statistically significant variables at p-values <0.05. RESULTS: The mean age of the 440 respondents studied was 37.22 ± 15.36 years, 193 (49.00%) were males, and 292 (67.30%) of the respondents had heard of the prospective COVID-19 vaccine. Among them, 232 (79.50%) respondents had positive perception regarding COVID-19 vaccine. Individuals in the fifth wealth quintile were ten times more likely to be willing to pay for the prospective COVID-19 vaccine compared to those in the first wealth quintile (Adjusted Odds Ratio = 9.57, 95% CI [2.88-31.82], p = <0.01). CONCLUSION: The prospective COVID-19 vaccine should be subsidized or made freely available to everyone.

Investigating the Influence of Vaccine Literacy, Vaccine Perception and Vaccine Hesitancy on Israeli Parents' Acceptance of the COVID-19 Vaccine for Their Children: A Cross-Sectional Study.

Vaccination is currently the most effective strategy for combating COVID-19. COVID-19 vaccines were introduced to the adult population in Israel in early December 2020 and have been available for children aged 12-15 since June 2021. Our study aimed at assessing the influence of vaccine literacy, perception, hesitancy, and behavior on Israeli parents' intentions to have their children vaccinated. Using an anonymous online questionnaire, we recruited 520 parents; 70.4% of the parents indicated that they would get their children vaccinated. The participants' COVID-19 vaccination status was the only socio-demographic factor significantly associated with COVID-19 vaccination acceptability (OR = 32.89; 95%CI = [13.11, 82.54]). The most common sources of information regarding the COVID-19 vaccine were health-care providers and the Internet. Parents who intend to vaccinate their children had higher mean levels of vaccine literacy (2.99 ± 0.47 vs. 3.07 ± 0.44 respectively, p = 0.06), more positive perception of the vaccine (mean scores of 2.26 ± 0.75 vs. 3.44 ± 0.68 respectively, p < 0.001), and lower perceived vaccine hesitancy (7.53 ± 2.37 vs. 4.68 ± 2.71 respectively, p < 0.001) than parents who do not intend to do so. Vaccine behavior was measured using the 5C model of psychological antecedents. All 5C components were significantly correlated with parents' willingness to vaccinate their children. Understanding of parents' willingness to have their children receive the COVID-19 vaccine and the barriers to and facilitators of the vaccination is crucial, as vaccination of children aged 5-11 has recently been approved by the FDA. Providing the population with reliable information regarding the COVID-19 vaccine is an important measure in the attempt to increase COVID-19 vaccine acceptance.

COVID-19 Vaccine Perception in South Korea: Web Crawling Approach.

BACKGROUND: The US Centers for Disease Control and Prevention and the World Health Organization emphasized vaccination against COVID-19 because physical distancing proved inadequate to mitigate death, illness, and massive economic loss. OBJECTIVE: This study aimed to investigate Korean citizens' perceptions of vaccines by examining their views on COVID-19 vaccines, their positive and negative perceptions of each vaccine, and ways to enhance policies to increase vaccine acceptance. METHODS: This cross-sectional study analyzed posts on NAVER and Instagram to examine Korean citizens' perception of COVID-19 vaccines. The keywords searched were "vaccine," "AstraZeneca," and "Pfizer." In total 8100 posts in NAVER and 5291 posts in Instagram were sampled through web crawling. Morphology analysis was performed, overlapping or meaningless words were removed, sentiment analysis was implemented, and 3 public health professionals reviewed the results. RESULTS: The findings revealed a negative perception of COVID-19 vaccines; of the words crawled, the proportion of negative words for AstraZeneca was 71.0% (476/670) and for Pfizer was 56.3% (498/885). Among words crawled with "vaccine," "good" ranked first, with a frequency of 13.43% (312/2323). Meanwhile, "side effect" ranked highest, with a frequency of 29.2% (163/559) for "AstraZeneca," but 0.6% (4/673) for "Pfizer." With "vaccine," positive words were more frequently used, whereas with "AstraZeneca" and "Pfizer" negative words were prevalent. CONCLUSIONS: There is a negative perception of AstraZeneca and Pfizer vaccines in Korea, with 1 in 4 people refusing vaccination. To address this, accurate information needs to be shared about vaccines including AstraZeneca, and the experiences of those vaccinated. Furthermore, government communication about risk management is required to increase the AstraZeneca vaccination rate for herd immunity before the vaccine expires.

COVID-19 Vaccine Hesitancy Among the Adult Population in Saudi Arabia.

BACKGROUND: Vaccine hesitancy in Saudi Arabia continues even after reaching 17 million doses. This study was conducted to comprehensively assess coronavirus disease 2019 (COVID-19) vaccine hesitancy in adult people who ignore the COVID-19 vaccine in the Saudi Arabian population and explore community awareness of public health after 17 million doses of COVID-19 vaccination. METHODS: A cross-sectional survey was used in this study. The questionnaire included three domains: demographic information, vaccine hesitancy by the health belief model related to the COVID-19 vaccine, and hesitancy by attitude and conspiracy towards the COVID-19 vaccine. A total of 401 adults participated in this study. RESULTS: The respondents' perceptions of COVID-19 susceptibility and severity showed that the participants did not feel at risk nor believe that COVID-19 was serious. Connivance beliefs were found to be associated with reliance on social media as a major source of information about COVID-19 vaccines, and lack of trust in vaccine manufacturers (pharmaceutical companies). The majority of the respondents were concerned about the efficacy and safety of the COVID-19 vaccine, which can be reported as a major barrier to vaccination. RECOMMENDATIONS: To increase vaccination rates, health authorities need to communicate both the benefits and risks of vaccination. In addition, we recommend using a qualitative study to understand and evaluate the participants' concepts in depth.

Seasonal influenza vaccination: knowledge, attitude and practice in Varna, Bulgaria.

BACKGROUND: Seasonal influenza vaccination is recommended for certain at-risk groups in Bulgaria, but vaccine coverage and the population's perception of vaccination are currently unknown. The objective of this study was to assess the level of seasonal influenza vaccination in Varna Region, Bulgaria. It also aimed to investigate the status of knowledge and the attitude towards the reliability, safety, and other aspects associated with the use of influenza vaccines. METHODS: A cross-sectional survey was conducted among 120 responders in Varna Region, Bulgaria. They completed a questionnaire assessing the practice, knowledge, and attitude towards seasonal influenza vaccination. RESULTS: Nearly 70% of all responders have never been vaccinated against seasonal influenza in their lives. The main reason indicated was a lack of confidence in the vaccine in general (53.7% of nonvaccinated responders). Individuals with insufficient knowledge, or with a negative perception, were more likely to not be vaccinated: being poorly informed and having a negative attitude towards influenza vaccination also decreased the chance of being vaccinated by 29% and 36%, respectively. CONCLUSIONS: This study indicates that efforts should be made towards achieving better understanding and knowledge of the vaccine's mechanism of prevention and effectiveness among the Bulgarian population.