Comparison of Current Attitudes Toward COVID-19 Vaccination in New York City and the US Nationally.

COVID-19 vaccination has resulted in decreased hospitalization and mortality, particularly among those who have received a booster. As new effective pharmaceutical treatments are now available and requirements for non-pharmaceutical interventions (e.g. masking) are relaxed, perceptions of the risk and health consequences of SARS-CoV-2 infection have decreased, risking potential resurgence. This June 2022 cross-sectional comparative study of representative samples in New York City (NYC, n = 2500) and the United States (US, n = 1000) aimed to assess differences in reported vaccine acceptance as well as attitudes toward vaccination mandates and new COVID-19 information and treatments. NYC respondents reported higher COVID-19 vaccine acceptance and support for vaccine mandate than U.S. respondents, yet lower acceptance for the booster dose. Nearly one-third of both NYC and U.S. respondents reported paying less attention to COVID-19 vaccine information than a year earlier, suggesting health communicators may need innovation and creativity to reach those with waning attention to COVID-19-related information.

Vaccine Trust Gauge: Mixed methods research to measure and understand vaccine trust.

INTRODUCTION: While trust in vaccination is one factor in the ecosystem that surrounds vaccine decision-making and acceptance, understanding its role may provide insights into effective and tailored approaches to help build individual-level vaccine confidence. The authors developed the Vaccine Trust Gauge (VTG), a scale used to measure trust in vaccines, and conducted mixed methods research to provide an in-depth understanding of the various factors shaping vaccine trust in the United States. MATERIALS AND METHODS: The VTG instrument was developed from previous and scoping research of questionnaires (Larson et al., 2018; Palmedo et al., 2021) and fielded in the US to n = 3026 adults ages ≥18. Based on survey responses, participants were segmented by vaccine trust level (low, medium, or high) through an aggregated scoring system constructed from the VTG. 65 respondents were recruited to participate in in-depth interviews or focus groups conducted by phone or video conference. A conceptual definition of vaccine trust was developed using components of the VTG scale. RESULTS: Multivariate regressions found that higher levels of vaccine trust measured by the VTG are closely associated with trust in healthcare providers and trust in government. College or higher degree, Democrats, and those aged 55+ were more likely to have higher trust in vaccines compared to Black/African Americans, and those experiencing discrimination in the healthcare system. The qualitative analysis allowed the authors to add diverse, contextual elements to the vaccine trust levels summarized here. DISCUSSION: These mixed methods findings suggest future implications for research and practice. Ideas for potential communication, policy, and public health strategies are offered to build vaccine confidence and advance uptake for COVID-19 and other vaccines. CONCLUSIONS: There are diverse underlying factors that influence an individual's trust in vaccines, which means trust categories and demographic characteristics cannot be used as monolithic identifiers. Assessing vaccine trust provides insights into a foundation for engagement to promote individual-level vaccine acceptance. The authors present recommendations for the use of the VTG, future implications for research and practice, and potential strategies to build vaccine confidence.

Statement: Multisectoral actions to build trust at the local and community level to promote vaccine acceptance.

On 12 September 2022, attendees of the 16th Vaccine Congress in Riva del Garda, Italy were invited to attend a roundtable session entitled multi-sectoral actions to build trust at the local and community level to promote vaccine acceptance to participate in a discussion aimed at defining strategies and recommendations to support efforts that build community vaccine confidence. Presenters from the Vaccine Confidence Project and the New York Vaccine Literacy Campaign shared research and data point on the current state of vaccine confidence worldwide as well as global examples of "success stories" to prompt discussion. The group's key recommendations include prioritizing multi-sectoral responses and trust-building through policy and legislation, engaging with trusted local stakeholders, improving convenience, combating misinformation and empowering healthcare professionals to improve vaccine confidence. This report summarizes the considerations, recommendations, and suggested strategies discussed during the session, as prepared by the presenters.

Supporting US healthcare providers for successful vaccine communication.

BACKGROUND: While many healthcare providers (HCPs) have navigated patients' vaccine concerns and questions prior to the rollout of the COVID-19 vaccines, sentiments surrounding the COVID-19 vaccines have presented new and distinct challenges. OBJECTIVE: To understand the provider experience of counseling patients about COVID-19 vaccinations, aspects of the pandemic environment that impacted vaccine trust, and communication strategies providers found supportive of patient vaccine education. METHODS: 7 focus groups of healthcare providers were conducted and recorded during December 2021 and January 2022, at the height of the Omicron wave in the United States. Recordings were transcribed, and iterative coding and analysis was applied. RESULTS: 44 focus group participants representing 24 US states with the majority (80%) fully vaccinated at the time of data collection. Most participants were doctors (34%) or physician's assistants and nurse practitioners (34%). The negative impact of COVID-19 misinformation on patient-provider communication at both intrapersonal and interpersonal levels as well as barriers and facilitators to patient vaccine uptake are reported. People or sources that play a role in health communication ("messengers") and persuasive messages that impact behavior or attitudes towards vaccination ("messages") are described. Providers expressed frustration in the need to continuously address vaccine misinformation in clinical appointments among patients who remained unvaccinated. Many providers found value in resources that provided up-to-date and evidence-based information as COVID-19 guidelines continued to change. Additionally, providers indicated that patient-facing materials designed to support vaccination education were not frequently available, but they were the most valuable to providers in a changing information environment. CONCLUSIONS: While vaccine decision-making is complex and hinges on diverse factors such as health care access (i.e., convenience, expense) and individual knowledge, providers can play a major role in navigating these factors with their patients. But to strengthen provider vaccine communication and promote vaccine uptake, a comprehensive communication infrastructure must be sustained to support the patient-provider dyad. The findings provide recommendations to maintain an environment that facilitates effective provider-patient communication at the community, organizational and policy levels. There is a need for a unified multisectoral response to reinforce the recommendations in patient settings.

Collaborating With Student Parents as Participatory Researchers in a Qualitative Study.

When embarking on research within a community where little empirical research exists, the inclusion of a structured participant group-such as a steering committee or advisory board-can formalize the participant-research team partnership, increase community buy-in for action items, and reinforce the trustworthiness of research findings. These were among the aims of the multimethod design of the Student Parent Project, a qualitative study to determine the barriers and facilitators of academic achievement and well-being at six community colleges within a large, urban, public university system. The initial step of the study was to create a Student Advisory Board by recruiting one student parent from each of the participating campuses. The Student Advisory Board then met intermittently to review the research approach, data collection instruments, and preliminary findings at different stages. In this article, we describe the process of convening and collaborating with the advisory board and identify key areas in which their participation influenced the study design, findings, and recommendations. Based on lessons learned, we offer recommendations for the design and implementation of a participatory advisory board within qualitative studies.

Acceptability of COVID-19 vaccine mandates among New York City parents, November 2021.

School-based vaccine mandates improve vaccination coverage in children. We conducted a cross-sectional survey of parents in New York City (NYC) in November 2021 to measure acceptability of COVID-19 vaccine mandates for students, and for teachers and school staff. Random address-based sampling was used to recruit parents of children 5-11 years of age. Among 2,506 parents surveyed, 44.3% supported school-based vaccine mandates for students and 69.1% supported mandates for teachers and school staff. Asian parents, male parents, those with higher income, college education, those voting for the 2021 Democratic mayoral candidate and parents from Manhattan were most likely to support vaccine mandates for students. Among all parents, 25.1% said they would not vaccinate their child if required. Our data show only modest support for school-based COVID-19 vaccine mandates for children despite their importance in improving vaccination coverage.

COVID-19 Vaccine Coverage and Hesitancy Among New York City Parents of Children Aged 5-11 Years.

Objectives. To measure vaccine uptake and intentions among New York City (NYC) parents of children aged 5 to 11 years following emergency use authorization. Methods. We conducted a survey of 2506 NYC parents of children aged 5 to 11 years. We used survey weights to generate prevalence estimates of vaccine uptake and intentions. Multivariable Poisson regression models generated adjusted prevalence ratios (APRs) of vaccine hesitancy, defined as parents who reported being not very likely or not at all likely to vaccinate their children, or unsure about whether to do so. Results. Overall, 11.9% of NYC parents reported that their child was vaccinated; 51.0% were very or somewhat likely to vaccinate; 8.0% were not sure; 29.1% were not very likely or not at all likely to vaccinate their child. Among vaccine-hesitant parents, 89.9% reported safety concerns and 77.8% had concerns about effectiveness. In multivariable models, more vaccine hesitancy was expressed by non-Hispanic Black parents than by non-Hispanic White parents (APR = 1.41; 95% confidence interval [CI] = 1.17, 1.72) and by parents who were not themselves vaccinated than by parents who were vaccinated (APR = 1.53; 95% CI = 1.32, 1.77). Conclusions. In a survey conducted after authorization of COVID-19 vaccines for children aged 5 to 11 years, significant hesitancy among parents was observed. (Am J Public Health. 2022;112(6):931-936. https://doi.org/10.2105/AJPH.2022.306784).

The Vaccine Communication Demands on Community-Based Workforces.

Community-based organizations (CBOs) are experiencing some of the highest demand in years for a wide spectrum of health and social services. Their client-facing employees have taken on a new, challenging role as a sought-after source of COVID-19 vaccine information and guidance. These workforces operating on the frontlines, do their best to meet the increased need for services and information, often without additional resources or training to do so. The most effective immediate response to this challenge is a comprehensive communication support system working in tandem with CBOs. Our three organizations, the New York Vaccine Literacy Campaign at the CUNY Graduate School of Public Health and Health Policy, Hunger Free NYC, and Health Leads, have collaborated in key short-term approaches to meet these needs. We outline these processes and anticipated outcomes and offer lessons learned to advocate for long-term structural changes needed to increase community-level communication support.

COVID-19 vaccine acceptance among adults in four major US metropolitan areas and nationwide.

This study assesses attitudes towards COVID-19 vaccination and the predictive value of COVID-VAC, a novel scale, among adults in the four largest US metropolitan areas and nationally. A 36-item survey of 6037 Americans was conducted in mid-April 2021. The study reports factors for COVID-19 vaccine acceptance among: (1) already vaccinated; (2) unvaccinated but willing to accept a vaccine; and (3) unvaccinated and unwilling to vaccinate. More than 20% were unwilling to vaccinate, expressing concerns about vaccine efficacy and safety and questioning the disease's severity. Poverty, working outside of the home and conservative political views are predictors of unwillingness. Conversely, those who either personally tested positive for COVID-19, or had a family member who did so, were more likely to accept vaccination. Majorities of all respondents supported vaccination mandates for employees and university students. Respondents preferred to receive vaccines in their doctor´s office. Lower income and conservative ideology, but not race, were strongly associated with vaccine unwillingness. The predictive value of COVID-VAC was demonstrated. While vaccination mandates are likely to be accepted, additional effective, targeted interventions to increase vaccine uptake are needed urgently.

Enhancing global health communication during a crisis: lessons from the COVID-19 pandemic.

BACKGROUND/OBJECTIVE: The understanding and practice of public health crisis communication are improved through the study of responses to past crises, but require retooling for present challenges. The 'Addressing Ebola and other outbreaks' checklist contains guiding principles built upon maxims developed from a World Health Organization consultation in response to the mad cow (bovine spongiform encephalopathy) crisis that were later adopted for Ebola. The purpose of this article is to adapt the checklist for the health communication challenges and public health practices that have emerged during the coronavirus disease 2019 (COVID-19) pandemic. The communication challenges of promoting vaccine acceptance are used to illustrate a key area that requires strengthened communication. Type of program or service: Effective communication principles for application during the COVID-19 pandemic. RESULTS: The COVID-19 pandemic has introduced unique challenges for public health practitioners and health communicators that warrant an expansion of existing health communication principles to take into consideration: the new infodemic (or mis/disinfodemic) challenge - particularly as treatments and vaccines are being developed; communication of risk and uncertainty; health-information behaviours and the instantaneous nature of social media, and the relationship between media literacy and health literacy; the effects of the pandemic on other health issues; and the need for a flexible communication strategy that adapts to the different stages of the pandemic. LESSONS LEARNT: Principles discussed in this article will help build preparedness capacity and offer communication strategies for moving from the acute phase to the 'next normal' with likely prevention (e.g. herd immunity achieved through vaccination) and societal COVID-19 resilience.

Hesitant or Not? The Association of Age, Gender, and Education with Potential Acceptance of a COVID-19 Vaccine: A Country-level Analysis.

In December 2020, the first COVID-19 vaccines were approved. Despite more than 85 million reported cases and 1.8 million known deaths, millions worldwide say they may not accept it. This study assesses the associations of age, gender, and level of education with vaccine acceptance, from a random sample of 13,426 participants selected from 19 high-COVID-19 burden countries in June 2020. Based on univariable and multivariable logistic regression, several noteworthy trends emerged: women in France, Germany, Russia, and Sweden were significantly more likely to accept a vaccine than men in these countries. Older (≥50) people in Canada, Poland, France, Germany, Sweden, and the UK were significantly more favorably disposed to vaccination than younger respondents, but the reverse trend held in China. Highly educated individuals in Ecuador, France, Germany, India, and the US reported that they will accept a vaccine, but higher education levels were associated with lower vaccination acceptance in Canada, Spain, and the UK. Heterogeneity by demographic factors in the respondents' willingness to accept a vaccine if recommended by employers were substantial when comparing responses from Brazil, Ecuador, France, India, Italy, Mexico, Poland, Russia, South Africa, South Korea, Sweden, and the US. This information should help public health authorities target vaccine promotion messages more effectively.

Building Confidence to CONVINCE.

This paper describes the inception and evolution to date of CONVINCE - COVID-19 New Vaccine Information, Communication and Engagement - a rapidly expanding, voluntary global initiative to promote the use of effective public communications and engagement to build vaccine literacy and expedite immunization programs to protect communities against the COVID-19 Pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).

A Select Bibliography of Actions to Promote Vaccine Literacy: A Resource for Health Communication.

In this bibliography, the researchers provide an introduction to the available evidence base of actions to promote vaccine literacy. The research team organized interventions to create a tool that can inform health communicators and practitioners seeking a resource focused on strategy and implementation design for actions that support vaccine literacy. This scoping bibliography is honed specifically to respond to the urgency of the current pandemic, when supporting and increasing vaccine literacy offers promise for achieving the critically needed high levels of vaccination. Over the course of the coming months and year, this bibliography will be a dynamic and "living" document hosted and maintained on vaccineliteracy.com.