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1. Modification of a vaccine hesitancy scale for use in adult vaccinations in the United States and China

   https://doi.org/10.1080/21645515.2021.1884476  

   Akel, Kaitlyn B.; Masters, Nina B.; Shih, Shu-Fang; Lu, Yihan; Wagner, Abram L. (January 2021, Human Vaccines & Immunotherapeutics)

   null (Ed.)

   Most research on vaccine hesitancy has focused on parental attitudes toward childhood vaccination, but it will be important to understand dimensions of vaccine hesitancy in the adult population as more adult vaccines are introduced in the future. We modified the Vaccine Hesitancy Scale to target adult vaccines and provide measures of its reliability and validity relative to influenza vaccine uptake and COVID-19 vaccination acceptance in cross-sectional internet surveys in the United States and in China. We assessed the impact of vaccine hesitancy on influenza and COVID-19 vaccination using multivariable regression modeling, which informed concurrent validity of the adult Vaccine Hesitancy Scale (aVHS). Among 1103 participants in the March 2020 China survey, 5.4% would not accept a COVID-19 vaccine, whereas this figure was 18.8% for the March 2020 US survey and 27.3% for the June 2020 US survey. The aVHS exhibits good internal consistency in all three surveys. Models adjusted for age, gender and income level show that prevalence of COVID-19 vaccine acceptance was a fraction as high in those who scored higher on the VHS than those who scored lower on all three surveys. Prevalence of past and future flu vaccine acceptance was a fraction as high in those with higher aVHS scores than those with lower scores. Prevalence of COVID-19 vaccine acceptance is lower in those with higher vaccine hesitancy scores, which supports the scale’s concurrent validity. The aVHS exhibits good internal consistency, making it a valid and reliable tool for measuring vaccination uptake. 

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2. Using Gaming to Promote Vaccination Among Youth: A Systematic Review

   https://doi.org/10.1177/23779608241256998  

   Ou, Lihong; Reifsnider, Elizabeth; Chen, Angela Chia-Chen; Todd, Michael; Amresh, Ashish; Mun, Chung Jung (January 2024, SAGE Open Nursing)

   IntroductionWhile vaccines are crucial for disease prevention, disparities in vaccination coverage persist among youths aged 10 to 29 years, including within the United States. Serious games are emerging as a new strategy to address vaccine hesitancy. This systematic review aimed to aggregate and assess the current evidence on game-based interventions to improve youth vaccination rates, evaluating their impact and identifying factors influencing their effectiveness. MethodsThis systematic review was conducted through a meticulous search and evaluation of literature from databases including PubMed, Cumulative Index to Nursing and Allied Health Literature database, ProQuest platform, Cochrane Library, and Google Scholar. Studies were included if they (a) were designed with the purpose of improving youth vaccination rates; (b) were published in English; (c) were published between January 2011 and June 2023; and (d) evaluated the effect of game-based interventions. Search terms included Medical Subject Headings terms and keywords of the eligible articles. ResultsOut of 269 studies, 11 were included in the final analysis of this review. The earliest study dated back to 2013, with 5 being randomized controlled trial and 6 studies incorporating theoretical models in their design or outcome measures. The findings indicated a generally positive effect of game-based interventions on vaccine-related knowledge. However, the impact on actual vaccine uptake was limited. In-game avatar customization and collaboration games were found as effective tools for player engagement. ConclusionThe review findings indicated that serious games boost vaccine knowledge but lack strong evidence for influencing youth vaccine uptake. More rigorous research and tailored game designs are needed to determine the effectiveness of game-based interventions and effectively address the diverse needs of youth in vaccine decision-making. 

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3. Differential Effect of Vaccine Effectiveness and Safety on COVID-19 Vaccine Acceptance across Socioeconomic Groups in an International Sample

   https://doi.org/10.3390/vaccines9091010  

   Kerekes, Stefania; Ji, Mengdi; Shih, Shu-Fang; Chang, Hao-Yuan; Harapan, Harapan; Rajamoorthy, Yogambigai; Singh, Awnish; Kanwar, Shailja; Wagner, Abram L. (September 2021, Vaccines)

   Controlling the spread of SARS-CoV-2 will require high vaccination coverage, but acceptance of the vaccine could be impacted by perceptions of vaccine safety and effectiveness. The aim of this study was to characterize how vaccine safety and effectiveness impact acceptance of a vaccine, and whether this impact varied over time or across socioeconomic and demographic groups. Repeated cross-sectional surveys of an opt-in internet sample were conducted in 2020 in the US, mainland China, Taiwan, Malaysia, Indonesia, and India. Individuals were randomized into receiving information about a hypothetical COVID-19 vaccine with different safety and effectiveness profiles (risk of fever 5% vs. 20% and vaccine effectiveness 50% vs. 95%). We examined the effect of the vaccine profile on vaccine acceptance in a logistic regression model, and included interaction terms between vaccine profile and socioeconomic/demographic variables to examine the differences in sensitivity to the vaccine profile. In total, 12,915 participants were enrolled in the six-country study, including the US (4054), China (2797), Taiwan (1278), Malaysia (1497), Indonesia (1527), and India (1762). Across time and countries, respondents had stronger preferences for a safer and more effective vaccine. For example, in the US in November 2020, acceptance was 3.10 times higher for a 95% effective vaccine with a 5% risk of fever, vs a vaccine 50% effective, with a 20% risk of fever (95% CI: 2.07, 4.63). Across all countries, there was an increase in the effect of the vaccine profile over time (p < 0.0001), with stronger preferences for a more effective and safer vaccine in November 2020 compared to August 2020. Sensitivity to the vaccine profile was also stronger in August compared to November 2020, in younger age groups, among those with lower income; and in those that are vaccine hesitant. Uptake of COVID-19 vaccines could vary in a country based upon effectiveness and availability. Effective communication tools will need to be developed for certain sensitive groups, including young adults, those with lower income, and those more vaccine hesitant. 

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4. COVID-19 Vaccine Refusal and Medical Distrust Held by Correctional Officers

   https://doi.org/10.3390/vaccines11071237  

   Kerrison, Erin_Michelle Turner; Hyatt, Jordan M (July 2023, Vaccines)

   This study explores COVID-19 vaccine acceptance among prison security staff and the extent to which they trust varied sources of information about the vaccines. Cross-sectional survey data were obtained from a state-wide sample of corrections officers (COs, hereafter; n = 1208) in February 2021. Group differences, disaggregated by demographic characteristics, were examined using F-tests and t-tests. Despite the comparatively limited risk of contracting the virus, non-security staff reported they would accept a COVID-19 vaccine at no cost (74%), compared to their more vulnerable CO counterparts (49%). We observed vaccine refusal correlations between COs’ reported gender, age, and length of time working as a CO, but none with their self-reported race. Vaccine refusal was more prevalent among womxn officers, younger officers, and those who had spent less time working as prison security staff. Our findings also suggest that the only trusted source of information about vaccines were family members and only for officers who would refuse the vaccine; the quality of trust placed in those sources, however, was not substantially positive and did not vary greatly across CO racial groups. By highlighting characteristics of the observed gaps in COVID-19 vaccine acceptance between COs and their non-security staff coworkers, as well as between corrections officers of varied demographic backgrounds, these findings can inform the development of responsive and accepted occupational health policies for communities both inside and intrinsically linked to prisons. 

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5. The Role of Medical Mistrust in Vaccination Decisions in Rural, Indigenous Namibian Communities

   https://doi.org/10.1007/s40615-025-02442-5  

   Prall, Sean; Scelza, Brooke; Davis, Helen Elizabeth (April 2025, Journal of Racial and Ethnic Health Disparities)

   Objectives Substantial inequalities in access to healthcare are common in rural and marginalized populations in the Global South, and these inequalities can drive health disparities. Historical mistrust of healthcare institutions can further impact healthcare behaviors, including vaccination. Here, we apply the concept of medical mistrust, which has been widely applied to healthcare decisions in industrialized countries, across a rural–urban spectrum of communities in Namibia, and assess its utility in understanding vaccination decisions. Methods Otjiherero-speaking indigenous communities of Kunene, Namibia, were surveyed to assess medical mistrust. Participants also answered questions about COVID-19 vaccination status, vaccine safety, and interest in a hypothetical malaria vaccine. Bayesian multilevel models were used to compare medical mistrust across communities and its influence on vaccination and vaccine perceptions. Results The level of medical mistrust varied across contexts, with the highest level of mistrust in peri-urban communities. Medical mistrust predicted beliefs about vaccine safety and interest in the malaria vaccine, but not COVID-19 vaccine status, which was largely driven by access to the vaccine. For rural and peri-urban Himba, participants also expressed disinterest in the COVID-19 vaccine and worries about its safety. Conclusion Addressing global health disparities requires understanding how locally contextualized social and ecological experiences shape healthcare and vaccination decisions. Results of this study show fundamental differences in medical mistrust by community, which may be contributing to beliefs about vaccines. Understanding how medical mistrust varies across these contexts, and how it impacts perceptions about vaccination, can inform health communication and public policy in underserved communities. 

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