Emerging Issues Regarding COVID-19 Vaccination Behavior, Intention, and Resistance: Interdisciplinary Approaches

A special issue of Vaccines (ISSN 2076-393X). This special issue belongs to the section "COVID-19 Vaccines and Vaccination".

Deadline for manuscript submissions: closed (1 September 2022) | Viewed by 50551

Special Issue Editors


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Guest Editor
Health Behaviours Research, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
Interests: vaccination; emerging infectious diseases; interdisciplinary research; health education and promotion; COVID-19; influenza; randomized controlled trial; epidemiology; behavioral science
Special Issues, Collections and Topics in MDPI journals

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Guest Editor
Center for Health Behaviours Research, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
Interests: health psychology; behavioral health research; psychological aspects in disease prevention and management; Internet on health and patient empowerment; mental health in minorities and disease populations
Special Issues, Collections and Topics in MDPI journals

E-Mail Website
Guest Editor
Center for Health Behaviours Research, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
Interests: interdisciplinary behavioral health research including mental and behavioral responses to infectious diseases

Special Issue Information

Dear Colleagues,

COVID-19 vaccination has been seen as a solution to control the pandemic. Several months have passed since the rollout. Many pre-rollout studies focused on vaccination hesitancy/intention. Yet, the contexts embedding COVID-19 vaccination keep changing. The vaccination rate is higher than expected in some countries; more data about safety are available; outbreaks of the Delta variant transformed perceptions about vaccine efficacy. It is important to update our knowledge about COVID-19 vaccination and its changes.

We are pleased to invite you to contribute to this special issue, which aims at investigating emerging issues on COVID-19 vaccination. Inter-disciplinary approaches involving public health, social sciences, policy analysis, and modeling are required and deem suitable for inclusion. Novel manuscripts based on original research, review, meta-analysis, and position papers are all welcome.

Research areas include but are not limited to surveillance of changes in prevalence and factors of vaccination over time, modeling of vaccination rates/consequences, behavioral economics, theory development and testing, experiments and interventions, health promotion, social media impact and health communication, consideration of socio-cultural and structural determinants, measurement tools of vaccination intention/hesitancy/reluctance and related factors, prospective prediction of vaccination behaviors, comparative research, inequity and subgroup differences, policy analysis, and behavioral after uptake of vaccination (e.g. risk compensation in preventive behaviors).

We look forward to receiving your contributions.

Prof. Dr. Joseph Tak-fai Lau
Prof. Dr. Phoenix Mo
Dr. Yanqiu Yu
Guest Editors

Manuscript Submission Information

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Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Vaccines is an international peer-reviewed open access monthly journal published by MDPI.

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Keywords

  • COVID-19
  • vaccine hesitancy
  • surveillance
  • interventions
  • policy
  • socio-cultural determinants
  • inequity
  • health communication
  • modeling

Published Papers (17 papers)

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Research

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12 pages, 286 KiB  
Article
Exploring Factors Associated with Chinese-Americans’ Willingness to Receive an Additional Hypothetical Annual Dose of the COVID-19 Vaccine
by Ming Li, Bo Kyum Yang, Zuojin Yu, Lin Zhu, Xuewei Chen, Gary L. Kreps and Radhika Kansangra
Vaccines 2023, 11(1), 185; https://doi.org/10.3390/vaccines11010185 - 15 Jan 2023
Cited by 1 | Viewed by 1801
Abstract
Chinese-Americans are one of the largest groups of Asian-Americans in the US with distinctive behavioral and cultural characteristics that influence health service use. Although Chinese-Americans have significantly higher COVID-19-related mortality rates, relative to other racial and ethnic groups, limited literature is available examining [...] Read more.
Chinese-Americans are one of the largest groups of Asian-Americans in the US with distinctive behavioral and cultural characteristics that influence health service use. Although Chinese-Americans have significantly higher COVID-19-related mortality rates, relative to other racial and ethnic groups, limited literature is available examining their willingness to accept the COVID-19 vaccine. With recent development of the combination influenza-COVID-19 vaccine by biotechnology companies to mitigate COVID-19 infection, we examined factors associated with Chinese-Americans’ acceptance of hypothetical annual doses of COVID-19 vaccination before the vaccine rollout. A total of 241 Chinese-Americans who received at least one dose of the COVID-19 vaccine completed an online questionnaire developed and based on health behavior theories. Our results indicated that Chinese-American participants who were satisfied with their prior COVID-19 vaccination experience, who had more accurate knowledge and perceived higher susceptibility of getting COVID-19, were more willing to receive the annual COVID-19 vaccine in the future. The findings of our current study may be used to guide the development of strategic messages to promote uptake of the annual COVID-19 vaccine by Chinese-Americans in the U.S. Full article
13 pages, 274 KiB  
Article
Factors of COVID-19 Vaccination among Hong Kong Chinese Men Who Have Sex with Men during Months 5–8 since the Vaccine Rollout—General Factors and Factors Specific to This Population
by Yanqiu Yu, Rachel Hau Yin Ling, Tsun Kwan Mary Ip, Sitong Luo and Joseph T. F. Lau
Vaccines 2022, 10(10), 1763; https://doi.org/10.3390/vaccines10101763 - 20 Oct 2022
Cited by 3 | Viewed by 2262
Abstract
This study investigated an under-researched topic regarding the prevalence of COVID-19 vaccination behavior among Chinese men who have sex with men (MSM) and the associations of this with general and MSM-specific perceptions grounded in the health belief model (HBM) and the theory of [...] Read more.
This study investigated an under-researched topic regarding the prevalence of COVID-19 vaccination behavior among Chinese men who have sex with men (MSM) and the associations of this with general and MSM-specific perceptions grounded in the health belief model (HBM) and the theory of planned behaviors (TPB). A total of 400 Chinese MSM were recruited from multiple sources (site recruitment, online recruitment, and peer referral) in Hong Kong from July to October 2021, who then participated in a structured telephone interview. Of all the participants, the prevalence of COVID-19 vaccination (i.e., taking at least one dose of COVID-19 vaccination) was 78.3%. Multivariable logistic regression analyses showed that, after adjusting for background factors, (1) the general and MSM-specific HBM variables of perceived benefits and self-efficacy were positively associated with COVID-19 vaccination behavior; (2) the items or scale of general/MSM-specific perceived barriers and social norms were negatively associated with COVID-19 vaccination behavior; (3) the general perceived severity and MSM-specific perceived susceptibility, perceived severity, and cue to action were not significantly associated with COVID-19 vaccination behavior. The findings suggest that the HBM and social norm construct of the TPB only partially explained the participant’s COVID-19 vaccination behavior. Health promotion may need to focus more on modifying perceptions related to COVID-19 vaccination rather than COVID-19. Full article
12 pages, 943 KiB  
Article
The Association between Socio-Demographics and Mental Distress Following COVID-19 Vaccination—Mediation of Vaccine Hesitancy
by Xiaoying Zhang, Junwei Shen, Ming Li, Yijian Shi, Qing Wang, Fazhan Chen, Hongyun Qin and Xudong Zhao
Vaccines 2022, 10(10), 1697; https://doi.org/10.3390/vaccines10101697 - 11 Oct 2022
Cited by 6 | Viewed by 1478
Abstract
The COVID-19 vaccine has been administered to over 200 countries and regions. With the unprecedented vaccination scale and speed, vaccination correlated mental health issues should be paid precise attention to. This study aims to assess the association between socio-demographic factors and mental health [...] Read more.
The COVID-19 vaccine has been administered to over 200 countries and regions. With the unprecedented vaccination scale and speed, vaccination correlated mental health issues should be paid precise attention to. This study aims to assess the association between socio-demographic factors and mental health following vaccination and to analyze the mediation effect of vaccine hesitancy. This study recruited 2112 individuals who took two doses of the COVID-19 vaccine in Shanghai. Structural equation modeling was performed to assess factors associated with anxiety and depression of the vaccinated individuals and the underlying mechanism. The results yielded that vaccine hesitancy partially mediated/suppressed the effect from gender and employment status to anxiety/depression and fully mediated the effects from education to anxiety/depression. This study advanced the understanding of mental health disparity among different socio-demographic groups after vaccination and the impact of vaccine hesitancy on the vaccinated population’s mental health. The finding offered insights into the possible mental vulnerability of people holding a hesitant attitude before vaccination and suggested that vaccine hesitancy played a crucial role in people’s mental health after vaccination. Health promotion programs can target vaccine hesitancy to prevent unfavorable mental health consequences among specific populations. Full article
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17 pages, 328 KiB  
Article
Determining the Prevalence and Correlates of COVID-19 Booster Vaccine Hesitancy in the Singapore Population Following the Completion of the Primary Vaccination Series
by Kevin Y. K. Tan, Alexius S. E. Soh, Brenda W. L. Ong, Mark IC. Chen and Konstadina Griva
Vaccines 2022, 10(7), 1088; https://doi.org/10.3390/vaccines10071088 - 6 Jul 2022
Cited by 12 | Viewed by 4108
Abstract
In response to declining vaccine-induced immunity and the emergence of new COVID-19 variants, COVID-19 booster vaccination programmes have been widely launched in several high-income countries. However, public response has been slow, and scepticism about these programmes is rising in these settings. This study [...] Read more.
In response to declining vaccine-induced immunity and the emergence of new COVID-19 variants, COVID-19 booster vaccination programmes have been widely launched in several high-income countries. However, public response has been slow, and scepticism about these programmes is rising in these settings. This study sought to identify the sociodemographic, emotional, and psychological factors associated with COVID-19 booster vaccine hesitancy in Singapore. Derived from a community cohort, 1005 fully vaccinated adults (62.1% female, mean age = 42.6 years) that had not received their COVID-19 booster shots completed an online survey between October and November 2021 on vaccination beliefs, intentions, and behaviours. Results indicated that despite completing the primary COVID-19 vaccination, 30.5% of those surveyed were hesitant about receiving the booster shot (25.9% unsure; 4.7% refused the booster), and 39.2% perceived more vaccine risks than benefits. Multivariable models indicated that a tertiary education, lower COVID-19 threat perception, lower perceived benefits, higher perceived concerns, a decreased need for booster vaccination, and a lower benefit/concerns differential score were associated with higher odds of booster vaccine hesitancy. Success in the primary vaccination series may not warrant widespread public acceptance for recurrent COVID-19 vaccination doses. In addressing booster vaccine hesitancy as restrictive measures and mandates are lifted, health perceptions relevant or unique to booster vaccine uptake should be considered. Full article
13 pages, 275 KiB  
Article
Listening to Voices from African American Communities in the Southern States about COVID-19 Vaccine Information and Communication: A Qualitative Study
by Ran Zhang, Shan Qiao, Brooke W. McKeever, Bankole Olatosi and Xiaoming Li
Vaccines 2022, 10(7), 1046; https://doi.org/10.3390/vaccines10071046 - 29 Jun 2022
Cited by 8 | Viewed by 2459
Abstract
The high uptake of COVID-19 vaccines is one of the most promising measures to control the pandemic. However, some African American (AA) communities exhibit vaccination hesitancy due to mis- or disinformation. It is important to understand the challenges in accessing reliable COVID-19 vaccine [...] Read more.
The high uptake of COVID-19 vaccines is one of the most promising measures to control the pandemic. However, some African American (AA) communities exhibit vaccination hesitancy due to mis- or disinformation. It is important to understand the challenges in accessing reliable COVID-19 vaccine information and to develop feasible health communication interventions based on voices from AA communities. We conducted 2 focus group discussions (FGDs) among 18 community stakeholders recruited from 3 counties in South Carolina on 8 October and 29 October 2021. The FGDs were conducted online via Zoom meetings. The FGD data were managed and thematically analyzed using NVivo 12. Participants worked primarily in colleges, churches, and health agencies. We found that the challenges of accessing reliable vaccine information in AA communities primarily included structural barriers, information barriers, and a lack of trust. Community stakeholders recommended recruiting trusted messengers, using social events to reach target populations, and conducting health communication campaigns through open dialogue among stakeholders. Health communication interventions directed at COVID-19 vaccine uptake should be grounded in ongoing community engagement, trust-building activities, and transparent communication about vaccine development. Tailoring health communication interventions to different groups may help reduce misinformation spread and thus promote vaccination in AA communities in the southern states. Full article
19 pages, 342 KiB  
Article
Two-Tailed Dogs, Social Unrest and COVID-19 Vaccination: Politics, Hesitancy and Vaccine Choice in Hungary and Thailand
by Robin Goodwin, Lan Anh Nguyen Luu, Juthatip Wiwattanapantuwong, Mónika Kovács, Panrapee Suttiwan and Yafit Levin
Vaccines 2022, 10(5), 789; https://doi.org/10.3390/vaccines10050789 - 16 May 2022
Cited by 6 | Viewed by 2236
Abstract
Background: A long tradition of research has shown an association between political orientation and vaccine uptake. However, we know little about political preferences and the choice of specific vaccines. Methods: We conducted two national surveys, in Hungary (Study 1, online, n = 1130) [...] Read more.
Background: A long tradition of research has shown an association between political orientation and vaccine uptake. However, we know little about political preferences and the choice of specific vaccines. Methods: We conducted two national surveys, in Hungary (Study 1, online, n = 1130) and Thailand (Study 2, on the street survey: n = 1052), testing associations between political allegiance, trust in government, vaccine willingness, and vaccine choice. Results: In Hungary, those supporting the government or on the political right were more willing to be vaccinated, with this association strongest for government approved vaccines. These respondents were also more likely to accept Chinese and Russian vaccines and reject the Moderna vaccine. In Thailand, vaccinated respondents reported greater trust in the government, with preference for AstraZeneca associated with support for pro-government political parties and preference for Pfizer with anti-government attitudes. Conclusions: Vaccine campaigns need to recognise the role of political loyalties not only in vaccine willingness, but in vaccine choice, especially given the mixing of vaccines across doses. Full article
17 pages, 2343 KiB  
Article
Successive Pandemic Waves with Different Virulent Strains and the Effects of Vaccination for SARS-CoV-2
by Alcides Castro e Silva, Américo Tristão Bernardes, Eduardo Augusto Gonçalves Barbosa, Igor Aparecido Santana das Chagas, Wesley Dáttilo, Alexandre Barbosa Reis and Sérvio Pontes Ribeiro
Vaccines 2022, 10(3), 343; https://doi.org/10.3390/vaccines10030343 - 22 Feb 2022
Cited by 3 | Viewed by 2991
Abstract
One hundred years after the flu pandemic of 1918, the world faces an outbreak of a new severe acute respiratory syndrome, caused by a novel coronavirus. With a high transmissibility, the pandemic has spread worldwide, creating a scenario of devastation in many countries. [...] Read more.
One hundred years after the flu pandemic of 1918, the world faces an outbreak of a new severe acute respiratory syndrome, caused by a novel coronavirus. With a high transmissibility, the pandemic has spread worldwide, creating a scenario of devastation in many countries. By the middle of 2021, about 3% of the world population had been infected and more than 4 million people had died. Different from the H1N1 pandemic, which had a deadly wave and ceased, the new disease is maintained by successive waves, mainly produced by new virus variants and the small number of vaccinated people. In the present work, we create a version of the SIR model using the spatial localization of persons, their movements, and considering social isolation probabilities. We discuss the effects of virus variants, and the role of vaccination rate in the pandemic dynamics. We show that, unless a global vaccination is implemented, we will have continuous waves of infections. Full article
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13 pages, 2399 KiB  
Article
Post-Vaccination SARS-CoV-2 Infections among Health Workers at the University Hospital of Verona, Italy: A Retrospective Cohort Survey
by Stefano Porru, Gianluca Spiteri, Maria Grazia Lourdes Monaco, Alessandro Valotti, Angela Carta, Virginia Lotti, Erica Diani, Giuseppe Lippi, Davide Gibellini and Giuseppe Verlato
Vaccines 2022, 10(2), 272; https://doi.org/10.3390/vaccines10020272 - 10 Feb 2022
Cited by 24 | Viewed by 2005
Abstract
Background: The SARS-CoV-2 vaccination campaign began on 27 December 2020 in Europe, primarily involving health workers. This study aimed to assess the SARS-CoV-2 vaccination effectiveness, as assessed by reductions in incidence, symptom severity, and further infection spreading. Methods: A retrospective cohort study was [...] Read more.
Background: The SARS-CoV-2 vaccination campaign began on 27 December 2020 in Europe, primarily involving health workers. This study aimed to assess the SARS-CoV-2 vaccination effectiveness, as assessed by reductions in incidence, symptom severity, and further infection spreading. Methods: A retrospective cohort study was conducted on 9811 health workers operating at the Verona University Hospital, Italy, from 27 December 2020 to 3 May 2021. All health workers were offered vaccination with Comirnaty (BNT162b2, BioNTech/Pfizer, Mainz, Germany/New York, United States), and a health surveillance program was implemented with periodical swab testing. Vaccination status and clinical data were collected using an ad hoc semi-structured questionnaire and health surveillance charts. Results: As of 3rd of May, 82.5% of health workers had been vaccinated against SAR-CoV-2, and 177 (1.8%) had tested positive for SARS-CoV-2. Vaccination more than halved the cumulative incidence of SARS-CoV-2 infection and reduced by two-thirds the cumulative incidence of symptomatic subjects. In detail, most unvaccinated HWs were symptomatic; 50% reported fever, 45% reported ageusia/anosmia, and nearly 20% reported dyspnea. These percentages were much lower in HWs who had been vaccinated for at least 14 days (18% for fever and anosmia, 6% for dyspnea and ageusia). Moreover, cases of vaccine breakthrough were sixfold less likely to further spread the infection than unvaccinated HWs. Conclusions: SARS-CoV-2 vaccination reduced the infection frequency among HWs, further spreading of the infection, and the presence, severity, and duration of COVID-19-related symptoms. Full article
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8 pages, 613 KiB  
Communication
Emerging Socioeconomic Disparities in COVID-19 Vaccine Second-Dose Completion Rates in the United States
by Autumn Gertz, Benjamin Rader, Kara Sewalk and John S. Brownstein
Vaccines 2022, 10(1), 121; https://doi.org/10.3390/vaccines10010121 - 14 Jan 2022
Cited by 14 | Viewed by 2526
Abstract
Although COVID-19 vaccination plans acknowledge a need for equity, disparities in two-dose vaccine initiation have been observed in the United States. We aim to assess if disparity patterns are emerging in COVID-19 vaccination completion. We gathered (n = 843,985) responses between February [...] Read more.
Although COVID-19 vaccination plans acknowledge a need for equity, disparities in two-dose vaccine initiation have been observed in the United States. We aim to assess if disparity patterns are emerging in COVID-19 vaccination completion. We gathered (n = 843,985) responses between February and November 2021 from a web survey. Individuals self-reported demographics and COVID-19 vaccination status. Dose initiation and completion rates were calculated incorporating survey weights. A multi-variate logistic regression assessed the association between income and completing vaccination, accounting for other demographics. Overall, 57.4% initiated COVID-19 vaccination, with 84.5% completing vaccination. Initiation varied by income, and we observed disparities in completion by occupation, race, age, and insurance. Accounting for demographics, higher incomes are more likely to complete vaccination than lower incomes. We observe disparities in completion across annual income. Differences in COVID-19 vaccination completion may lead to two tiers of protection in the population, with certain sub-groups being better protected from future infection. Full article
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15 pages, 310 KiB  
Article
Evaluating Rates and Determinants of COVID-19 Vaccine Hesitancy for Adults and Children in the Singapore Population: Strengthening Our Community’s Resilience against Threats from Emerging Infections (SOCRATEs) Cohort
by Konstadina Griva, Kevin Y. K. Tan, Frederick H. F. Chan, Ramanathan Periakaruppan, Brenda W. L. Ong, Alexius S. E. Soh and Mark IC. Chen
Vaccines 2021, 9(12), 1415; https://doi.org/10.3390/vaccines9121415 - 30 Nov 2021
Cited by 36 | Viewed by 5756
Abstract
COVID-19 vaccines are crucial for achieving sufficient immunisation coverage to manage the pandemic, but vaccine hesitancy persists. This study aimed to investigate the prevalence and determinants of vaccine hesitancy in adults and in parents for vaccinating their children using an integrated social cognition [...] Read more.
COVID-19 vaccines are crucial for achieving sufficient immunisation coverage to manage the pandemic, but vaccine hesitancy persists. This study aimed to investigate the prevalence and determinants of vaccine hesitancy in adults and in parents for vaccinating their children using an integrated social cognition model. A community-based cohort in Singapore [N = 1623] completed a survey (wave 25) between June and July 2021 which measured their risk perceptions, distress, trust, vaccination beliefs, and vaccine intentions/behaviours. Results indicated low rates of hesitancy (9.9%) for own vaccination, with most concerns citing side effects, safety, and hasty development. Remaining respondents were vaccinated (69%) or intended to vaccinate (21%). The multivariable model (non-vaccinated respondents) indicated that, living with people in poor health, subjective norm, moral norm, benefits, and necessity of vaccination were associated with lower vaccine hesitancy (R2 Cox & Snell: 51.4%; p < 0.001). Hesitancy rates were higher for children’s vaccination (15.9%), with male gender, lower perceived vaccine benefits, high COVID-19 risk perceptions, vaccination concerns, and necessity beliefs associated with higher odds of parental vaccine hesitancy (R2 Cox & Snell = 36.4%; p < 0.001). While levels of vaccine acceptance are high, more targeted messages are needed. For adults’ vaccination, more emphasis should be on benefits and social gains, while for parental hesitancy, messages related to safety should be prioritised. Full article
12 pages, 446 KiB  
Article
Opposing Mechanisms Involving Perceived Benefits versus Safety Partially Explained an Increase in COVID-19 Vaccination Intention among Unvaccinated Chinese Adults during a Post-Rollout Period: Results of Two Serial Surveys
by Yanqiu Yu, Joseph T. F. Lau and Mason M. C. Lau
Vaccines 2021, 9(12), 1414; https://doi.org/10.3390/vaccines9121414 - 30 Nov 2021
Cited by 5 | Viewed by 1633
Abstract
Background: Perceptions related to COVID-19 vaccination are evolving over time, leading to potential changes in vaccination intention among unvaccinated people, which helps in the predictions of vaccination rates. This study investigated the changes in COVID-19 vaccination intention at the population level during a [...] Read more.
Background: Perceptions related to COVID-19 vaccination are evolving over time, leading to potential changes in vaccination intention among unvaccinated people, which helps in the predictions of vaccination rates. This study investigated the changes in COVID-19 vaccination intention at the population level during a post-rollout period and two potential mechanisms underlying the change via the mediation/suppression effects that involve the perceived benefits/severe side effects of vaccination. Methods: Two serial random population-based telephone surveys interviewed 358 and 145 Chinese adults (aged 18–70) who were unvaccinated and who were unscheduled for COVID-19 vaccination, respectively, in May and August 2021 in Hong Kong, China. Results: The prevalence of vaccination intention increased from 14.5% to 22.8%, while the levels of perceived benefits (protection and travel-related advantages due to vaccination) and the perceived risk of severe side effects resulting from COVID-19 vaccination both significantly declined over time. Structural equation modeling found a simultaneous partial suppression effect via perceived benefits and a partial mediation effect via perceived severe side effects between the time when the surveys were conducted and COVID-19 vaccination intention, with adjustment for background factors. Conclusion: Perceptions related to COVID-19 vaccination are likely to change over time and partially account for changes in vaccination intention, sometimes in opposite directions. Ongoing health promotion may take such changes into account. Serial surveillance is warranted to monitor these changes. Full article
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13 pages, 415 KiB  
Article
Dualistic Determinants of COVID-19 Vaccination Intention among University Students in China: From Perceived Personal Benefits to External Reasons of Perceived Social Benefits, Collectivism, and National Pride
by Phoenix K. H. Mo, Yanqiu Yu, Sitong Luo, Suhua Wang, Junfeng Zhao, Guohua Zhang, Lijuan Li, Liping Li and Joseph T. F. Lau
Vaccines 2021, 9(11), 1323; https://doi.org/10.3390/vaccines9111323 - 15 Nov 2021
Cited by 10 | Viewed by 2532
Abstract
Vaccination is one of the most effective ways of controlling the COVID-19 pandemic. However, vaccine hesitancy is prevalent, and relatively few studies have explored how variables related to personal and external motives have affected the intention to vaccinate. The present study investigated the [...] Read more.
Vaccination is one of the most effective ways of controlling the COVID-19 pandemic. However, vaccine hesitancy is prevalent, and relatively few studies have explored how variables related to personal and external motives have affected the intention to vaccinate. The present study investigated the association between perceived personal benefits, variables reflecting external motives (i.e., perceived social benefits, collectivism, and national pride) and intention to receive COVID-19 vaccination among university students in China. The interaction between perceived personal benefits and the three factors reflecting external motives on intention to receive COVID-19 vaccination was also examined. A total of 6922 university students from five provinces of China completed a cross-sectional survey. Results showed that adjusting for significant background variables, perceived personal benefits, perceived social benefits, collectivism, and national pride were all significant factors of intention to receive COVID-19 vaccination. Results from interaction analyses also showed that the association between perceived personal benefits and COVID-19 vaccination intention was stronger among those with lower levels of national pride. Findings highlighted the important role of self-directed interest and external motives in promoting uptake of COVID-19 vaccination. Full article
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11 pages, 548 KiB  
Article
COVID-19 Vaccine Hesitancy in a City with Free Choice and Sufficient Doses
by Martin C. S. Wong, Eliza L. Y. Wong, Annie W. L. Cheung, Junjie Huang, Christopher K. C. Lai, Eng Kiong Yeoh and Paul K. S. Chan
Vaccines 2021, 9(11), 1250; https://doi.org/10.3390/vaccines9111250 - 28 Oct 2021
Cited by 19 | Viewed by 3599
Abstract
Background: Vaccine hesitancy represents one of the major global health issues around the world. We examined the perception, attitude, perceived barriers and facilitation measures of receiving the COVID-19 vaccine in a Chinese population with free vaccine choices (Sinovac [Coronavac] vs. BioNTech/Fosun [Comirnaty]) and [...] Read more.
Background: Vaccine hesitancy represents one of the major global health issues around the world. We examined the perception, attitude, perceived barriers and facilitation measures of receiving the COVID-19 vaccine in a Chinese population with free vaccine choices (Sinovac [Coronavac] vs. BioNTech/Fosun [Comirnaty]) and adequate doses. Method: We conducted a random telephone survey of the general population in 1195 subjects aged 18 years or above from 23 April 2021 to 8 May 2021 after two months of vaccine rollout. A descriptive analysis of the levels of enabling factors, obstacles and perception of COVID-19 vaccination was conducted using ANOVA and Chi-square tests for trend. Results: Only 10.1% and 13.5% had received one and two COVID-19 vaccine doses, respectively. Among those who had not received any COVID-19 vaccine (75.4%), only 25.1% expressed their intention to receive in the coming 6 months. The barriers with the highest scores included “having heard of cases with serious adverse events or death after vaccination” (score: 8.17 out 10, 95% C.I. 7.99, 8.35), “lack of confidence on governmental recommendations” (7.69, 95% C.I. 7.47, 7.91), and “waiting for a better vaccine” (7.29, 95% C.I. 7.07, 7.52). The highest score for the impact of various incentives for vaccination was for “vaccine passports for overseas travel” (4.44, 95% C.I. 4.18, 4.71). Conclusions: Vaccine hesitancy is commonly observed in this Chinese population despite adequate provision of vaccine doses and choices. No single incentive is strong enough to promote vaccination, and multiple facilitation measures for different groups of population are needed to encourage vaccine uptake. Active clarification and promotion by medical professionals together with a variety of incentives are needed to drive vaccine uptake. Full article
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12 pages, 432 KiB  
Article
Positive Association between Individualism and Vaccination Resistance against COVID-19 Vaccination among Chinese Adults: Mediations via Perceived Personal and Societal Benefits
by Yanqiu Yu, Mason M. C. Lau and Joseph Tak-Fai Lau
Vaccines 2021, 9(11), 1225; https://doi.org/10.3390/vaccines9111225 - 21 Oct 2021
Cited by 11 | Viewed by 2713
Abstract
Background: Vaccination resistance is the key hurdle against herd immunity as it limits the final vaccination coverage. This study investigated the prevalence and factors of COVID-19 vaccination resistance (i.e., those indicating definitely not taking up COVID-19 vaccination), including individualism, perceived personal benefits (PPB) [...] Read more.
Background: Vaccination resistance is the key hurdle against herd immunity as it limits the final vaccination coverage. This study investigated the prevalence and factors of COVID-19 vaccination resistance (i.e., those indicating definitely not taking up COVID-19 vaccination), including individualism, perceived personal benefits (PPB) and perceived societal benefits (PSB) of COVID-19 vaccination, and related mechanisms of the association. Methods: A random telephone survey interviewed 395 unvaccinated adults aged 18–75 not having scheduled for COVID-19 vaccination in May 2021 in Hong Kong, China (response rate = 56.8%). Results: The prevalence of vaccination resistance was 56.5%. Adjusted for background factors, individualism, PPB, and PSB were significantly associated with vaccination resistance. Path analysis showed that individualism exhibited a direct effect on vaccination resistance and a 3-step indirect effect (individualism → PSB → PPB→ vaccination resistance) that explained 46.8% of the total effect. The two 2-step indirect paths via PPB only and via PSB only were non-significant. Conclusion: High prevalence of vaccination resistance was observed. Individualism increased vaccination resistance via its direct and indirect effects. Health promotion may emphasize collective good to reduce the impact of individualism and promote PPB/PSB, which may reduce vaccination resistance directly and alleviate the impact of individualism on vaccination resistance indirectly. Full article
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12 pages, 1660 KiB  
Article
Prediction Model for COVID-19 Vaccination Intention among the Mobile Population in China: Validation and Stability
by Fan Hu, Ruijie Gong, Yexin Chen, Jinxin Zhang, Tian Hu, Yaqi Chen, Kechun Zhang, Meili Shang and Yong Cai
Vaccines 2021, 9(11), 1221; https://doi.org/10.3390/vaccines9111221 - 21 Oct 2021
Cited by 1 | Viewed by 1841
Abstract
Since China’s launch of the COVID-19 vaccination, the situation of the public, especially the mobile population, has not been optimistic. We investigated 782 factory workers for whether they would get a COVID-19 vaccine within the next 6 months. The participants were divided into [...] Read more.
Since China’s launch of the COVID-19 vaccination, the situation of the public, especially the mobile population, has not been optimistic. We investigated 782 factory workers for whether they would get a COVID-19 vaccine within the next 6 months. The participants were divided into a training set and a testing set for external validation conformed to a ratio of 3:1 with R software. The variables were screened by the Lead Absolute Shrinkage and Selection Operator (LASSO) regression analysis. Then, the prediction model, including important variables, used a multivariate logistic regression analysis and presented as a nomogram. The Receiver Operating Characteristic (ROC) curve, Kolmogorov–Smirnov (K-S) test, Lift test and Population Stability Index (PSI) were performed to test the validity and stability of the model and summarize the validation results. Only 45.54% of the participants had vaccination intentions, while 339 (43.35%) were unsure. Four of the 16 screened variables—self-efficacy, risk perception, perceived support and capability—were included in the prediction model. The results indicated that the model has a high predictive power and is highly stable. The government should be in the leading position, and the whole society should be mobilized and also make full use of peer education during vaccination initiatives. Full article
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13 pages, 684 KiB  
Article
The Impact of Social Media Exposure and Interpersonal Discussion on Intention of COVID-19 Vaccination among Nurses
by Meiqi Xin, Sitong Luo, Rui She, Xi Chen, Liping Li, Lijuan Li, Xiaojun Chen and Joseph T. F. Lau
Vaccines 2021, 9(10), 1204; https://doi.org/10.3390/vaccines9101204 - 19 Oct 2021
Cited by 17 | Viewed by 5937
Abstract
COVID-19 vaccine hesitancy among nurses is a global public health concern and it is imperative to understand associated factors. Information environment plays a critical role in shaping health behaviors, while few studies explored such effects in the context of COVID-19 vaccination. A cross-sectional [...] Read more.
COVID-19 vaccine hesitancy among nurses is a global public health concern and it is imperative to understand associated factors. Information environment plays a critical role in shaping health behaviors, while few studies explored such effects in the context of COVID-19 vaccination. A cross-sectional survey was conducted among 1902 nurses in China. The study investigated the effects of social media exposure/interpersonal discussion on intention of COVID-19 vaccination and tested whether perceived effectiveness of COVID-19 vaccines (perceived vaccine efficacy, perceived duration of protection, and perceived effectiveness in preventing resurgences) mediated such associations. Results showed that about 68.0% and 56.5% of the participants had an intention of free and self-paid COVID-19 vaccinations, respectively. Frequent social media exposure and interpersonal discussion were positively associated with vaccination intentions. Perceived vaccine efficacy significantly mediated the effects of frequent social media exposure and interpersonal discussion, whereas perceived effectiveness in preventing resurgences suppressed the effects of frequent social media exposure. In conclusion, the prevalence of intention of COVID-19 vaccination was relatively low among Chinese nurses and health promotion is needed. Frequent social media exposure and interpersonal discussion potentially enhanced vaccination intentions via increased perceived vaccine efficacy. The findings can help inform the development of relevant health communication interventions. Full article
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Review

Jump to: Research

9 pages, 548 KiB  
Review
Traumatic Events and Vaccination Decisions: A Systematic Review
by Maria Christou-Ergos, Kerrie E. Wiley, Julie Leask and Gilla K. Shapiro
Vaccines 2022, 10(6), 911; https://doi.org/10.3390/vaccines10060911 - 8 Jun 2022
Cited by 1 | Viewed by 1726
Abstract
Despite the apparent relationship between past experiences and subsequent vaccination decisions, the role of traumatic events has been overlooked when understanding vaccination intention and behaviour. We conducted a systematic review to synthesize what is known about the relationship between traumatic events and subsequent [...] Read more.
Despite the apparent relationship between past experiences and subsequent vaccination decisions, the role of traumatic events has been overlooked when understanding vaccination intention and behaviour. We conducted a systematic review to synthesize what is known about the relationship between traumatic events and subsequent vaccination decisions. MEDLINE, PsycINFO and CINHAL electronic databases were searched, and 1551 articles were screened for eligibility. Of the 52 articles included in full-text assessment, five met the eligibility criteria. Findings suggest that the experience of trauma is associated with individual vaccination decisions. Social and practical factors related to both trauma and vaccination may mediate this relationship. As this is a relatively new field of inquiry, future research may help to clarify the nuances of the relationship. This review finds that the experience of psychological trauma is associated with vaccination intention and behaviour and points to the potential importance of a trauma-informed approach to vaccination interventions during the current global effort to achieve high COVID-19 vaccine coverage. Full article
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