key: cord-0981979-qabnl2qc
authors: Troiano, Gianmarco; Nardi, Alessandra
title: Vaccine hesitancy in the era of COVID-19
date: 2021-03-04
journal: Public Health
DOI: 10.1016/j.puhe.2021.02.025
sha: 87aaeb478b781e6c8385e1115cef66ac8e526b68
doc_id: 981979
cord_uid: qabnl2qc

Objectives In 2019 a new coronavirus has been identified and many efforts have been directed towards the development of effective vaccines. However, the willingness for vaccination is deeply influenced by several factors. So the aim of our review was to analyze the theme of vaccine hesitancy during COVID-19 pandemic, with a particular focus on vaccine hesitancy toward COVID-19 vaccine. Study Design Narrative Review. Methods In November 2020 we performed a search for original peer-reviewed papers in the electronic database PubMed (MEDLINE). The key search terms were “Vaccine hesitancy AND COVID-19”. We searched for studies published during COVID 19 pandemic and reporting information about the phenomenon of vaccine hesitancy. Results 15 studies were included in the review. The percentage of COVID-19 vaccine acceptance was not so high (up to 86.1% students or 77.6% general population); for influenza vaccine the maximum percentage was 69%. Several factors influenced the acceptance or refusal (ethnicity, working status, religiosity, politics, gender, age, education, income, ..). The most given reasons to refuse vaccine were: being against vaccines in general, concerns about safety/thinking that a vaccine produced in a rush is too dangerous, considering the vaccine useless because of the harmless nature of COVID-19, general lack of trust, doubts about the efficiency of the vaccine, belief to be already immunized, doubt about the provenience of vaccine. Conclusions The high vaccine hesitancy, also during COVID-19 pandemic, represents an important problem, and further efforts should be done in order to support people and give them correct information about vaccines.

The presence of available vaccines is the key element to minimize new infections so it is crucial to 63 vaccinate people, and especially healthcare workers [10] . 64 However, the willingness for vaccination is deeply influenced especially by the mistrust of health 65 authorities, as demonstrated in other studies focused on vaccine trials of HPV and HIV, in Europe 66 and United States [11, 12] . 67 The worldwide COVID-19 crisis may have a more or less important impact on public trust in public 68 health authorities, science, and medicine, from a country to another, according to the burden of 69 its health and socio-economic consequences and intensity of controversies [13] . 70 In addition to a segment of population that refuses vaccines, the novelty of the disease and 71 concerns over safety and efficacy of the vaccine have generated a sizable proportion of U.S. 72 people indicating reluctance to getting vaccinated against . 73 But this phenomenon is also spread elsewhere: in May 2020, about 25% of people in 5 surveys in 74 France (representative samples of 1000 adults) stated that they would refuse a future vaccine 75 against it if it would have been available, mainly due to safety concerns around a vaccine 76 developed in an emergency situation [15] . 77 The aim of our study was, therefore, through a narrative review, to deepen and analyze the theme Inclusion criteria 89 We considered eligible for the review all the articles (original articles, but also letters to the 90 editor if containing original data) that reported data on: i) type of investigated vaccine vaccine but also other vaccines if investigated), ii) a deep and complete analysis of the attitude 92 towards the vaccine and the main reasons or factor influencing this attitude. We considered 93 eligible for the review all descriptive studies, written in English, French, Spanish, Italian. 96 Studies were selected in a 2-stage process. Titles and abstracts from electronic searches 97 were scrutinised by 2 reviewers independently (A.N. and G.T.) and full manuscripts and their 98 citations list were analysed to retrieve missing articles and to select the eligible manuscripts 99 according to the inclusion criteria. The level of agreement between the reviewers was high. Then, 100 each article was further reviewed to identify the manuscripts suitable for our review. 

The literature search yielded 49 publications. The titles, abstracts and full texts of these 105 manuscripts were screened, resulting in 15 studies considered potentially eligible to be included in 106 J o u r n a l P r e -p r o o f the review (4 articles were letters without original data, 1 was a review, 29 were not in line with 107 the aim of the study) [10, [15] [16] [17] [18] [19] [20] [21] [22] [23] [24] [25] [26] [27] [28] . 108 The studies, published in 2020, have been conducted in the period March-September 2020; another study that showed that among African Americans there was a higher degree of scepticism 179 and concern about the flu vaccine [33] . 180 Our review highlighted that unemployed people and those with a lower income had a lower 196 In our review we observed that religiosity was negatively correlated with This particular aspect has already been described by other authors which observed that some In our review we observed three apparently independent phenomena: 1) low age was associated 214 to a lower willingness to receive vaccination; 2) those who were highly concerned about being 215 infected were less likely to refuse the vaccine; 3) no difference observed between those who have 216 been infected and those who have not. It is important to remember that risk perception is an 217 important factor influencing risk behaviors and people with lower risk perception tend to take risk and those with a lower income were more likely to refuse vaccines -No difference was observed between those who were diagnosed with COVID-19 and those who were not -Those who were highly concerned about being infected were less likely to refuse the vaccine -Those who felt close to radical parties or those who didn't vote/didn't feel close to any party were significantly more likely to refuse the vaccine -Most given reasons to refuse vaccine were: being against vaccines in general (27.6%), thinking that a vaccine produced in a rush is too dangerous (64.4%), considering the vaccine useless because of the harmless nature of COVID-19 (9.6%). J o u r n a l P r e -p r o o f 2020 -Significant increase in willingness to be vaccinated (from 49% to 69%)

-Almost 50% expressed their willingness to be vaccinated -Almost 25% were undecided and almost 25% didn't want to be vaccinated -Men were more likely to accept vaccine Wang, 2020

Hong 

What influences vaccine acceptance: A model of determinants of vaccine 267 hesitancy

From SARS to COVID-19: What we have learned about children infected with 269 COVID-19