Lived Religion in Religious Vaccine Exemptions.

This essay explores a more inclusive and equitable interpretation of "religion" within the context of religious vaccine exemptions. The existing literature critiques the prevalent interpretation of the meaning of religion in religious exemption cases, but frequently overlooks the importance of incorporating the concept of "lived religion." This essay introduces the concept of lived religion from religious studies, elucidates why this lived religion approach is crucial for redefining "religion," and illustrates its application in the domain of religious vaccine exemptions. The author contends that broadening the meaning of religion by employing the concept of lived religion would promote a more inclusive and equitable implementation of religious vaccine exemptions.

Characterizing predictors of COVID-19 vaccine refusal in an urban southern California jail population.

BACKGROUND: Correctional populations have been disproportionately affected by COVID-19, and many large outbreaks have occurred in jails and prisons. Vaccination is a key strategy to reduce the SARS-CoV-2 transmission in carceral settings. Although implementation can be challenging due to vaccine hesitancy and medical mistrust, correctional settings provide largely equitable healthcare access and present a unique opportunity to identify potential predictors of vaccine hesitancy independent of access issues. METHODS: We retrospectively analyzed electronic health record data for individuals offered COVID-19 vaccination at the Los Angeles County Jail between January 19, 2021, and January 31, 2023, and used multivariable logistic regression to determine predictors of COVID-19 vaccine refusal. RESULTS: Of the 21,424 individuals offered COVID-19 vaccination, 2,060 (9.6 %) refused. Refusal was associated with male sex ([aOR] = 2.3, 95 % CI (1.9, 2.8)), age 18-34 ([aOR] = 1.2, 95 % CI (1.1, 1.4), referent group: age 45-54), Black race ([aOR] = 1.2, 95 % CI (1.1, 1.4)), reporting ever being houseless ([aOR] = 1.2, 95 % CI (1.1, 1.3)), and having a history of not receiving influenza vaccination while incarcerated ([aOR] = 2.4, 95 % CI (2.0, 2.8)). When analyzing male and female populations separately, male-specific trends reflected those seen in the overall population, whereas the only significant predictor of vaccine refusal in the female population was not receiving influenza vaccination while in custody ([aOR] = 6.5, 95 % CI (2.4, 17.6)). CONCLUSION: Identifying predictors of vaccine refusal in correctional populations is an essential first step in the development and implementation of targeted interventions to mitigate vaccine hesitancy.

The mental health symptoms of individuals with sensory disabilities and the reasons that lead to COVID-19 vaccine refusal and hesitancy.

The relationship between the reasons for COVID-19 vaccine hesitancy or refusal among people with sensory disabilities and mental health conditions (MHCs) are unclear. Data from the Census Bureau's Household Pulse Survey were analyzed to examine reasons for COVID-19 vaccination refusal among persons with sensory disabilities. Multivariable logistic and polytomous regression were used to examine the relationships among sensory disability status, MHC, and reasons for vaccine refusal and hesitancy. Individuals with sensory disabilities had higher proportion of anxiety and depression than those without a sensory disability. Individuals with a sensory disability and MHCs were less likely to obtain a vaccine and have a general distrust in the COVID-19 vaccine and the government than those without a disability or a MHC. These findings can assist in tailoring messages and developing programs to increase COVID-19 vaccination trust and uptake among individuals with disabilities and MHCs.

Tracking COVID-19 vaccination expectancies and vaccination refusal in the United States.

To identify factors that predict COVID-19 vaccination refusal and show how expectancies affect vaccination acceptance for non-vaccinated adults, we used a monthly repeated cross-sectional sample from June/2021 to October/2021 to collect data on vaccination behaviors and predictor variables for 2,116 US adults over 50 years of age. Selection bias modeling - which is required when data availability is a result of behavioral choice - predicts two outcomes: (1) no vaccination vs. vaccination for the entire sample and (2) the effects of expectancy indices predicting vaccination Refuser vs. vaccination Accepters for the unvaccinated group. Vaccine refusers were younger and less educated, endorsed common misconceptions about the COVID-19 epidemic, and were Black. Vaccination expectancies were related to vaccination refusal in the unvaccinated eligible group: negative expectancies increased vaccine refusal, while positive expectancies decreased it. We conclude that behavior-related expectancies (as opposed to more stable psychological traits) are important to identify because they are often modifiable and provide a point of intervention, not just for COVID-19 vaccination acceptance but also for other positive health behaviors.

Childhood vaccine refusal and what to do about it: a systematic review of the ethical literature.

BACKGROUND: Parental refusal of routine childhood vaccination remains an ethically contested area. This systematic review sought to explore and characterise the normative arguments made about parental refusal of routine vaccination, with the aim of providing researchers, practitioners, and policymakers with a synthesis of current normative literature. METHODS: Nine databases covering health and ethics research were searched, and 121 publications identified for the period Jan 1998 to Mar 2022. For articles, source journals were categorised according to Australian Standard Field of Research codes, and normative content was analysed using a framework analytical approach. RESULTS: Most of the articles were published in biomedical journals (34%), bioethics journals (21%), and journals that carry both classifications (20%). Two central questions dominated the literature: (1) Whether vaccine refusal is justifiable (which we labelled 'refusal arguments'); and (2) Whether strategies for dealing with those who reject vaccines are justifiable ('response arguments'). Refusal arguments relied on principlism, religious frameworks, the rights and obligations of parents, the rights of children, the medico-legal best interests of the child standard, and the potential to cause harm to others. Response arguments were broadly divided into arguments about policy, arguments about how individual physicians should practice regarding vaccine rejectors, and both legal precedents and ethical arguments for vaccinating children against a parent's will. Policy arguments considered the normative significance of coercion, non-medical or conscientious objections, and possible reciprocal social efforts to offset vaccine refusal. Individual physician practice arguments covered nudging and coercive practices, patient dismissal, and the ethical and professional obligations of physicians. Most of the legal precedents discussed were from the American setting, with some from the United Kingdom. CONCLUSIONS: This review provides a comprehensive picture of the scope and substance of normative arguments about vaccine refusal and responses to vaccine refusal. It can serve as a platform for future research to extend the current normative literature, better understand the role of cultural context in normative judgements about vaccination, and more comprehensively translate the nuance of ethical arguments into practice and policy.

The issue of vaccine refusal: study of risky behaviour.

BACKGROUND: The aim of this study is to identify the influence of factors that determine the refusal of influenza vaccine among three subjects groups. METHODS: A survey was conducted amongst three high­risk groups in years 2018-2019 (Moscow, Russia). The survey involved 1,620 parents and pregnant women (group 1), 324 doctors (group 2) and 433 students (group 3). The analysis revealed a poor vaccine uptake among respondents of all three groups. RESULTS: According to the survey results, only 22.2 % of children and 13.8 % of adults were vaccinated against influenza. The group 2 showed higher rates for vaccinated adults and children, namely 36.7 % and 58.7 % , respectively. The lowest adherence to annual vaccinations was recorded in group 3 (only 17.3 %). There is also a negative correlation between adherence to vaccination and smoking -0.66), unhealthy diet -0.73), poor oral hygiene -0.61) as well as insufficient awareness of the need of influenza vaccine -0.81). CONCLUSION: The general lack of vaccination awareness has a fundamental role in forming a negative attitude toward influenza vaccine. It is necessary to conduct research to promote vaccination against influenza to improve vaccine uptake among high­risk groups, particularly in students (Tab. 1, Fig. 1, Ref. 32).

COVID-19 Vaccination Willingness and Reasons for Vaccine Refusal.

Importance: Hong Kong was held as an exemplar for pandemic response until it recorded the world's highest daily COVID-19 mortality, which was likely due to vaccine refusal. To prevent this high mortality in future pandemics, information on underlying reasons for vaccine refusal is necessary. Objectives: To track the evolution of COVID-19 vaccination willingness and uptake from before vaccine rollout to mass vaccination, to examine factors associated with COVID-19 vaccine refusal and compare with data from Singapore, and to assess the population attributable fraction for vaccine refusal. Design, Setting, and Participants: This cohort study used data from randomly sampled participants from 14 waves of population-based studies in Hong Kong (February 2020 to May 2022) and 2 waves of population-based studies in Singapore (May 2020 to June 2021 and October 2021 to January 2022), and a population-wide registry of COVID-19 vaccination appointments. Data were analyzed from February 23, 2021, to May 30, 2022. Exposures: Trust in COVID-19 vaccine information sources (ie, health authorities, physicians, traditional media, and social media); COVID-19 vaccine confidence on effectiveness, safety, and importance; COVID-19 vaccine misconceptions on safety and high-risk groups; political views; and COVID-19 policies (ie, workplace vaccine mandates and vaccine pass). Main Outcomes and Measures: Primary outcomes were the weighted prevalence of COVID-19 vaccination willingness over the pandemic, adjusted incidence rate ratios, and population attributable fractions of COVID-19 vaccine refusal. A secondary outcome was change in daily COVID-19 vaccination appointments. Results: The study included 28 007 interviews from 20 waves of longitudinal data, with 1114 participants in the most recent wave (median [range] age, 54.2 years [20-92] years; 571 [51.3%] female). Four factors-mistrust in health authorities, low vaccine confidence, vaccine misconceptions, and political views-could jointly account for 82.2% (95% CI, 62.3%-100.0%) of vaccine refusal in adults aged 18 to 59 years and 69.3% (95% CI, 47.2%-91.4%) of vaccine refusal in adults aged 60 years and older. Workplace vaccine mandates were associated with 62.2% (95% CI, 9.9%-139.2%) increases in daily COVID-19 vaccination appointments, and the Hong Kong vaccine pass was associated with 124.8% (95% CI, 65.9%-204.6%) increases in daily COVID-19 vaccination appointments. Conclusions and Relevance: These findings suggest that trust in health authorities was fundamental to overcoming vaccine hesitancy. As such, engendering trust in health care professionals, experts, and public health agencies should be incorporated into pandemic preparedness and response.

Why healthcare providers are not vaccinated? A qualitative study during the COVID-19 pandemic in Iran.

BACKGROUND: Vaccination has been effective in controlling contagious diseases, especially among high-risk groups such as medical staff. Their unwillingness to be vaccinated might adversely affect individual and public health. This study aimed to explore the factors related to the refusal of COVID-19 vaccines among health service providers. METHODS: A qualitative study was conducted on 28 healthcare providers in Mashhad, Northeast of Iran from March to June 2022. The method of data collection was face-to-face interviews. The purposive method was used for sampling. Data collection continued until the saturation was reached. To analyze the data, the content analysis method was applied, and Maxqda (version 10) software was used. RESULTS: By analyzing interview transcripts, six themes and ten sub-themes were extracted. Factors that explained employees' reluctance to be vaccinated against COVID-19 were the opinion of peers, lack of trust in vaccines, fear of vaccination, mistrust to the government and health authorities, low perceived risk of coronavirus disease, and the contradictions of traditional and modern medicine in their approach to controlling the disease. CONCLUSIONS: Among healthcare workers, concerns about the side effects of vaccines were the most influential factors in refusing vaccination. Providing reliable information about vaccines and their safety is key to increasing the trust of health workers in vaccination and facilitating its acceptance.

Parental anxiety and pediatric vaccine refusal in a US national sample of parents.

OBJECTIVES: Understanding vaccine hesitancy among parents is of emerging interest and of rising importance for promoting vaccine uptake to prevent pediatric illness. Here, we examine associations between pediatric vaccine refusal and parental symptoms of anxiety. METHODS: Our cross-sectional survey assessed pediatric vaccine refusal in 1699 parents in a US national sample. Participants completed a sociodemographic questionnaire, the Vaccine Hesitancy Scale, and symptoms of anxiety (GAD-7). RESULTS: The prevalence of pediatric vaccine refusal was 15.5 %. Parent symptoms of anxiety were related to vaccine refusal (OR = 1.07 [1.03, 1.10]). Mild (1.88 [1.39, 2.54], p <.001) and clinically significant (2.14 [1.39, 3.31], p <.001) symptoms of anxiety were also related to pediatric vaccine refusal. Parental anxiety was also associated with perceived risks of vaccines and reduced confidence. CONCLUSIONS: Findings highlight the need to consider parental anxiety in the development of public health interventions that address substandard pediatric vaccine uptake.

Measuring the monetization strategies of websites with application to pro- and anti-vaccine communities.

Anti-vaccine content and other kinds of misinformation are hypothesized to be more heavily monetized than other kinds of online content. We test this hypothesis by applying several novel and scalable measures of website monetization strategies to more than 400,000 links shared by 261 anti-vaccine Facebook pages and 190 pro-vaccine ones. Contrary to expectations, websites promoted in pro-vaccine venues do more to monetize attention than those promoted in anti-vaccine venues. This is a consequence of how intensely monetized news websites are-pro-vaccine venues share more links to news. The specific news sites shared by anti-vaccine venues are rated less credible by fact-checking organizations, but we find little substantive difference in their monetization strategies. These results emphasize the need to interpret measures of monetization within the context of the broader "attention economy".

Los sesgos cognitivos en la comunicación provacunas. Un estudio de la página de vacunación de la COVID-19 del Gobierno de España / Cognitive bias in pro-vaccine communication. A study of the COVID-19 vaccination page of the Government of Spain

Fundamentos: La comunicación en salud pretende modificar actitudes y comportamientos, por lo que se vale, entre otros, deestrategias persuasivas y de sesgos cognitivos. Ambos elementos han sido investigados en estudios previos, pero no se han encontrado precedentes de investigaciones que evalúen los mensajes gubernamentales desde ambas perspectivas a la vez. El objetivode esta investigación fue analizar el tipo de información relacionada con la vacunación contra la COVID-19 que se distribuía en lapágina oficial del Gobierno de España, evaluando su capacidad persuasiva y el uso de sesgos cognitivos como herramientas contrala renuencia a la vacunación. Métodos: Se analizó la información de la página oficial sobre vacunación contra la COVID-19 del Gobierno de España, teniendoen cuenta tanto su estructura como el contenido de la información. Se prestó especial atención a la estrategia comunicativa desarrollada para elaborar mensajes provacunas.Resultados: En primer lugar, la información proveniente del Gobierno de España se presentaba de forma concisa, clara y sencillaen una web bien estructurada. En segundo lugar, el contenido compartido giraba en torno a ciertos temas recurrentes como los beneficios y el proceso de la vacunación. En tercer lugar, el contenido poseía un gran carácter científico y se apoyaba en argumentos paraderribar sesgos cognitivos contrarios a la vacunación. Por último, la estrategia comunicativa se basa en contenidos más informativos(racionales) que persuasivos (emocionales). Conclusiones: Conocer las técnicas de persuasión y la implicación de sesgos cognitivos, especialmente en el área de la vacunación, ayudará a orientar las estrategias comunicativas de Salud Pública.(AU)

Background: Health communication aims to modify attitudes and behaviors, which is why it uses, among others, persuasivestrategies and the use of cognitive biases. Both elements have been investigated in previous studies, however, no research precedentshave been found that evaluate government messages from both perspectives at the same time. The objective of this research wasto analyze the type of information related to the COVID-19 vaccination that was distributed on the official page of the Government ofSpain, evaluating its persuasive capacity and the use of cognitive biases as tools against vaccination reluctance. Methods: The information from the official page on vaccination of COVID-19 of the Government of Spain was analysed, taking intoaccount both its structure and the content of the information. Special attention was paid to the communication strategy developed todevelop pro-vaccine messages. Results: First, the information coming from the Government was presented in a concise, clear and simple way on a well-structured webpage. Second, the content shared revolved around certain recurring themes such as the benefits and the vaccination process.Third, the content had a highly scientific nature and was supported by arguments to overthrow cognitive biases against vaccination.Lastly, the communication strategy was based on content that were more informative (rational) than persuasive (emotional). Conclusions: Knowing the techniques of persuasion and the implication of cognitive biases, especially in the area of vaccination, will help guide communication strategies in Public Health.(AU)

Religious Exemptions, Public Health, and School Vaccination Requirements.

This Viewpoint examines 2 recent cases that encapsulate the debate on religious exemptions to school vaccination requirements and further argues against these exemptions for schoolchildren.

Sick as a dog? The prevalence, politicization, and health policy consequences of canine vaccine hesitancy (CVH).

Canine vaccine hesitancy (CVH) can be thought about as dog owners' skepticism about the safety and efficacy of administering routine vaccinations to their dogs. CVH is problematic not only because it may inspire vaccine refusal - which may in turn facilitate infectious disease spread in both canine and human populations - but because it may contribute to veterinary care provider mental/physical health risks. In a nationally representative survey of US adults (N = 2200), we introduce a novel survey-based instrument for measuring CVH. We document pervasive CVH in dog owner subpopulations. Troublingly, we find that CVH is associated with rabies non-vaccination, as well as opposition to evidence-based vaccine policies. We conclude by discussing the human and animal health consequences of CVH, and outline a research agenda for future opinion-based research on this important topic.

The Importance of Mapping Determinants, Attitudes and Beliefs of Vaccine Hesitancy in the Great Challenge of Compulsory Childhood Vaccination Comment on "Convergence on Coercion: Functional and Political Pressures as Drivers of Global Childhood Vaccine Mandates".

Vaccine hesitancy (VH) has risen significantly during the COVID-19 pandemic, becoming a major global health concern. VH is characterized by the delay or refusal of vaccination despite its availability. Various frameworks have been developed to understand the complex factors influencing VH, with attitudes, beliefs, and external influences being the most significant. The surge in VH has reignited the debate on the best approach to address it: persuasive/ educational or coercive. Attwell and Hannah studied the political and social reasons behind the adoption of mandatory vaccination in four jurisdictions (Italy, France, Australia, and California) due to declining vaccine coverage below the safety threshold. However, these methods may foster parental disbeliefs and opposition to vaccination campaigns. To combat VH, it is crucial to systematically assess its determinants within specific contexts and population groups. Increasing awareness about vaccination benefits, engaging with social media, and employing tailored strategies can foster spontaneous adherence to vaccination programs, eliminating the need for coercive measures.

Beginning to address vaccine reluctance and refusal.

Those who refuse immunizations are risks to the public health. Others who are vaccine reluctant are also problematic because they may reinforce the uncertainties of others and refuse vaccines in the future. Common to the multiple, complex causes of vaccine reluctance and refusal is the fact that many have little knowledge about microbiology, infectious diseases, or public health. Consequently, it is not surprising that many have questions about vaccines, find making vaccine decisions difficult, and are vulnerable to vaccine misinformation. Therefore, improving the knowledge of consumers about these biologic sciences would seem to be essential to begin addressing vaccine reluctance and refusal. This would be most effective if it were accomplished before they need to begin to make vaccine decisions.

The societal cost of vaccine refusal: A modelling study using measles vaccination as a case study.

BACKGROUND: Increasing vaccine hesitancy and refusal poses a challenge to public health as even small reductions in vaccine uptake can result in large outbreaks of infectious diseases. Here we estimate the societal costs of vaccine refusal using measles as a case study. METHODS: We developed a compartmental metapopulation model of measles transmission to explore how the changes in the size and level of social mixing between populations that are "pro-vaccination", and "anti-vaccination" impacts the burden of measles. Using the projected cases and deaths, we calculated the health, healthcare, direct medical costs, and productivity loss associated with vaccine refusal. Using measles in England as a case study, we quantified the societal costs that each vaccine refusal imposes on society. FINDINGS: When there is a high level of mixing between the pro- and anti-vaccination populations, those that refuse to be vaccinated benefit from the herd immunity afforded by the pro-vaccination population. At the same time, their refusal to be vaccinated increases the burden in those that are vaccinated due to imperfect vaccines, and in those that are not able to be vaccinated due to other underlying health conditions. Using England as a case study, we estimate that this translates to a societal loss of GBP 292 million and disease burden of 17 630 quality-adjusted-life-years (sensitivity range 10 594-50 379) over a 20-year time horizon. Of these costs, 26 % are attributable to healthcare costs and 74 % to productivity losses for patients and their carers. This translates to a societal loss per vaccine refusal of GBP 162.21 and 0.01 (0.006-0.03) quality-adjusted-life-years. INTERPRETATION: Our findings demonstrate that even low levels of vaccine refusal can have a substantial and measurable societal burden on the population. These estimates can support the value of investment in interventions that address vaccine hesitancy and vaccine refusal, providing not only improved public health but also potential economic benefits to society.

Evaluación del efecto Dunning-Kruger en relación a la vacunación: un estudio de los mensajesen la red social LinkedIn / Evaluation of the Dunning Kruger effect in relation to vaccination: a study of messages on the social network LinkedIn

FUNDAMENTOS: El efecto Dunning-Kruger hace referencia a un exceso de confianza respecto a las propias habilidades y conoci-mientos. Es este un sesgo cognitivo por el cual las personas con poca preparación, habilidad o conocimientos tienden a sobrestimarestos factores. La confianza lleva a transmitir la información de una manera asertiva, independientemente de la validez o veracidadde esta. En el contexto de la pandemia por la COVID-19 se han publicado gran cantidad de opiniones sin base científica en redes socia-les, ajenas a la información científica y de los expertos, pero de gran impacto en la opinión pública. Este estudio evaluó la existenciadel efecto Dunning-Kruger en los mensajes relacionados con la vacunación frente a la COVID-19 enLinkedIn. MÉTODOS: Se evaluaron 448 mensajes y se relacionaron los conocimientos y formación sobre el tema de los autores. En el trata-miento estadístico se procedió a realizar el test de Chi cuadrado para determinar si existe una asociación significativa entre las varia-bles, estableciendo el nivel de significancia en P<0,05. Estos procedimientos se llevaron a cabo utilizando software estadísticoSPSS. RESULTADOS: De los 448 mensajes, 153 reflejaron muy alta certeza, 115 certeza media, 107 certeza baja y 73 reflejaron dudas. Elgrupo que porcentualmente emitió más mensajes con certeza absoluta (41,8%) fue el de conocimientos mínimos sobre la COVID-19. De este grupo sin conocimiento en el tema solo el 7,1% expresaba mensajes sin manifestar certeza. El grupo con conocimientos muyelevados sobre el tema fue más propenso a reflejar incertidumbre, comunicando el 15,7% de los mensajes con certeza absoluta y el37,1% con certeza nula. CONCLUSIONES: Se obtiene que aquellas personas con menores conocimientos expresan de forma más asertiva sus mensajesy presentan en sus discursos menor aceptación de la vacuna para la COVID-19. Se demuestra la presencia del efecto...(AU)

BACKGROUND: The Dunning-Kruger effect refers to an excess of confidence regarding one’s abilities and knowledge; trust leads totransmitting information in an assertive manner, regardless of its validity or veracity, of experts, but of great impact on public opinion. This study evaluated the existence of the Dunning-Kruger effect in messages related to vaccination against COVID-19 onLinkedIn. METHODS: 448 messages were evaluated and the authors’ knowledge and training on the subject were related. In the statisticaltreatment, the Chi-square test was performed to determine if there is a significant association between the variables, establishing thelevel of significance at P<0.05. These procedures were carried out usingSPSS statistical software. RESULTS: 448 messages were analyzed. Of these, 153 reflected very high certainty, 115 medium certainty, 107 low certainty and 73reflected doubts. The group that issued the most messages with absolute certainty (41.8%) was the group with minimal knowledgeabout COVID-19. Of this group without knowledge on the subject, only 7.1% expressed messages without expressing certainty. Thegroup with very high knowledge on the subject was more likely to reflect uncertainty, communicating 15.7% of the messages withabsolute certainty and 37.1% with zero certainty. CONCLUSIONS: It is obtained that those people with less knowledge express their messages more assertively and present less acceptan-ce of the COVID-19 vaccine in their speeches. The presence of the Dunning-Kruger effect in relation to COVID-19 vaccination is demonstrated.(AU)