Aug 2026· Vaccine· Vol 91, pp.
129024
· 0 citations· 48 references
Medicine
TL;DR
There were racial and educational differences in reasons for being unvaccinated, such as dislike of needles and belonging to communities that disproved of being vaccinated, which may underscore the need for continued improvements to vaccine initiatives to improve vaccine uptake.
Abstract
Vaccine hesitancy has been identified as a barrier to reducing COVID-19 morbidity and mortality. This study is a secondary analysis of factors related to vaccine hesitancy among a cohort of participants in the Community Engagement Alliance (CEAL) Common Survey 2. Administered by all 21 CEAL sites from November 2020 to November 2022, this survey included the responses from thousands of U.S. residents across multiple U.S. States. We hypothesized significant demographic differences in vaccine hesitancy, perceptions of trustworthiness of physicians and institutions (e.g. the Centers for Disease Control and Prevention), and reasons for vaccine refusal. Multiple variable logistic regression models were used to examine whether individual-level factors explained sociodemographic characteristics in vaccine hesitance. This large national sample included 13,802 participants; 31.30% Non-Hispanic Black, 36.70% Hispanic, and 27.75% Non-Hispanic White. Over 12% of sample respondents indicated they had not received any dose of the COVID-19 vaccine. NH White participants were most likely to be vaccinated (91.80%), while Non-Hispanic Black participants were least (81.78%). There were significant educational and age gradients related to vaccination; 20.78% of those with high school education were unvaccinated compared to 6.18% of those with a graduate degree. Participants 55 years and older were less likely to be unvaccinated compared to younger participants. Less than 5% of the participants distrusted their doctors in providing COVID-19 information, while approximately over 40% distrusted the FDA to ensure a safe pediatric vaccine. Among the unvaccinated, there were racial and educational differences in reasons for being unvaccinated, such as dislike of needles and belonging to communities that disproved of being vaccinated. Future vaccine campaigns will likely need different approaches to convince population sub-groups to be vaccinated. These results may underscore the need for continued improvements to vaccine initiatives to may improve vaccine uptake.
Despite vaccines being one of the most effective tools for preventing severe disease caused by infections such as COVID-19, vaccine hesitancy is a growing concern. Vaccine uptake among rural communities has lagged behind urban areas, and factors associated with vaccine hesitancy among individual communities can vary.
An online Qualtrics survey was developed using principles from the World Health Organization (WHO) to identify demographic, modifiable (e.g., confidence-related attitudes, trusted information sources), and non-modifiable (e.g., age, education, health care worker status) risk factors associated with COVID-19 vaccine hesitancy among rural, underserved populations of North Carolina using a multivariate logistic regression. We also sought to identify the preferred sources of health information. In this study, 918 participants from 40 counties with high health professional shortage area (HPSA) scores in primary care completed the survey and were identified as either “vaccine willing” or “vaccine hesitant.”
We determined that age, education level, having a family member seriously ill with COVID-19, and working in health care were associated with willingness to vaccinate. Free-response questions revealed safety as the top concern for vaccine-hesitant participants, who expressed concerns for long- and short-term side effects and even death from the vaccines. Convenience played a very limited role in vaccine behavior. Health care professionals were identified as the most trusted source of health care information and preferred resource for learning more about vaccines.
Self-reported data limited to English speakers with access to technology alongside the evolving nature of vaccine attitudes may not fully represent current attitudes in these counties.
Vaccine hesitancy among rural, underserved North Carolina populations is related to modifiable and non-modifiable risk factors. Trust in health care providers for reliable health information including vaccines remained high even among those who were vaccine hesitant, suggesting provider-led, trust-building vaccination outreach in rural settings.
Celeste R. Gracey, G. Dogbey, David R. Tillman et al.· North Carolina Medical Journ...· 0 citations
Background Vaccine hesitancy is viewed as a complex interaction of behavioral and societal factors that can intervene in the uptake of vaccines or lack thereof. To date, no existing instrument developed for the U. S. adult population measures general vaccine hesitancy in a way that integrates behavioral and cognitive determinants and generalizes across vaccines rather than targeting a specific disease. The development of this tool will be useful for clinicians to counsel patients on vaccination and for vaccine related public health interventions targeted at improving population health. Methods Based on a comprehensive review of the literature, 38 items were developed to be rated on a 5-point Likert scale. Eight subject matter experts across the United States completed a content validity review to determine the relevance of survey items. Face validity feedback was collected from three self-reported vaccine-hesitant, one with a neutral stance on vaccines, and three not vaccine-hesitant individuals. Results Item-Level CVI (I-CVI) ranged from 0.38 to 1.00 for the initial 38 items. Five items were dropped due to low CVI scores, face validity feedback, and similarity to other items. Four items were revised to incorporate the viewpoints of comparable items, address face validity feedback, and improve overall clarity and alignment with the survey’s objectives. Lastly, two items below the I-CVI threshold of 0.80 were retained after the research team deemed them necessary for addressing general vaccine hesitancy in the adult population. The Scale-Level CVI (S-CVI) was 0.87 across all 38 items initially rated and 0.90 for the final 33-item scale, indicating strong content validity, and the final survey consists of 33 items. Conclusion This tool lays the groundwork for better understanding the barriers associated with vaccination and hesitancies that prevent the growth of herd immunity and overall vaccination uptake. Pilot testing on a large sample of the adult population is required to refine the tool items further.
D. Subramaniam, Michael Poirier, Elizabeth Ward et al.· Frontiers in Public Health· 0 citations
BACKGROUND
Vaccine hesitancy represents a growing challenge for immunization programs worldwide. In Latin America, population-based estimates derived from probabilistic surveys remain scarce, limiting the design of evidence-informed interventions.
METHODS
We conducted a population-based study in the City of Buenos Aires, Argentina, between April and June 2025 using a stratified multistage probabilistic sampling design embedded within an official periodic household survey. A culturally adapted version of the Vaccine Hesitancy Scale was administered and psychometrically evaluated. Household-level vaccine hesitancy was assessed using two complementary outcomes: strict hesitancy, defined as explicit refusal of recommended vaccines, and extended hesitancy, defined as a broader programmatic outcome combining refusal and reported vaccination delays related to access, convenience, or organizational barriers. Analyses accounted for sampling weights, strata, and primary sampling units.
RESULTS
A total of 1934 households were surveyed. The weighted prevalence of strict vaccine hesitancy was 7.1% (95% CI: 5.8-8.6).Female respondent sex (adjusted OR 2.77; 95% CI: 1.68-4.57) and lower vaccine confidence (adjusted OR 4.19; 95% CI: 2.65-6.64) were independent associated with strict vaccine hesitancy. The weighted prevalence of extended vaccine hesitancy was 24.1% (95% CI: 21.8-26.5). Lower vaccine confidence (adjusted OR 2.10; 95% CI: 1.61-2.74), female respondent sex (adjusted OR 1.33; 95% CI: 1.03-1.74), younger age, and residence in informal settlements (adjusted OR 2.00; 95% CI: 1.30-3.08) were independently associated with extended hesitancy.
CONCLUSIONS
Outright vaccine refusal was uncommon, but broader forms of hesitancy linked to delays and access barriers affected a substantial proportion of households. Vaccine confidence was the most consistent correlate across definitions.
P. Angeleri, C. Biscayart, D. Ferrante et al.· Vaccine· 0 citations
Introduction: Community engagement offers an approach to improve our understanding of vaccine hesitancy, yet some worry that public engagement centered around controversial and politicized topics such as COVID-19 vaccines carries a risk of increasing concerns. Methods: Respondents who reported hesitance to vaccinate against COVID-19 in a December 2020 national panel survey were recruited to participate in three interactive and respectful virtual community engagement meetings. A second survey in September 2021 resampled respondents to ascertain changes over time. Of the 291 respondents to both survey waves who had been willing to participate in community meetings, 94 (32%) participated. Multivariate linear and logistic regressions were used to assess the potential impact of meeting participation on outcomes of interest. Results: At follow-up, participants had nearly double the odds of vaccinating against COVID-19 (adjusted Odds Ratio: 1.88; 95% Confidence Interval: 1.06–3.34), about one-third the odds of contracting COVID-19 disease (aOR: 0.37; 95% CI: 0.14–0.96), and increased trust in the Centers for Disease Control and Prevention (CDC) (adjusted Regression Coefficient: 4.16; 95% CI: 0.37–7.94), compared to non-participants. Most participants found the meetings unbiased (89%) and trustworthy (90%). Conclusions: The design of our community meetings to focus on learning from and supporting the decision-maker (versus only promoting “shots in arms”) improved health outcomes and increased trust. Similar meetings could improve how public health engages communities.
Matthew Z. Dudley, Janesse Brewer, Roger R. Bernier et al.· COVID· 0 citations
ABSTRACT Objectives: to analyze factors associated with healthcare professionals’ decisions regarding COVID-19 vaccination schedule continuation. Methods: an analytical cross-sectional study was conducted with 221 healthcare professionals working in public healthcare services in a regional hub municipality in Minas Gerais. A questionnaire was used with questions about sociodemographic factors, vaccination status, and the determinants of confidence, convenience, and compliance. The response variable was the number of doses of COVID-19 vaccines. Descriptive data analysis and logistic regression were performed. Results: it was identified that 21.5% of healthcare professionals hesitated to continue the COVID-19 vaccination schedule, with the sex (p=0.037; OR=2.163) and confidence in vaccine safety (p=0.003; OR=0.317) variables being associated with this vaccine hesitancy. Conclusions: there are professionals hesitant to continue being vaccinated against COVID-19. Interventions that strengthen confidence in vaccines and adopt continuous education strategies are essential.
Amanda Cristina Costa Prado, A. L. B. Silva, Gabriela Gonçalves Amaral et al.· Revista Brasileira de Enferm...· 0 citations
Immunization is a key public health strategy for preventing vaccine-preventable diseases; however, vaccine hesitancy remains a persistent challenge. This study determined the level of vaccine hesitancy among mothers of non- and under-immunized children aged 0-24 months in a third-class municipality in Occidental Mindoro, Philippines. A community-based cross-sectional study was conducted in Magsaysay, Occidental Mindoro, from February to July 2020. A total of 299 mothers participated. Data were collected using a structured questionnaire assessing vaccine hesitancy across the domains of confidence and trust, complacency, and perceived risk. Descriptive statistics summarized participant characteristics and hesitancy levels, while nonparametric tests examined associations between sociodemographic factors and vaccine hesitancy domains at a significance level of p < .05. Results showed that work status was significantly associated with perceived confidence and trust (U = 5408.50, p = .03) and perceived complacency and risk (U = 5122.00, p < .01), with stay-at-home mothers reporting higher ranks in both domains. Marital status was significantly associated with perceived confidence and trust, H(3) = 25.07, p < .01. Geographic location, H(2) = 24.61, p < .01, prenatal visit history, H(2) = 17.20, p < .01, and health information sources were also significantly associated with perceived confidence and trust, H(5) = 19.04, p < .01, and perceived complacency and risk, H(5) = 32.50, p < .01. These findings highlight the importance of targeted health communication strategies that address determinants of vaccine hesitancy. Engaging health care providers and leveraging trusted information sources may strengthen vaccine confidence and improve routine childhood immunization uptake.
Indah Amina An-Nur S Ulay, Cherry May L Delos Trinos, Chona D Alejandro et al.· Health Promotion Practice· 0 citations
