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Introduction: Understanding changes in vaccine hesitancy, overall and by sociodemographic characteristics, may highlight sub-populations for whom more intensive efforts are needed to increase vaccine uptake and confidence. Methods: We analyzed data using the CDC's Research and Development Survey (RANDS), a nationally representative survey of U.S. adults ≥18years, collected from 17 May 2021-30 June 2021 (n=5,458) and 3 November 2022-12 December 2022 (n=6,821). We assessed changes in vaccine hesitancy, changes in vaccine attitudes and attitudes, and factors associated with hesitancy toward both vaccines in general and COVID-19 vaccines among a nationally representative sample of U.S. adults. Results: Although COVID-19 vaccination (≥1 dose) increased from 67.2% (2021) to 74.7% (2022), COVID-19 vaccine hesitancy increased from 40.7% to 44.6% during the same period. During the same period, hesitancy toward both COVID-19 vaccines and vaccines in general increased among those who were aged ≥65 years and who were non-Hispanic White. However, COVID-19 vaccine hesitancy decreased among non-Hispanic Black adults. Current or former smokers were more hesitant toward vaccines in general (aPR = 1.13, 95%CI: 1.03-1.24) and toward COVID-19 vaccines (aPR = 1.08, 95%CI: 1.01-1.16) compared to never smokers. Among adults who did not receive any COVID-19 vaccines, COVID-19 vaccine hesitancy increased from 86.6% in 2021 to 92.4% in 2022. Furthermore, belief in the overall social benefit of the COVID-19 vaccine decreased from 47.5% to 25.1%. Conclusion: This study highlights concerning trends in vaccine hesitancy and uptake of the COVID-19 and other recommended vaccines. We found that some high-risk groups (e.g. smokers) and population subgroups have become more vaccine hesitant, suggesting the need for improved and intensified strategies to increase vaccine confidence and uptake. Future research may focus on qualitative inquiry to understand specific concerns and determinants contributing to increased hesitancy among these groups to help inform interventions and communication campaigns to support vaccination. [ABSTRACT FROM AUTHOR]

The health-care workers (HCWs) were one of the vulnerable populations prioritized during the COVID-19 vaccination (COVISHIELD and COVAXIN) campaign. We aimed to estimate vaccine hesitancy and explore influencing factors among 238 HCWs in 21 Urban Primary Health Centres (UPHCs) across Hyderabad during June and July 2021. We used a semi-structured questionnaire and the SAGE determinants of vaccine hesitancy to determine factors underlying vaccine hesitancy and acceptance. A thematic framework was developed to unpack the factors that shaped the perceptions about the COVID-19 vaccine. We found a 17% hesitancy rate, primarily due to concerns about “vaccine-safety.” HCWs were susceptible to misinformation, potentially shaping their views on COVID-19 vaccines. Despite regulatory approval, one in six HCWs in Hyderabad’s UPHCs delayed or refused vaccinations, citing limited “vaccine-safety” information. This underscores the urgent need to address HCW vaccine hesitancy early, given its potential impact on general vaccine acceptance.

We developed and tested MivacunaLA/MyshotLA, a community-informed mobile phone intervention, to increase COVID-19 vaccination among Latino parents/caretakers of minors in under-resourced areas of Los Angeles by addressing misinformation and building trust. We recruited Latino parents/caregivers with at least one unvaccinated child in East and South Los Angeles in the summer of 2021 and evaluated MivacunaLA as a randomized controlled trial with a wait-list control group. A difference-in-difference analysis showed Latino parents/caregivers that participated in MivacunaLA (n = 246), in comparison to the control group, were 15 percentage points more likely (p = 0.04) to report vaccination of minors aged 12-17 years, and 12 percentage points more likely (p = 0.03) to report a positive intention to vaccinate minors aged 2-11 years (when COVID-19 vaccines became available). Mobile phone-delivered digital interventions using videos and culturally tailored educational material to promote COVID-19 vaccine confidence can be an effective way to combat misinformation and deliver timely information to marginalized communities. Community-based participatory research approaches are crucial to advance health equity among minority communities, especially immigrant Spanish-speaking underserved communities.

Abstract Background Vaccine confidence is described as a belief that vaccines are effective, safe, and part of a trustworthy health system. The objective of this study was to develop and validate an Arabic tool to evaluate confidence in the received coronavirus disease 2019 (COVID-19) vaccines (ARAB-VAX-CONF). Methods The research team developed the ARAB-VAX-CONF based on three areas specified by the Centers for Disease Control and Prevention (CDC): confidence in vaccine effectiveness, confidence in vaccine safety, and confidence in the healthcare system. The analysis includes data from 406 eligible vaccinated persons (≥ 18 years). Cronbach’s alpha was used to measure internal consistency, while convergent, discriminant, exploratory, and confirmatory factor analyses were used to verify construct validity. Results A total of 406 adults were recruited, with a mean age of 33.0 ± 12.2 years. A total of 63.1% were males, 56.7% were married, 21.9% had chronic conditions, 93.3% were nonsmokers, and 39.6% were obligated to obtain vaccines. The three domains of the scale met the criterion of internal consistency (Cronbach’s alpha > 0.7). Convergent validity was identified by the significant inter-item and item-mean score of the domain correlation (P

Abstract Background Black people are disproportionately affected by structural and social determinants of health, resulting in greater risks of exposure to and deaths from COVID-19. Structural and social determinants of health feed vaccine hesitancy and worsen health disparities. Objective This scoping review explored interventions that have been employed to address vaccine hesitancy among Black population outside of African and Caribbean countries. This review provides several strategies for addressing this deep-rooted public health problem. Methods The scoping review followed the five-step framework outlined by Arksey and O’Malley. It complies with reporting guidelines from the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Research studies that examined interventions utilized to promote vaccine confidence within Black populations living outside of African and Caribbean countries were reviewed. Findings A total of 20 articles met the inclusion criteria for this study: 17 were quantitative studies and three were mixed-method studies. This scoping review highlighted six themes: educational advancement, messaging, multi-component approaches, outreach efforts, enhancing healthcare access, and healthcare provider leadership. Conclusion The review identified effective interventions for addressing vaccine hesitancy among Black populations outside Africa and the Caribbean, emphasizing education, multidimensional approaches, and healthcare provider recommendations. It calls for more qualitative research and interventions in countries like Canada and the UK to enhance vaccine confidence and reduce mistrust.

Lale Türkmen Medical Laboratory Department, Vocational School of Health Services, Gazi University, Ankara, TurkeyCorrespondence: Lale Türkmen, Medical Laboratory Department, Vocational School of Health Services, Gazi University, Bahçelievler District, Gölbaşı Campus, No: 10, Ankara, Turkey, Tel +90 0532 625 19 63, Email lturkmen@gazi.edu.trPurpose: A lack of confidence in vaccination is a threat to public health and undermines vaccine uptake at national and global levels. Unfortunately, COVID-19 vaccine confidence among Turkish young adults is poorly known. This study aims to understand COVID-19 vaccine confidence among Turkish young adults aged 18– 29 and the barriers to and facilitators of vaccine uptake.Methods: The present research is a cross-sectional study. Survey data were collected in May and June 2022 (n = 1066) during the COVID-19 vaccination campaign. Results were expressed in frequencies and percentages for dichotomous variables and mean with standard deviation for continuous variables. To assess COVID-19 vaccine confidence based on selected sociodemographic characteristics, a one-way ANOVA analysis and an independent-sample t-test were used.Results: Almost half of the sample (43.9%) underestimated the risk of contracting COVID-19 disease. 65.9% of participants believed that getting vaccinated against COVID-19 was important, while 47.8% thought the vaccine was safe and not dangerous or harmful. Concerns about vaccine effectiveness (58.3%) were the primary reported reason for vaccination. The percentage of participants who reported barriers to vaccine access was generally low (8.7%). Importantly, 63.9% believed getting vaccinated is their responsibility to their community. 33.8% of participants reported encountering inaccurate, misleading, and unfavorable information about COVID-19 vaccines, while 22.9% said they were unsure.Conclusion: Addressing concerns about COVID-19 vaccine safety and efficacy, emphasizing the role of vaccination in societal benefits, ensuring easy access to vaccines, and providing access to up-to-date and accurate information from reliable sources might help increase coverage among young adults. Perhaps the most crucial advice is to instill the correct comprehension of vaccination and make lifelong vaccination a reality before individuals develop false beliefs that are challenging to rectify.Keywords: COVID-19, vaccine confidence, decision-making, socio-cultural factors, young adults

Abstract Background Across the globe, racial and ethnic minorities have been disproportionately affected by COVID-19 with increased risk of infection and burden from disease. Vaccine hesitancy has contributed to variation in vaccine uptake and compromised population-based vaccination programs in many countries. Connect, Collaborate and Tailor (CCT) is a Public Health Agency of Canada funded project to make new connections between public health, healthcare professionals and underserved communities in order to create culturally adapted communication about COVID-19 vaccines. This paper describes the CCT process and outcomes as a community engagement model that identified information gaps and created tailored tools to address misinformation and improve vaccine acceptance. Methods Semi-structured interviews with CCT participants were undertaken to evaluate the effectiveness of CCT in identifying and addressing topics of concern to underserved and ethnic minority communities. Interviews also explored CCT participants’ experiences of collaboration through the development of new partnerships between ethnic minority communities, public health and academic researchers, and the evolution of co-operation sharing ideas and creating infographics. Thematic analysis was used to produce representative themes. The activities described were aligned with the levels of public engagement described in the IAP2 spectrum (International Association for Public Participation). Results Analysis of interviews (n = 14) revealed that shared purpose and urgency in responding to the COVID-19 pandemic motivated co-operation among CCT participants. Acknowledgement of past harm, present health, and impact of social inequities on public service access was an essential first step in establishing trust. Creating safe spaces for open dialogue led to successful, iterative cycles of consultation and feedback between participants; a process that not only helped create tailored infographics but also deepened engagement and collaboration. Over time, the infographic material development was increasingly directed by community representatives’ commentary on their groups’ real-time needs and communication preferences. This feedback noticeably guided the choice, style, and presentation of infographic content while also directing dissemination strategies and vaccine confidence building activities. Conclusions The CCT process to create COVID-19 vaccine communication materials led to evolving co-operation between groups who had not routinely worked together before; strong community engagement was a key driver of change. Ensuring a respectful environment for open dialogue and visibly using feedback to create information products provided a foundation for building relationships. Finally, our data indicate participants sought reinforcement of close cooperative ties and continued investment in shared responsibility for community partnership-based public health.

Background: Vaccine confidence is described as a belief that vaccines are effective, safe, and part of a trustworthy health system. The objective of this study was to develop and validate an Arabic tool to evaluate confidence in the received coronavirus disease 2019 (COVID-19) vaccines (ARAB-VAX-CONF). Methods: The research team developed the ARAB-VAX-CONF based on three areas specified by the Centers for Disease Control and Prevention (CDC): confidence in vaccine effectiveness, confidence in vaccine safety, and confidence in the healthcare system. The analysis includes data from 406 eligible vaccinated persons (≥ 18 years). Cronbach's alpha was used to measure internal consistency, while convergent, discriminant, exploratory, and confirmatory factor analyses were used to verify construct validity. Results: A total of 406 adults were recruited, with a mean age of 33.0 ± 12.2 years. A total of 63.1% were males, 56.7% were married, 21.9% had chronic conditions, 93.3% were nonsmokers, and 39.6% were obligated to obtain vaccines. The three domains of the scale met the criterion of internal consistency (Cronbach's alpha > 0.7). Convergent validity was identified by the significant inter-item and item-mean score of the domain correlation (P < 0.001). Discriminant validity was reported as the inter-factor correlation matrix (< 0.7). The Kaiser–Meyer–Olkin sampling adequacy measure was 0.80, and Bartlett's sphericity test was significant (P < 0.001). Exploratory factor analysis indicated that the scale could be summarized into three factors. Confirmatory factor analysis confirmed the adequate psychometric properties and fit with observed data (root-mean-square error of approximation = 0.08, comparative fit index = 0.945, Tucker-Lewis index = 0.924, standardized root-mean-square residual = 0.086, normed fit index = 0.918, and goodness-of-fit index = 0.909). Conclusions: The ARAB-VAX-CONF developed in this study is valid and reliable for assessing confidence in vaccine effectiveness, safety, and confidence in the healthcare system. The ARAB-VAX-CONF can support decision-makers in addressing the gap in vaccine confidence among various populations. [ABSTRACT FROM AUTHOR]

Background: Youth have been uniquely affected by the COVID‐19 pandemic. Despite high rates of COVID‐19 infection, youth had one of the lowest vaccine uptake rates. Certain characteristics can affect vaccine uptake, such as mental health and substance use, but it is important to understand uptake for an effective response to pandemics. Objective: This study examined the perspectives of youth with mental health or substance use concerns on COVID‐19 vaccine confidence, hesitancy and overall COVID‐19 vaccine perspectives. Methods: Using photovoice, a community‐based participatory research method, a sample of 27 youth aged 14−24 years participated in a series of photography workshops and focus groups. Participants submitted final photographs for discussion. Focus groups were recorded, transcribed and thematically analysed. Results: Four themes were generated: (1) Youth deciphered the vaccine discourse in a changing information landscape; (2) mixed perspectives of families, friends and loved ones influenced the vaccine journey; (3) complex societal influences affected views and decisions around the COVID‐19 vaccine; and (4) youth navigated their vaccine journeys through first‐ and second‐hand experiences. The four themes and subthemes highlight the evolution of youth's journeys with the COVID‐19 vaccine over the course of the pandemic and into the late‐pandemic period. Conclusions: Youth with mental health or substance use challenges navigated a complex environment during the COVID‐19 pandemic. The wide variety of factors influencing vaccine perspectives should be taken into account in public health messaging and future research on youth vaccine uptake. Youth‐led and youth‐engaged research can help solicit rich and meaningful perspectives of young people on important public health issues. Patient or Public Contribution: This was a youth‐led study. A youth research analyst conducted the study activities together with the support of a youth advisory group, an adult photographer with lived experience, and a scientific team. [ABSTRACT FROM AUTHOR]

Background: Across the globe, racial and ethnic minorities have been disproportionately affected by COVID-19 with increased risk of infection and burden from disease. Vaccine hesitancy has contributed to variation in vaccine uptake and compromised population-based vaccination programs in many countries. Connect, Collaborate and Tailor (CCT) is a Public Health Agency of Canada funded project to make new connections between public health, healthcare professionals and underserved communities in order to create culturally adapted communication about COVID-19 vaccines. This paper describes the CCT process and outcomes as a community engagement model that identified information gaps and created tailored tools to address misinformation and improve vaccine acceptance. Methods: Semi-structured interviews with CCT participants were undertaken to evaluate the effectiveness of CCT in identifying and addressing topics of concern to underserved and ethnic minority communities. Interviews also explored CCT participants' experiences of collaboration through the development of new partnerships between ethnic minority communities, public health and academic researchers, and the evolution of co-operation sharing ideas and creating infographics. Thematic analysis was used to produce representative themes. The activities described were aligned with the levels of public engagement described in the IAP2 spectrum (International Association for Public Participation). Results: Analysis of interviews (n = 14) revealed that shared purpose and urgency in responding to the COVID-19 pandemic motivated co-operation among CCT participants. Acknowledgement of past harm, present health, and impact of social inequities on public service access was an essential first step in establishing trust. Creating safe spaces for open dialogue led to successful, iterative cycles of consultation and feedback between participants; a process that not only helped create tailored infographics but also deepened engagement and collaboration. Over time, the infographic material development was increasingly directed by community representatives' commentary on their groups' real-time needs and communication preferences. This feedback noticeably guided the choice, style, and presentation of infographic content while also directing dissemination strategies and vaccine confidence building activities. Conclusions: The CCT process to create COVID-19 vaccine communication materials led to evolving co-operation between groups who had not routinely worked together before; strong community engagement was a key driver of change. Ensuring a respectful environment for open dialogue and visibly using feedback to create information products provided a foundation for building relationships. Finally, our data indicate participants sought reinforcement of close cooperative ties and continued investment in shared responsibility for community partnership-based public health. [ABSTRACT FROM AUTHOR]

Purpose: We examined associations between vaccine confidence and COVID-19 vaccine uptake among gay, bisexual, and other men who have sex with men (GBMSM). Methods: Computer-assisted self-interviews were conducted among 249 GBMSM participating in mSTUDY from May to October 2021-a cohort of GBMSM with a history of substance use in Los Angeles. Data were collected using a vaccine confidence index. The association between vaccine confidence and COVID-19 vaccine uptake was assessed using multivariable log-binomial regression. Results: Two-thirds (64.7%) of GBMSM reported receiving at least one dose of COVID-19 vaccine. Vaccine confidence was positively associated with COVID-19 vaccine uptake. Participants expressed neutral attitudes on government trust and vaccine safety. Perceived health benefit and vaccine effectiveness were statistically significantly associated with vaccine uptake (adjusted prevalence ratio [APR] = 1.59, 95% confidence interval [CI]: 1.20-2.16; APR = 1.51, 95% CI: 1.07-2.15). Conclusions: Public health programs should prioritize public benefit and vaccine effectiveness messaging to advance vaccination among GBMSM who use substances.

Improving vaccine confidence is a topic of major public health importance. Reasons for vaccine hesitancy are multifactorial, making it challenging to find strategies to address them. This systematic review aimed to synthesize the literature on how co-design has been used to reduce vaccine hesitancy. We searched six databases in March and October 2024. Eligible studies described the co-design process used to develop interventions for addressing vaccine hesitancy and increasing vaccine confidence. We assessed the quality of included studies, extracted and descriptively summarized the key data. Twenty-seven articles were included, 20 of which were based in a high-income setting. Most studies centered on the COVID-19 (n = 9) and HPV (n = 9) vaccines. Co-design yielded diverse interventions, with videos being the most common intervention format (n = 11). We observed substantial variations in the reporting style and terminology used within the studies and limited attempts to assess intervention effectiveness.

ABSTRACTHealthcare workers (HCW) perceptions toward vaccines influence patient and community vaccine decision making. In an era of rising vaccine hesitancy, understanding HCW vaccine confidence is critical. This systematic review aims to review instruments that have been validated to measure HCW vaccine confidence. We conducted a search in five databases in June 2023. Data was descriptively synthesized. Twelve articles describing 10 different tools were included. Most tools included dimensions or items on vaccine knowledge (n = 9), safety (n = 8), vaccine usefulness (n = 8), recommendation behavior (n = 8), and self-vaccination practice (n = 7). All, except one study, were conducted in high-income countries. There was variability in the quality of the validation process. There is limited existing literature on development and validation of tools for HCW vaccine confidence. Based on the tools currently available, the Pro-VC-Be tool is the most well validated. Further research needs to include low- and middle-income contexts.

Introduction Understanding changes in vaccine hesitancy, overall and by sociodemographic characteristics, may highlight sub-populations for whom more intensive efforts are needed to increase vaccine uptake and confidence.Methods We analyzed data using the CDC’s Research and Development Survey (RANDS), a nationally representative survey of U.S. adults ≥18 years, collected from 17 May 2021–30 June 2021 (n = 5,458) and 3 November 2022–12 December 2022 (n = 6,821). We assessed changes in vaccine hesitancy, changes in vaccine attitudes and attitudes, and factors associated with hesitancy toward both vaccines in general and COVID-19 vaccines among a nationally representative sample of U.S. adults.Results Although COVID-19 vaccination (≥1 dose) increased from 67.2% (2021) to 74.7% (2022), COVID-19 vaccine hesitancy increased from 40.7% to 44.6% during the same period. During the same period, hesitancy toward both COVID-19 vaccines and vaccines in general increased among those who were aged ≥65 years and who were non-Hispanic White. However, COVID-19 vaccine hesitancy decreased among non-Hispanic Black adults. Current or former smokers were more hesitant toward vaccines in general (aPR = 1.13, 95%CI: 1.03–1.24) and toward COVID-19 vaccines (aPR = 1.08, 95%CI: 1.01–1.16) compared to never smokers. Among adults who did not receive any COVID-19 vaccines, COVID-19 vaccine hesitancy increased from 86.6% in 2021 to 92.4% in 2022. Furthermore, belief in the overall social benefit of the COVID-19 vaccine decreased from 47.5% to 25.1%.Conclusion This study highlights concerning trends in vaccine hesitancy and uptake of the COVID-19 and other recommended vaccines. We found that some high-risk groups (e.g. smokers) and population subgroups have become more vaccine hesitant, suggesting the need for improved and intensified strategies to increase vaccine confidence and uptake. Future research may focus on qualitative inquiry to understand specific concerns and determinants contributing to increased hesitancy among these groups to help inform interventions and communication campaigns to support vaccination.

During the coronavirus disease 2019 (COVID-19) pandemic, scheduled vaccinations were postponed, mass vaccination programmes were suspended and opportunities for healthcare workers to administer vaccines ad hoc decreased. The aims of this systematic literature review were to determine the impact of the COVID-19 pandemic on vaccine confidence, intent and uptake in preexisting routine childhood or adult vaccination programmes, and to identify factors associated with changes in acceptance, intent and uptake of preexisting vaccines. Medline and Embase were searched for studies in Australia, Brazil, Canada, China, Japan, the USA, and European countries, published between 1 January 2021 and 4 August 2022. A complementary gray literature search was conducted between 11 and 13 October 2022, and supplemented with additional gray research in October 2023. In total, 54 citations were included in the review. Study design and geography were heterogeneous. The number of adults who received or intended to receive an influenza or pneumococcal vaccine was higher during the pandemic than in previous seasons (n = 28 studies). In addition, increased acceptance of adult vaccinations was observed during 2020–21 compared with 2019–20 (n = 12 studies). The rates of childhood vaccinations decreased during the COVID-19 pandemic across several countries (n = 11 studies). Factors associated with changes in intention to receive a vaccination, or uptake of influenza vaccine, included previous vaccination, older age, higher perceived risk of contracting COVID-19, anxiety regarding the pandemic and fear of contracting COVID-19. Acceptance and uptake of influenza and pneumococcal vaccines generally increased after onset of the COVID-19 pandemic.

COVID-19 vaccination effectively reduces disease severity, hospitalization, and mortality, particularly among individuals with chronic conditions who bear a disproportionate burden of disease complications. Vaccine confidence – belief in its safety, effectiveness, and importance – boosts uptake. However, limited data on vaccine confidence in this population hinders the development of targeted interventions. This study examined COVID-19 vaccine confidence and its impact on uptake among individuals with hypertension or diabetes mellitus in the Kilimanjaro region, Tanzania. A community-based cross-sectional study was conducted in March 2023 among 646 randomly selected adults aged ≥18 years with hypertension or diabetes mellitus in three districts of Kilimanjaro region, northern Tanzania. An interviewer-administered electronic questionnaire assessed confidence and uptake of COVID-19 vaccines in addition to related knowledge and demographic characteristics. Data analysis was done for 646 individuals who consented to participate. Multivariable logistic regression models determined the factors associated with COVID-19 vaccine confidence and its effect on vaccine uptake. The proportion of COVID-19 vaccine confidence among all 646 participants was 70% and was highest for perceived vaccine importance (80%), followed by perceived vaccine effectiveness (77%) and perceived vaccine safety (74%). Good knowledge of COVID-19 vaccines and living in the Mwanga municipal council (MC), a semi-urban district, was independently associated with confidence in the vaccines’ importance, safety, effectiveness, and overall COVID-19 vaccine confidence. Confidence in COVID-19 vaccines increased the odds of vaccine uptake. Targeted interventions to boost vaccine confidence are therefore essential to enhance vaccine uptake in this high-risk population.

Background People with disabilities are at increased risk for severe COVID-19 health outcomes and face barriers accessing COVID-19 vaccines. The aim of this study is to examine receipt of ≥ 1 dose of the COVID-19 vaccine, intention to vaccinate in the future, and reasons for not vaccinating among people with disabilities and functional limitations using a large, nationally representative dataset of adults in the United States.Methods Data were analyzed from the Census Bureau’s Household Pulse Survey (14–26 April 2021, n = 68,913). Separate logistic regression models were conducted to examine the association between each disability (vision, hearing, cognition and mobility), overall disability status, and functional status on ≥1 dose COVID-19 vaccination receipt and intention to vaccinate. Furthermore, reasons for not getting vaccinated were examined among those with disabilities or functional limitations.Results Approximately 13% of adults reported having a disability, and almost 60% reported having some or a lot of functional limitations. Over 65% of adults with disabilities had received ≥1 dose of COVID-19 vaccines, compared to 73% among adults without disabilities (adjusted prevalence ratio = 0.94). Among adults with disabilities, those who were younger, had lower educational attainment and income, did not have insurance and had a prior history of COVID-19 were less likely to get vaccinated or intend to get vaccinated than their respective counterparts. The main reasons for not getting vaccinated were concerns about possible side effects (52.1%), lack of trust in COVID-19 vaccines (45.4%) and lack of trust in the government (38.6%).Discussion and conclusion Efforts to ensure high and equitable vaccination coverage include working with communities to strengthen the message that the vaccine is safe and effective, educating health professionals about the need to recommend and promote vaccines, and making vaccination sites more accessible for people who need additional accommodations.

Healthcare workers (HCWs) are trusted sources of information for vaccination and their attitude toward vaccination is thus critical. We aimed to synthesize existing literature on healthcare workers’ HPV vaccine confidence and their practices of recommending this vaccine. We conducted a systematic literature review and meta-analysis, with the search conducted last in March 2024. For the inclusion criteria, the studies needed to include healthcare worker practices or behaviors on recommending the HPV vaccination. Seventy-three articles were included. The proportions of HCWs recommending varied considerably by region and gender of the recipient, but there was no statistically significant difference in income level or pre- or post-HPV vaccine introduction into the national vaccination program. The main barriers to recommending HPV vaccination were concerns around safety and efficacy, cost, parental concerns, and systemic barriers. The results illustrate the importance of contextually adapted approaches to improving vaccine acceptance and recommendation.

Purpose: Human papillomavirus (HPV) vaccine uptake is lower in rural areas, particularly for boys. The purpose of the study was to demonstrate how a participatory approach to developing a series of videos about the HPV vaccine better meets the informational needs of rural parents. Methods: We recruited six rural parents to participate on a parent advisory board (PAB). The PAB met monthly spanning five months (n = 5 meetings) from February to May 2023. Each meeting focused on an element of video creation, including: 1) Providing feedback on existing HPV vaccine videos created by federal agencies and developing a tailored plan for local rural parents; 2) Providing feedback on the video plan so the study team could draft scripts; 3) Editing scripts; 4) Finalizing video concepts; and 5) Providing feedback to produced videos. Between meetings, parents completed tasks to facilitate the process, which also served as a way for parent input to be documented. We worked with a local, professional videographer to produce the videos. A local parent and a nurse practitioner were recruited as actors. Results: Six one-minute videos were produced on the following topics: What is HPV?; Does the vaccine prevent cancer?; How does the vaccine work?; Is the vaccine safe?; Who should get the vaccine?; and Where can you go to get the vaccine? The PAB was essential in clarifying source, message, channel and receiver throughout the video creation process. Conclusions: Engaging parents to co-create a series of one-minute videos supports HPV vaccine confidence efforts in rural areas.

Abstract Background Healthcare professionals (HCPs) can play an important role in encouraging patients and their caregivers to be vaccinated. The objective of this qualitative study was to investigate HCPs’ perspectives on challenges in vaccine communication and unmet training needs in this domain. Methods Semi-structured interviews were conducted with 41 HCPs (mainly nurses and physicians) with vaccination roles (23 in England; 18 in France), gathering information on: (1) HCPs’ approach to vaccine conversations with patients; (2) Challenges of communicating about vaccines; (3) Vaccine-related training and learning resources available to HCPs, and; (4) HCPs’ training needs around vaccine communication. Results HCPs described a range of communication experiences that indicated insufficient time, information, and skills to confidently navigate difficult conversations with vaccine-hesitant patients. Communication skills were especially important to avoid conflict that could potentially damage the patient-provider relationship. Some HCPs interviewed had received communication training, but for most, this training was not specific to vaccination. Although general communication skills were transferable to vaccine conversations, most HCPs welcomed specific training and informational resources to support countering patients’ misconceptions or misinformation about vaccines. Conclusions HCPs would benefit from training tailored to address vaccine communication with patients, and this should be part of a systemic approach that also provides time and space to have effective vaccine conversations.

Abstract Background Vaccination is one of the greatest tools for individuals to stay healthy. Individuals are, however, often exposed to misinformation via digital and social media, and thus, may miss the opportunity to develop scientific knowledge about vaccines and trust in relevant stakeholders. This has a damaging impact on vaccine confidence. Understanding vaccine confidence is particularly important in North Dakota, where vaccination rates are lower than national averages. Objectives The objectives of this research are to examine the association between vaccine confidence and three potential sources of it, namely, trust, vaccine knowledge, and vaccine information sources and to investigate the relative strength of three vaccine confidence sources, while accounting for covariates. Methods Students (n = 517, 56.6%) and staff and faculty (n = 397, 43.4%) at the University of North Dakota (n = 914) completed an online survey. Logistic regressions estimated odds ratios (OR) and 95% confidence intervals (CI) for associations among trust in doctors, family/friends, government health agencies, charitable organizations, and religious organizations, vaccine knowledge, vaccine information sources as well as vaccine confidence, accounting for gender, race, marital status, age, religion, political ideology, education, and health status. Results The mean age of participants was 29.43 years (SD = 13.48). Most were females (71.6%) and white (91.5%). Great trust in doctors (OR = 3.29, p

Our study focused on the discovery of how vaccine hesitancy is framed in Twitter discourse, allowing us to recognize at-scale all tweets that evoke any of the hesitancy framings as well as the stance of the tweet authors towards the frame. By categorizing the hesitancy framings that propagate misinformation, address issues of trust in vaccines, or highlight moral issues or civil rights, we were able to empirically recognize their ontological commitments. Ontological commitments of vaccine hesitancy framings couples with the stance of tweet authors allowed us to identify hesitancy profiles for two most controversial yet effective and underutilized vaccines for which there remains substantial reluctance among the public: the Human Papillomavirus and the COVID-19 vaccines. The discovered hesitancy profiles inform public health messaging approaches to effectively reach Twitter users with promise to shift or bolster vaccine attitudes.

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This study aimed to understand vaccine hesitancy and confidence toward the COVID-19 vaccines among Latino adults in Arizona. Latinos (n = 71) aged 18 years or older who resided in Arizona participated in 14 focus groups between February and June 2021. Theoretical thematic analysis was used to examine drivers of these two behaviors, namely, vaccine hesitancy and confidence toward the COVID-19 vaccines, using the COM-B model, comprising capability, opportunity, and motivation factors that generate a behavior. Vaccine hesitancy stemmed from the need for vaccine information (capability factor) and fear of the vaccines, religious beliefs, and perceived barriers stemming from government mistrust (motivation factors). Vaccine confidence arose from trust in science and doctors (capability factor), and a fear of getting sick, protection against COVID-19, getting vaccinated as a civic duty, and a desire to return to normal life (motivation factors). The influence of opportunity factors, such as having access to vaccinations, were not discussed as contributing to vaccine confidence or hesitancy. As predicted by the COM-B model, factors reflecting capabilities and motivations contributed to vaccine hesitancy and confidence, all of which need to be considered in public health messaging. These factors can be targeted to facilitate efforts to promote vaccine uptake and reduce the spread of COVID-19. [ABSTRACT FROM AUTHOR]

In Italy, free vaccinations for Herpes Zoster (HZ), pneumococcal (PCV), and influenza (FLU) are recommended each year for individuals turning 65. Despite this, achieving optimal vaccination coverage remains challenging. This study assesses coverage rates for HZ, PCV, and FLU in Forlì, Northern Italy, and examines how altitude, urban planning, and health organization variables (such as the presence of a vaccination center) impact vaccine uptake. Vaccination coverages were calculated for birth cohorts between 1952 and 1958 for each municipality in the Forlì area as of 1 March 2024. The geographical factors influencing the vaccination uptake were extracted from the Italian National Institute of Statistics (ISTAT) records and evaluated through a multivariate analysis. The sample analyzed included 15,272 vaccine campaign targets from Forlì's province (185,525 citizens); the vaccine uptake rates for HZ, PCV, and FLU were 26.9%, 36.7%, and 43.5%, respectively. Gender did not appear to influence vaccine uptake. Living in a flat area appeared to increase vaccine uptake in a statistically significant way for all the vaccinations when compared to a mountainous area (HZ: OR: 1.50, PCV: OR: 1.33, FLU: OR: 1.67). The presence of a vaccine service in low-urbanized areas was shown to increase vaccine uptake for all vaccinations (HZ: OR: 1.65, PCV: OR: 1.93, FLU: OR: 1.53) compared with low-urbanized areas without a vaccination center or more urbanized areas with a vaccination center. This study emphasizes the significance of the territorial context, along with the ease of access to vaccinations and geographic barriers, as key determinants in achieving vaccination targets. Local health authorities should consider these factors when implementing vaccination campaigns. [ABSTRACT FROM AUTHOR]

Background: Healthcare professionals (HCPs) can play an important role in encouraging patients and their caregivers to be vaccinated. The objective of this qualitative study was to investigate HCPs' perspectives on challenges in vaccine communication and unmet training needs in this domain. Methods: Semi-structured interviews were conducted with 41 HCPs (mainly nurses and physicians) with vaccination roles (23 in England; 18 in France), gathering information on: (1) HCPs' approach to vaccine conversations with patients; (2) Challenges of communicating about vaccines; (3) Vaccine-related training and learning resources available to HCPs, and; (4) HCPs' training needs around vaccine communication. Results: HCPs described a range of communication experiences that indicated insufficient time, information, and skills to confidently navigate difficult conversations with vaccine-hesitant patients. Communication skills were especially important to avoid conflict that could potentially damage the patient-provider relationship. Some HCPs interviewed had received communication training, but for most, this training was not specific to vaccination. Although general communication skills were transferable to vaccine conversations, most HCPs welcomed specific training and informational resources to support countering patients' misconceptions or misinformation about vaccines. Conclusions: HCPs would benefit from training tailored to address vaccine communication with patients, and this should be part of a systemic approach that also provides time and space to have effective vaccine conversations. [ABSTRACT FROM AUTHOR]

Health professionals' recommendations increase vaccine uptake. We aimed to document stances, practices regarding adult vaccination, and their predictors among undergraduate medical and biomedical science students, as well as their perspectives on increasing vaccine confidence. Among the 430 participants, third-year students from two universities in Greece, only 25.4% were in favor of all vaccines, while no refuters were detected. Predictors of recommending vaccination were the Attitudes Towards Adult Vaccination (ATAVAC) Value (OR 3.26, p < 0.001) and ATAVAC Safety subscales scores (OR 1.36, p < 0.05), being a medical student (OR 2.45, p < 0.05), and having better self-rated health status (OR 2.27, p < 0.05). The importance of getting vaccinated as health professionals was recognized by participants with a higher ATAVAC value (OR 5.39, p < 0.001), ATAVAC Safety scores (OR 1.46, p < 0.05), and increased knowledge regarding the National Immunization Program (OR 1.31, p < 0.05). The God Locus of Health Control (GLHC) was a predictor only in vaccination against COVID-19 (OR 0.91, p < 0.05). Improving community health literacy and health providers' education, boosting trust in authorities, and adopting a person-centered approach emerged as the main themes regarding how to increase vaccine confidence. Mapping health professionals' confidence in vaccines and providing lifelong training support is pivotal in supporting positive attitudes, enhancing their competence, and promoting vaccination in the post-COVID-19 era. [ABSTRACT FROM AUTHOR]

Background: Vaccination is one of the greatest tools for individuals to stay healthy. Individuals are, however, often exposed to misinformation via digital and social media, and thus, may miss the opportunity to develop scientific knowledge about vaccines and trust in relevant stakeholders. This has a damaging impact on vaccine confidence. Understanding vaccine confidence is particularly important in North Dakota, where vaccination rates are lower than national averages. Objectives: The objectives of this research are to examine the association between vaccine confidence and three potential sources of it, namely, trust, vaccine knowledge, and vaccine information sources and to investigate the relative strength of three vaccine confidence sources, while accounting for covariates. Methods: Students (n = 517, 56.6%) and staff and faculty (n = 397, 43.4%) at the University of North Dakota (n = 914) completed an online survey. Logistic regressions estimated odds ratios (OR) and 95% confidence intervals (CI) for associations among trust in doctors, family/friends, government health agencies, charitable organizations, and religious organizations, vaccine knowledge, vaccine information sources as well as vaccine confidence, accounting for gender, race, marital status, age, religion, political ideology, education, and health status. Results: The mean age of participants was 29.43 years (SD = 13.48). Most were females (71.6%) and white (91.5%). Great trust in doctors (OR = 3.29, p < 0.001, 95%CI 1.89, 5.73) government health agencies (OR = 2.95, p < 0.001, 95%CI 2.13, 4.08) and vaccine knowledge (OR = 1.28, p < 0.001, 95%CI 1.18, 1.38) had higher odds of vaccine confidence. Using Internet Government source as the primary source of vaccine information (OR = 1.73, p < 0.05, 95%CI 1.22, 2.44) showed higher odds of vaccine confidence before all independent variables were introduced, but it became non-significant after they were introduced. Trust in government health agencies showed strongest associations with vaccine confidence. Conclusion: Multiple stakeholders are necessary to ensure verified, accessible, and accurate information in order to advance vaccine confidence in rural, conservative areas. [ABSTRACT FROM AUTHOR]

Many studies have examined behavioral and social drivers of COVID-19 vaccination initiation, but few have examined these drivers longitudinally. We sought to identify the drivers of COVID-19 vaccination initiation using the Behavioral and Social Drivers of Vaccination (BeSD) Framework. Participants were a nationally-representative sample of 1,563 US adults who had not received a COVID-19 vaccine by baseline. Participants took surveys online at baseline (spring 2021) and follow-up (fall 2021). The surveys assessed variables from BeSD Framework domains (i.e., thinking and feeling, social processes, and practical issues), COVID-19 vaccination initiation, and demographics at baseline and follow-up. Between baseline and follow-up, 65% of respondents reported initiating COVID-19 vaccination. Vaccination intent increased from baseline to follow-up (p <.01). Higher vaccine confidence, more positive social norms towards vaccination, and receiving vaccine recommendations at baseline predicted subsequent COVID-19 vaccine initiation (all p <.01). Among factors assessed at follow-up, social responsibility and vaccine requirements had the greatest associations with vaccine initiation (all p <.01). Baseline vaccine confidence, social norms, and vaccination recommendations were associated with subsequent vaccine initiation, all of which could be useful targets for behavioral interventions. Furthermore, interventions that highlight social responsibility to vaccinate or promote vaccination requirements could also be beneficial. [ABSTRACT FROM AUTHOR]

Objectives Beginning early in the pandemic, there was a worldwide effort to develop effective vaccines against the SARS-CoV-2 virus. Before and after the approval and implementation of vaccines, there were concerns about their need as well as their safety and rapid development. We explored child demographic characteristics and parental concerns to identify factors associated with the decision to vaccinate. Methods A cohort of 1035 children from Calgary was assembled in 2020 to participate in 5 visits every 6 months for survey completion and blood sampling for SARS-CoV-2 antibodies. Visits 1 to 2 occurred before approval of vaccines for children; Visits 3 to 5 occurred after vaccine approval for different age groups. We described vaccine concerns and utilized logistic regression to examine factors associated with the decision to vaccinate in children ≥5 years of age. Results Children ≥12 years of age, of non-white or non-black ethnicity, and who had received previous influenza vaccines had higher odds of being vaccinated against SARS-CoV-2. Children with previous SARS-CoV-2 infection had lower odds of being vaccinated. The most common concerns in early 2021 were about vaccine safety. By summer 2022, the most common concern was a belief that vaccines were not necessary. Through the study 88% of children were vaccinated. Conclusions Age, ethnicity, previous infections, and vaccine attitudes were associated with parental decision to vaccinate against SARS-CoV-2. For children who remained unvaccinated, parents continued to have safety concerns and questioned the necessity of the vaccine. Complacency about the need for vaccination may be more challenging to address and overcome than concerns about safety alone. [ABSTRACT FROM AUTHOR]

Given the increase in COVID-19 emergency department visits and hospitalizations during the winter of 2023–2024, identifying groups that have a high prevalence of COVID-19 cases, severity, and long-term symptoms can help increase efforts toward reducing disparities and prevent severe COVID-19 outcomes. Using data from the 2022 National Health Interview Survey (n = 27,651), we assessed the prevalence of COVID-19 outcomes (prior diagnosis, moderate/severe COVID-19, and long COVID) by sociodemographic characteristics and factors associated with each COVID-19 outcome. Approximately one third of adults reported a prior COVID-19 diagnosis (30.7%), while one half (51.6%) who had COVID-19 reported moderate or severe symptoms, and one fifth (19.7%) who had COVID-19 symptoms reported long COVID. The following were associated with higher odds of moderate/severe COVID-19 and long COVID: havinga high-risk condition (aOR = 1.20, OR = 1.52); having anxiety or depression (OR = 1.46, OR = 1.49); having a disability (OR = 1.41, OR = 1.60); and having a food insecurity (OR = 1.37, OR = 1.50) compared to a lack of these conditions. Having two or more COVID-19 vaccinations was associated with lower odds of a COVID-19 diagnosis (OR = 0.75), moderate/severe COVID-19 (OR = 0.86), and long COVID (OR = 0.82). Improving vaccination coverage and reducing disparities in COVID-19 outcomes could advance health equities and protect against future resurgence of disease. [ABSTRACT FROM AUTHOR]

Understanding how attitudes and beliefs about COVID-19 vaccination have changed over time is essential for identifying areas where targeted messaging and interventions can improve vaccination confidence and uptake. Using data from multiple waves of the nationally representative U.S. Census Bureau's Household Pulse Survey collected from January 2021 to May 2023, we assessed reasons for the non-vaccination of adults, adolescents, and children using the Health Belief Model as the framework for understanding behavior. Among unvaccinated adults, perceived vulnerability increased from 11.9% to 44.1%, attitudinal factors/mistrust increased from 28.6% to 53.4%, and lack of cue to action increased from 7.5% to 9.7% from January 2021 to May 2022. On the other hand, safety/efficacy concerns decreased from 74.0% to 60.9%, and logistical barriers to vaccination decreased from 9.1% to 3.4% during the same time period. Regarding reasons for non-vaccination of youth, perceived vulnerability increased from 32.8% to 40.0%, safety/efficacy concerns decreased from 73.9% to 60.4%, and lack of cue to action increased from 10.4% to 13.4% between September 2021 and May 2023. While safety/efficacy concerns and logistic barriers have decreased, increases in perceived vulnerability to COVID-19, mistrust, and lack of cues to action suggest that more efforts are needed to address these barriers to vaccination. [ABSTRACT FROM AUTHOR]

IntroductionThe COVID-19 pandemic has greatly impacted the way that the world views vaccines. While safe and effective, COVID-19 vaccines were, and continue to be met with hesitancy and misinformation. We aimed to understand public perceptions and trust in COVID-19 vaccinations and how the pandemic has impacted perceptions of non-COVID-19 vaccines.MethodsSurvey data were collected between August 7, 2023–August 16, 2023, from 7,000 respondents aged 18 years and older from the United States (n = 1,000); Nigeria (n = 1,000); United Kingdom (n = 1,000); France (n = 1,000); Canada (n = 1,000); Brazil (n = 1,000); and India (n = 1,000).ResultsTrust in COVID-19 vaccines was highest in Brazil (84.6%) and India (80.4%) and lowest in the United States (63.5%) and France (55.0%). 47.5% of respondents agreed that they trust traditional protein-based vaccines more than mRNA vaccines, 13.5% disagree and 39.0% are neutral about their trust in protein-based versus mRNA vaccines. Overall, 53.9% of respondents reported that the COVID-19 pandemic impacted their perceptions of vaccines with half of these respondents (51.7%) reporting that the pandemic made them think that other vaccines are more important as they understand how critical vaccines can be at preventing serious illnesses.DiscussionThese data can be used by health system decision makers, public health and researchers to understand how vaccine trust impacts perceptions of COVID-19 and influenza vaccines globally and develop tailored interventions that address local concerns.

The COVID-19 pandemic exacerbated existing health disparities among historically and currently underserved, underresourced, and marginalized communities worldwide. These communities faced disproportionate COVID-19 morbidity and mortality and were generally less likely to receive a COVID-19 vaccine once it became widely available to the public. Community engagement is an approach that can help bridge these inequities. This community case study adapted and implemented an existing community engagement framework to tailor a statewide vaccine equity effort that addresses community-specific priorities during a public health emergency. The adapted framework includes the following key phases: (1) creating an environment for community engagement; (2) making the work relevant; (3) narrowing the focus; (4) planning and conducting the work; and (5) evaluating the work. All of these supported the successful establishment of a statewide collaboration that consisted of various partners from various sectors who shared a collective commitment to increase COVID-19 vaccine confidence and address barriers to vaccination among the diverse communities in Nevada. Ultimately, a community engagement framework can provide a roadmap to navigate the dynamic and multifaceted nature of equity-related work by paving the way for meaningful interventions to mitigate health disparities.

Research has shown that building public trust in institutions contributes to vaccine confidence. However, this association has not been validated in the cross-cultural context, which requires retesting using a larger, and more representative cross-cultural sample and considering potential moderating factors, such as sociocultural context. Using a large sample from Gallup (involving 102,156 participants from 134 countries), we explored the link of institutional trust and vaccine confidence in a global context, and the role of cultural religiosity and individualism in this relationship. Individual-level institutional trust and vaccine confidence were measured using respective Gallup data. Country-level cultural religiosity scores were used to capture the sociocultural context, while Hofstede's individualism scores reflected the societal inclination towards individual or collective orientation. The results of the multilevel analyses found that institutional trust positively correlates with vaccine confidence on the global scale. Furthermore, the benefits of institutional trust on vaccine confidence is weaker in more religious or individualistic countries. We also identified several individual and cross-country characteristics that influence vaccine confidence, such as age, income, Gini coefficient, and uncertainty avoidance. These findings reveal the influence of individual factors on vaccine confidence and emphasize the importance of understanding the interaction of personal factors with sociocultural context. [ABSTRACT FROM AUTHOR]

Purpose: Understanding disparities in COVID-19 outcomes, overall and stratified by vaccination status, is important for developing targeted strategies to increase vaccination coverage and protect adolescents from COVID-19. Design: The 2022 National Health Interview Survey (NHIS) is a cross-sectional nationally representative household survey of U.S. adults. Setting: A probability sample of households in the U.S. Sample: One child aged 12-17 years is randomly selected from each family in the household. A knowledgeable adult (eg, parent or guardian), responds on behalf of the child through an in-person interview (response rate = 49.9%). Measures: Input measures-sociodemographic characteristics and COVID-19 vaccination status; output measures-ever had COVID-19, moderate/severe COVID-19, long COVID Analysis: Prevalence of COVID-19 outcomes was assessed for adolescents aged 12-17 years. Factors associated with each COVID-19 outcome were assessed with multivariable logistic regression analyses. Results: Among 2758 adolescents aged 12-17 years in 2022, 60.5% had received ≥1 dose of COVID-19 vaccine, 30.2% had ever been diagnosed by a doctor that they had COVID-19, 29.5% had moderate/severe COVID-19, and 6.2% had long COVID. Adolescents who were vaccinated with ≥1 dose were less likely to be diagnosed with COVID-19 (aOR =.79) and less likely to have long COVID (aOR =.30). Conclusion: Targeted messaging to highlight the importance of early treatment, the harms of long COVID-19, and the benefits of vaccination in protecting against long-term effects may be necessary to ensure that all adolescents and their families are adequately protected. [ABSTRACT FROM AUTHOR]

Understanding the association between booster vaccination and COVID-19 outcomes can help strengthen post-pandemic messaging and strategies to increase vaccination and reduce severe and long-term consequences of COVID-19. Using the Household Pulse Survey data collected from U.S. adults from 9 December 2022 to 13 February 2023 (n = 214,768), this study assessed the relationship between COVID-19 booster vaccination and COVID-19 outcomes (testing positive for COVID-19, moderate/severe COVID-19, and long COVID). Disparities were found in COVID-19 outcomes (e.g., testing positive for COVID-19, moderate/severe COVID-19, and long COVID) by sociodemographic characteristics, region of residence, food insecurity status, mental health status, disability status, and housing type. Receipt of a COVID-19 booster vaccination was negatively associated with testing positive for COVID-19 (aOR = 0.75, 95%CI: 0.72,0.79), having moderate/severe COVID-19 (aOR = 0.92, 95%CI: 0.88, 0.97), or having long COVID (aOR = 0.86 (0.80, 0.91)). Even among those who tested positive for COVID-19, those who received the booster vaccine were less likely to have moderate/severe COVID-19 and less likely to have long COVID. Communicating the benefits of COVID-19 booster vaccination, integrating vaccination in patient visits, and reducing access barriers can increase vaccination uptake and confidence for all individuals and protect them against the severe negative outcomes of COVID-19. [ABSTRACT FROM AUTHOR]

Multiple factors may influence parental vaccine hesitancy towards pediatric COVID-19 vaccines and routine childhood immunizations (RCIs). Using the United States National Immunization Survey—Child COVID Module data collected from parents/guardians of children aged 5–11 years, this cross-sectional study (1) identified the trends and prevalence estimates of parental hesitancy towards pediatric COVID-19 vaccines and RCIs, (2) examined the relationship between hesitancy towards pediatric COVID-19 vaccines and RCIs, and (3) assessed trends in parental hesitancy towards RCIs by sociodemographic characteristics and behavioral and social drivers of COVID-19 vaccination. From November 2021 to July 2022, 54,329 parents or guardians were interviewed. During this 9-month period, the proportion of parents hesitant about pediatric COVID-19 vaccines increased by 15.8 percentage points (24.8% to 40.6%). Additionally, the proportion of parents who reported RCIs hesitancy increased by 4.7 percentage points from November 2021 to May 2022 but returned to baseline by July 2022. Over nine months, parents' concerns about pediatric COVID-19 infections declined; however, parents were increasingly worried about pediatric COVID-19 vaccine safety and overall importance. Furthermore, pediatric COVID-19 vaccine hesitancy was more prevalent among parents of children who were White (43.2%) versus Black (29.3%) or Hispanic (26.9%) and those residing in rural (51.3%) compared to urban (28.9%) areas. In contrast, RCIs hesitancy was higher among parents of children who were Black (32.0%) versus Hispanic (24.5%) or White (23.6%). Pediatric COVID-19 vaccine hesitancy was 2–6 times as prevalent among parents who were RCIs hesitant compared to those who were RCIs non-hesitant. This positive correlation between parental hesitancy towards pediatric COVID-19 vaccines and RCIs was observed for all demographic and psychosocial factors for unadjusted and adjusted prevalence ratios. Parent–provider interactions should increase vaccine confidence, shape social norms, and facilitate behavior change to promote pediatric vaccination rates. [ABSTRACT FROM AUTHOR]

Healthcare providers (HCP) are seen by the public as the most trustworthy source of information about vaccination. While HCPs could be a valuable partner to increase vaccine confidence in general, it is not clear whether they feel confident themselves to address questions concerning vaccination. In the context of the EU Joint Action on Vaccination (EU-JAV), the Vaccine Training Barometer, an online survey tool, was developed to assess how frequently HCPs receive questions about vaccination, how confident they feel to answer these questions, and to what extent they are willing to follow extra training. After a pilot test in Flanders, Belgium, the Barometer was launched and completed by 833 HCPs in Flanders and 291 HCPs in the Spanish regions of Catalonia, Navarre and Valencian Community from November 2020 until January 2021, during the COVID-19 pandemic, just before and during the start of the first COVID-19 vaccination campaigns. In both countries, HCPs frequently received questions about vaccination (mostly on a daily or weekly basis), and about two thirds of them indicated that the frequency of questions had increased during the three months prior to completing the survey. Most questions were about the side effects and safety of vaccines. In both countries, a considerable proportion of HCPs did not feel confident to answer vaccine-related questions (31.5% felt confident in Flanders, 21.6% in Spain). A large proportion of HCPs received questions in the last three months before the survey that they could not answer (52.4% of respondents in Flemish sample, 41.5% in Spanish sample). Only 11.4% (Flanders) and 11.3% (Spain) of the respondents felt they gained sufficient knowledge through their standard education to be able to answer questions about vaccination. Almost all respondents were willing to follow extra training on vaccination (Flanders: 95.4%, Spain: 96.6%). The Vaccine Training Barometer is thus a useful tool to monitor HCPs' confidence to answer questions about vaccination and to capture their training needs. [ABSTRACT FROM AUTHOR]