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Vaccines
Special Issues
Advancing the Science on Vaccine Hesitancy to Inform Interventions
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Advancing the Science on Vaccine Hesitancy to Inform Interventions

A special issue of Vaccines (ISSN 2076-393X). This special issue belongs to the section "Human Vaccines and Public Health".

Deadline for manuscript submissions: 31 August 2025 | Viewed by 7633

Special Issue Editors

Dr. Kimberly H. Nguyen

E-Mail Website
Guest Editor
Department of Public Health and Community Medicine, Tufts University Medical School, 136 Harrison Ave, Boston, MA 02111, USA
Interests: exploring hesitancy toward COVID-19 and routinely recommended vaccines, identifying disparities in vaccination coverage, understanding reasons for non-vaccination, and developing strategies for increasing vaccine uptake and confidence
Prof. Dr. Jennifer Allen

E-Mail Website
Guest Editor
Department of Community Health, Tufts University School of Arts and Sciences, 574 Boston Ave, Medford, MA 02155, USA
Interests: developing community-based interventions to address health inequities among populations that experience social disadvantage/minoritization

Special Issue Information

Dear Colleagues,

The uptake of routinely recommended vaccines is suboptimal among some population subgroups in the U.S. Low vaccine uptake can be due to a variety of factors, including barriers to access, lack of trust in institutions, concerns about vaccine safety and efficacy, sociocultural factors, and religious or philosophical beliefs. While evidence-based interventions to promote the uptake of routine child and adult vaccinations exist, stagnating (or declining) rates of vaccine uptake among some groups suggests that new strategies may be needed to prepare the population for advances in vaccine technology and the inevitable next pandemic. This Special Issue will include papers that propose new or adapted conceptual frameworks, measures to assess vaccine hesitancy, qualitative and/or quantitative studies that advance our understanding of what is currently known, and studies evaluating the effectiveness or feasibility of new public health strategies.

Dr. Kimberly H. Nguyen
Prof. Dr. Jennifer Allen
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Vaccines is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2700 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • vaccine hesitancy
  • vaccine confidence
  • COVID-19
  • routinely recommended vaccines
  • epidemiologic methods
  • conceptual frameworks
  • strategies
  • surveillance

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Published Papers (6 papers)

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Research

16 pages, 232 KiB  
Article
Provider Preference, Logistical Challenges, or Vaccine Hesitancy? Analyzing Parental Decision-Making in School Vaccination Programs: A Qualitative Study in Sydney, Australia
by Leigh McIndoe, Alexandra Young, Cristyn Davies, Cassandra Vujovich-Dunn, Stephanie Kean, Michelle Dives and Vicky Sheppeard
Vaccines 2025, 13(1), 83; https://doi.org/10.3390/vaccines13010083 - 17 Jan 2025
Viewed by 490
Abstract
Background: School-based immunization programs are crucial for equitable vaccine coverage, yet their success depends on parental consent processes. This study investigates patterns of vaccine decision-making within Australia’s school-based immunization program, specifically focusing on human papillomavirus (HPV) and diphtheria-tetanus-pertussis (dTpa) vaccines offered free to [...] Read more.
Background: School-based immunization programs are crucial for equitable vaccine coverage, yet their success depends on parental consent processes. This study investigates patterns of vaccine decision-making within Australia’s school-based immunization program, specifically focusing on human papillomavirus (HPV) and diphtheria-tetanus-pertussis (dTpa) vaccines offered free to adolescents aged 12–13. Methods: This qualitative study was conducted in the South Eastern Sydney Local Health District (2022–2023). Semi-structured interviews were held with school staff (n = 11) across government, Catholic, and independent schools, parents whose children were not vaccinated at school (n = 11) and a focus group with public health unit staff (n = 5). Data were analyzed to identify key barriers and patterns in vaccine decision-making. Results: Analysis revealed three distinct groups of parents whose children were not vaccinated through the school program: (1) those favoring general practitioners for vaccination, driven by trust in medical providers and a preference for personalized care; (2) those intending to consent but facing logistical barriers, including communication breakdowns and online consent challenges; and (3) vaccine-hesitant parents, particularly regarding HPV vaccination, influenced by safety concerns and misinformation. These findings demonstrate that non-participation in school vaccination programs should not be automatically equated with vaccine hesitancy. Conclusions: Tailored interventions are necessary for addressing vaccine non-participation. Recommendations include strengthening collaboration with general practitioners, streamlining consent processes and providing targeted education to counter misinformation. This study provides valuable insights into social determinants of vaccine acceptance and offers actionable strategies for improving vaccine uptake in school-based programs. Full article
(This article belongs to the Special Issue Advancing the Science on Vaccine Hesitancy to Inform Interventions)
13 pages, 547 KiB  
Article
Are HPV Vaccines Well Accepted among Parents of Adolescent Girls in China? Trends, Obstacles, and Practical Implications for Further Interventions: A Five-Year Follow-Up Study
by Yu Huang, Jie Ling, Xiang Zhao, Qiaohong Lv, Lei Wang, Qingqing Wu, Shuiyang Xu and Xuehai Zhang
Vaccines 2024, 12(9), 1073; https://doi.org/10.3390/vaccines12091073 - 19 Sep 2024
Viewed by 1415
Abstract
Background: In 2020, the WHO proposed the global strategic goal of accelerating the elimination of cervical cancer (CC). One of the key strategies is that, by 2030, 90% of girls will complete HPV vaccination by age 15. In 2017, HPV vaccines were first [...] Read more.
Background: In 2020, the WHO proposed the global strategic goal of accelerating the elimination of cervical cancer (CC). One of the key strategies is that, by 2030, 90% of girls will complete HPV vaccination by age 15. In 2017, HPV vaccines were first marketed in China. Objectives: This study aimed to explore the changes in parents’ knowledge about CC, HPV, HPV vaccines, and acceptance of HPV vaccination 5 years after the introduction of HPV vaccines into China. Associated factors and reasons for refusal by parents were also explored. Methods: A school-based follow-up study was conducted among parents in China from May 2018 to May 2023. Comparison using Chi-square tests was performed to measure the changes. Univariate and multivariate analyses were used to explore factors associated with HPV vaccination among teenage girls. Results: The overall cognitive level in terms of CC- and HPV-related knowledge among parents increased, and they expressed more willingness to vaccinate their daughter (35.4% in 2018 vs. 56.6% in 2023). The HPV vaccination rate among teenage girls remained at a low level (4.4% in 2018, 9.8% in 2023). The main obstacles reported by parents were limited knowledge (42.0%), scarcity of the HPV vaccine (29.2%), waiting until their daughter was older (27.5%), safety concerns (14.7%), high cost (9.0%), and effectiveness concerns (4.6%). Parents who are elderly, local residents, have received HPV vaccines themselves, have had experience of vaccinating their children with influenza vaccines, and have a higher knowledge level of CC, HPV and HPV vaccines are more likely to vaccinate their children with HPV vaccines. Conclusions: Although we observed an increment in parents’ knowledge level in terms of CC, HPV, HPV vaccines, and HPV vaccine uptake over the past 5 years, the HPV vaccine coverage among girls still falls short of the WHO’s 2030 target. Comprehensive intervention strategies, including tailored health education among adolescents and their parents, doctor recommendations, and providing financial subsidies or free HPV vaccines are needed in China. Full article
(This article belongs to the Special Issue Advancing the Science on Vaccine Hesitancy to Inform Interventions)
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17 pages, 2921 KiB  
Article
Decision Regret and Vaccine Hesitancy among Nursing Students and Registered Nurses in Italy: Insights from Structural Equation Modeling
by Alice Silvia Brera, Cristina Arrigoni, Silvia Belloni, Gianluca Conte, Arianna Magon, Marco Alfredo Arcidiacono, Malgorzata Pasek, Galyna Shabat, Luigi Bonavina and Rosario Caruso
Vaccines 2024, 12(9), 1054; https://doi.org/10.3390/vaccines12091054 - 14 Sep 2024
Viewed by 1416
Abstract
This study focused on vaccine hesitancy and decision regret about the COVID-19 vaccine among nursing students (BScN and MScN) and Registered Nurses (RNs) in Italy. The primary aim was to describe decision regret and vaccine hesitancy among these groups and to understand what [...] Read more.
This study focused on vaccine hesitancy and decision regret about the COVID-19 vaccine among nursing students (BScN and MScN) and Registered Nurses (RNs) in Italy. The primary aim was to describe decision regret and vaccine hesitancy among these groups and to understand what influences vaccine hesitancy. Data were collected through an e-survey conducted from March to June 2024. The Decision Regret Scale and the Adult Vaccine Hesitancy Scale were employed to assess regret and hesitancy levels, assessing trust, concerns, and compliance regarding vaccination. Among the participants, 8.64% were not vaccinated. The results indicated moderate to high levels of decision regret and diverse levels of trust, concerns, and compliance with COVID-19 vaccination. Structural equation modeling revealed that decision regret significantly predicted Trust (R2 = 31.3%) and Concerns (R2 = 26.9%), with lower regret associated with higher trust and lower concerns about vaccine safety. The number of COVID-19 vaccine boosters was a significant predictor of Trust and Concerns, with more boosters associated with higher trust and lower concerns. MScN students exhibited higher Compliance compared to RNs (R2 = 2.9%), highlighting the role of advanced education. These findings suggest that addressing decision regret and providing comprehensive vaccine information could enhance trust and compliance. Full article
(This article belongs to the Special Issue Advancing the Science on Vaccine Hesitancy to Inform Interventions)
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14 pages, 227 KiB  
Article
Attitudes toward Adolescent HPV Vaccination after the COVID-19 Pandemic: A National Survey of Mothers
by Gary Glauberman, Erica Liebermann, Melanie L. Kornides, Masako Matsunaga, Eunjung Lim, Gregory Zimet and Holly B. Fontenot
Vaccines 2024, 12(9), 976; https://doi.org/10.3390/vaccines12090976 - 28 Aug 2024
Viewed by 1016
Abstract
In the United States, vaccination rates for many routinely recommended vaccines have recovered to pre-pandemic levels, yet human papillomavirus (HPV) vaccination rates still lag pre-pandemic levels. This study sought to uncover the potential effects of the pandemic on attitudes about the HPV vaccine, [...] Read more.
In the United States, vaccination rates for many routinely recommended vaccines have recovered to pre-pandemic levels, yet human papillomavirus (HPV) vaccination rates still lag pre-pandemic levels. This study sought to uncover the potential effects of the pandemic on attitudes about the HPV vaccine, and factors associated with changes in attitudes. We conducted a national survey (n = 3968) of U.S. mothers with children aged 9–17 years. Outcome variables measured changes in attitude toward the HPV vaccine following the pandemic. Two logistic regression models identified predictors of (1) those who did not have attitude changes (always negative vs. always positive), and (2) those who reported attitude changes (change to negative vs. change to positive). Attitudes toward the HPV vaccine remained unchanged in 78.9% of participants (58.1% positive, 20.8% negative). Of the 21.1% reporting changed attitudes, 9.6% changed to positive and 11.5% to negative. Those reporting changing to a negative attitude had a greater odds of reporting conservative political views, and being unsure/undecided about vaccinating their child against HPV compared to those who reported changing to a positive attitude. Targeted strategies are needed to address erosion in confidence in the HPV vaccine and other vaccines resulting from mis- and disinformation associated with the COVID-19 pandemic and future pandemics. Full article
(This article belongs to the Special Issue Advancing the Science on Vaccine Hesitancy to Inform Interventions)
15 pages, 418 KiB  
Article
Prior COVID-19 Diagnosis, Severe Outcomes, and Long COVID among U.S. Adults, 2022
by Kimberly H. Nguyen, Yingjun Bao, Siyu Chen, Robert A. Bednarczyk, Lavanya Vasudevan and Laura Corlin
Vaccines 2024, 12(6), 669; https://doi.org/10.3390/vaccines12060669 - 17 Jun 2024
Cited by 1 | Viewed by 1342
Abstract
Given the increase in COVID-19 emergency department visits and hospitalizations during the winter of 2023–2024, identifying groups that have a high prevalence of COVID-19 cases, severity, and long-term symptoms can help increase efforts toward reducing disparities and prevent severe COVID-19 outcomes. Using data [...] Read more.
Given the increase in COVID-19 emergency department visits and hospitalizations during the winter of 2023–2024, identifying groups that have a high prevalence of COVID-19 cases, severity, and long-term symptoms can help increase efforts toward reducing disparities and prevent severe COVID-19 outcomes. Using data from the 2022 National Health Interview Survey (n = 27,651), we assessed the prevalence of COVID-19 outcomes (prior diagnosis, moderate/severe COVID-19, and long COVID) by sociodemographic characteristics and factors associated with each COVID-19 outcome. Approximately one third of adults reported a prior COVID-19 diagnosis (30.7%), while one half (51.6%) who had COVID-19 reported moderate or severe symptoms, and one fifth (19.7%) who had COVID-19 symptoms reported long COVID. The following were associated with higher odds of moderate/severe COVID-19 and long COVID: havinga high-risk condition (aOR = 1.20, OR = 1.52); having anxiety or depression (OR = 1.46, OR = 1.49); having a disability (OR = 1.41, OR = 1.60); and having a food insecurity (OR = 1.37, OR = 1.50) compared to a lack of these conditions. Having two or more COVID-19 vaccinations was associated with lower odds of a COVID-19 diagnosis (OR = 0.75), moderate/severe COVID-19 (OR = 0.86), and long COVID (OR = 0.82). Improving vaccination coverage and reducing disparities in COVID-19 outcomes could advance health equities and protect against future resurgence of disease. Full article
(This article belongs to the Special Issue Advancing the Science on Vaccine Hesitancy to Inform Interventions)
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16 pages, 1068 KiB  
Article
Reasons for COVID-19 Non-Vaccination from 2021 to 2023 for Adults, Adolescents, and Children
by Kimberly H. Nguyen, Yingjun Bao, Julie Mortazavi, Laura Corlin and Jennifer D. Allen
Vaccines 2024, 12(6), 568; https://doi.org/10.3390/vaccines12060568 - 22 May 2024
Viewed by 1098
Abstract
Understanding how attitudes and beliefs about COVID-19 vaccination have changed over time is essential for identifying areas where targeted messaging and interventions can improve vaccination confidence and uptake. Using data from multiple waves of the nationally representative U.S. Census Bureau’s Household Pulse Survey [...] Read more.
Understanding how attitudes and beliefs about COVID-19 vaccination have changed over time is essential for identifying areas where targeted messaging and interventions can improve vaccination confidence and uptake. Using data from multiple waves of the nationally representative U.S. Census Bureau’s Household Pulse Survey collected from January 2021 to May 2023, we assessed reasons for the non-vaccination of adults, adolescents, and children using the Health Belief Model as the framework for understanding behavior. Among unvaccinated adults, perceived vulnerability increased from 11.9% to 44.1%, attitudinal factors/mistrust increased from 28.6% to 53.4%, and lack of cue to action increased from 7.5% to 9.7% from January 2021 to May 2022. On the other hand, safety/efficacy concerns decreased from 74.0% to 60.9%, and logistical barriers to vaccination decreased from 9.1% to 3.4% during the same time period. Regarding reasons for non-vaccination of youth, perceived vulnerability increased from 32.8% to 40.0%, safety/efficacy concerns decreased from 73.9% to 60.4%, and lack of cue to action increased from 10.4% to 13.4% between September 2021 and May 2023. While safety/efficacy concerns and logistic barriers have decreased, increases in perceived vulnerability to COVID-19, mistrust, and lack of cues to action suggest that more efforts are needed to address these barriers to vaccination. Full article
(This article belongs to the Special Issue Advancing the Science on Vaccine Hesitancy to Inform Interventions)
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Planned Papers

The below list represents only planned manuscripts. Some of these manuscripts have not been received by the Editorial Office yet. Papers submitted to MDPI journals are subject to peer-review.

Title: Role of individual, social and health factors as determinants of COVID-19 vaccine hesitancy: results from the second phase of the Italian EPICOVID19 web-based survey
Author: Curzio
Highlights: A multivariate multinomial logistic regression model revealed factors positively associated with anti-SARS-CoV-2 vaccine hesitancy: female, middle age, deprived status, poor health status, fear of contaminated food and natural disasters, low trust in science, traditional mass media, government Low hesitancy was associated with overweight status, alcohol consumption, no concern about economic conditions, sensitivity to climate change, environmental pollution and epidemics

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