University of South Australia, Clinical and Health Sciences, Rosemary Bryant AO Research Centre, City East Campus | Centenary Building P4-32 North Terrace, Adelaide, SA 5000, Australia; Faculty of Health and Medical Sciences, University of Adelaide, Adelaide Nursing School, Adelaide, SA, Australia; The Centre for Evidence-based Practice South Australia (CEPSA): A Joanna Briggs Institute Centre of Excellence, Australia; Australian Nursing and Midwifery Federation (ANMF) Federal Office, Australia.
Int J Nurs Stud. 2022 Jul;131:104241. doi: 10.1016/j.ijnurstu.2022.104241. Epub 2022 Apr 1.
The COVID-19 vaccine rollout has had various degrees of success in different countries. Achieving high levels of vaccine coverage is key to responding to and mitigating the impact of the pandemic on health and aged care systems and the community. In many countries, vaccine hesitancy, resistance, and refusal are emerging as significant barriers to immunisation uptake and the relaxation of policies that limit everyday life. Vaccine hesitancy/ resistance/ refusal is complex and multi-faceted. Individuals and groups have diverse and often multiple reasons for delaying or refusing vaccination. These reasons include: social determinants of health, convenience, ease of availability and access, health literacy understandability and clarity of information, judgements around risk versus benefit, notions of collective versus individual responsibility, trust or mistrust of authority or healthcare, and personal or group beliefs, customs, or ideologies. Published evidence suggests that targeting and adapting interventions to particular population groups, contexts, and specific reasons for vaccine hesitancy/ resistance may enhance the effectiveness of interventions. While evidence regarding the effectiveness of interventions to address vaccine hesitancy and improve uptake is limited and generally unable to underpin any specific strategy, multi-pronged interventions are promising. In many settings, mandating vaccination, particularly for those working in health or high risk/ transmission industries, has been implemented or debated by Governments, decision-makers, and health authorities. While mandatory vaccination is effective for seasonal influenza uptake amongst healthcare workers, this evidence may not be appropriately transferred to the context of COVID-19. Financial or other incentives for addressing vaccine hesitancy may have limited effectiveness with much evidence for benefit appearing to have been translated across from other public/preventive health issues such as smoking cessation. Multicomponent, dialogue-based (i.e., communication) interventions are effective in addressing vaccine hesitancy/resistance. Multicomponent interventions that encompasses the following might be effective: (i) targeting specific groups such as unvaccinated/under-vaccinated groups or healthcare workers, (ii) increasing vaccine knowledge and awareness, (iii) enhanced access and convenience of vaccination, (iv) mandating vaccination or implementing sanctions against non-vaccination, (v) engaging religious and community leaders, (vi) embedding new vaccine knowledge and evidence in routine health practices and procedures, and (vii) addressing mistrust and improving trust in healthcare providers and institutions via genuine engagement and dialogue. It is universally important that healthcare professionals and representative groups, as often highly trusted sources of health guidance, should be closely involved in policymaker and health authority decisions regarding the establishment and implementation of vaccine recommendations and interventions to address vaccine hesitancy.
译文：
在不同国家，新冠疫苗的推出取得了不同程度的成功。实现高疫苗接种率是应对和减轻大流行对卫生和老年保健系统以及社区影响的关键。在许多国家，疫苗犹豫、抵制和拒绝接种正在成为疫苗接种率提高和放宽限制日常生活政策的重大障碍。疫苗犹豫/抵制/拒绝接种是复杂的，多方面的。个人和群体推迟或拒绝接种疫苗的原因各不相同，而且往往有多种原因。这些原因包括：健康的社会决定因素、便利性、方便性和可及性、健康素养的可理解性和信息的清晰度、风险与收益之间的判断、集体责任与个人责任的观念、对权威或医疗保健的信任或不信任，以及个人或群体的信仰、习俗或意识形态。已发表的证据表明，针对特定人群、背景和疫苗犹豫/抵制的具体原因进行干预和调整，可能会提高干预措施的效果。虽然针对解决疫苗犹豫和提高疫苗接种率的干预措施的有效性的证据有限，而且通常无法为任何特定策略提供依据，但多管齐下的干预措施是有希望的。在许多情况下，政府、决策者和卫生当局已经实施或正在讨论为特定人群（如从事卫生或高风险/传播行业的人群）强制接种疫苗。虽然强制接种疫苗对卫生保健工作者季节性流感的接种率有效，但这一证据可能不适用于新冠疫情的情况。解决疫苗犹豫问题的财政或其他激励措施可能效果有限，而且许多证据表明，这些激励措施是从其他公共/预防卫生问题（如戒烟）中转化而来的。基于对话的多组分（即沟通）干预措施在解决疫苗犹豫/抵制方面是有效的。以下各项综合起来可能会有效果：（i）针对特定群体，如未接种/未充分接种疫苗的群体或卫生保健工作者，（ii）提高疫苗知识和认识，（iii）增强疫苗接种的可及性和便利性，（iv）强制接种疫苗或对未接种疫苗实施制裁，（v）让宗教和社区领袖参与进来，（vi）将新的疫苗知识和证据纳入常规卫生实践和程序，（vii）通过真正的参与和对话，解决对医疗保健提供者和机构的不信任问题，并增强对其的信任。至关重要的是，医疗保健专业人员和代表团体（通常是高度可信的健康指导来源）应密切参与决策者和卫生当局关于疫苗接种建议和干预措施的制定和实施的决策，以解决疫苗犹豫问题。
