Vaccine refusal in pregnant women in Kahramanmaras: a community-based study from Türkiye.

Background: The global health landscape is increasingly challenged by the rejection of childhood vaccines. This study investigates vaccination reservations and refusal among pregnant women. Methods: A cross-sectional study was conducted in Kahramanmaras, Türkiye, spanning January to March 2019, entailing face to face interviews with 938 pregnant women. The questionnaire collected sociodemographic data and probed vaccination attitudes. The decision to vaccinate the baby was treated as the dependent variable, analyzed alongside sociodemographic factors and other variables. Data underwent evaluation via descriptive analysis, the Chi-square test, and binary logistic regression. Results: Participants had a mean age of 27.6 years. Among them 20 (2.1%) expressed intent to either abstain from or partially vaccinate their babies, with 70% citing apprehensions regarding potential vaccine-related harm. Statistical analysis unveiled that higher economic income, elevated parental education level, fewer than two children, reliance on the Internet for vaccination information, and a lack of trust in physicians significantly correlated with vaccine refusal among pregnant women (p < 0.05). Conclusions: The study concludes that dissemination of vaccination information by the healthcare professionals, complemented by the enactment of pro-vaccine internet policies holds promise in shaping vaccination behavior.

Discriminatory attitudes against unvaccinated people during the pandemic.

During the COVID-19 pandemic, sizeable groups of unvaccinated people persist even in countries with high vaccine access1. As a consequence, vaccination became a controversial subject of debate and even protest2. Here we assess whether people express discriminatory attitudes in the form of negative affectivity, stereotypes and exclusionary attitudes in family and political settings across groups defined by COVID-19 vaccination status. We quantify discriminatory attitudes between vaccinated and unvaccinated citizens in 21 countries, covering a diverse set of cultures across the world. Across three conjoined experimental studies (n = 15,233), we demonstrate that vaccinated people express discriminatory attitudes towards unvaccinated individuals at a level as high as discriminatory attitudes that are commonly aimed at immigrant and minority populations3-5. By contrast, there is an absence of evidence that unvaccinated individuals display discriminatory attitudes towards vaccinated people, except for the presence of negative affectivity in Germany and the USA. We find evidence in support of discriminatory attitudes against unvaccinated individuals in all countries except for Hungary and Romania, and find that discriminatory attitudes are more strongly expressed in cultures with stronger cooperative norms. Previous research on the psychology of cooperation has shown that individuals react negatively against perceived 'free-riders'6,7, including in the domain of vaccinations8,9. Consistent with this, we find that contributors to the public good of epidemic control (that is, vaccinated individuals) react with discriminatory attitudes towards perceived free-riders (that is, unvaccinated individuals). National leaders and vaccinated members of the public appealed to moral obligations to increase COVID-19 vaccine uptake10,11, but our findings suggest that discriminatory attitudes-including support for the removal of fundamental rights-simultaneously emerged.

Causas de no vacunación contra la Covid-19 en trabajadores de un hospital de España / Causes of Non-Vaccination Against Covid-19 in Workers at a Spanish Hospital

Introducción: En Ceuta, el 82,3% de la población ha recibido al menos una vacuna contra la COVID-19. El 17,7% es reticente a recibir ninguna vacuna relacionada con esta enfermedad. El objetivo de este estudio es conocer el grado de rechazo y las causas del mismo hacia la vacunación contra la COVID-19 en trabajadores del ámbito sanitario de Hospital Universitario de Ceuta; además, poder comparar estos resultados con las causas en diferentes países y con otros sanitarios del mundo. Método: Se realizó un estudio descriptivo transversal donde se revisó la base de datos de los trabajadores excluyendo aquellos que sí habían recibido al menos una dosis de la vacuna. En aquellos donde no se tenía información o bien no habían recibido vacunación, se realizó una llamada telefónica. Se diseñó una base de datos con diferentes variables entre las que se incluyen: categoría profesional, sexo y edad. El análisis de los datos se llevó a cabo con Excel 2010. Resultados: De los 1009 trabajadores registrados, 17 de ellos confirmó no haber recibido ninguna vacuna: 6 enfermeros (35%), 6 médicos (35%), 3 administrativos (18%), 1 celador (6%) y 1 auxiliar de enfermería (6%). 35% lo atribuyó a causas médicas, 35% se encontraron reticentes a recibir la vacuna y 18% refirió tener anticuerpos contra el virus y por lo tanto, no deseó recibir la vacunación. Conclusiones: La causa más frecuente de no vacunación es el miedo (35%) tanto a los efectos secundarios como a la rapidez del desarrollo de la vacuna (AU)

Introduction: In Ceuta, 82.3% of the population has received at least one vaccine against COVID-19. 17.7% reject to receive any vaccine related to this disease. The objective of this study is to determine the degree of rejection and its causes towards vaccination against COVID-19 in health workers of the Hospital Universitario de Ceuta; In addition, to be able to compare these results with the causes in different countries and with other healthcare providers in the world.Method: A cross-sectional descriptive study was carried out where the database of workers was reviewed, exclud-ing those who had received at least one dose of the vaccine. In those where there was no information or had not received vaccination, a telephone call was made. A database was designed with different variables, including: pro-fessional category, sex and age. Data analysis was carried out with Excel 2010.Results: Of the 1,009 registered workers, 17 of them confirmed that they had not received any vaccine: 6 nurses (35%), 6 doctors (35%), 3 administrative staff (18%), 1 porter (6%), and 1 nursing assistant (6 %). 35% attributed it to medical causes, 35% were reluctant to receive the vaccine and 18% reported having antibodies against the virus and therefore did not want to receive the vaccination.Conclusions: The most frequent cause of non-vaccination is fear (35%) of both side effects and the speed of vaccine development (AU)

COVID-19 Vaccine in Inherited Metabolic Disorders Patients: A Cross-Sectional Study on Rate of Acceptance, Safety Profile and Effect on Disease.

BACKGROUND: Vaccines for COVID-19 have had a significant impact on the spread of COVID-19 infection, reducing the incidence and mortality of the infection in several countries. However, hesitancy toward this vaccine is a global health issue for the general population The Vaccine acceptance rate among patients affected with inherited metabolic disorders (IMD), as well as safety profile, has not been described. METHODS: We conducted a cross-sectional study, based on a telephone survey, investigating the COVID-19 vaccination rate, the incidence and type of adverse effects (AEs), the reasons for vaccine refusal and the effects on the underlying disease in a cohort of IMD patients followed at a single center and invited directly to vaccination by specialistic team. RESULTS: Seventy-four patients were included in the study, the median age was 23.4 years (min 12.1-max 61.7), 47% (n = 85) were females and 61% (107) were affected from impaired metabolism of phenylalanine. By October 2021, 94% (n = 163) of them had received at least one dose of the vaccine, which was, in 98% of cases, mRNA-based vaccine, given at the referral hospital in 65% of cases. Overall, 72% of patients with IMD reported AE to the vaccine: 60% after the first dose, 81% after the second. The highest rate of adverse events at the first dose was reported in patients with amino acids related disorders other than impaired phenylalanine metabolism (PKU/HPA) (88%). For the second dose, the PKU/HPA group reported the highest rate of AEs (89% of cases). There was no effect on the underlying disease or acute decompensation after the vaccine. Eleven patients (6%) were not vaccinated because they considered it dangerous. CONCLUSION: Among individuals with IMD, the vaccination rate was high, the incidence and severity of AEs were comparable to those in the general population with no effects on the disease. Direct contact with the specialist medical team, has proven to reassure patients and effectively contrast hesitancy.

Aceptabilidad de la vacuna contra la COVID-19 en alumnos de una universidad pública de Honduras / Acceptability of the COVID-19 vaccine in students of a public university in Honduras

La pandemia de la COVID-19 continúa reportando casos y fallecimientos a nivel mundial y nacional. La vacuna contra COVID-19, ha logrado contener la propagación de la enfermedad, sin embargo, todavía no tiene una aceptación total. Objetivo: Determinar el nivel de conocimiento, actitudes y aceptabilidad de la vacuna contra la COVID-19 y factores asociados, en estudiantes de la Universidad Nacional Autónoma de Honduras (UNAH) en año 2021. Métodos: Estudio observacional, transversal, descriptivo con análisis de asociación. La población de estudio fueron los estudiantes de la UNAH. Resultados: Un total de 1,417 estudiantes participaron, de los cuales el 52.3% (741) no estaban vacunados contra la COVID-19. Se encontró que el 93.5% (693/741) aceptaría aplicarse la vacuna. Se realizó una regresión logística binaria múltiple reportando que, el grupo de edad de 40 a 44 años tendrían mayor posibilidad de no aceptabilidad de la vacuna (OR=17, IC95% 2.462-120.661; p=0.004). Con respecto a los factores psicosociales se encontró que, la norma subjetiva y el control conductual inadecuado conllevaría a mayor posibilidad de no aceptación de la vacuna. (OR=11.4, IC95% 3.605- 36.664; p=0.000) y (OR=4.6, IC95% 1.678-12.281; p=0.003), respectivamente. Finalmente, la actitud social y la percepción de riesgo inadecuado implicaría no aceptar la vacuna (OR=13, IC95% 5.683-30.322; p=0.000) y (OR=6, IC95% 2.189- 15.159; p=0.000), respectivamente. Discusión: Según los resultados de este estudio, los estudiantes que no aceptaron vacunarse tuvieron influencia en su entorno familiar, social y de su propia capacidad para decidir, sumado a una percepción de riesgo inadecuada por una influencia directa en los mismos...(AU)

Reasons for COVID-19 vaccine refusal among people incarcerated in Canadian federal prisons.

BACKGROUND: Vaccine uptake rates have been historically low in correctional settings. To better understand vaccine hesitancy in these high-risk settings, we explored reasons for COVID-19 vaccine refusal among people in federal prisons. METHODS: Three maximum security all-male federal prisons in British Columbia, Alberta, and Ontario (Canada) were chosen, representing prisons with the highest proportions of COVID-19 vaccine refusal. Using a qualitative descriptive design and purposive sampling, individual semi-structured interviews were conducted with incarcerated people who had previously refused at least one COVID-19 vaccine until data saturation was achieved. An inductive-deductive thematic analysis of audio-recorded interview transcripts was conducted using the Conceptual Model of Vaccine Hesitancy. RESULTS: Between May 19-July 8, 2021, 14 participants were interviewed (median age: 30 years; n = 7 Indigenous, n = 4 visible minority, n = 3 White). Individual-, interpersonal-, and system-level factors were identified. Three were particularly relevant to the correctional setting: 1) Risk perception: participants perceived that they were at lower risk of COVID-19 due to restricted visits and interactions; 2) Health care services in prison: participants reported feeling "punished" and stigmatized due to strict COVID-19 restrictions, and failed to identify personal benefits of vaccination due to the lack of incentives; 3) Universal distrust: participants expressed distrust in prison employees, including health care providers. INTERPRETATION: Reasons for vaccine refusal among people in prison are multifaceted. Educational interventions could seek to address COVID-19 risk misconceptions in prison settings. However, impact may be limited if trust is not fostered and if incentives are not considered in vaccine promotion.

Willingness to take COVID-19 vaccination in low-income countries: Evidence from Ethiopia.

BACKGROUND: In low-income countries, vaccination campaigns are lagging, and evidence on vaccine acceptance, a crucial public health planning input, remains scant. This is the first study that reports willingness to take COVID-19 vaccines and its socio-demographic correlates in Ethiopia, Africa's second most populous country. METHODS: The analysis is based on a nationally representative survey data of 2,317 households conducted in the informal economy in November 2020. It employs two logistic regression models where the two outcome variables are (i) a household head's willingness to take a COVID-19 vaccine or not, and (ii) if yes if they would also hypothetically pay (an unspecified amount) for it or not. Predictors include age, gender, education, marital status, income category, health insurance coverage, sickness due to COVID-19, chronic illness, trust in government, prior participation in voluntary activities, urban residence. RESULTS: Willingness to take the vaccine was high (88%) and significantly associated with COVID-19 cases in the family, trust in government and pro-social behavior. All other predictors such as gender, education, income, health insurance, chronic illness, urban residence did not significantly predict vaccine willingness at the 5% level. Among those willing to take the vaccine, 33% also answered that they would hypothetically pay (an unspecified amount) for it, an answer that is significantly associated with trust in government, health insurance coverage and income. CONCLUSION: The results highlight both opportunities and challenges. There is little evidence of vaccine hesitancy in Ethiopia among household heads operating in the informal economy. The role played by trust in government and pro-social behavior in motivating this outcome suggests that policy makers need to consider these factors in the planning of COVID-19 vaccine campaigns in order to foster vaccine uptake. At the same time, as the willingness to hypothetically pay for a COVID-19 vaccine seems to be small, fairly-priced vaccines along with financial support are also needed to ensure further uptake of COVID-19 vaccines.

Health Care System View of Human Papilloma Virus (HPV) Vaccine Acceptability by Emirati Men.

This is the most frequent sexually transmitted illness on the planet, and both men and women are equally vulnerable. HPV is associated with a broad variety of female disorders, including 99 percent of all cervical cancer cases. Specifically, the goal and contributions of this study are to determine Emirati men's opinions about the HPV vaccination, specifically whether they would use it themselves or allow their female relatives to use the vaccine. To collect the primary data, a statistical cross-sectional survey was conducted. This quantitative study was conducted using primary sources of data. A questionnaire survey with a sample size of 390 participants was used to collect data from 400 individuals. Male university students in the United Arab Emirati men have a weak grasp of HPV and are averse to vaccination (Ortashi et al., 2013). The percentage of Emirati men who accept the HPV vaccination is 37%. A total of 40.3% of the respondents opted not to participate in the survey at all. Eighty-six percent of the women surveyed had heard of cervical cancer, and one-third believed that they were at risk in the future. Twenty-five percent of those surveyed said that the HPV vaccination was safe, while 26% said it was unsafe. Respondents were just 3.1 percent vaccinated, and their family members were only 87% not vaccinated.

The social specificities of hostility toward vaccination against Covid-19 in France.

Equal Access to the COVID-19 vaccine for all remains a major public health issue. The current study compared the prevalence of vaccination reluctance in general and COVID-19 vaccine hesitancy and social and health factors associated with intentions to receive the vaccine. A random socio-epidemiological population-based survey was conducted in France in November 2020, in which 85,855 adults participants were included in this study. We used logistic regressions to study being "not at all in favor" to vaccination in general, and being "certainly not" willing to get vaccinated against Covid-19. Our analysis highlighted a gendered reluctance toward vaccination in general but even more so regarding vaccination against COVID-19 (OR = 1.88 (95% CI: 1.79-1.97)). We also found that people at the bottom of the social hierarchy, in terms of level of education, financial resources, were more likely to refuse the COVID-19 vaccine (from OR = 1.22 (95% CI:1.10-1.35) for respondents without diploma to OR = 0.52 (95% CI:0.47-0.57) for High school +5 or more years level). People from the French overseas departments, immigrants and descendants of immigrants, were all more reluctant to the Covid-19 vaccine (first-generation Africa/Asia immigrants OR = 1.16 (95% CI:1.04-1.30)) versus OR = 2.19 (95% CI:1.96-2.43) for the majority population). Finally, our analysis showed that those who reported not trusting the government were more likely to be Covid-19 vaccine-reluctant (OR = 3.29 (95% CI: 3.13-3.45)). Specific campaigns should be thought beforehand to reach women and people at the bottom of the social hierarchy to avoid furthering social inequalities in terms of morbidity and mortality.

COVID-19 vaccination beliefs, attitudes, and behaviours among health and social care workers in the UK: A mixed-methods study.

BACKGROUND: The UK began delivering its COVID-19 vaccination programme on 8 December 2020, with health and social care workers (H&SCWs) given high priority for vaccination. Despite well-documented occupational exposure risks, however, there is evidence of lower uptake among some H&SCW groups. METHODS: We used a mixed-methods approach-involving an online cross-sectional survey and semi-structured interviews-to gain insight into COVID-19 vaccination beliefs, attitudes, and behaviours amongst H&SCWs in the UK by socio-demographic and employment variables. 1917 people were surveyed- 1656 healthcare workers (HCWs) and 261 social care workers (SCWs). Twenty participants were interviewed. FINDINGS: Workplace factors contributed to vaccination access and uptake. SCWs were more likely to not be offered COVID-19 vaccination than HCWs (OR:1.453, 95%CI: 1.244-1.696). SCWs specifically reported uncertainties around how to access COVID-19 vaccination. Participants who indicated stronger agreement with the statement 'I would recommend my organisation as a place to work' were more likely to have been offered COVID-19 vaccination (OR:1.285, 95%CI: 1.056-1.563). Those who agreed more strongly with the statement 'I feel/felt under pressure from my employer to get a COVID-19 vaccine' were more likely to have declined vaccination (OR:1.751, 95%CI: 1.271-2.413). Interviewees that experienced employer pressure to get vaccinated felt this exacerbated their vaccine concerns and increased distrust. In comparison to White British and White Irish participants, Black African and Mixed Black African participants were more likely to not be offered (OR:2.011, 95%CI: 1.026-3.943) and more likely to have declined COVID-19 vaccination (OR:5.550, 95%CI: 2.294-13.428). Reasons for declining vaccination among Black African participants included distrust in COVID-19 vaccination, healthcare providers, and policymakers. CONCLUSION: H&SCW employers are in a pivotal position to facilitate COVID-19 vaccination access, by ensuring staff are aware of how to get vaccinated and promoting a workplace environment in which vaccination decisions are informed and voluntary.

COVID-19 vaccine hesitancy among healthcare workers and its socio-demographic determinants in Abia State, Southeastern Nigeria: a cross-sectional study.

INTRODUCTION: healthcare workers are at higher risk of COVID-19 infection with ease of infection transmissibility to coworkers and patients. Vaccine hesitancy rates of 56% and up to 25% have been reported among healthcare workers in US and China respectively. Vaccination is known as the most effective strategy to combat infectious diseases. Acceptance of the COVID-19 vaccine plays a major role in combating the pandemic. This study assessed the sociodemographic factors associated with COVID-19 vaccine hesitancy among healthcare workers in Abia State. METHODS: a cross-sectional study among 422 healthcare workers was conducted in Abia State with an online-based questionnaire. The questionnaire extracted information on socio-demographics and willingness to take vaccine uptake. Descriptive statistics was used to calculate frequencies and proportions. Bivariate analysis was used to test the association between the socio-demographic factors and the outcome variable (vaccine hesitancy). Logistic regression was conducted to identify the predictors of COVID-19 vaccine hesitancy. The level of significance was 5%. RESULTS: mean age of the respondents was 40.6 ± 9.5 years and 67.1% were females The COVID-19 vaccine hesitancy rate was 50.5% (95%CI: 45.6%-55.3%). Socio-demographic factors included age, marital status, location of practice, profession, and income. Vaccine Hesitancy was predicted significantly by younger age (aOR=9.34, 95%CI:2.01-43.39), marital status (single) (aOR=4.97, 95%CI:1.46-16.97), lower income (aOR=2.84, 95%CI:1.32-6.08), and profession - Doctor (aOR=0.28, 95%CI:0.11-0.70), Nurse (aOR=0.31, 95%CI:0.15-0.64) and other allied health professionals (aOR=0.22, 95%CI:0.10-0.44). CONCLUSION: COVID-19 vaccine hesitancy was high among healthcare workers. Significant sociodemographic predictors influence the uptake of the COVID-19 vaccine. We recommend that the Federal and State Ministries of Health conduct awareness campaigns targeting the younger age group, singles, lower income class, and non-clinical staff.

Determinants of COVID-19 vaccine hesitancy among health care workers in Amhara region referral hospitals, Northwest Ethiopia: a cross-sectional study.

Vaccine hesitancy remains a serious global threat to achieve herd immunity, and this study aimed to assess the magnitude and associated factors of coronavirus disease-19 (COVID-19) vaccine hesitancy among healthcare workers (HCWs) in Amhara regional referral hospitals. A web-based anonymised survey was conducted among 440 HCWs in the Amhara region referral hospitals. The questionnaire was designed using Google Forms and distributed using telegram and e-mail from 15 May to 10 June 2021 to the randomly selected participants in each hospital. The data were analysed with Stata 14.0 and described using frequency tables. A multivariable binary logistic regression model was fitted and model fitness was checked with the Hosmer-Lemeshow goodness of fit test. Out of 440 participants, 418 were willing to participate in the study and the mean age was about 30 years. Overall, 45.9% (n = 192) of participants reported vaccine hesitancy. After applying multivariate analysis, age ≤25 years (adjusted odds ratio (aOR) = 5.6); do not wear a mask (aOR = 2.4); not compliance with physical distancing (aOR = 3.6); unclear information by public health authorities (aOR = 2.5); low risk of getting COVID-19 infection (aOR = 2.8); and not sure about the tolerability of the vaccine (aOR = 3.76) were associated with COVID-19 vaccine hesitancy. A considerable proportion of HCWs were hesitant towards COVID-19 vaccine, and this can be tackled with the provision of clear information about the vaccine.

Misinformation, perceptions towards COVID-19 and willingness to be vaccinated: A population-based survey in Yemen.

BACKGROUND: Since the beginning of the COVID-19 outbreak, many pharmaceutical companies have been racing to develop a safe and effective COVID-19 vaccine. Simultaneously, rumors and misinformation about COVID-19 are still widely spreading. Therefore, this study aimed to investigate the prevalence of COVID-19 misinformation among the Yemeni population and its association with vaccine acceptance and perceptions. METHODS: A cross-sectional online survey was conducted in four major cities in Yemen. The constructed questionnaire consisted of four main sections (sociodemographic data, misinformation, perceptions (perceived susceptibility, severity, and worry), and vaccination acceptance evaluation). Subject recruitment and data collection were conducted online utilizing social websites and using the snowball sampling technique. Descriptive and inferential analyses were performed using SPSS version 27. RESULTS: The total number of respondents was 484. Over 60% of them were males and had a university education. More than half had less than 100$ monthly income and were khat chewers, while only 18% were smokers. Misinformation prevalence ranged from 8.9% to 38.9%, depending on the statement being asked. Men, university education, higher income, employment, and living in urban areas were associated with a lower misinformation level (p <0.05). Statistically significant association (p <0.05) between university education, living in urban areas, and being employed with perceived susceptibility were observed. The acceptance rate was 61.2% for free vaccines, but it decreased to 43% if they had to purchase it. Females, respondents with lower monthly income, and those who believed that pharmaceutical companies made the virus for financial gains were more likely to reject the vaccination (p <0.05). CONCLUSION: The study revealed that the acceptance rate to take a vaccine was suboptimal and significantly affected by gender, misinformation, cost, and income. Furthermore, being female, non-university educated, low-income, and living in rural areas were associated with higher susceptibility to misinformation about COVID-19. These findings show a clear link between misinformation susceptibility and willingness to vaccinate. Focused awareness campaigns to decrease misinformation and emphasize the vaccination's safety and efficacy might be fundamental before initiating any mass vaccination in Yemen.

COVID-19 vaccine hesitancy among patients with diabetes in Saudi Arabia.

BACKGROUND AND AIMS: The survey aimed to assess COVID-19 vaccine acceptance and hesitancy rate among patients with diabetes and address barriers and beliefs that affect acceptance to take COVID-19 vaccine. METHODS: A quantitative research approach with cross-sectional design was used to collect data from March-May'2021. Saudi residents with diabetes, aged ≥18 years were included. RESULTS: Of the total 709 participants, 42.2% had family member with COVID-19, 14.7% had COVID-19, 34.0% had been with someone who had COVID-19. 34.7% of participants taken COVID-19 vaccination, 36.2% were willing to take, while 79.0% supported COVID-19 vaccine. Main reasons behind uncertainties towards vaccinations were relatively fast production, not many trials done and about genetic component. 44.6% got information about COVID-19 and vaccination through television, social media, and ministry website. On adjusting models, female gender, longer duration of diabetes and no history of influenza vaccine significantly associated with COVID vaccine uptake. CONCLUSION: Participants are willing to vaccinate but show some fear and misinformation. It is imperative that due efforts are made for increasing vaccine willingness, and availability of precise information holds key to success. Otherwise, state will have to continue to funnel in resources towards post-on-set disease management, consuming a lot more resources than preventive measures like vaccination.

Addressing vaccine hesitancy and access barriers to achieve persistent progress in Israel's COVID-19 vaccination program.

As of March 31, 2021, Israel had administered 116 doses of vaccine for COVID-19 per 100 population (of any age) - far more than any other OECD country. It was also ahead of other OECD countries in terms of the share of the population that had received at least one vaccination (61%) and the share that had been fully vaccinated (55%). Among Israelis aged 16 and over, the comparable figures were 81 and 74%, respectively. In light of this, the objectives of this article are: 1. To describe and analyze the vaccination uptake through the end of March 2021 2. To identify behavioral and other barriers that likely affected desire or ability to be vaccinated 3. To describe the efforts undertaken to overcome those barriers Israel's vaccination campaign was launched on December 20, and within 2.5 weeks, 20% of Israelis had received their first dose. Afterwards, the pace slowed. It took an additional 4 weeks to increase from 20 to 40% and yet another 6 weeks to increase from 40 to 60%. Initially, uptake was low among young adults, and two religious/cultural minority groups - ultra-Orthodox Jews and Israeli Arabs, but their uptake increased markedly over time.In the first quarter of 2021, Israel had to enhance access to the vaccine, address a moderate amount of vaccine hesitancy in its general population, and also address more intense pockets of vaccine hesitancy among young adults and religious/cultural minority groups. A continued high rate of infection during the months of February and March, despite broad vaccination coverage at the time, created confusion about vaccine effectiveness, which in turn contributed to vaccine hesitancy. Among Israeli Arabs, some residents of smaller villages encountered difficulties in reaching vaccination sites, and that also slowed the rate of vaccination.The challenges were addressed via a mix of messaging, incentives, extensions to the initial vaccine delivery system, and other measures. Many of the measures addressed the general population, while others were targeted at subgroups with below-average vaccination rates. Once the early adopters had been vaccinated, it took hard, creative work to increase population coverage from 40 to 60% and beyond.Significantly, some of the capacities and strategies that helped Israel address vaccine hesitancy and geographic access barriers are different from those that enabled it to procure, distribute and administer the vaccines. Some of these strategies are likely to be relevant to other countries as they progress from the challenges of securing an adequate vaccine supply and streamlining distribution to the challenge of encouraging vaccine uptake.

Association Between Human Papillomavirus Vaccination and Primary Ovarian Insufficiency in a Nationwide Cohort.

Importance: Anecdotal case reports have suggested an association between human papillomavirus (HPV) vaccination and primary ovarian insufficiency, but observational studies of HPV and primary ovarian insufficiency are rare, and their findings do not support an association. However, available studies have been limited by statistical power, and concerns about infertility after vaccination are associated with lower levels of uptake of the cancer-preventing vaccine in many countries. Objective: To evaluate the risk of primary ovarian insufficiency after quadrivalent human papillomavirus (4HPV) vaccination. Design, Setting, and Participants: This retrospective cohort study with follow-up from 2007 to 2016 used nationwide data for 996 300 Danish-born girls and women aged 11 to 34 years. Cox proportional hazards regression was used to estimate hazard ratios (HRs) of primary ovarian insufficiency diagnoses by 4HPV vaccination status with adjustment for age, calendar period, and a propensity score summarizing health care use. Data were analyzed from October 2020 to January 2021. Exposures: Receiving 4HPV vaccination compared with receiving no vaccination. Main Outcomes and Measures: The main outcome was hospital contacts for primary ovarian insufficiency, and the main outcome measures were HRs comparing rates of primary ovarian insufficiency among vaccinated and unvaccinated individuals. Results: During 6 781 166 person-years of follow-up among 996 300 girls and women aged 11 to 34 years (505 829 vaccinated individuals [50.8%] and 490 471 unvaccinated individuals [49.2%]), 144 individuals were diagnosed with primary ovarian insufficiency, including 54 individuals diagnosed after 4HPV vaccination. The median (interquartile range) age of primary ovarian insufficiency diagnosis was 26.94 (12.68) years. The adjusted HR of primary ovarian insufficiency comparing 4HPV vaccination to no vaccination was 0.96 (95% CI, 0.55-1.68). Conclusions and Relevance: This study found no association between HPV vaccination and primary ovarian insufficiency. However, given the rarity of the outcome in this study, the presence of a clinically relevant increase in rate of diagnosis cannot be excluded.