General Hesitancy
Websites
1. Kaiser Family Foundation has multiple ongoing research projects tracking the public’s attitudes and experiences with COVID-19 vaccinations.
Scholarly Articles
Open Forum Infectious Diseases, Volume 9, Issue 3, March 2022
Authors: Albert L Hsu, Traci Johnson, Lynelle Phillips, and Taylor B Nelson
The coronavirus disease 2019 (COVID-19) epidemic continues to evolve, with variants of concern and new surges of COVID-19 noted over the past months. The limited data and evolving recommendations regarding COVID-19 vaccination in pregnancy have led to some understandable hesitancy among pregnant individuals. On social media, misinformation and unfounded claims linking COVID-19 vaccines to infertility are widespread, leading to vaccine skepticism among many men and women of reproductive age. The disproportionate impact of COVID-19 on communities of color, coupled with the unfortunate and troubled history of abuses of African Americans by the biomedical research community in the US, has also led to hesitancy and skepticism about the COVID-19 vaccines among some of our most vulnerable. The complex nature of vaccine hesitancy is evidenced by further divides between different demographic, political, age, geographical, and socioeconomic groups. Better understanding of these concerns is important in the individualized approaches to each patient.
The College of Family Physicians of Canada 2019 Mar; 65(3): 175–181.
Authors: Shixin Shen and Vinita Dubey
Practical tips for addressing parental vaccine hesitancy in primary care include starting early, presenting vaccination as the default approach, building trust, being honest about side effects, providing reassurance on a robust vaccine safety system, and focusing on the protection of the child and community, telling stories, and addressing pain. Also provided are statements that providers could use in vaccination-related conversations; answers to commonly asked questions on benefits, safety, and immunologic aspects of vaccines; and links to a number of online resources for physicians and parents.
Migrant Worker/Rural Population Hesitancy
Websites
Kaiser Family Foundation presents vaccine hesitancy data among rural communities and effective messages for rural Americans.
Scholarly Articles
National Institute of Health June 25 2021
Authors: Daniel Gehlbach, Evelyn Vázquez, Gabriela Ortiz, Erica Li, Cintya Beltrán Sánchez, Sonia Rodríguez, María Pozar, and Ann Marie Cheney
Gehlbach et al. (2021) discusses misinformation, lack of trust in institutions, and insecurity among Latinx immigrants in rural agricultural communities.
PDFs
The CDC presents 12 evidence-based strategies to increase COVID-19 confidence and uptake in rural communities with the help of rural health organizations. s
Minority Hesitancy
Websites
The CDC discusses health inequities that have disproportionally affected minorities in the United States. They have provided definitions, issues, and more resources surrounding this topic.
Scholarly Articles
Journal of Urban Health volume 99, pages 3–14 (2022)
Authors: SarahAnn M. McFadden, Jemal Demeke, Debbie Dada, Leo Wilton, Mengzu Wang, David Vlahov & LaRon E. Nelson
Black and Hispanic Americans have been hardest hit with COVID-19 infections, hospitalizations, and deaths, yet during the first several months of vaccine roll-out they had the lowest level of vaccine uptake. Primarily, our research on vaccine hesitancy focused on skepticism around the vaccine itself and its roll-out. Our search strategy used PUBMED and Google with a prescribed set of definitions and search terms for two reasons: there were limited peer-reviewed studies during early period of roll-out and real-time perspectives were crucially needed. Literature searches occurred in April 2021and covered September 2020-April 2021. Analyses included expert opinion, survey results and qualitative summaries. Overall, for the general U.S. population, there was considerable hesitancy initially that remained high during the early roll-out. The general population expressed concerns over the speed of vaccine development (“warp speed”), confidence in the competence of government being involved in the development of vaccines and general mistrust of government. Among Black and Hispanic Americans, hesitancy was further expressed as mistrust in the medical establishment that was related to past and current medical mistreatment. Undocumented immigrants worried about access to insurance and possible deportation. These results on confidence in the vaccine early during vaccine roll-out suggest diverse reasons that influence a person’s decision to vaccinate or not. Additional barriers to vaccine uptake include complacency and access. To ensure health equity, particularly to address disparities in morbidity and mortality, vaccine hesitancy needs to be acknowledged and addressed as COVID-19 vaccine roll-out continues, and these observations calls for conscious planning to address these issues early with future health crises.
Brain, Behavior, Immunity Journal 2021 Aug; 15
Authors: Jagdish Khubchandania and Yilda Maciasb
COVID-19 vaccines were approved for use in the general American public by late 2020 and early 2021. Media reports started highlighting COVID-19 vaccination hesitancy in racial and ethnic minorities. However, little is known about the extent of COVID-19 vaccination hesitancy in racial and ethnic minorities and whether there are unique sociodemographic and cognitive correlates associated with vaccine hesitancy. Thus, the purpose of this study was to review all nationwide studies on COVID-19 vaccine hesitancy among African-Americans and Hispanics (the largest minority groups in the U.S.). A comprehensive review of the published literature was conducted to search for national studies and a final pool of 13 studies (n = 107,841 participants) was included in this review. The overall pooled prevalence rate of COVID-19 vaccination hesitancy for adult Americans across all studies was 26.3% (95%Ci = 17.3–36.4). In contrast, the overall pooled prevalence rate of COVID-19 vaccination hesitancy for African-Americans was 41.6% (95%Ci = 34.4–48.9) and for Hispanics, it was 30.2% (95%Ci = 23.2–37.7). The major predictors of vaccine hesitancy in African-Americans and Hispanics were: sociodemographic characteristics (e.g., age, gender, income, education, and household size); medical mistrust and history of racial discrimination; exposure to myths and misinformation, perceived risk of getting infected with COVID-19; beliefs about vaccines and past vaccine compliance, and concerns about the safety, efficacy, and side effects from the COVID-19 vaccines. Given the high COVID-19 vaccine hesitancy rates in racial/ethnic minorities and the unique factors associated with vaccine hesitancy in African-Americans and Hispanics, several clinic-based and community-oriented practice recommendations have been included in this article.
Pediatric Hesitancy
Website Articles
Scholarly Articles
The Journal of Pediatrics Volume 175, P248-249.E1, August 01, 2016
Authors: E. David G. McIntosh, MBBS, MPH, LLM, PhD Jan Janda, MD Jochen H.H. Ehrich, MD, DCMT Massimo Pettoello-Mantovani, MD, PhD Eli Somekh, MD
McIntosh et al. (2016) discusses general pediatric vaccine hesitancy and refusal phenomenon. Researchers define pediatric vaccine hesitancy, and discuss the political and social aspects, ethics, and consequences of this phenomenon prior to the COVID-19 pandemic.
Vaccines (Basel). 2022 Jan; 10(1): 31.
Authors: Celia B. Fisher, Aaliyah Gray, and Isabelle Sheck
On 29 October 2021, the U.S. FDA authorized the Pfizer-BioNTech COVID-19 (SARS-CoV-2) vaccine for emergency use in children ages 5–11 years. Racial/ethnic minorities have born the greatest burden of pediatric COVID-19 infection and hospitalization. Research indicates high prevalence of parental vaccine hesitancy among the general population, underscoring the urgency of understanding how race/ethnicity may influence parents’ decision to vaccinate their children. Two weeks prior to FDA approval, 400 Hispanic and non-Hispanic Asian, Black, and White parents of children 5–10 years participated in an online survey assessing determinants of COVID-19 pediatric vaccine hesitancy. Compared to 31% Black, 45% Hispanic, and 25% White parents, 62% of Asian parents planned to vaccinate their child. Bivariate and multivariate ordinal logistic regression demonstrated race/ethnicity, parental vaccine status, education, financial security, perceived childhood COVID-19 susceptibility and severity, vaccine safety and efficacy concerns, community support, and FDA and physician recommendations accounted for 70.3% of variance for vaccine hesitancy. Findings underscore the importance of multipronged population targeted approaches to increase pediatric COVID-19 vaccine uptake including integrating health science literacy with safety and efficacy messaging, communication efforts tailored to parents who express unwillingness to vaccinate, and interventions developed in partnership with and delivered through existing trusted community coalitions.
Journal of Pediatrics Volume 29, Issue 4, P385-394, 01 July 2015
Authors: Meagan A. Barrows, BSN, RN Jennifer A. Coddington, DNP, MSN, RN, CPNP Elizabeth A. Richards, PhD, MSN, RN, CHES Pamela M. Aaltonen, PhD, RN
Despite being recognized as one of the greatest public health achievements, vaccines are increasingly under scrutiny for a multitude of reasons. “Parental vaccine hesitancy,” an emerging term in today’s literature, encompasses a wide range of concerns regarding vaccines and is believed to be responsible for decreasing coverage of many childhood vaccines. The threat to herd immunity posed by poor vaccine uptake increases the risk for resurgence of vaccine-preventable diseases. Pediatric primary health care providers have an obligation to respond to the increasing prevalence of vaccine hesitancy by providing education related to vaccines to ensure the safety and health of the population. The purpose of this article is to examine the most common concerns surrounding vaccine hesitancy and outline strategies for pediatric providers to address concerns with parents in the clinical setting.
Health Provider Hesitancy
Website Articles
- Safety and efficacy concerns
- Preference for physiological immunity
- Distrust in government and health organizations
- Autonomy and personal freedom
Scholarly Articles
Vaccines (Basel). 2021 Jul; 9(7): 713.
Authors: Cheryl Lin, Jewel Mullen, Danielle Smith, Michaela Kotarba, Samantha J. Kaplan, and Pikuei Tu
Despite vaccines’ effectiveness in reducing the rate of preventable diseases, vaccine hesitancy has threatened public health and economies worldwide. Healthcare providers’ (HCP) communications and behavior strongly influence patient receptivity and uptake. The goal of this review was to examine HCP vaccine perceptions, knowledge, and reservations and how these attitudes affect their recommendations and vaccination practices. Primary research studies published by 16 September 2020 were searched in PubMed, Web of Science, Embase, CINAHL, and PsycINFO. A 14-item scale was developed for survey study and risk of bias appraisal (SSRBA). In total, 96 papers from 34 countries were included, covering 17 vaccines (HPV and influenza vaccines the most studied). Recommendation was positively associated with provider knowledge and experience, beliefs about disease risk, and perceptions of vaccine safety, necessity, and efficacy. HCP vaccination attitudes and practices varied across specialties, vaccines, and countries; demographic impact was inconclusive. Barriers included anticipation of patient/parental concerns or refusal, lacking clear guidelines, time constraints, and cost. For HPV, vaccines were more often recommended to older, female adolescents and by physicians who discussed sexual health. HCPs are vital advocates for patients and the public, but studies indicated a prevalence of provider hesitancy pertaining to inadequate knowledge, low vaccine confidence, and suboptimal uptake themselves. Improving HCP knowledge and assuring their access to information they deem trustworthy are essential to supporting HCPs‘ role as “trusted messengers” to promote vaccine acceptance.
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