It is widely acknowledged that vaccine hesitancy is a multifaceted problem that cannot be addressed by a single strategy. Behavior change theories and social media tools may together help to guide the design of interventions aimed at improving vaccination uptake. This systematic review aims to identify the breadth and effectiveness of such theories and tools. The systematic review search was performed in PubMed, Scopus, ACM, Cochrane Library, ProQuest, and Web of Science databases for studies between January 2011 and January 2021 that applied social media tools to increase vaccine confidence or improve vaccination uptake. The literature search yielded a total of 3,065 publications. Twenty articles met the eligibility criteria, 12 of which were theory-based interventions. The result shows that the Health Belief Model was the most frequently deployed theory, and the most common social media tool was educational posts, followed by dialogue-based groups, interactive websites, and personal reminders. Theory-based interventions were generally more measurable and comparable and had more evidence to trigger the positive behavior change. Fifteen studies reported the effectiveness in knowledge gain, intention increase, or behavior change. Educational messages were proved to be effective in increasing knowledge but less helpful in triggering behavior change. Dialogue-based social media intervention performed well in improving people’s intention to vaccinate. Interventions informed by behavior change theory and delivered via social media platforms offer an important opportunity for addressing vaccine hesitancy. This review highlights the need to use a multitheory framework and tailoring social media interventions to the specific circumstances and needs of the target audience in future interventions. The results and insights gained from this review will be of assistance to future studies.

Background: A life-course immunization approach would enhance the quality of life across all age groups and improve societal well-being. The herpes zoster (HZ) vaccine is highly recommended for older adults to prevent HZ infection and related complications. The proportions of willingness to receive the HZ vaccine varies across countries, and various kinds of factors, including sociodemographics and individual perceptions, influence the willingness to vaccinate. Objective: We aim to estimate the HZ vaccination willingness rate and identify factors associated with vaccine uptake willingness across all World Health Organization (WHO) regions. Methods: A global systematic search was performed on PubMed, Web of Science, and the Cochrane Library for all papers related to the HZ vaccine published until June 20, 2022. Study characteristics were extracted for each included study. Using double arcsine transformation, vaccination willingness rates with 95% CIs were pooled and reported. The willingness rate and associated factors were analyzed by geographical context. Associated factors were also summarized based on Health Belief Model (HBM) constructs. Results: Of the 26,942 identified records, 13 (0.05%) papers were included, covering 14,066 individuals from 8 countries in 4 WHO regions (Eastern Mediterranean Region, European Region, Region of the Americas, and Western Pacific Region). The pooled vaccination willingness rate was 55.74% (95% CI 40.85%-70.13%). Of adults aged ≥50 years, 56.06% were willing to receive the HZ vaccine. After receiving health care workers’ (HCWs) recommendations, 75.19% of individuals were willing to get the HZ vaccine; without HCWs’ recommendations, the willingness rate was only 49.39%. The willingness rate was more than 70% in the Eastern Mediterranean Region and approximately 55% in the Western Pacific Region. The willingness rate was the highest in the United Arab Emirates and the lowest in China and the United Kingdom. The perception of HZ severity and susceptibility was positively associated with vaccination willingness. The perceived barriers to vaccination willingness (main reasons for unwillingness) included low trust in the effectiveness of the HZ vaccine, concerns about safety, financial concerns, and being unaware of the HZ vaccine’s availability. Older individuals, those having lower education, or those having lower income levels were less likely to willing to be vaccinated. Conclusions: Only 1 in 2 individuals showed a willingness to be vaccinated against HZ. The willingness rate was the highest in the Eastern Mediterranean Region. Our findings show the critical role HCWs play in promoting HZ vaccination. Monitoring HZ vaccination willingness is necessary to inform public health decision-making. These findings provide critical insights for designing future life-course immunization programs.

During the COVID-19 pandemic, information is being rapidly shared by public health experts and researchers through social media platforms. Whilst government policies were disseminated and discussed, fake news and misinformation simultaneously created a corresponding wave of “infodemics.” This study analyzed the discourse on Twitter in several languages, investigating the reactions to government and public health agency social media accounts that share policy decisions and official messages. The study collected messages from 21 official Twitter accounts of governments and public health authorities in the UK, US, Mexico, Canada, Brazil, Spain, and Nigeria, from 15 March to 29 May 2020. Over 2 million tweets in various languages were analyzed using a mixed-methods approach to understand the messages both quantitatively and qualitatively. Using automatic, text-based clustering, five topics were identified for each account and then categorized into 10 emerging themes. Identified themes include political, socio-economic, and population-protection issues, encompassing global, national, and individual levels. A comparison was performed amongst the seven countries analyzed and the United Kingdom (Scotland, Northern Ireland, and England) to find similarities and differences between countries and government agencies. Despite the difference in language, country of origin, epidemiological contexts within the countries, significant similarities emerged. Our results suggest that other than general announcement and reportage messages, the most-discussed topic is evidence-based leadership and policymaking, followed by how to manage socio-economic consequences.

COVID-19 vaccines have been developed and administered at record pace in order to curtail the impact of the COVID-19 pandemic. Vaccine hesitancy has impacted uptake unequally across different groups. This study explores the drivers for vaccine hesitancy in ethnic minority groups in the UK, the impact of social media on vaccine hesitancy and how vaccine hesitancy may be overcome. Twelve semi-structured interviews were conducted, coded and thematically analyzed with participants from ethnic minority groups in the UK who identified as vaccine hesitant. Social media played a significant role in vaccine hesitancy. For those who considered themselves healthy, seeing misinformation of extreme side effects relating to COVID-19 vaccinations on social media resulted in the opinion that the risk of vaccination is greater than risk from COVID-19 infection. For women, misinformation on social media regarding fertility was a reason for delaying or not getting vaccinated. Participants who had sources of information they trusted in outside of social media were more likely to choose to get vaccinated. This study identified the broad spectrum of views on vaccine hesitancy in ethnic minority groups in the UK. Enabling factors such as a desire to travel, and positive public health messaging can increase vaccine uptake, whereas a lack of trusted sources of information may cause vaccine hesitancy. Further research is required to combat misinformation and conspiracy theories. Effective methods include actively responding and disproving the misinformation. For an inclusive vaccination programme that reduces health inequality, policy makers should build trust amongst marginalized communities and address their concerns through tailored public health messaging.

This longitudinal study determines the frequency and way of people doing activities from Spring 2020 to Summer 2021 during different phases of the COVID-19 pandemic in the UK. Six online surveys were carried out between April 2020 and July 2021. 4,992 participants were engaged in the cross-sectional study and 203 participants who provided repeat responses were included in the subset sample of prospective cohort analysis. Primary outcomes measured were the frequency and the mode of doing the activities (online or in-person) across sixteen selected activity groups, as defined by the UK National Time Use Survey. The results show that cultural activities, spending time with others, and travelling, were the activities with the largest proportions of frequency and mode changes. The most significant changes occurred from March to June 2020, a period that included the first lockdown. Survey results from this period show a significant decrease among most of the sixteen measured activities. From March to October 2020, a period which spans the first lockdown and its subsequent ease of restrictions, showed the most significant shift from accessing activities in-person to online. Despite ‘Freedom Day’, the July 19^th 2021 date in which all restrictions were abolished, it was found that people do cultural activities and group activities at a significantly lower frequency than before the pandemic. In addition, despite a lack of restrictions after this date, more than half of participants access many activities, such as spending time with others, shopping, work and studying, online or hybrid. This study provides an invaluable insight into understanding how people in the UK changed their lifestyle, including what activities they do, and how they accessed those activities in light of the COVID-19 pandemic and related public health policy implemented to address the pandemic. These results may serve as unique evidence for policymakers.

Background Seasonal influenza vaccine (SIV) greatly reduces disease burden among school-aged children, yet parental vaccine hesitancy remains a persistent challenge. Two types of SIV are available for children in Hong Kong and other locations: inactivated influenza vaccine (IIV), administered through intramuscular injection, and live attenuated influenza vaccine (LAIV), administered via nasal spray. We aimed to understand how vaccine hesitancy shaped parental preference for LAIV versus IIV, particularly amidst important public health events, such as the COVID-19 pandemic and the massive rollout of COVID-19 vaccination campaigns. Methods We employed a concurrent mixed-methods design. The quantitative part involves longitudinal surveys spanning three years, from pre-pandemic to post-pandemic periods, tracking parental vaccine hesitancy and preference for SIV types. The qualitative part involves 48 in-depth interviews, providing insights into parental preference for SIV types, underlying reasons, and related values. Results Our quantitative analyses show an overall increase in parental vaccine hesitancy and preference for LAIV over IIV after the onset of the COVID-19 pandemic and especially after the rollout of the COVID-19 vaccination campaign. Further logistic regression modelling based on the cohort data shows that higher vaccine hesitancy, coupled with the COVID-19 vaccination campaign rollout, predicts a greater preference for LAIV over IIV. The qualitative analysis complements these results, highlighting that LAIV’s non-invasive nature aligns with parental values of prioritizing natural immunity and concerns about overmedication, leading to a more acceptable attitude towards LAIV. Conclusions Leveraging the higher acceptability of LAIV compared to IIV among parents with high vaccine hesitancy could promote childhood vaccination uptake.