Factors contributing to vaccine hesitancy and reduced vaccine confidence in rural underserved populations

Abstract

Vaccination remains one of the most effective ways to limit the spread of infectious diseases, and reduce mortality and morbidity in rural areas. Waning public confidence in vaccines, especially the COVID-19 vaccine, remains a cause for concern. A number of individuals in the US and worldwide remain complacent, choosing not to be vaccinated and/or delay COVID-19 vaccination, resulting in suboptimal herd immunity. The primary goal of this study is to identify modifiable factors contributing to COVID-19 vaccine hesitancy among vaccine-eligible individuals with access to vaccines in two under-resourced rural states, Alaska and Idaho. This qualitative study used semi-structured interviews with providers and focus groups with community participants in Alaska and Idaho. A moderator’s guide was used to facilitate interviews and focus groups conducted and recorded using Zoom and transcribed verbatim. Thematic, qualitative analysis was conducted using QDA Miner. Themes and subthemes that emerged were labeled, categorized, and compared to previously described determinants of general vaccine hesitancy: established contextual, individual and/or social influences, vaccine and vaccination-specific concerns. Themes (n = 9) and sub-themes (n = 51) identified during the qualitative analysis highlighted a factor’s contributing to COVID-19 vaccine hesitancy and poor vaccine uptake. Relevant influenceable factors were grouped into three main categories: confidence, complacency, and convenience. Vaccines are effective public health interventions to promote health and prevent diseases in rural areas. Practical solutions to engage healthcare providers, researchers, vaccine advocates, vaccine manufacturers, and other partners in local communities are needed to increase public trust in immunization systems to achieve community immunity.

COVID-19 Vaccine Acceptance, Attitude and Perception among Slum and Underserved Communities: A Systematic Review and Meta-Analysis

“…On further screening, 42 articles remained for eligibility assessment after excluding those which were not original studies and not done in slum/underserved communities. The final assessment yielded 24 articles for further analysis [ 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 ].…”

“…Good knowledge and awareness of the vaccines as well as reliable information sources, were strong positive associates of vaccine acceptance and uptake [ 28 , 34 , 37 , 41 ]. Perceived benefit of vaccination, high perceived susceptibility and severity of COVID-19, and self-efficacy to receive vaccination were also strong positive predictors of vaccine acceptance and uptake [ 27 , 30 , 34 , 39 , 41 , 48 ], same as cues to action in the forms of text messages and reminders for people to get vaccinated [ 41 , 48 ]. However, perceived barriers such as serious side effects and safety concerns of the vaccines and long distances to vaccination centres were associated with higher vaccine hesitancy, same as negative attitudes, beliefs and perceptions about the vaccine, for example, anti-vaccine attitudes and religious beliefs against vaccination [ 28 , 33 , 34 , 37 , 39 , 41 , 48 ].…”

“…Perceived benefit of vaccination, high perceived susceptibility and severity of COVID-19, and self-efficacy to receive vaccination were also strong positive predictors of vaccine acceptance and uptake [ 27 , 30 , 34 , 39 , 41 , 48 ], same as cues to action in the forms of text messages and reminders for people to get vaccinated [ 41 , 48 ]. However, perceived barriers such as serious side effects and safety concerns of the vaccines and long distances to vaccination centres were associated with higher vaccine hesitancy, same as negative attitudes, beliefs and perceptions about the vaccine, for example, anti-vaccine attitudes and religious beliefs against vaccination [ 28 , 33 , 34 , 37 , 39 , 41 , 48 ]. Trust and confidence in the vaccine, healthcare workers and the government were also reported in several studies as strong positive predictors [ 33 , 34 , 42 , 47 , 48 ].…”

“…However, perceived barriers such as serious side effects and safety concerns of the vaccines and long distances to vaccination centres were associated with higher vaccine hesitancy, same as negative attitudes, beliefs and perceptions about the vaccine, for example, anti-vaccine attitudes and religious beliefs against vaccination [ 28 , 33 , 34 , 37 , 39 , 41 , 48 ]. Trust and confidence in the vaccine, healthcare workers and the government were also reported in several studies as strong positive predictors [ 33 , 34 , 42 , 47 , 48 ]. Other reported factors with a positive association included urban residence [ 25 , 35 ], COVID-19 infection and test history, and vaccination of other family members [ 39 , 45 ].…”

Factors Affecting Vaccine Attitudes Influenced by the COVID-19 Pandemic

“…Misinformation and lack of information have played a substantial role in affecting attitudes about vaccination during the COVID pandemic [ 24 ]. According to one source, the speed of transmission of false information about COVID-19 proved to be more dangerous than the speed of the spread of the virus [ 1 ].…”