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Current evidence demonstrates that the efficacy of COVID-19 vaccines wane over time [7], with booster doses necessary to increase protection [8]. However, vaccine availability does not necessarily translate to vaccine acceptance, with vaccine hesitancy causing a significant barrier to societal protection [9,10,11]. Models regarding the drivers of vaccination behaviour have suggested several pathways to vaccination, including psychological and cognitive perceptions (perceived risk of disease and vaccine confidence), social processes (social norms, health worker recommendation, and vaccine equity) and practical considerations (including access, availability, and cost) [12]. In the present study, we focus on the first of these: psychological and cognitive perceptions in conjunction with contextual factors relevant to vaccine readministration, as outlined below.
Over the past few years, considerable empirical evidence has amassed regarding the factors that predict the intention to receive the primary course of a COVD-19 vaccine. Meta-analyses of these data indicate that, beyond basic sociodemographic variables, psychological perceptions comprising concern regarding COVID-19 virus and positive perceptions of the COVID-19 vaccine, as well as situational and contextual factors such as previous COVID-19 infection, and regular experience with the influenza vaccine, are some of the strongest predictors of COVID-19 vaccine acceptance [13,14,15,16]. However, in all cases, respondents had no prior experience with a COVID-19 vaccine. In contrast, we know relatively little about the predictors of intent to receive a booster vaccine. This is important because a number of additional situational and contextual factors regarding the vaccine should feedback to inform predictors of vaccine behaviour in cases where the same vaccine is repeatedly administered [12]. These may include factors such as the experience of adverse events to the primary course of the vaccine, number of months elapsing since last receiving a vaccine, perceived need for continued vaccination due to being immunocompromised, and familiarity with information regarding potential side effects accumulating as the vaccine programme has matured. At present, however, very few studies have investigated the intention to receive a booster vaccine. A recent meta-analysis reported on just twelve studies that have investigated the predictors of booster intent, with the majority focusing on sociodemographic factors and limited to Asian samples [17]. Additionally, despite concern regarding the COVID-19 virus and positive perceptions of the COVID-19 vaccine (i.e., psychological perceptions) being some of the strongest predictors of the intention to receive a first COVID-19 vaccine, only five studies included predictors investigating the former, and four the latter. With respect to experiential factors that may feedback to modulate the intention to receive a booster vaccine, only four investigated previous adverse reactions, six prior COVID-19 infection, and three experience with the influenza vaccine. As such our understanding of the psychological and contextual factors that serve to maintain continued COVID-19 vaccination is currently lacking.
Consistent with the results of the present study, positive vaccine perceptions and concern regarding the virus have repeatedly been found to predict the intention to receive the first dose of a COVID-19 vaccination [23,33,34,35,36] as well as the booster vaccine [21,37,38]. These findings are reflected in systematic review and meta-analysis regarding the COVID-19 [17,32,39], influenza [40], and MMR [41] vaccination, demonstrating that psychological perceptions of this kind are key variables pertaining to vaccination intentions more broadly [12].
That trust and importance of COVID-19 vaccination predicted booster intention is consistent with evidence demonstrating that a lack of trust in the COVID-19 vaccines due to the speed of development and approval [42], or fears concerning adverse events and vaccine efficacy [35,43], increased initial COVID-19 vaccine hesitancy. As such, potential interventions that stress the safety, efficacy, and importance of COVID-19 vaccination may serve to maintain participation within a given COVID-19 vaccination programme. Evidence regarding the efficacy of such interventions is mixed; some studies have reported increased vaccine intent [44,45,46,47,48,49], and others not [50,51,52,53,54]. However, recent meta-analysis suggests that information regarding vaccine efficacy may be of particular relevance to those most hesitant [55]. Additional research provides preliminary evidence that emphasising vaccine efficacy may also increase COVID-19 vaccine uptake [56,57]. For any intervention of this type to be practical, it must be ensured that information is deployed in a transparent and ethical manner, without downplaying the risks of vaccination that may obscure patient informed consent. At the time of writing, only one study has addressed this issue, finding that transparency did not reduce the perception of vaccine efficacy, but failed to significantly modulate vaccine intent [58]. As such, it is unclear whether transparent communication diminishes any active benefit of this type of messaging on increased intention, with further controlled research employing matched comparators required. Additionally, as most interventions occurred during the early phases of vaccine development, a paucity of evidence exists regarding the interplay between interventions designed to increase vaccine perceptions and prior vaccine experience. Longitudinal research across all stages of the vaccine rollout (i.e., primary course and booster vaccination) is therefore needed. 2ff7e9595c
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