Factors Affecting Vaccine Attitudes Influenced by the COVID-19 Pandemic

"The COVID-19 pandemic had both positive and negative effects on attitudes toward common vaccinations and taught several lessons about vaccination programs."

Research has indicated that exposure to vaccine-preventable diseases (VPDs) or education about the organisms responsible for diseases can improve vaccine attitudes. In light of the exponential increase in communication about VPDs brought on by the COVID-19 pandemic and associated worldwide vaccination effort, one might hypothesise that the COVID-19 pandemic may have improved vaccine attitudes. However, pandemic-era restrictions had a significant effect on the administration of childhood vaccinations, and there has been an increase in parental vaccine hesitancy. The purpose of this paper is to explore factors that contribute to vaccination during the age of COVID-19 and to analyse ways that those factors either improve or impair vaccination hesitancy or rates. The paper addresses vaccine hesitancy as a whole for the entire population, both children and adults, and considers mainly routine (non-COVID-19) vaccines.

The paper begins by examining convenience factors - convenience being one of the "3 Cs" often discussed in the context of vaccine hesitancy, with the others being confidence and complacency. Convenience can refer to the direct, indirect, and opportunity costs people consider before being vaccinated. Convenience due to the lack of access that people in lower- and middle-income countries (LMICs) have contributes to lower vaccination rates. Convenience could refer to clinics and their ability to provide vaccinations in a time of limited resources. In addition, convenience, in combination with confidence and complacency, can be affected by the ease of accessibility of information that people need in order to reach the decision to be vaccinated. All of these different aspects were affected in some way during the COVID-19 pandemic. For example, the Global Polio Eradication Initiative (GPEI) advised the suspension of polio vaccination programmes until the second half of 2020; as a result, vaccination programmes in 68 countries were disrupted, affecting around 80 million children. Also, misinformation has substantially affected attitudes about vaccination during the COVID-19 pandemic.

Furthermore, the release of SARS-CoV-19 vaccines has caused people across the globe to reconsider and alter their risk perception as it pertains to receiving vaccinations. Different studies have shown that for some, the pandemic led to increased intent to vaccinate, while for others, vaccine hesitancy had increased. There has been an increase in Google searches, and media coverage pertaining to vaccination and the risks involved with being vaccinated. Whether or not this increased perception of risk associated with general vaccination will deter a larger population from receiving vaccinations has yet to be seen.

Lack of trust in the news media, as demonstrated by various surveys, can motivate individuals to consider using other sources to supplement their intake of information. An analysis of Google search trends about vaccines correlates peaks in searches with significant milestones during the heat of the COVID-19 pandemic. This trend indicates that there was an emotional aspect in terms of the desire to intake information, which can open up an individual to manipulation and other forms of misinformation and dishonesty. The same is true of social media. On the flip side, social media can be a useful tool for spreading correct information easily to a wider population than traditional methods.

Since healthcare providers (HCPs) remain the strongest influencers of vaccine decisions, as reported here - both before and during the COVID-19 pandemic - it follows that their views on vaccination have significant effects on patient vaccine uptake. The literature agrees that systemic approaches need to be taken to both decrease HCP vaccine hesitancy and increase training that teaches how to adequately respond to their patients' vaccine concerns. Taken together, these findings indicate that while some improvements in training have been made due to the COVID-19 pandemic, there is more work to be done.

Based on this analysis, recommendations include:

• When dealing with convenience factors, travel, expense, and wait times should be minimised. Parents are more likely to vaccinate their children when routine vaccinations can be given together with their COVID-19 vaccinations.
• In terms of risk perception, it is important to consider that anxiety may drive increased vaccine hesitancy. Given the correlations between trust an individual has in government and the vaccine's safety, the more likely that individual is to be vaccinated if this trust can be supported and improved. In addition, risk perception is affected by misinformation in the media and on social media. However, evidence suggests that using, rather than dismissing, social media may be an effective strategy to minimize vaccine hesitancy.
• To improve HCPs' attitudes toward vaccinating, there needs to be an increase in training and education to enhance their knowledge.

In conclusion: "As the world gets back to a new normal, post-pandemic, there needs to be consideration taken for how childhood vaccination rates can rebound to pre-pandemic levels or higher. Some strategies include increasing convenience, effective use of social media and governmental resources to dispel misinformation, and focused training of healthcare workers to encourage vaccination."