Delayed-interval BNT162b2 mRNA COVID-19 vaccination enhances humoral immunity and induces robust T cell responses.

Delayed dosing intervals are a strategy to immunize a greater proportion of the population. In an observational study, we compared humoral and cellular responses in health care workers receiving two doses of BNT162b2 (Pfizer-BioNTech) vaccine at standard (3- to 6-week) and delayed (8- to 16-week) intervals. In the delayed-interval group, anti-receptor-binding domain antibody titers were significantly enhanced compared to the standard-interval group. The 50% plaque reduction neutralization test (PRNT50) and PRNT90 titers against wild-type (ancestral) severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and Alpha, Beta and Delta variants were higher in the delayed-interval group. Spike-specific polyfunctional CD4+ and CD8+ T cells expressing interferon-γ and interleukin-2 were comparable between the two groups. Here, we show that the strategy of delaying second doses of mRNA vaccination may lead to enhanced humoral immune responses, including improved virus neutralization against wild-type and variant SARS-CoV-2 viruses. This finding has potentially important implications as vaccine implementation continues across a greater proportion of the global population.

Last-mile delivery increases vaccine uptake in Sierra Leone.

Less than 30% of people in Africa received a dose of the COVID-19 vaccine even 18 months after vaccine development1. Here, motivated by the observation that residents of remote, rural areas of Sierra Leone faced severe access difficulties2, we conducted an intervention with last-mile delivery of doses and health professionals to the most inaccessible areas, along with community mobilization. A cluster randomized controlled trial in 150 communities showed that this intervention with mobile vaccination teams increased the immunization rate by about 26 percentage points within 48-72 h. Moreover, auxiliary populations visited our community vaccination points, which more than doubled the number of inoculations administered. The additional people vaccinated per intervention site translated to an implementation cost of US $33 per person vaccinated. Transportation to reach remote villages accounted for a large share of total intervention costs. Therefore, bundling multiple maternal and child health interventions in the same visit would further reduce costs per person treated. Current research on vaccine delivery maintains a large focus on individual behavioural issues such as hesitancy. Our study demonstrates that prioritizing mobile services to overcome access difficulties faced by remote populations in developing countries can generate increased returns in terms of uptake of health services3.

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.

Unrepresentative big surveys significantly overestimated US vaccine uptake.

Surveys are a crucial tool for understanding public opinion and behaviour, and their accuracy depends on maintaining statistical representativeness of their target populations by minimizing biases from all sources. Increasing data size shrinks confidence intervals but magnifies the effect of survey bias: an instance of the Big Data Paradox1. Here we demonstrate this paradox in estimates of first-dose COVID-19 vaccine uptake in US adults from 9 January to 19 May 2021 from two large surveys: Delphi-Facebook2,3 (about 250,000 responses per week) and Census Household Pulse4 (about 75,000 every two weeks). In May 2021, Delphi-Facebook overestimated uptake by 17 percentage points (14-20 percentage points with 5% benchmark imprecision) and Census Household Pulse by 14 (11-17 percentage points with 5% benchmark imprecision), compared to a retroactively updated benchmark the Centers for Disease Control and Prevention published on 26 May 2021. Moreover, their large sample sizes led to miniscule margins of error on the incorrect estimates. By contrast, an Axios-Ipsos online panel5 with about 1,000 responses per week following survey research best practices6 provided reliable estimates and uncertainty quantification. We decompose observed error using a recent analytic framework1 to explain the inaccuracy in the three surveys. We then analyse the implications for vaccine hesitancy and willingness. We show how a survey of 250,000 respondents can produce an estimate of the population mean that is no more accurate than an estimate from a simple random sample of size 10. Our central message is that data quality matters more than data quantity, and that compensating the former with the latter is a mathematically provable losing proposition.

Impact of waning immunity against SARS-CoV-2 severity exacerbated by vaccine hesitancy.

The SARS-CoV-2 pandemic has generated a considerable number of infections and associated morbidity and mortality across the world. Recovery from these infections, combined with the onset of large-scale vaccination, have led to rapidly-changing population-level immunological landscapes. In turn, these complexities have highlighted a number of important unknowns related to the breadth and strength of immunity following recovery or vaccination. Using simple mathematical models, we investigate the medium-term impacts of waning immunity against severe disease on immuno-epidemiological dynamics. We find that uncertainties in the duration of severity-blocking immunity (imparted by either infection or vaccination) can lead to a large range of medium-term population-level outcomes (i.e. infection characteristics and immune landscapes). Furthermore, we show that epidemiological dynamics are sensitive to the strength and duration of underlying host immune responses; this implies that determining infection levels from hospitalizations requires accurate estimates of these immune parameters. More durable vaccines both reduce these uncertainties and alleviate the burden of SARS-CoV-2 in pessimistic outcomes. However, heterogeneity in vaccine uptake drastically changes immune landscapes toward larger fractions of individuals with waned severity-blocking immunity. In particular, if hesitancy is substantial, more robust vaccines have almost no effects on population-level immuno-epidemiology, even if vaccination rates are compensatorily high among vaccine-adopters. This pessimistic scenario for vaccination heterogeneity arises because those few individuals that are vaccine-adopters are so readily re-vaccinated that the duration of vaccinal immunity has no appreciable consequences on their immune status. Furthermore, we find that this effect is heightened if vaccine-hesitants have increased transmissibility (e.g. due to riskier behavior). Overall, our results illustrate the necessity to characterize both transmission-blocking and severity-blocking immune time scales. Our findings also underline the importance of developing robust next-generation vaccines with equitable mass vaccine deployment.

Population Attributable Fraction of Nonvaccination of COVID-19 Due to Vaccine Hesitancy, United States, 2021.

Understanding the extent of coronavirus disease 2019 (COVID-19) nonvaccination attributable to vaccine hesitancy versus other barriers can help prioritize approaches for increasing vaccination uptake. Using data from the Centers for Disease Control and Prevention's Research and Development Survey, a nationally representative survey fielded from May 1 to June 30, 2021 (n = 5,458), we examined the adjusted population attribution fraction (PAF) of COVID-19 vaccine hesitancy attributed to nonvaccination according to sociodemographic characteristics and health-related variables. Overall, the adjusted PAF of nonvaccination attributed to vaccine hesitancy was 76.1%. The PAF was highest among adults who were ≥50 years of age (87.9%), were non-Hispanic White (83.7%), had a bachelor's degree or higher (82.7%), had an annual household income of at least $75,000 (85.5%), were insured (82.4%), and had a usual place for health care (80.7%). The PAF was lower for those who were current smokers (65.3%) compared with never smokers (77.9%), those who had anxiety or depression (65.2%) compared with those who did not (80.1%), and those who had a disability (64.5%) compared with those who did not (79.2%). Disparities in PAF suggest areas for prioritization of efforts for intervention and development of messaging campaigns that address all barriers to uptake, including hesitancy and access, to advance health equity and protect individuals from COVID-19.

Dynamic evolution of COVID-19 vaccine hesitancy over 2021-2023 among Chinese population: Repeated nationwide cross-sectional study.

Globally, the rollout of COVID-19 vaccine had been faced with a significant barrier in the form of vaccine hesitancy. This study adopts a multi-stage perspective to explore the prevalence and determinants of COVID-19 vaccine hesitancy, focusing on their dynamic evolutionary features. Guided by the integrated framework of the 3Cs model (complacency, confidence, and convenience) and the EAH model (environmental, agent, and host), this study conducted three repeated national cross-sectional surveys. These surveys carried out from July 2021 to February 2023 across mainland China, targeted individuals aged 18 and older. They were strategically timed to coincide with three critical vaccination phases: universal coverage (stage 1), partial coverage (stage 2), and key population coverage (stage 3). From 2021 to 2023, the surveys examined sample sizes of 29 925, 6659, and 5407, respectively. The COVID-19 vaccine hesitation rates increased from 8.39% in 2021 to 29.72% in 2023. Urban residency, chronic condition, and low trust in vaccine developer contributed to significant COVID-19 vaccine hesitancy across the pandemic. Negative correlations between the intensity of vaccination policies and vaccine hesitancy, and positive correlations between vaccine hesitancy and long COVID, were confirmed. This study provides insights for designing future effective vaccination programs for emerging vaccine-preventable infectious X diseases.

Confronting Health Misinformation Surrounding COVID-19 Vaccines in the State of Florida.

COVID-19 vaccination is estimated to have averted more than 2.4 million deaths globally. In the United States (U.S.) alone, more than 120,000 deaths and 700,000 hospitalizations are reportedly estimated to have been prevented during the first six months of the vaccine campaign. Despite the overwhelming evidence regarding the safety and efficacy of vaccination, COVID-19 vaccine hesitancy continues to pose a significant threat to public health. Notably, an unexpected source of vaccine misinformation has been the Surgeon General of the State of Florida, Dr. Joseph Ladapo. While both a tenured faculty member of the University of Florida, College of Medicine and the Surgeon General of Florida, Dr. Ladapo has delivered official Florida Department of Health statements regarding COVID-19 vaccines that run contrary to those of the U.S. Centers for Disease Control and Prevention (CDC). While tenure is designed to protect those with contrarian views, we believe that the University has an ethical obligation to condemn misleading statements that put public health at risk. Herein, we explore the challenges of managing misinformation disseminated by someone who is simultaneously a tenured professor at a public, state-supported university, and a politically appointed public health official.

Health Care Discrimination and Immigration Fears: Unpacking COVID-19 Vaccine Hesitancy in Latino Adults.

Objectives. To examine the relationship between health care discrimination and COVID-19 vaccine hesitancy attributed to fears of immigration status complications among unvaccinated Latino adults and to determine whether the association differs among immigrants and US-born individuals. Methods. After universal adult eligibility for the COVID-19 vaccine, a nationally representative sample of 12 887 adults was surveyed using online and mobile random digit dialing from May 7 to June 7, 2021. The analytic sample (n = 881) comprised unvaccinated Latino adults. We examined the association between individual and cumulative health care discrimination measures and COVID-19 vaccine hesitancy assignable to immigration-related fears. Results. Using a cumulative measure of health care discrimination, each additional experience corresponded to a 28% higher odds of reporting vaccine hesitancy Because of immigration-related fears. Findings were consistent across US-born and immigrant Latino adults. Four of the 5 discriminatory experiences were positively associated with vaccine hesitancy, including the absence of optimal treatment options, denial or delayed access to necessary health care, physician communication barriers, and lack of specialist referrals. Conclusions. Findings confirm a positive association between health care discrimination and COVID-19 vaccine hesitancy attributable to immigration-related fears among Latino adults, regardless of immigration status. (Am J Public Health. 2024;114(S6):S505-S509. https://doi.org/10.2105/AJPH.2024.307668) [Formula: see text].

Partnering With Churches to Address COVID-19 Vaccine Hesitancy and Uptake in Trustworthy Contexts.

The Black church has long been seen as a crucial partner in addressing public health issues. This paper describes the development, implementation, and evaluation of a community-engaged church intervention addressing COVID-19 vaccine hesitancy in underserved Black communities in Jefferson County, Alabama. We partnered with churches to implement and evaluate the intervention between March and June of 2022 and found that our church partners were capable of significant messaging reach, particularly through electronic means. (Am J Public Health. 2024;114(S5):S392-S395. https://doi.org/10.2105/AJPH.2024.307683).

Factors Influencing Knowledge and Acceptance of Nonavalent Human Papillomavirus Vaccine Among University Population in Southern China: A Cross-Sectional Study.

BACKGROUND: Vaccine hesitancy among young Chinese remains a challenge, contributing to low vaccination rates for the nonavalent Human Papillomavirus (HPV) vaccine. This study evaluated the knowledge and acceptance of this vaccine among students at a southern Chinese university and identified factors influencing these outcomes. METHODS: This cross-sectional, anonymous questionnaire survey was conducted from April to November 2023 at a multi-campus university in southern China. The questionnaire was comprised of three sections: the first collected demographic data; the second evaluated students' knowledge of the nonavalent HPV vaccine on a scale from 0 to 15, with cut-off points at 5 and 10 delineating low, medium, and high knowledge levels, respectively; the third section assessed vaccine acceptance on a scale from 8 to 40, using scores above the 50th percentile as the benchmark for positive acceptance. RESULTS: Among the participants, 18% demonstrated low-level, 40.20% medium-level, and 41.70% high-level knowledge of the nonavalent HPV vaccine. Notably, 71.95% of respondents showed positive acceptance, whereas 28.05% expressed negative acceptance. Male students and those with lower economic conditions (monthly living expenses below 1000 RMB, P = 0.004; 1000-1499 RMB, P = 0.012) exhibited lower knowledge levels. As for acceptance, female students and those with higher monthly living expenses (1000-1499 RMB, P = 0.007; 1500-1999 RMB, P = 0.002; over 2000 RMB, P = 0.002) demonstrated greater vaccine acceptance. A positive correlation was noted between the level of knowledge and vaccine acceptance (rs = 0.256, P < 0.001). CONCLUSIONS: Gender and economic status are significantly associated with nonavalent HPV vaccine knowledge and acceptance among university students. These findings highlight the potential impact of targeted educational initiatives, especially for economically disadvantaged male students, in enhancing vaccine uptake rates.

Many young people in China are hesitant to get the nine - valent HPV vaccine, which protects against certain types of viruses that can cause cancer. This study looked at how much students at a university in southern China know about the nine - valent HPV vaccine and whether they are willing to get vaccinated. We asked students to fill out a survey between April and November 2023 to gather this information. The survey showed that knowledge about this vaccine varied: about 18% of the students knew very little, 40% had a moderate understanding, and roughly 42% knew a lot about this vaccine. Interestingly, more than 70% of the students were open to getting the vaccine, but about 28% were not. We found that male students and those with less money generally knew less about the vaccine and were more likely to not accept it. There was also a clear link between how much students knew about the vaccine and their willingness to get vaccinated. This suggests that teaching students more about this vaccine, especially boys and those from poorer backgrounds, could encourage more of them to get vaccinated. This is important because increasing vaccine rates can help prevent diseases spread by the virus.

Hesitancy towards R21/Matrix-M malaria vaccine among Ghanaian parents and attitudes towards immunizing non-eligible children: a cross-sectional survey.

BACKGROUND: The newly developed malaria vaccine called "R21/Matrix-M malaria vaccine" showed a high safety and efficacy level, and Ghana is the first country to approve this new vaccine. The present study aimed to evaluate the rate of vaccine hesitancy (VH) towards the newly developed malaria vaccine among parents who currently have children who are not eligible for the vaccine but may be eligible in the near future. Additionally, the study aimed to identify the factors that could potentially influence VH. METHODS: A cross-sectional survey using both online-based questionnaires and face-to-face interviews was conducted in Ghana from June to August 2023. The survey specifically targeted parents of ineligible children for vaccination, including those aged less than 5 months or between 3 and 12 years. The Parent Attitudes about Childhood Vaccination (PACV) scale was used to assess parental VH. RESULTS: A total of 765 people participated in this study. Their median age was 36.0 years with an interquartile range of 31.0-41.0 years, 67.7% were females, 41.8% completed their tertiary education, 63.3% were married, 81.6% worked in non-healthcare sectors, and 59.7% reported that their monthly income was insufficient. About one-third (34.5%) of the parents were hesitant to give their children the R21/Matrix-M malaria vaccine. The following predictors were associated with VH: working in the healthcare sector (adjusted odds ratio (AOR) = 0.50; 95% confidence interval (CI) 0.30-0.80; p = 0.005), having the other parent working in the healthcare sector (AOR = 0.54; 95% CI 0.30-0.94; p = 0.034), and not taking scheduled routine vaccinations (AOR = 1.90; 95% CI 1.27-2.84; p = 0.002). CONCLUSIONS: Addressing VH is crucial for optimizing R21/Matrix-M vaccine coverage in Ghana's malaria control strategy. By tackling VH issues, Ghana can effectively safeguard children's health in malaria-prone areas.

Expectations Versus Fantasies and Vaccine Hesitancy: How Suffering From COVID-19 Versus Suffering From Vaccines Interact.

BACKGROUND: Previous research on COVID-19 vaccination highlights future thoughts associated with possible Coronavirus infection and vaccine side effects as key predictors of vaccine hesitancy. Yet, research has focused on independent contributions of such future thoughts, neglecting their interactive aspects. PURPOSE: We examined whether thoughts about two possible COVID-related futures (suffering from COVID-19 and vaccine side effects) interactively predict vaccine hesitancy and vaccination behavior among unvaccinated and vaccinated people. Importantly, we compared two forms of future thinking: beliefs or expectations (likelihood judgments) versus fantasies (free thoughts and images describing future events). METHODS: In Study 1, we conducted a longitudinal study with an unvaccinated group (N = 210). We assessed expectations versus fantasies about the two COVID-related futures as predictors. As outcome variables, we measured vaccine hesitancy, and 9 weeks later we assessed information seeking and vaccine uptake. Study 2 was a cross-sectional study comparing vaccine hesitancy of an unvaccinated group (N = 307) to that of a vaccinated group (N = 311). RESULTS: Study 1 found that more negative fantasies about COVID-19 impact and less negative fantasies about vaccine side effects interactively predicted lower vaccine hesitancy and more vaccine-related behaviors among unvaccinated people; no such interaction was observed between respective expectations. Study 2 replicated these results of Study 1. Additionally, for vaccinated people, low expectations of negative COVID-19 impact and high expectations of negative vaccine impact interactively predicted higher vaccine hesitancy, whereas no such interaction was observed for respective fantasies. CONCLUSIONS: Research on vaccine hesitancy should explore interactions between future thinking about disease and about vaccine side effects. Importantly, there is much to be gained by distinguishing expectations versus fantasies: vaccination interventions aiming to boost vaccine uptake among unvaccinated people should tap into their negative future fantasies regarding both disease and vaccine side effects.

In two correlational studies, we investigated the relationship between future thoughts about two possible COVID-related futures­suffering from COVID-19 and vaccine side effects­and vaccine hesitancy. Prior research has emphasized thoughts about these potential risks as significant predictors of vaccine hesitancy but has focused on their independent contributions, neglecting their interactive nature. Our research examined the interaction between the thoughts about disease and those about vaccine side effects, highlighting the two forms of future thinking: expectations (likelihood judgments) and fantasies (free-flowing thoughts and images describing a future event). In a longitudinal study (Study 1) with an unvaccinated group, we found that more negative fantasies about COVID-19 disease and less negative fantasies about vaccine side effects interactively predicted lower vaccine hesitancy and more vaccination behavior. There was no interaction between the expectations. Study 2, a cross-sectional study comparing another unvaccinated sample to a vaccinated sample, revealed a divergent pattern in the two groups; negative fantasies, not expectations, interactively predicted vaccine hesitancy among unvaccinated people while expectations, not fantasies, did so among vaccinated people. The research suggests the importance of considering interactions between future thoughts about disease and vaccine side effects in understanding vaccine hesitancy and distinguishing expectations and fantasies.

Predictors of Change in Vaccination Decisions Among the Vaccine Hesitant: Examining the Roles of Age and Intolerance of Uncertainty.

BACKGROUND: Vaccine hesitancy and resistance pose significant threats to controlling pandemics and preventing infectious diseases. In a group of individuals unvaccinated against the disease caused by the SARS-CoV-2 coronavirus (COVID-19), we investigated how age, intolerance of uncertainty (IU), and their interaction affected the likelihood of having changed one's vaccination decision a year later. We hypothesized that higher IU would increase the likelihood of becoming vaccinated, particularly among individuals of younger age. We predicted that this effect would remain significant, even after controlling for delay discounting and trust in science. PURPOSE: The goal of this research was to understand the factors influencing changes in vaccination decisions among the vaccine hesitant. METHODS: In a larger longitudinal study, ~7,500 participants from Prolific.co completed demographic and vaccination status questions, a delay discounting task, and the Intolerance of Uncertainty Scale in June-August 2021. Approximately 3,200 participants completed a follow-up survey in July-August 2022, answering questions about vaccination status, reasons for vaccination decision, and trust in science. We analyzed data from 251 participants who initially had no intention of getting vaccinated and completed the follow-up survey; 38% reported becoming vaccinated in the intervening year. RESULTS: Data were analyzed using multilevel logistic regression. Over and above other factors related to vaccination decisions (delay discounting, trust in science), younger participants were more likely to change their decision and become vaccinated a year later, especially if they had higher IU, confirming our predictions. Primary reasons for becoming vaccinated were necessity and seeking protection against the virus. CONCLUSIONS: These findings highlight the complex interplay between age, uncertainty, and vaccination decisions, and inform health policies by suggesting the need for tailoring interventions to specific concerns in different age groups.

Vaccine hesitancy and resistance pose significant threats to controlling pandemics and preventing infectious diseases. It is important to understand the factors that influence whether or not unvaccinated individuals change their mind and get vaccinated. We investigated how age and one's intolerance of uncertainty predicted the likelihood of changing one's mind about getting a COVID-19 vaccination in a group of 251 unvaccinated participants. In mid-2021, these individuals indicated they had no intention to get vaccinated; by mid-2022, 38% of them reported that they had been vaccinated. Over and above other factors known to be related to vaccination decisions (delay discounting and trust in science), we found that younger participants were more likely to have changed their minds and become vaccinated a year later, especially if they were less tolerant of uncertainty. Of the reasons provided by participants for having been vaccinated, necessity and seeking protection against the virus were the most common. These findings highlight the complex interplay between age, uncertainty, and vaccination decisions. Importantly, these findings will inform health policies, suggesting the need for tailoring interventions to specific concerns in different age groups.

The impact of COVID-19 vaccine reactions on secondary vaccine hesitancy.

BACKGROUND: Primary and booster vaccinations are critical for mitigating COVID-19 transmission, morbidity, and mortality. Future booster vaccine campaigns rely on an increased understanding of vaccine hesitancy. OBJECTIVE: To evaluate self-reported allergic and skin vaccine reactions as factors potentially associated with vaccine hesitancy in a nationwide vaccine allergy registry. METHODS: Responses to survey questions concerning COVID-19 vaccine perceptions, coded from free text by 2 independent reviewers. Multivariable logistic regression models were used to determine the association between changed negative perception and respondent demographics, vaccination history, and reaction characteristics. RESULTS: A total of 993 individuals (median of 46 years [IQR, 36-59], 88% female, 82% White) self-reported reactions to COVID-19 vaccination. Reactions included the following: delayed large local skin reaction (40%), hives/urticaria (32%), immediate large local skin reaction (3%), swelling (3%), anaphylaxis (2%), and other or unspecified (20%). Most respondents were initially unconcerned about the safety of COVID-19 vaccines (56%). After reactions, 401 of 993 (40%) report negative change in perception of vaccination, with more than half of these respondents (n = 211, 53%) citing their reasoning as a negative experience with adverse effects. Of 102 individuals asked about future vaccination, 79 (77%) indicated that they were unlikely or very unlikely to receive future COVID-19 vaccinations. Increased negative perception after reaction was associated with younger age, later COVID-19 vaccination dose number, and reaction type. CONCLUSION: Our findings reveal that an individual's experience with allergic or cutaneous adverse effects after COVID-19 vaccination affects attitudes and decision-making regarding future vaccination, even in initially non-hesitant individuals. Further investigation of secondary vaccine hesitancy is necessary for adapting public health messaging to this important population.

COVID-19 Vaccine Acceptance and Hesitancy among People Living with HIV: Review and Meta-Analysis.

This study aims to estimate the COVID-19 vaccine acceptance and hesitancy among people living with HIV (PLWHA). A search for observational studies was conducted in five databases and preprinted literature. Summary estimates were pooled using a random effects model and meta-regression. Of 150 identified studies, 31 were eligible (18,550 PLWHA). The weighted prevalence of COVID-19 vaccine hesitancy overall was 29.07% among PLWHA (95%CI = 24.33-34.32; I² = 98%,) and that of vaccine acceptance was 68.66% (95%CI = 62.25-74.43; I² = 98%). Higher hesitancy prevalence was identified in low/lower-middle income countries (35.05; 95% CI = 19.38-54.78). The heterogeneity was explained by the risk of bias, region, and year of data collection. The findings conclude that the COVID-19 vaccine hesitancy rate remains high, especially in low-income countries. Evidence-informed interventions aimed at increasing COVID-19 vaccine acceptance at the national and individual levels ought to be designed to increase COVID-19 vaccine acceptance among PLWHA.

COVID-19 Vaccine Hesitancy Among People Living with HIV: A Systematic Review and Meta-Analysis.

Vaccine hesitancy is one of the top 10 threats to global health, which affects the prevalence and fatality of vaccine-preventable diseases over the world. During the COVID-19 pandemic, people living with HIV (PLWH) may have higher risks of infection, more serious complications, and worse prognosis without the protection of the COVID-19 vaccine. A systematic review and meta-analysis aiming to evaluate the prevalence of COVID-19 vaccine hesitancy among PLWH was conducted using PubMed, Embase, and Web of Science databases for studies published between January 1, 2020, and August 31, 2022. The pooled prevalence with a corresponding 95%CI of COVID-19 vaccine hesitancy among PLWH was reported. Subgroup analysis was conducted to explore variation in prevalence across different categories. 23 studies with a total of 19,922 PLWH were included in this study. The prevalence of COVID-19 vaccine hesitancy among PLWH was 34.0%, and the influencing factors included male, influenza vaccination experience, and a CD4 count of more than 200 cells/mm3. Subgroup analysis did not identify significant causes of heterogeneity but showed that the prevalence of COVID-19 vaccine hesitancy among PLWH varies by study period, region, and race. Although all PLWH are recommended to receive the COVID-19 vaccine, a large proportion of them remain hesitant to be vaccinated. Therefore, governments and relevant institutions should take specific measures to encourage and promote vaccination to improve the coverage of the COVID-19 vaccine among PLWH.

Gay and Bisexual Men's Perceptions about a Potential HIV Vaccine within a Post-COVID-19 Era: A Qualitative Study.

To end the HIV epidemic, there is need for targeted strategies to reduce HIV incidence for those most vulnerable, including an HIV vaccine. This study seeks to understand the perceptions that non-PrEP using gay and bisexual men and other men who have sex with men (GBMSM) have about a potential HIV vaccine, while contextualizing their perspectives within the context of heightened vaccine hesitancy that has emerged since the COVID-19 pandemic. Between March and May of 2022, GBMSM (N = 20) participated in in-depth interviews, which assessed their perceptions about an HIV vaccine. Interviews were analysed using a codebook approach to thematic analysis. We oversampled for those unvaccinated against COVID-19 as a proxy for vaccine hesitation. Participants expressed a range of enthusiastic support, cautious optimism and skepticism when presented with the possibility of an HIV vaccine. Factors that drove willingness to receive an HIV vaccine included community-oriented altruism, individualized risk-benefit assessment, and/or the perception that a vaccine could provide a beneficial shift in sexual experiences. Participants also expressed hesitations about receiving an HIV vaccine, including concerns about potential side-effects and efficacy, as well as mistrust in the vaccine development process. Notably, participants often evaluated the vaccine in comparison to PrEP and condoms. Participants offered specific insights into information they would like to receive about an HIV and where/how they would like to receive it. Our findings can help inform future HIV vaccine implementation efforts by offering insights into the factors that motivate and deter GBMSM to receive an HIV vaccine.

Coronavirus disease 2019 vaccination acceptance and associated factors among residents of Dire Dawa Administration, Eastern Ethiopia: a community-based cross-sectional study.

BACKGROUND: Corona virus disease 2019 (COVID-19) is an extremely contagious viral infection caused by the severe acute respiratory syndrome coronavirus 2. Understanding the willingness of the community to receive the COVID-19 vaccine will help in the development and implementation of effective COVID-19 vaccination promotion programs. Therefore, we aimed to assess the level of COVID-19 vaccine acceptance and associated factors among residents of Dire Dawa Administration, Eastern Ethiopia. METHODS: A community-based cross-sectional study was conducted among 840 residents in Dire Dawa Administration from May 18th to June 18th, 2021. Multistage cluster sampling followed by systematic random sampling was used to select respondents. A pretested interviewer-administered structured questionnaire was used to collect the data from respondents. Bivariable and multivariable logistic regression were used to identify predictors of COVID-19 vaccine acceptance. The odds ratio (OR), along with a 95% confidence interval (CI), was used to estimate the strength of the association. RESULTS: Out of 840 respondents recruited, the proportion of COVID-19 vaccine acceptance was found to be 54.4% (457/840); (95% CI: 51.0%, 57.7%) Being male [AOR = 1.85, 95% CI: (1.35, 2.54), P < 0.001], not having a current habit of substance use [AOR = 2.38, 95% CI: (1.73, 3.26), P < 0.001], having a monthly income of less than 51.31 USD [AOR = 0.19, 95% CI: (0.04, 0.88), P = 0.001]; and not having a prior history of vaccination experience [AOR = 0.40, 95% CI: (0.29, 0.54), P < 0.001] were significantly associated with COVID-19 vaccine acceptance. CONCLUSION: This study reveals that the proportion of COVID-19 vaccine acceptance among residents of Dire Dawa Administration, Eastern Ethiopia, was 54.4%. Factors like being male and not having a current habit of substance use were positively associated, whereas having a monthly income of less than 51.31 USD and not having a prior history of vaccination experience were negatively associated with COVID-19 vaccine acceptance. Health information dissemination and economic empowerment are crucial to improving COVID-19 vaccine acceptance among the community. This study provides valuable data for policymakers to plan early vaccination programs and tackle the challenges identified in the study.