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Johns Hopkins University and the University of Washington hosted a high-level symposium, “The Scientific Integrity of COVID-19 Vaccine Efficacy Trials: From Clinical Trials to Public Allocation,” that explored complex issues, brought together leading voices in the field, and put forward a concise plan for protecting the scientific integrity of these ongoing efforts.

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Part 1: the science and structure of the u.s. government’s covid-19 vaccine trial program, part 2: protecting scientific integrity in the design & conduct of covid-19 vaccine efficacy trials, part 3: regulatory integrity and the assessment of vaccine safety and efficacy, latest news & resources.

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experts | March 29, 2022

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Questions and answers /

Coronavirus disease (COVID-19): Vaccine research and development

Reviewed and current on 10 August 2021.

WHO and its partners are committed to accelerating the development of COVID-19 vaccines while maintaining the highest standards on safety.

Vaccines go through various phases of development and testing – there are usually three phases to clinical trials, with the last one designed to assess the ability of the product to protect against disease, which is called efficacy. All phases assess safety. The last phase, phase III, are usually conducted in a large number of people, often 10’s of thousands. After that, the vaccine needs to go through a review by the national regulatory authority, who will decide if the vaccine is safe and effective enough to be put on the market, and a policy committee, who will decide how the vaccine should be used.

In the past, vaccines have been developed through a series of consecutive steps that can take many years. Now, given the urgent need for COVID-19 vaccines, unprecedented financial investments and scientific collaborations are changing how vaccines are developed. This means that some of the steps in the research and development process have been happening in parallel, while still maintaining strict clinical and safety standards. For example, some clinical trials are evaluating multiple vaccines at the same time. It is the scale of the financial and political commitments to the development of a vaccine that has allowed this accelerated development to take place. However, this does not make the studies any less rigorous.

The more vaccines in development the more opportunities there are for success.

Any longer-term safety assessment will be conducted through continued follow up of the clinical trial participants, as well as through specific studies and general pharmacovigilance of those being vaccinated in the roll out. This represents standard practise for all newly authorized vaccines.

In a regular vaccine study, one group of volunteers at risk for a disease is given an experimental vaccine, and another group is not; researchers monitor both groups over time and compare outcomes to see if the vaccine is safe and effective.

In a human challenge vaccine study, healthy volunteers are given an experimental vaccine, and then deliberately exposed to the organism causing the disease to see if the vaccine works. Some scientists believe that this approach could accelerate COVID-19 vaccine development, in part because it would require far fewer volunteers than a typical study.

However, there are important ethical considerations that must be addressed – particularly for a new disease like COVID-19, which we do not yet fully understand and are still learning how to treat; it may be difficult for the medical community and potential volunteers to properly estimate the potential risks of participating in a COVID-19 human challenge study. For more information, see this WHO publication on the ethics of COVID-19 human challenge studies .

Small (phase I) safety studies of COVID-19 vaccines should enroll healthy adult volunteers. Larger (phase II and III) studies should include volunteers that reflect the populations for whom the vaccines are intended. This means enrolling people from diverse geographic areas, racial and ethnic backgrounds, genders, and ages, as well as those with underlying health conditions that put them at higher risk for COVID-19. Including these groups in clinical trials is the only way to make sure that a vaccine will be safe and effective for everyone who needs it.

Opportunities to volunteer for a COVID-19 vaccine trial vary from country to country. If you are interested in volunteering, check with local health officials or research institutions or email [email protected] for more information about vaccine trials.

The push for a COVID-19 vaccine

Vaccines explained

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Vaccines and immunization: What is vaccination?

Coronavirus disease (COVID-19): Vaccines

Coronavirus disease (COVID-19): COVID-19 Vaccine access and allocation

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Open access
Published: 14 May 2021

Public attitudes toward COVID-19 vaccination: The role of vaccine attributes, incentives, and misinformation

Sarah Kreps 1 ,
Nabarun Dasgupta 2 ,
John S. Brownstein 3 , 4 ,
Yulin Hswen 5 &
Douglas L. Kriner ORCID: orcid.org/0000-0002-9353-2334 1

npj Vaccines volume 6 , Article number: 73 ( 2021 ) Cite this article

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While efficacious vaccines have been developed to inoculate against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2; also known as COVID-19), public vaccine hesitancy could still undermine efforts to combat the pandemic. Employing a survey of 1096 adult Americans recruited via the Lucid platform, we examined the relationships between vaccine attributes, proposed policy interventions such as financial incentives, and misinformation on public vaccination preferences. Higher degrees of vaccine efficacy significantly increased individuals’ willingness to receive a COVID-19 vaccine, while a high incidence of minor side effects, a co-pay, and Emergency Use Authorization to fast-track the vaccine decreased willingness. The vaccine manufacturer had no influence on public willingness to vaccinate. We also found no evidence that belief in misinformation about COVID-19 treatments was positively associated with vaccine hesitancy. The findings have implications for public health strategies intending to increase levels of community vaccination.

Measuring the impact of COVID-19 vaccine misinformation on vaccination intent in the UK and USA

Vaccine hesitancy and monetary incentives

Providing normative information increases intentions to accept a COVID-19 vaccine

Introduction.

In less than a year, an array of vaccines was developed to bring an end to the SARS-CoV-2 pandemic. As impressive as the speed of development was the efficacy of vaccines such as Moderna and Pfizer, which are over 90%. Despite the growing availability and efficacy, however, vaccine hesitancy remains a potential impediment to widespread community uptake. While previous surveys indicate that overall levels of vaccine acceptance may be around 70% in the United States 1 , the case of Israel may offer a cautionary tale about self-reported preferences and vaccination in practice. Prospective studies 2 of vaccine acceptance in Israel showed that about 75% of the Israeli population would vaccinate, but Israel’s initial vaccination surge stalled around 42%. The government, which then augmented its vaccination efforts with incentive programs, attributed unexpected resistance to online misinformation 3 .

Research on vaccine hesitancy in the context of viruses such as influenza and measles, mumps, and rubella, suggests that misinformation surrounding vaccines is prevalent 4 , 5 . Emerging research on COVID-19 vaccine preferences, however, points to vaccine attributes as dominant determinants of attitudes toward vaccination. Higher efficacy is associated with greater likelihood of vaccinating 6 , 7 , whereas an FDA Emergency Use Authorization 6 or politicized approval timing 8 is associated with more hesitancy. Whether COVID-19 misinformation contributes to vaccine preferences or whether these attributes or policy interventions such as incentives play a larger role has not been studied. Further, while previous research has focused on a set of attributes that was relevant at one particular point in time, the evidence and context about the available vaccines has continued to shift in ways that could shape public willingness to accept the vaccine. For example, governments, employers, and economists have begun to think about or even devise ways to incentivize monetarily COVID-19 vaccine uptake, but researchers have not yet studied whether paying people to receive the COVID-19 vaccine would actually affect likely behavior. As supply problems wane and hesitancy becomes a limiting factor, understanding whether financial incentives can overcome hesitancy becomes a crucial question for public health. Further, as new vaccines such as Johnson and Johnson are authorized, knowing whether the vaccine manufacturer name elicits or deters interest in individuals is also important, as are the corresponding efficacy rates of different vaccines and the extent to which those affect vaccine preferences. The purpose of this study is to examine how information about vaccine attributes such as efficacy rates, the incidence of side effects, the nature of the governmental approval process, identity of the manufacturers, and policy interventions, including economic incentives, affect intention to vaccinate, and to examine the association between belief in an important category of misinformation—false claims concerning COVID-19 treatments—and willingness to vaccinate.

General characteristics of study population

Table 1 presents sample demographics, which largely reflect those of the US population as a whole. Of the 1335 US adults recruited for the study, a convenience sample of 1100 participants consented to begin the survey, and 1096 completed the full questionnaire. The sample was 51% female; 75% white; and had a median age of 43 with an interquartile range of 31–58. Comparisons of the sample demographics to those of other prominent social science surveys and U.S. Census figures are shown in Supplementary Table 1 .

Vaccination preferences

Each subject was asked to evaluate a series of seven hypothetical vaccines. For each hypothetical vaccine, our conjoint experiment randomly assigned values of five different vaccine attributes—efficacy, the incidence of minor side effects, government approval process, manufacturer, and cost/financial inducement. Descriptions of each attribute and the specific levels used in the experiment are summarized in Table 2 . After seeing the profile of each vaccine, the subject was asked whether she would choose to receive the vaccine described, or whether she would choose not to be vaccinated. Finally, subjects were asked to indicate how likely they would be to take the vaccine on a seven-point likert scale.

Across all choice sets, in 4419 cases (58%) subjects said they would choose the vaccine described in the profile rather than not being vaccinated. As shown in Fig. 1 , several characteristics of the vaccine significantly influenced willingness to vaccinate.

Circles present the estimated effect of each attribute level on the probability of a subject accepting vaccination from the attribute’s baseline level. Horizontal lines through points indicate 95% confidence intervals. Points without error bars denote the baseline value for each attribute. The average marginal component effects (AMCEs) are the regression coefficients reported in model 1 of Table 3 .

Efficacy had the largest effect on individual vaccine preferences. An efficacy rate of 90% increased uptake by about 20% relative to the baseline at 50% efficacy. Even a high incidence of minor side effects (1 in 2) had only a modest negative effect (about 5%) on willingness to vaccinate. Whether the vaccine went through full FDA approval or received an Emergency Use Authorization (EUA), an authority that allows the Food and Drug Administration mechanisms to accelerate the availability and use of treatments or medicines during medical emergencies 9 , significantly influenced willingness to vaccinate. An EUA decreased the likelihood of vaccination by 7% compared to a full FDA authorization; such a decline would translate into about 23 million Americans. While a $20 co-pay reduced the likelihood of vaccination relative to a no-cost baseline, financial incentives did not increase willingness to vaccinate. Lastly, the manufacturer had no effect on vaccination attitudes, despite the public pause of the AstraZeneca trial and prominence of Johnson & Johnson as a household name (our experiment was fielded before the pause in the administration of the Johnson & Johnson shot in the United States).

Model 2 of Table 3 presents an expanded model specification to investigate the association between misinformation and willingness to vaccinate. The primary additional independent variable of interest is a misinformation index that captures the extent to which each subject believes or rejects eight claims (five false; three true) about COVID-19 treatments. Additional analyses using alternate operationalizations of the misinformation index yield substantively similar results (Supplementary Table 4 ). This model also includes a number of demographic control variables, including indicators for political partisanship, gender, educational attainment, age, and race/ethnicity, all of which are also associated with belief in misinformation about the vaccine (Supplementary Table 2 ). Finally, the model also controls for subjects’ health insurance status, past experience vaccinating against seasonal influenza, attitudes toward the pharmaceutical industry, and beliefs about vaccine safety generally.

Greater levels of belief in misinformation about COVID-19 treatments were not associated with greater vaccine hesitancy. Instead, the relevant coefficient is positive and statistically significant, indicating that, all else being equal, individuals who scored higher on our index of misinformation about COVID-19 treatments were more willing to vaccinate than those who were less susceptible to believing false claims.

Strong beliefs that vaccines are safe generally was positively associated with willingness to accept a COVID-19 vaccine, as were past histories of frequent influenza vaccination and favorable attitudes toward the pharmaceutical industry. Women and older subjects were significantly less likely to report willingness to vaccinate than men and younger subjects, all else equal. Education was positively associated with willingness to vaccinate.

This research offers a comprehensive examination of attitudes toward COVID-19 vaccination, particularly the role of vaccine attributes, potential policy interventions, and misinformation. Several previous studies have analyzed the effects of vaccine characteristics on willingness to vaccinate, but the modal approach is to gauge willingness to accept a generic COVID-19 vaccine 10 , 11 . Large volumes of research show, however, that vaccine preferences hinge on specific vaccine attributes. Recent research considering the influence of attributes such as efficacy, side effects, and country of origin take a step toward understanding how properties affect individuals’ intentions to vaccinate 6 , 7 , 8 , 12 , 13 , but evidence about the attributes of actual vaccines, debates about how to promote vaccination within the population, and questions about the influence of misinformation have moved quickly 14 .

Our conjoint experiment therefore examined the influence of five vaccine attributes on vaccination willingness. The first category of attributes involved aspects of the vaccine itself. Since efficacy is one of the most common determinants of vaccine acceptance, we considered different levels of efficacy, 50%, 70%, and 90%, levels that are common in the literature 7 , 15 . Evidence from Phase III trials suggests that even the 90% efficacy level in our design, which is well above the 50% threshold from the FDA Guidance for minimal effectiveness for Emergency Use Authorization 16 , has been exceeded by both Pfizer’s and Moderna’s vaccines 17 , 18 . The 70% efficacy threshold is closer to the initial reports of the efficacy of the Johnson & Johnson vaccine, whose efficacy varied across regions 19 . Our analysis suggests that efficacy levels associated with recent mRNA vaccine trials increases public vaccine uptake by 20% over a baseline of a vaccine with 50% efficacy. A 70% efficacy rate increases public willingness to vaccinate by 13% over a baseline vaccine with 50% efficacy.

An additional set of epidemiological attributes consisted of the frequency of minor side effects. While severe side effects were plausible going into early clinical trials, evidence clearly suggests that minor side effects are more common, ranging from 10% to 100% of people vaccinated depending on the number of doses and the dose group (25–250 mcg) 20 . Since the 100 mcg dose was supported in Phase III trials 21 , we include the highest adverse event probability—approximating 60% as 1 in 2—and 1 in 10 as the lowest likelihood, approximating the number of people who experienced mild arthralgia 20 . Our findings suggest that a the prevalence of minor side effects associated with recent trials (i.e. a 1 in 2 chance), intention to vaccinate decreased by about 5% versus a 1 in 10 chance of minor side effects baseline. However, at a 25% rate of minor side effects, respondents did not indicate any lower likelihood of vaccination compared to the 10% baseline. Public communications about how to reduce well-known side effects, such as pain at the injection site, could contribute to improved acceptance of the vaccine, as it is unlikely that development of vaccine-related minor side effects will change.

We then considered the effect of EUA versus full FDA approval. The influenza H1N1 virus brought the process of EUA into public discourse 22 , and the COVID-19 virus has again raised the debate about whether and how to use EUA. Compared to recent studies also employing conjoint experimental designs that showed just a 3% decline in support conditional on EUA 6 , we found decreases in support of more than twice that with an EUA compared to full FDA approval. Statements made by the Trump administration promising an intensely rapid roll-out or isolated adverse events from vaccination in the UK may have exacerbated concerns about EUA versus full approval 8 , 23 , 24 , 25 . This negative effect is even greater among some subsets of the population. As shown in additional analyses reported in the Supplementary Information (Supplementary Fig. 5 ), the negative effects are greatest among those who believe vaccines are generally safe. Among those who believe vaccines generally are extremely safe, the EUA decreased willingness to vaccinate by 11%, all else equal. This suggests that outreach campaigns seeking to assure those troubled by the authorization process used for currently available vaccines should target their efforts on those who are generally predisposed to believe vaccines are safe.

Next, we compared receptiveness as a function of the manufacturer: Moderna, Pfizer, Johnson and Johnson, and AstraZeneca, all firms at advanced stages of vaccine development. Vaccine manufacturers in the US have not yet attempted to use trade names to differentiate their vaccines, instead relying on the association with manufacturer reputation. In other countries, vaccine brand names have been more intentionally publicized, such as Bharat Biotech’s Covaxin in India and Gamaleya Research Institute of Epidemiology and Microbiology Sputnik V in Russia. We found that manufacturer names had no impact on willingness to vaccinate. As with hepatitis and H. influenzae vaccines 26 , 27 , interchangeability has been an active topic of debate with coronavirus mRNA vaccines which require a second shot for full immunity. Our research suggests that at least as far as public receptiveness goes, interchangeability would not introduce concerns. We found no significant differences in vaccination uptake across any of the manufacturer treatments. Future research should investigate if a manufacturer preference develops as new evidence about efficacy and side effects becomes available, particularly depending on whether future booster shots, if needed, are deemed interchangeable with the initial vaccination.

Taking up the question of how cost and financial incentives shape behavior, we looked at paying and being paid to vaccinate. While existing research suggests that individuals are often willing to pay for vaccines 28 , 29 , some economists have proposed that the government pay individuals up to $1,000 to take the COVID-19 vaccine 30 . However, because a cost of $300 billion to vaccinate the population may be prohibitive, we posed a more modest $100 incentive. We also compared this with a $10 incentive, which previous studies suggest is sufficient for actions that do not require individuals to change behavior on a sustained basis 31 . While having to pay a $20 co-pay for the vaccine did deter individuals, the additional economic incentives had no positive effect although they did not discourage vaccination 32 . Consistent with past research 31 , 33 , further analysis shows that the negative effect of the $20 co-pay was concentrated among low-income earners (Supplementary Fig. 7 ). Financial incentives failed to increase vaccination willingness across income levels.

Our study also yields important insights into the relationship between one prominent category of COVID-19 misinformation and vaccination preferences. We find that susceptibility to misinformation about COVID-19 treatments—based on whether individuals can distinguish between factual and false information about efforts to combat COVID-19—is considerable. A quarter of subjects scored no higher on our misinformation index than random guessing or uniform abstention/unsure responses (for the full distribution, see Supplementary Fig. 2 ). However, subjects who scored higher on our misinformation index did not exhibit greater vaccination hesitancy. These subjects actually were more likely to believe in vaccine safety more generally and to accept a COVID-19 vaccine, all else being equal. These results run counter to recent findings of public opinion in France where greater conspiracy beliefs were negatively correlated with willingness to vaccinate against COVID-19 34 and in Korea where greater misinformation exposure and belief were negatively correlated with taking preventative actions 35 . Nevertheless, the results are robust to alternate operationalizations of belief in misinformation (i.e., constructing the index only using false claims, or measuring misinformation beliefs as the number of false claims believed: see Supplementary Table 4 ).

We recommend further study to understand the observed positive relationship between beliefs in COVID-19 misinformation about fake treatments and willingness to receive the COVID-19 vaccine. To be clear, we do not posit a causal relationship between the two. Rather, we suspect that belief in misinformation may be correlated with an omitted factor related to concerns about contracting COVID-19. For example, those who believe COVID-19 misinformation may have a higher perception of risk of COVID-19, and therefore be more willing to take a vaccine, all else equal 36 . Additional analyses reported in the Supplementary Information (Supplementary Fig. 6 ) show that the negative effect of an EUA on willingness to vaccinate was concentrated among those who scored low on the misinformation index. An EUA had little effect on the vaccination preferences of subjects most susceptible to misinformation. This pattern is consistent with the possibility that these subjects were more concerned with the disease and therefore more likely to vaccinate, regardless of the process through which the vaccine was brought to market.

We also observe that skepticism toward vaccines in general does not correlate perfectly with skepticism toward the COVID-19 vaccine. Therefore, it is important not to conflate people who are wary of the COVID-19 vaccine and those who are anti-vaccination, as even medically informed individuals may be hesitant because of the speed at which the COVID-19 vaccine was developed. For example, older people are more likely to believe vaccines are safe but less willing to receive the COVID-19 vaccine in our survey, perhaps following the high rates of vaccine skepticism among medical staff expressing concerns regarding the safety of a rapidly-developed vaccine 2 . This inverse relationship between age and willingness to vaccinate is also surprising. Most opinion surveys find older adults are more likely to vaccinate than younger adults 37 . However, most of these survey questions ask about willingness to take a generic vaccine. Two prior studies, both recruiting subjects from the Lucid platform and employing conjoint experiments to examine the effects of vaccine attributes on public willingness to vaccinate, also find greater vaccine hesitancy among older Americans 6 , 7 . Future research could explore whether these divergent results are a product of the characteristics of the sample or of the methodological design in which subjects have much more information about the vaccines when indicating their vaccination preferences.

An important limitation of our study is that it necessarily offers a snapshot in time, specifically prior to both the election and vaccine roll-out. We recommend further study to understand more how vaccine perceptions evolve both in terms of the perceived political ownership of the vaccine—now that President Biden is in office—and as evidence has emerged from the millions of people who have been vaccinated. Similarly, researchers should consider analyzing vaccine preferences in the context of online vaccine controversies that have been framed in terms of patient autonomy and right to refuse 38 , 39 . Vaccination mandates may evoke feelings of powerlessness, which may be exacerbated by misinformation about the vaccines themselves. Further, researchers should more fully consider how individual attributes such as political ideology and race intersect with vaccine preferences. Our study registered increased vaccine hesitancy among Blacks, but did not find that skepticism was directly related to misinformation. Perceptions and realities of race-based maltreatment could also be moderating factors worth exploring in future analyses 40 , 41 .

Overall, we found that the most important factor influencing vaccine preferences is vaccine efficacy, consistent with a number of previous studies about attitudes toward a range of vaccines 6 , 42 , 43 . Other attributes offer potential cautionary flags and opportunities for public outreach. The prospect of a 50% likelihood of mild side effects, consistent with the evidence about current COVID-19 vaccines being employed, dampens likelihood of uptake. Public health officials should reinforce the relatively mild nature of the side effects—pain at the injection site and fatigue being the most common 44 —and especially the temporary nature of these effects to assuage public concerns. Additionally, in considering policy interventions, public health authorities should recognize that a $20 co-pay will likely discourage uptake while financial incentives are unlikely to have a significant positive effect. Lastly, belief in misinformation about COVID-19 does not appear to be a strong predictor of vaccine hesitancy; belief in misinformation and willingness to vaccinate were positively correlated in our data. Future research should explore the possibility that exposure to and belief in misinformation is correlated with other factors associated with vaccine preferences.

Survey sample and procedures

This study was approved by the Cornell Institutional Review Board for Human Participant Research (protocol ID 2004009569). We conducted the study on October 29–30, 2020, prior to vaccine approval, which means we captured sentiments prospectively rather than based on information emerging from an ongoing vaccination campaign. We recruited a sample of 1096 adult Americans via the Lucid platform, which uses quota sampling to produce samples matched to the demographics of the U.S. population on age, gender, ethnicity, and geographic region. Research has shown that experimental effects observed in Lucid samples largely mirror those found using probability-based samples 45 . Supplementary Table 1 presents the demographics of our sample and comparisons to both the U.S. Census American Community Survey and the demographics of prominent social science surveys.

After providing informed consent on the first screen of the online survey, participants turned to a choice-based conjoint experiment that varied five attributes of the COVID-19 vaccine. Conjoint analyses are often used in marketing to research how different aspects of a product or service affect consumer choice. We build on public health studies that have analyzed the influence of vaccine characteristics on uptake within the population 42 , 46 .

Conjoint experiment

We first designed a choice-based conjoint experiment that allowed us to evaluate the relative influence of a range of vaccine attributes on respondents’ vaccine preferences. We examined five attributes summarized in Table 2 . Past research has shown that the first two attributes, efficacy and the incidence of side effects, are significant drivers of public preferences on a range of vaccines 47 , 48 , 49 , including COVID-19 6 , 7 , 13 , 50 . In this study, we increased the expected incidence of minor side effects from previous research 6 to reflect emerging evidence from Phase III trials. The third attribute, whether the vaccine received full FDA approval or an EUA, examines whether the speed of the approval process affects public vaccination preferences 6 . The fourth attribute, the manufacturer of the vaccine, allows us to examine whether the highly public pause in the AstraZeneca trial following an adverse event, and the significant differences in brand familiarity between smaller and less broadly known companies like Moderna and household name Johnson & Johnson affects public willingness to vaccinate. The fifth attribute examines the influence of a policy tool—offsetting the costs of vaccination or even incentivizing it financially—on public willingness to vaccinate.

Attribute levels and attribute order were randomly assigned across participants. A sample choice set is presented in Supplementary Fig. 1 . After viewing each profile individually, subjects were asked: “If you had to choose, would you choose to get this vaccine, or would you choose not to be vaccinated?” Subjects then made a binary choice, responding either that they “would choose to get this vaccine” or that they “would choose not to be vaccinated.” This is the dependent variable for the regression analyses in Table 3 . After making a binary choice to take the vaccine or not be vaccinated, we also asked subjects “how likely or unlikely would you be to get the vaccine described above?” Subjects indicated their vaccination preference on a seven-point scale ranging from “extremely likely” to “extremely unlikely.” Additional analyses using this ordinal dependent variable reported in Supplementary Table 3 yield substantively similar results to those presented in Table 3 .

To determine the effect of each attribute-level on willingness to vaccinate, we followed Hainmueller, Hopkins, and Yamamoto and employed an ordinary least squares (OLS) regression with standard errors clustered on respondent to estimate the average marginal component effects (AMCEs) for each attribute 51 . The AMCE represents the average difference in a subject choosing a vaccine when comparing two different attribute values—for example, 50% efficacy vs. 90% efficacy—averaged across all possible combinations of the other vaccine attribute values. The AMCEs are nonparametrically identified under a modest set of assumptions, many of which (such as randomization of attribute levels) are guaranteed by design. Model 1 in Table 3 estimates the AMCEs for each attribute. These AMCEs are illustrated in Fig. 1 .

Analyzing additional correlates of vaccine acceptance

To explore the association between respondents’ embrace of misinformation about COVID-19 treatments and vaccination willingness, the survey included an additional question battery. To measure the extent of belief in COVID-19 misinformation, we constructed a list of both accurate and inaccurate headlines about the coronavirus. We focused on treatments, relying on the World Health Organization’s list of myths, such as “Hand dryers are effective in killing the new coronavirus” and true headlines such as “Avoiding shaking hands can help limit the spread of the new coronavirus 52 .” Complete wording for each claim is provided in Supplementary Appendix 1 . Individuals read three true headlines and five myths, and then responded whether they believed each headline was true or false, or whether they were unsure. We coded responses to each headline so that an incorrect accuracy assessment yielded a 1; a correct accuracy assessment a -1; and a response of unsure was coded as 0. From this, we created an additive index of belief in misinformation that ranged from -8 to 8. The distribution of the misinformation index is presented in Supplementary Fig. 2 . A possible limitation of this measure is that because the survey was conducted online, some individuals could have searched for the answers to the questions before responding. However, the median misinformation index score for subjects in the top quartile in terms of time spent taking the survey was identical to the median for all other respondents. This may suggest that systematic searching for correct answers is unlikely.

To ensure that any association observed between belief in misinformation and willingness to vaccinate is not an artifact of how we operationalized susceptibility to misinformation, we also constructed two alternate measures of belief in misinformation. These measures are described in detail in the Supplementary Information (see Supplementary Figs. 3 and 4 ). Additional regression analyses using these alternate measures of misinformation beliefs yield substantively similar results (see Supplementary Table 4 ). Additional analyses examining whether belief in misinformation moderates the effect of efficacy and an FDA EUA on vaccine acceptance are presented in Supplementary Fig. 6 .

Finally, model 2 of Table 3 includes a range of additional control variables. Following past research, it includes a number of demographic variables, including indicator variables identifying subjects who identify as Democrats or Republicans; an indicator variable identifying females; a continuous variable measuring age (alternate analyses employing a categorical variable yield substantively similar results); an eight-point measure of educational attainment; and indicator variables identifying subjects who self-identify as Black or Latinx. Following previous research 6 , the model also controlled for three additional factors often associated with willingness to vaccinate: an indicator variable identifying whether each subject had health insurance; a variable measuring past frequency of influenza vaccination on a four-point scale ranging from “never” to “every year”; beliefs about the general safety of vaccines measured on a four-point scale ranging from “not at all safe” to “extremely safe”; and a measure of attitudes toward the pharmaceutical industry ranging from “very positive” to “very negative.”

Reporting summary

Further information on research design is available in the Nature Research Reporting Summary linked to this article.

Data availability

All data and statistical code to reproduce the tables and figures in the manuscript and Supplementary Information are published at the Harvard Dataverse via this link: 10.7910/DVN/ZYU6CO.

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Acknowledgements

S.K. and D.K. would like to thank the Cornell Atkinson Center for Sustainability for financial support.

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S.K. and D.K. designed the experiment/survey instrument and conducted the statistical analysis. S.K., N.D., J.B., Y.H., and D.K. all contributed to the conceptual design of the research and to the writing of the paper.

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Kreps, S., Dasgupta, N., Brownstein, J.S. et al. Public attitudes toward COVID-19 vaccination: The role of vaccine attributes, incentives, and misinformation. npj Vaccines 6 , 73 (2021). https://doi.org/10.1038/s41541-021-00335-2

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DOI : https://doi.org/10.1038/s41541-021-00335-2

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Vaccines, Blood & Biologics

Updated COVID-19 Vaccines for Use in the United States Beginning in Fall 2024

Fda updates advice to manufacturers of covid-19 vaccines (2024-2025 formula): if feasible use kp.2 strain of jn.1-lineage.

FDA's Vaccines and Related Biological Products Advisory Committee (VRBPAC) met on June 5, 2024, to discuss and make recommendations on the selection of the 2024-2025 Formula for COVID-19 vaccines for use in the United States beginning in the fall of 2024.

The committee unanimously voted to recommend a monovalent JN.1-lineage vaccine composition. Following the vote, the committee discussed considerations for the selection of a specific JN.1 lineage SARS-CoV-2 strain (e.g., JN.1 or KP.2) and expressed a strong preference for JN.1.

During this meeting, the advisory committee was informed of the manufacturing timelines, and they reviewed the available data. These data included information on the circulation of SARS-CoV-2 virus variants, current vaccine effectiveness, human immunogenicity data of current vaccines against recently circulating virus variants, the antigenic characterization of circulating virus variants, animal immunogenicity data on new candidate vaccines expressing or containing updated spike components, and preliminary human immunogenicity data on JN.1 candidate vaccines.

Based on the totality of the evidence, on June 6, 2024, FDA initially advised the manufacturers of the licensed and authorized COVID-19 vaccines that the COVID-19 vaccines (2024-2025 Formula) for use in the United States beginning in fall 2024 should be monovalent JN.1 vaccines.

FDA has continued to monitor the circulating strains of SARS-CoV-2. Based on the most current available data, along with the recent rise in cases of COVID-19 in areas of the country, the agency has further determined that the preferred JN.1-lineage for the COVID-19 vaccines (2024-2025 Formula) is the KP.2 strain, if feasible. This change is intended to ensure that the COVID-19 vaccines (2024-2025 Formula) more closely match circulating SARS-CoV-2 strains. FDA has communicated this change to the manufacturers of the licensed and authorized COVID-19 vaccines. The agency does not anticipate that a change to KP.2 will delay the availability of the vaccines for the United States.

FDA will continue to monitor the safety and effectiveness of the COVID-19 vaccines and the evolution of the SARS-CoV-2 virus.

ORIGINAL RESEARCH article

Covid-19 vaccination acceptance and its associated factors among a middle eastern population.

$\nWalid A. Al-Qerem$

1 Department of Pharmacy, Al-Zaytoonah University of Jordan, Amman, Jordan
2 Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan

Background: The Coronavirus disease 2019 (COVID-19) pandemic is a major threat to public health and has had a significant impact on all aspects of life. An effective vaccine is the most anticipated resolution. This study aims to evaluate Jordanian intent to be vaccinated.

Methods: This is a cross-sectional web-based study. Sample characteristics were gathered, and the participants were classified according to the degree of COVID-19 risk based on the categories of the Centers for Disease Control and Prevention (CDC). Participants' KAP toward COVID-19 were assessed, and two scores were calculated: knowledge score and practice score. The association between different sample characteristics and these scores was identified using binary logistical regressions. The participants' vaccination intention was evaluated and multinomial logistic regression was applied to identify the predictors of vaccination intention. Finally, the reasons behind the participants' vaccination refusal/hesitation were determined and categorized into different groups.

Results: 1,144 participants were enrolled in the study (females = 66.5%). 30.4% of the participants were at high risk of COVID-19 complications, and 27.5% were at medium risk. Overall, participants' knowledge of COVID-19 symptoms, transmission methods, protective measures, and availability of cure were high (median of knowledge score = 17 out of 21). High protective practices were followed by many participants (median of practice score = 7 out of 10). 3.7% of participants were infected, and 6.4% suspected they were infected with the COVID-19 virus. 36.8% of the participants answered “No” when asked if they would take the vaccine once it becomes available, and 26.4% answered, “Not sure.” The main reasons for the participants' vaccination refusal or hesitancy were concerns regarding the use of vaccines and a lack of trust in them.

Conclusion: Participants reported high refusal/hesitancy. Several barriers were identified, and efforts should be intensified to overcome these barriers.

Introduction

The Coronavirus disease 2019 (COVID-19) pandemic has been a health issue of great concern since 2020. Confirmed cases of the disease reached more than 35 million by October 2020 and have caused more than one million mortalities ( 1 ), particularly among the higher-risk population, including people who are obese, smokers, and patients that have cancer, chronic kidney disease, heart conditions, immunocompromised state, sickle cell disease, and type 2 diabetes mellitus ( 1 ).

In addition to the health impact of COVID-19, it has a significant economic burden that cannot be underestimated ( 2 ). It has caused a substantial reduction in workforces and an increase in unemployment globally ( 2 ). These negative impacts have encouraged pharmaceutical companies to develop a vaccine urgently. In December 2020, several vaccines were authorized to prevent COVID-19 infection ( 3 ), and more than 50 COVID-19 vaccine candidates were being developed ( 4 ). Vaccination has now begun in several countries around the world ( 5 ), with plans to begin vaccination in Jordan from February 2021 ( 6 ). Nevertheless, people still have doubts about the safety and efficacy of vaccines, including the longevity of protection against COVID-19, as several cases of reinfection have been reported ( 7 , 8 ). Moreover, the rapid development of vaccines casts doubt on safety. Previously, the rapid development of vaccines has been linked to adverse issues. For example, the swine flu vaccine increased the risk of Guillain-Barré syndrome ( 9 ).

Vaccines have been a successful measure of disease prevention for decades ( 10 ). However, vaccine hesitancy and refusal are significant concerns globally, prompting the World Health Organization (WHO) to declare this uncertainty among the top 10 health threats in 2019 ( 11 ). The causes of vaccine hesitancy, as reported in different studies, include religious reasons, personal beliefs, and safety concerns due to wide-spread myths, including the association of vaccines and autism, brain damage, and other conditions ( 12 ). Unfortunately, in Jordan, no sufficient studies have been conducted to assess the Jordanian population's attitudes toward vaccination. To the best of our knowledge, no previously published work has evaluated the intent of Jordanians to be vaccinated against COVID-19 when a vaccine does become available. The present study aims to evaluate the intent of people from Jordan to be vaccinated against COVID-19 and evaluate the different sample characteristics associated with vaccine refusal/hesitancy, including KAP.

Materials and Methods

This is a cross-sectional web-based survey. The enrolled participants were Jordanian in nationality and aged 18 years and above. A questionnaire was made using Google forms. The link was then distributed via different Jordanian all-purpose Facebook groups that included thousands of members. To ensure that participants met the inclusion criteria, questions about age, area of residence, and nationality were included in the questionnaire. Ethical approval was obtained from the Al-Zaytoonah ethical committee.

Study Instrument

The questionnaire was developed based on a literature review. A panel of experts confirmed the content validity of the questionnaire. The questionnaire was developed in the English language and then translated to Arabic, which is the only official language in Jordan (98% of the Jordanian population are Arabs and the remaining 2% use Arabic for their daily interactions) ( 13 ). It was then translated back into English by different translators, and finally, compared by a third translator. Face validity was conducted in a pilot study that included 30 participants who assessed the questionnaire's clarity, and no significant modifications were required.

The final Arabic version of the questionnaire consisted of six branched sections. The first section collected participants' demographic information, including marital status, smoking habits, obesity status, education level, household average monthly income, health status, and whether participants worked in or studied a health-related field. The second section gathered information about the participants' experience with COVID-19. The third section assessed the attitudes of participants toward COVID-19, while the fourth evaluated their knowledge about COVID-19, including symptoms, transmission methods, preventive measures, and treatment availability. The fifth section asked about the preventive measures against COVID-19 used by the participants. The sixth and final section asked about the participants' willingness to be vaccinated against COVID-19 (once available), and the participants who responded “No” or “Not sure” were asked to give their reasons.

The degree of Covid-19 risk affecting participants was determined according to the Centers for Disease Control and Prevention (CDC) ( 1 ) categories. The high-risk group included smokers, obese, pregnant, or who had at least one of the following conditions (Type 2 diabetes mellitus/Chronic Obstructive Pulmonary Disease (COPD)/Cancer/Kidney Failure/Heart diseases/Organ transplantation/Sickle Cell Anemia). The medium-risk group included those who did not fit for the high-risk category but were overweight or had at least one of these conditions (Type 1 diabetes mellitus/Hypertension/Bone marrow transplant/ Cerebrovascular diseases or stroke/ Cystic Fibrosis/Asthma/Taking steroids or immunosuppressant drugs/Hepatic diseases/ Thalassemia/Lung fibrosis). The low-risk group included all other participants that do not fit the previously mentioned criteria.

Two scores were calculated: the knowledge score and the practice score. For knowledge, the maximum possible score was 21, as for each right answer, one point was granted (the score was calculated based on items in Table 3 ). The participants were divided into two groups based on their knowledge scores. The high-knowledge group included participants that scored more than the total sample median (median = 17), and the low-knowledge group included participants that scored below the total sample median.

Practice scores were calculated for those who had not been infected with the COVID-19 virus. One point was added for each answer representing a scientifically proven protective measure against COVID-19, and the maximum possible score was 10. After calculating the practice scores, the participants were divided into two groups. The high protective practice group included those who scored more than the sample median (median = 7), and the low protective practice group included those who scored below the median.

Statistical Analysis

Kish formula ( 14 ) was applied to determine the least required sample size with a confidence interval level of 95% and a 4% margin for error. The estimated sample size was 600. Categorical variables were presented, such as frequency and percentages, and continuous variables were presented as means and standard deviations (SD). Crosstabulation with χ2 was applied to evaluate the association between intent to be vaccinated and participants' demographic characteristics, knowledge level about COVID-19, and protective practice against COVID-19. Binary logistic regressions were conducted on participants who answered “No” to “Have you ever been infected with COVID-19?” to evaluate variables associated with knowledge level and protective practice against COVID-19 level. A multinomial logistic regression was used to evaluate the variables related to the participants' intent to be vaccinated when a vaccine against COVID-19 becomes available.

An analysis of variance (ANOVA) with LSD post hoc test was applied to measure the difference in the perceived degree of seriousness of COVID-19 between participants with different responses to “Have you ever been infected with COVID-19?” All statistical analysis was conducted using SPSS version 25.

Sample characteristics are presented in Table 1 . Thousand one hundred fourty four participants were enrolled in the study. Almost half of the participants (54.6%) were between 18–29 years, and 26.9% were between 30–40 years. 66.5% of the participants were female. Half of the participants were currently married, and 47.4% did not have children. Those with bachelor's degrees represented 53.5% of the sample, and <7% had a high school education or less. Most participants (67.2%) lived in Amman, and <4% lived in the southern governorates.

Table 1 . Sample characteristics.

The participants' health status is outlined in Table 2 . Fifteen percent of the participants had chronic diseases. Approximately one-third (30.4%) of the participants were at high risk of COVID-19 complications, and 27.5% were at medium risk.

Table 2 . Participants' health status.

Table 3 represents the participants' knowledge about COVID-19 and vaccination. The most known symptom of COVID-19 was fever (97.6%), followed by the loss of smell and taste (96.8%), and the least known symptom was chills (70.1%). 99.2% of the participants were aware that the COVID-19 virus could be transmitted via the inhalation of respiratory droplets from an infected person. The most commonly known protective procedure amongst participants was social distancing (97.6%), followed by avoiding touching face/mouth/nose/eyes (95.4%) and using detergents (94.8%). 30.9% of the participants knew that zinc consumption could not prevent COVID-19 infection, and 15.6% knew the same fact about vitamin C.

Table 3 . Participants' knowledge about COVID-19 and vaccination.

Participants' attitudes and practices toward COVID-19 are shown in Table 4 . Only 12.1% of the participants reported receiving the influenza vaccine last year. A fifth of the participants had done the PCR test to check if they had COVID-19, and 3.7% of the participants tested positive. 58.9% expect that they will be infected with COVID-19 but that their symptoms would be mild. In their response to their intention to take the COVID-19 vaccine once it was available, only 36.8% of the participants intend to be vaccinated, and 26.4% were not sure.

Table 4 . Participants' attitudes and practices toward COVID-19 and vaccination.

The results of binary logistical regression between knowledge score and different sample characteristics are shown in Table 5 . Not knowing someone infected with COVID-19 significantly decreased the odds of having high knowledge scores compared to those who knew someone infected ( p -value = 0.01). A low or medium household monthly average income also considerably reduced the odds of having a high knowledge score compared to high income. Lastly, those with a high-risk of COVID-19 had significantly lower odds of getting high knowledge scores compared to those with low-risk degree.

Table 5 . Binary logistical regression analysis of knowledge score.

The results of binary logistical regression between practice score and different sample characteristics are shown in Table 6 . Significant predictors of high protective practices were older groups (those who were older than 60 years compared to those between 18–29 years), not having children, residency (AlZarqa residents when compared to Amman residents), and higher knowledge score ( p -values < 0.05). Meanwhile, the only significant predictor of low protective practices was being unmarried ( p -value = 0.03).

Table 6 . Binary logistical regression analysis of practice score.

The χ2 test assessed the association between the sample characteristics and the participant's intent to be vaccinated (Appendix) and revealed that the participants' characteristics were significantly associated with the response of “No” vs. “Yes,” when they were female, married, having children, and had a diploma degree. On the other hand, acquaintance with someone who was infected with COVID-19 was significantly associated with the response of “Yes” vs. “No” and “Yes” vs. “Not sure” ( p -values 0.01 and 0.03, respectively). Higher percentages of those who work/study in the medical field responded “Yes” rather than “Not sure” (39.7 vs. 23.9%). Those who wore face masks and used detergents, but did not consume vitamin C to protect themselves from COVID-19, had a higher percentage of “Yes” vs. “No” ( p -values= 0.002, 0.02, and 0.04, respectively). No significant difference was found in the vaccine acceptance between the participants with different risk degrees for COVID-19 complications (Percentage of responding “Yes” was 37.1 % in the high-risk group, 35.9% in the medium-risk group, and 37.2% in the low-risk group).

Table 7 shows the multivariate predictors of responding “Not Sure” or “No” regarding the intent to be vaccinated, according to the multinomial model. Female participants had a 3-fold higher relative likelihood of responding “No” vs. “Yes” and a nearly 1.5-fold higher relative chance of responding “Not sure” vs. “Yes” when compared with male participants ( p -values < 0.05). Moreover, a significant association was found between the participants' perception of the seriousness of COVID-19 and his/her intention to be vaccinated. The higher the perceived seriousness of COVID 19, the significantly lower the odds of responding “Not sure” or “No.”

Table 7 . Multivariate predictors of responding “not sure” or “no” regarding intent to be vaccinated.

Table 8 represents the attitudes and practices of those who were infected with COVID-19 or suspected infection. Those who were infected adhered to quarantine procedures significantly more than those who suspected they were infected. Moreover, confirmed cases of COVID-19 tended to tell relatives/friends more about infection, compared to those who suspected infection. ANOVA with post hoc analysis indicated that there were no significant differences in the perception of COVID-19 seriousness between the three groups (infected, suspected infection, and not infected with COVID-19).

Table 8 . Attitudes and Practices of the participants who were infected or suspected their infection.

The reasons participants' did not want to take the vaccine or were hesitant about vaccination are shown in Table 9 . The most mentioned reasons were concerns about the vaccines as 98.3% of those who answered “No” and 99.3% of those who answered “Not sure” had at least one concern. Concerns about the efficacy of the vaccine and its newness were the most reported by the participant, while the least reported concern was about the association between vaccination and autism (7.8%). The second most mentioned reasons represented attitudes toward vaccines. 52.3% of those who answered “No” stated that they do not take vaccines at all. The need for additional information was a cause for answering “No” or “Not sure” for 87.9 and 97.4%, respectively, of the participants. Lack of trust was another reason for refusal or hesitation about taking the vaccine once available as 81% and 66.2%, respectively, of those who answered “No” or “Not sure” believed that the vaccine might have been approved too quickly because of political pressure.

Table 9 . Reasons participants provided for responding “no” or “not sure” regarding intent to be vaccinated.

In recent history, vaccination has played an essential role in reducing the burden of infectious diseases. It prevented 33,000 deaths and 14 million diseases in 2001 ( 15 ). Vaccines from different companies, including Pfizer BioNTech, Moderna, and Oxford AstraZeneca have recently been approved, but their distribution is still limited ( 16 ). Identifying the populations' intention to be vaccinated, and the barriers to vaccination could remove these barriers and increase the vaccination rate once the vaccine is widely available.

Attitudes and Practices of Participants Infected With COVID-19 or Suspected That They Were

The participants' perception of the seriousness of COVID-19 among participants was not associated with COVID-19 infection history. The degree of seriousness estimations were not different between those who were not infected, those who suspected their infection, and those who were infected (means = 6.49, 6.52, and 6.57, respectively). High adherence to quarantine was reported by those infected, which contradicts the results of other studies ( 17 , 18 ), which reported poor adherence to quarantine during different pandemics. However, the degree of quarantine adherence among those who were certain about their infection was significantly higher than those who only suspected that they were infected. This indicates the importance of COVID-19 testing in decreasing the disease spread by increasing the adherence of infected patients to quarantine.

Vaccination Intentions

Even though this study was conducted in October 2020 when the number of COVID-19 cases increased rapidly in Jordan, only 36.8% of participants intend to be vaccinated once the vaccine was available. This percentage is much lower than the percentage reported by a global survey that included participants from 19 countries ( 19 ) (71.5%) and by studies conducted in Ecuador ( 20 ) (97%), the United States ( 21 ) (57%), France ( 22 ) (76%), China ( 23 ) (91.3%), and Saudi Arabia ( 24 ) (64.7%). The peak rise in COVID-19 cases happened much earlier in other countries than in Jordan, which may contribute to the higher vaccination hesitancy among the Jordanian population compared to other populations, as the disease is new to Jordan. Although the percentage of the population who need to be vaccinated to achieve herd immunity against COVID-19 is not yet well-known, in general, 50–90% ( 25 ) of the population needs to be immune either naturally or by vaccines to achieve herd immunity. Should this high hesitancy toward vaccination continue among the Jordanian population, it might be difficult to achieve herd immunity. Several sample characteristics had a significant negative impact on the participants' intention to be vaccinated, including; being female, married, and having a postgrad degree compared to university students. Lower vaccination intention among female participants was also observed in studies conducted in France ( 22 ), China ( 23 ), and Europe ( 26 ). However, other factors reported in other studies, like income ( 22 , 26 ) and age ( 22 ), were not significant predictors in this study. The recognition of these factors could help develop targeted awareness campaigns directed to the population to increase the vaccination rate once the vaccine is available.

The perceived risk of COVID-19 was a significant predictor of the participants' vaccination intention in this study, reflecting several other studies ( 22 , 23 ). The higher the perceived risk, the lower the vaccination hesitancy. Therefore, increasing the population's consciousness about the seriousness of the disease is essential in improving their willingness to be vaccinated.

Detecting the causes of vaccination refusal or hesitancy could improve the population's vaccination intentions. It is important to better understand the rationales and reasons for vaccination refusal or hesitancy if we are to remove these barriers.

Concerns about the vaccine were the most common reason behind hesitancy or refusal among the participants. These concerns about vaccine safety and side effects are global, as indicated by studies conducted in the United States ( 21 ), Europe ( 26 ), and China ( 23 ). The rationale behind these concerns is reasonable, as several vaccine candidate trials were paused ( 27 , 28 ) due to detected side effects. However, the suspension of these studies, once side effects were noted, could be used to assure the rigor of vaccine testing, another concern among the population. Misbeliefs about the association between vaccines and autism or the vaccine's effect on fertility were not common among the participants, implying the dubiety about many popular myths associated with vaccines.

Efficacy is a frequently mentioned concern whenever a new vaccine is developed ( 29 , 30 ). This concern could be of less importance once the vaccine is available and successful results are published.

Undesirable attitudes were the second most mentioned barriers. Increasing the population's understanding of the vaccines and the related mechanisms of action through different awareness-raising methods could overcome this barrier. About 30% of those with undesirable attitudes were against vaccination in general. Several studies ( 31 , 32 ) have established approaches to overcome vaccine refusal that could be useful for COVID-19 vaccination. For example, opposing the spread of false information and targeting children and adolescence, who might not have robust emotions about vaccines yet, could increase COVID-19 vaccine acceptability.

The need for additional information was reported as a barrier by 58% of the respondents and 79% of participants in an Indonesian study ( 33 ). The role of healthcare providers is influential in this respect, as they provide patients and the general population with much-needed information. An Australian study ( 34 ) provided a framework that could be used by healthcare providers to increase confidence in any potential COVID-19 vaccines.

Lack of trust was also a cause of vaccination hesitation or refusal for many participants in this study and an American study ( 21 ). A belief in the conspiracy theories associated with COVID-19 among the Jordanian population was observed in the present study. These beliefs have also been reported by another Jordanian study on COVID-19 (unpublished data). Several strategies have been suggested to combat conspiracy theories ( 35 ), including the careful dissemination of medical research, social media campaigns, and developing a culture of fact-checking. A report issued by WHO has discussed the behavioral considerations of COVID-19 acceptance and suggested different approaches to increasing vaccine acceptance. These include building an enabling environment and using open communication to address people's beliefs and uncertainty, educating them about the safety and efficacy of the vaccine ( 36 ). Social and governmental collaboration will increase public confidence in the COVID-19 vaccine and enable the country to reach herd immunity rapidly.

Strengths and Limitations

One of this study's strengths is the large sample size, which decreases the influence of existing bias. Another strong aspect of the present study is that it evaluated the participants' KAP toward COVID-19 and their vaccination intentions and assessed the association between KAP and vaccination intentions.

At the time this study was conducted, the vaccine was not available. The participants' vaccination intentions may be different now, as the vaccine has been made available. More information has now been published, which may be considered a limitation of this study. This study was based on an online questionnaire, meaning the results are subject to recall and selection biases. However, previous studies have shown that web-based research is a cost-effective method that can be used to generate a sample that is representative of the total population with a fraction of the cost ( 37 ). It can reach people otherwise unreachable and provides a safe and private environment for the respondents to answer questions accurately and honestly compared with face-to-face interviews ( 38 ).

It has been suggested that as the number of Internet users has increased globally, the socio-demographic characteristics of the recruited participants via web-based surveys reflect the general population ( 39 ). This can be applied in Jordan as Internet users are estimated to be 67% of all age groups ( 40 ). This percentage could be higher when children under the age of 18 are excluded. Another limitation could be that the study sample age was positively skewed. However, the Jordanian population is a young one, and the age group between 20–29 years represents 33.45% of the total population above the age of 19 ( 41 ).

Finally, almost half of the sample participants worked in the medical field, which may cast doubt in the sample's representation of the total population. Nevertheless, the percentage of medical field workers in Jordan is significantly higher than in other countries globally. For example, Jordan is ranked fourth in terms of the number of pharmacists for every 10,000 people (16 pharmacists for 10,000) ( 42 ). Furthermore, the authors believe that the perception of medical-related staff is particularly interesting, as their opinions influence the general population, and they represent a high-risk group, therefore, their vaccination is a priority. Finally, as indicated by the Kish formula, the smallest required sample size is 600, therefore, a study sample that includes 1,144 participants could provide sufficient data to evaluate each subgroup.

The results of this study indicate that the study sample has good KAP toward COVID-19. However, the participants' vaccination intentions were unfavorable. The total sample acceptance of the vaccine was 36.8%, while the approval of the participants who work/study in a medical field or those who are at high risk of COVID-19 complications was slightly higher (39.7 and 37.1%, respectively). The main reasons for participants' refusal of vaccination or hesitation were concerns about safety and efficacy, in addition to insufficient information about the vaccine. Healthcare providers must activate their roles and address these concerns by increasing awareness about the role of vaccination in preventing the spread of infection and acquiring herd immunity. This could be achieved by designing and implanting different awareness campaigns via various media outlets guided by healthcare providers.

Data Availability Statement

The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.

Ethics Statement

The studies involving human participants were reviewed and approved by Al Zaytoonah University of Jordan ethical committee. The patients/participants provided their written informed consent to participate in this study.

Author Contributions

WA-Q: methodology, formal analysis, data curation, original draft preparation, writing, review and editing, funding acquisition, supervision, and final approval of the submitted manuscript. AJ: draft preparation, writing, review and editing, and final approval of the submitted manuscript. All authors contributed to the article and approved the submitted version.

This work was funded by Al-Zaytoonah University of Jordan Grant number (22/23/2019-2020).

Conflict of Interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Acknowledgments

We would like to thank Raghda Qarqaz for help with data acquisition and analysis and writing and editing this article.

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Keywords: knowladge, attitude, practice, COVID-19, vaccine

Citation: Al-Qerem WA and Jarab AS (2021) COVID-19 Vaccination Acceptance and Its Associated Factors Among a Middle Eastern Population. Front. Public Health 9:632914. doi: 10.3389/fpubh.2021.632914

Received: 24 November 2020; Accepted: 11 January 2021; Published: 10 February 2021.

Reviewed by:

Copyright © 2021 Al-Qerem and Jarab. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

*Correspondence: Walid A. Al-Qerem, waleed.qirim@zuj.edu.jo

Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

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New study involving nearly 185,000 patients recommends strengthening immunity against COVID-19 in people with cancer

by Barcelona Institute for Global Health

Researchers from the Institut d'Investigació en Atenció Primària Jordi Gol (IDIAPJGol) and the Barcelona Institute for Global Health (ISGlobal) have led a study on the effectiveness of vaccines against COVID-19 among cancer patients in Catalonia. The research, published in the journal Nature Communications , recommends administering additional doses of the vaccine among this risk population.

Cancer patients are at increased risk of death from COVID-19, especially those who have lung cancer , hematological malignancies or are undergoing systemic treatment, such as chemotherapy.

The participation of patients with active cancer in clinical trials that have been carried out to test the effectiveness of vaccines against COVID-19 has been very limited, so it has not been possible to know exactly the effectiveness of immunization against the SARS-CoV-2 virus among this risk group. However, prospective data from several studies show that cancer patients may develop fewer protective antibodies to COVID-19 virus than the general population, especially after receiving a single dose of the vaccine.

Real world data

The study confirms these results, based on the analysis of massive data obtained from clinical registries. This is the most comprehensive work yet on this issue and the first of this kind with information from real-world data, providing a more realistic view of how vaccines are working in everyday clinical practice among people with cancer.

The researchers have analyzed the data of 184,744 patients with neoplasia included in the information system for the development of research in primary care (SIDIAP), the database that includes people treated at the first level of care in Catalonia. Half of the individuals included in the study (92,372) had received at least the first complete immunization (two inoculations of the vaccine) and the other half (92,372) had not been vaccinated at the time of the work.

Researchers have compared the mortality data and serious complications derived from COVID-19 among the immunized group after receiving the first and second doses of the vaccine with those of the unvaccinated group. Next, the researchers compared the results of the members of the experimental group after having received the booster dose of the vaccine (which was 54,267 patients) with an equivalent sample of people in the control group who had only received the first two inoculations.

The results of the study show that the rate of mortality and serious complications among cancer patients not vaccinated against COVID-19 is twice that of those who have received the full first dose. However, this difference is smaller than the observed data among the general population immunized against SARS-CoV-2 and the non-immunized population.

"Our results clearly demonstrate that vaccination against COVID-19 significantly reduces mortality and serious complications among cancer patients, especially those who have received the booster dose," said ISGlobal researcher Otavio Ranzani, who supervised the study together with Talita Duarte-Sallés from IDIAPJGol.

For her part, this researcher explained that "this work provides essential information to understand the impact of vaccination against COVID-19 on cancer patients , and helps to design public health policies that protect this vulnerable population."

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Past COVID infections may help protect against certain colds. Could it lead to better vaccines?

FILE - This 2020 electron microscope image made available by the Centers for Disease Control and Prevention shows SARS-CoV-2 virus particles which cause COVID-19. If you’ve been sick with COVID-19, you may have some protection against certain versions of the common cold. A study published Wednesday, June 12, 2024, in the journal Science Translational Medicine, suggests previous COVID-19 infections lower the risk of getting colds caused by milder coronavirus cousins, which could provide a key to broader COVID-19 vaccines. (Hannah A. Bullock, Azaibi Tamin/CDC via AP, File)

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If you’ve been sick with COVID-19, you may have some protection against certain versions of the common cold.

A new study suggests previous COVID-19 infections lower the risk of getting colds caused by milder coronavirus cousins, which could provide a key to broader COVID-19 vaccines.

“We think there’s going to be a future outbreak of a coronavirus,” said Dr. Manish Sagar, senior author of the study published Wednesday in the journal Science Translational Medicine. “Vaccines potentially could be improved if we could replicate some of the immune responses that are provided by natural infection.”

The study looked at COVID-19 PCR tests from more than 4,900 people who sought medical care between November 2020 and October 2021. After controlling for things like age, gender and preexisting conditions, Sagar said he and his colleagues found people previously infected with COVID-19 had about a 50% lower chance of having a symptomatic coronavirus-caused common cold compared with people who were, at the time, fully vaccinated and hadn’t yet gotten COVID-19.

Several viruses cause colds; coronaviruses are thought to be responsible for about 1 in 5 colds.

Researchers linked the protection against coronavirus-caused colds to virus-killing cell responses for two specific viral proteins. These proteins aren’t used in most vaccines now, but researchers propose adding them in the future.

“Our studies would suggest that these may be novel strategies for better vaccines that not only tackle the current coronaviruses, but any potential future one that may emerge,” said Sagar of Boston Medical Center.

Dr. Wesley Long, a pathologist at Houston Methodist in Texas who was not involved in the study, said the findings shouldn’t be seen as a knock against current vaccines, which target the “spike” protein studding the surface of the SARS-CoV-2 virus that causes COVID-19.

These vaccines, he said, are “still your best defense against severe COVID-19 infection, hospitalization and death.”

But he added: “If we can find targets that cross-protect among multiple viruses, we can either add those to specific vaccines or start to use those as vaccine targets that would give us broader-based immunity from a single vaccination. And that would be really cool.”

The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group. The AP is solely responsible for all content.

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Supreme Court says Biden admin can combat social media misinformation in free speech case

The case turned on whether the biden administration had been using the bully pulpit or was actually bullying when officials urged removal of controversial posts on covid vaccines and other issues..

WASHINGTON −The Supreme Court on Wednesday handed the Biden administration an election-year victory, throwing out a conservative challenge to government efforts to have social media companies remove posts it considered misinformation.

The 6-3 decision, led by Justice Amy Coney Barrett , was a response to a suit that came during a hot-button period when social media was thick with contentious posts over COVID-19, vaccines, top government scientist Anthony Fauci , and other emotional topics. Justices Samuel Alito , Neil Gorsuch and Clarence Thomas dissented.

Barrett, writing for the majority, said the challengers argued that unfettered speech on social media is critical to their work as scientists, pundits and activists.

“But they do not point to any specific instance of content moderation that caused them identifiable harm,” Barrett wrote . “They have therefore failed to establish an injury that is sufficiently ‘concrete and particularized.’”

More: Supreme Court strikes down Trump-era ban on bump stocks for guns

In the dissent, Alito complained that the majority "unjustifiably refuses to address this serious threat to the First Amendment."

"For months, high-ranking Government officials placed unrelenting pressure on Facebook to suppress Americans’ free speech," Alito wrote.

Alito highlighted as problematic an email sent from a Biden COVID adviser to a Facebook official in March of 2021 complaining that the platform was not being responsive to the administration’s concerns and “we have been considering our options on what to do about it.”

By dismissing the case without deciding the underlying First Amendment issue, the justices avoided saying when governments go too far in interacting with media platforms about their content.

The Republican-led states of Missouri and Louisiana and five individual users of social media had charged the White House, the surgeon general and others with violating their free speech rights by coercing Facebook, YouTube and X (formerly Twitter) to remove or downgrade posts.

The Department of Justice said government agencies weren’t improperly threatening social media companies , but instead, were encouraging them to remove harmful or false information, including about vaccines. There was no retaliation when the platforms did not comply, the DOJ said.

In July 2023, a district court in Louisiana sided against the administration, imposing sweeping restrictions on the government’s interaction with social media platforms.

The New Orleans-based 5th Circuit U.S. Court of Appeals narrowed the restraints . But the DOJ said that would still place unprecedented limits on how government officials can speak about matters of public concern, address national security threats, or relay public health information.

The restrictions were on hold while the Supreme Court reviewed the case.

Related Supreme Court defines when public officials may block critics on personal social media accounts

Experts had called the case , Murthy v. Missouri, a unique chance for the court to define how far governments may go to protect against online distribution of harmful content.

Alex Abdo, litigation director of the Knight First Amendment Institute at Columbia University, said it was disappointing the high court didn't provide more guidance on the limits the First Amendment places on the government’s pressure campaigns.

“This guidance would have been especially valuable in the months leading up to the election,” he told USA TODAY.

But the Supreme Court said the challengers failed to show enough of a connection between the Biden administration’s communications with social media companies and restrictions on their postings.

"To be sure, the record reflects that the Government defendants played a role in at least some of the platforms’ moderation choices," Barrett wrote. "But the Fifth Circuit, by attributing every platform decision at least in part to the defendants, glossed over complexities in the evidence."

Even if there was a link, Barrett wrote, the challengers didn’t show enough likelihood that they would be harmed in the future.

Platforms have continued to enforce their own policies against COVID-19 misinformation, so blocking the government from communicating with the companies is unlikely to make a difference, the majority said.

“In my opinion, the plaintiffs were right on one issue – the potential for government pressure to implicate First Amendment rights warrants careful consideration from the courts,” said Gautman Hans, who helps lead the Cornell Law School First Amendment Clinic. "But this case was obviously the wrong one for the Court to assess those free speech questions."

The high court also heard another case this year about content moderation, examining the constitutionality of laws passed by Florida and Texas to limit the ability of social media giants to regulate user content.

Both cases grew out of concern from conservatives that their views were being suppressed, including claims of 2020 election fraud, the origin of and treatments for COVID-19.

The chairman of the House Judiciary Committee, Rep. Jim Jordan, who has argued the Biden administration pressured social media companies to censor posts about Hunter Biden’s laptop and COVID-19 vaccines, said Wednesday the high court’s decision demonstrated the need for legislation to protect the freedom of expression.

“Our country benefits when ideas can be tested and debated fairly on their merits, whether online or in the halls of Congress,” said Jordan, R-Ohio.

“While we respectfully disagree with the Court's decision, our investigation has shown the need for legislative reforms, such as the Censorship Accountability Act, to better protect Americans harmed by the unconstitutional censorship-industrial complex. Our important work will continue."

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How Americans View the Coronavirus, COVID-19 Vaccines Amid Declining Levels of Concern

Just 20% of the public views the coronavirus as a major threat to the health of the U.S. population and only 10% are very concerned about getting a serious case themselves. In addition, a relatively small share of U.S. adults (28%) say they’ve received an updated COVID-19 vaccine since last fall.

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Overall, 46% of Americans say the statement “public health officials were unprepared for the outbreak” describes their views extremely or very well, including similar shares of Republicans and Democrats.

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Current and Future Perspectives on the COVID-19 Vaccine: A Scientometric Review

Alireza noruzi.

1 Department of Knowledge and Information Science, Faculty of Management, University of Tehran, Tehran 1417935840, Iran; ri.ca.tu@izuron (A.N.); moc.oohay@727309dazheb (B.G.); [email protected] (S.J.)

Behzad Gholampour

Sajad gholampour.

2 Department of Sport Management, Faculty of Physical Education and Sports Sciences, Kharazmi University, Tehran 3197937551, Iran; moc.oohay@919809dajas

Somayeh Jafari

Razieh farshid.

3 Department of Knowledge and Information Science, Faculty of Psychology and Education, Kharazmi University, Tehran 3197937551, Iran; [email protected]

Agata Stanek

4 Department of Internal Medicine, Angiology and Physical Medicine, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Batorego 15 St., 41-902 Bytom, Poland

Ali Akbar Saboury

5 Institute of Biochemistry and Biophysics, University of Tehran, Tehran 1417614335, Iran

This study attempted to draw the present and future perspective of the COVID-19 vaccine by identifying the most important scientists and their scientific contexts, trends of research topics, and relationships between different entities. Methods: To achieve this purpose, bibliometric and scientometric techniques were used to analyze 6288 scientific documents contributing to COVID-19 vaccines from the beginning of 2019 to 13 December 2021, indexed in the Web of Science. Results: The United States (US) had the greatest impact by publishing 2104 documents and receiving 32,958 citations. The US and the UK countries had the highest level of scientific collaborations with 192 collaborative studies. The University of Oxford and the Harvard Medical School were the most active institutions, and the University of Oxford and Emory University were the most influential institutions. Pollard AJ and Lambe T had the most publications and the highest citations and h-index. T Lambe, SC Gilbert, M Voysey, and AJ Pollard from the University of Oxford had the highest number of co-authorships. More than 19% of the research was conducted in the field of immunology. The Vaccines journal had the most publications, with 425 articles. The US Department of Health & Human Services granted the most research. In 2019, studies were focused on the topics of COVID-19 virus identification and ways to deal with it; in 2020, studies focused on the topics of COVID-19 and vaccines, whereas in 2021, they focused on the topics of COVID-19 vaccines and their effects, vaccines hesitancy, the role of healthcare workers in COVID-19, as well as discussions about these vaccines in the social media. Conclusions: Recognition of the most important actors (countries, institutes, researchers, and channels for the release of COVID-19 vaccine studies), research trends, and fields of study on the COVID-19 vaccine can be useful for researchers, countries, and policy makers in the field of science and health to make decisions and better understand these vaccines.

1. Introduction

The new coronavirus, or COVID-19, is a deadly virus common between humans and animals [ 1 ], which was identified by the World Health Organization on 11 March 2020, as a pandemic [ 2 ]. The pandemic showed that it is not only a medical problem. Since the pandemic affects society as a whole, new research frameworks are needed, including interdisciplinary collaborations, to manage the problem [ 3 , 4 ]. It was in December 2019 that the first news of the Huanan seafood market was received in Wuhan City, the capital of Hubei Province, China, which reported cases of the disease [ 5 , 6 , 7 , 8 ], a disease that has been the news trend of all news media so far and has occupied the minds of all individuals and researchers in the 21st century. In other words, as of 15 December 2021, according to reports sent to the World Health Organization, 270,791,973 confirmed cases of COVID-19 and 5,318,216 deaths were registered [ 9 ]. Therefore, with the rapid spread of COVID-19 and the proliferation of patients around the world, as well as the change in new mutations and the lack of definitive treatment for it, the issue of vaccine and individual vaccination has become a priority of governments as the only way to control the disease [ 10 , 11 , 12 ]. Therefore, scientists believe that safety and control of this disease are achieved when 60 to 70% of the world’s population is vaccinated against this disease [ 13 ].

However, a vaccine is a biological preparation that provides acquired active immunity to a specific disease [ 11 ]. The main types of vaccines include live-attenuated vaccine, inactivated vaccine, subunit, recombinant, polysaccharide and conjugate, and toxoid vaccine [ 14 ]. To develop a vaccine, complete information on the characteristics of the antigen, adjuvant, vaccine production, and delivery system must be available [ 15 ]; due to the availability of genomic and structural information on the new coronavirus [ 16 , 17 ], different vaccines for this virus were produced [ 14 ]. In general, for the first time on 11 and 18 December 2020, the United States Food and Drug Administration (FDA) gave the Pfizer/BioNTech and Moderna COVID-19 vaccines an emergency authorization to control the disease [ 12 ]. Therefore, based on the latest global statistics, there are 232 vaccine candidates to date. One hundred and thirteen vaccines are in clinical trials on humans, 75 vaccines are in the preclinical phase, and approximately 15 vaccines have received the necessary licenses and are used by countries [ 15 ]. Therefore, according to reports received from the World Health Organization about vaccination, until 13 December 2021, a total of 8,200,642,671 doses of vaccine have been injected [ 9 ]. In total, in addition to vaccines and vaccinations, regular hand washing, mask use, observance of social distance, and adherence to health protocols have been declared the most reliable, efficient, and effective preventive measures against the new coronavirus.

In the section on research and technologies in the field of vaccines, we are witnessing the emergence of interdisciplinary fields, research collaborations, and new research fronts to transform the future of science and technology in this field. Identifying and evaluating research, research areas, and research fronts in COVID-19 vaccines familiarize researchers and related organizations with current and future research trends in this field and help them to better conduct training programs in this field. The present study helps to identify important interdisciplinary topics and research areas resulting from scientific publications, the most prolific and influential researchers, institutions, countries, and journals that publish new research on coronavirus vaccines and develops a plan for future research collaborations.

Therefore, considering the importance of using vaccines in the prevention and control of pandemics and following an increase of scientific publications on the COVID-19 vaccine, attention to scientometric studies to assess the research productivity and collaborations of various disciplines, researchers, and institutions of the world in this field have gained a special importance. Therefore, the current research aims to draw the present and future perspective of the COVID-19 vaccine studies by identifying the most important actors and their scientific fields, trends in research topics, and relationships between different entities.

Some studies by [ 2 , 14 , 18 , 19 ] in particular, examined the field of COVID-19 vaccines from the scientometric and bibliographic perspective. Hence, their studies are consistent with the current research in terms of method and subject. Among the distinguishing points of this study with the research conducted, we can mention the approach of the present study, in which an attempt was made to limit the search process to the beginning of the epidemic, i.e., the period from 2019 to 13 December 2021. Additionally, the intelligent selection of search keywords is another distinctive point of this research, making it possible to analyze studies focused on the COVID-19 vaccines, not the COVID-19 or coronavirus. On the other hand, the reference of the present study to the current and future research fields of studies on the COVID-19 vaccines is another distinguishing point of this research from other studies.

2. Materials and Methods

According to the objectives of the present research, the method of bibliometric and scientometric analysis was used to analyze scientific publications on the COVID-19 vaccines. The population of this research consists of all documents on the COVID-19 vaccines from 2019 to 13 December 2021 indexed in the Web of Science database. The methodology of this research was divided into two parts, which are described in detail below.

2.1. Data Retrieval

The search strategy was such that in the first step, the Clarivate Analytics Web of Science (WoS) Core Collection was selected [ 20 , 21 ]. Next, the three citation indexes of this database, i.e., SCI-EXPANDED, SSCI, and A&HCI indexes, became the basis of the research. Different names of COVID-19, along with the two words vaccine and vaccination, were searched to collect the documents through the Advanced Search of the WoS, as well as the scientific and common names of different types of vaccines (See Appendix A ) in the field of TOPIC (TS phrase in Web of Science) without any restrictions on the TYPE and LANGUAGE of the documents. The search strategy of this study led to the retrieval of 6288 records (See Figure 1 ), all records were extracted in plain text format in batches of 500 in 13 TXT files and saved on a personal computer; then, all the files were merged into one file for ease in analyzing.

An external file that holds a picture, illustration, etc.
Object name is jcm-11-00750-g001.jpg

PRISMA flow diagram in COVID-19 vaccines.

In other words, the website of COVID-19 vaccines www.track.org was used (19 January 2022) to gather information about the type of vaccine, primary developers, and status of approving countries. Additionally, information on the doses purchased from each vaccine was collected from the app.powerbi.com website. The website www.RAPS.org (accessed on 19 January 2022) was also used to identify vaccine-producing countries.

2.2. Data Analysis

All extracted files were analyzed using HistCite (v. 12.03.17, Philadelphia, PA, USA), Publish or Perish (v. 8, London, UK), VOSviewer (v. 1.6.17, Leiden, The Netherlands), CiteSpace (v. 5.8.R3, Philadelphia, PA, USA), and Bibliometrix R Package software (v. 3.1.4, Naples, Italy). The analysis process was such that the capabilities of HistCite software were used to analyze information about authors, institutions, countries, and journals [ 20 ]. In addition, Bibliometrix R Package was used to draw the maps of geographical distribution, three-field plot, and the process of publishing journals. While VOSviewer was used to determine the status of scientific collaborations between researchers, organizations, and institutions conducting research on the COVID-19 vaccines. Finally, CiteSpace was used to review the research process on the COVID-19 vaccines, as well as the timeline map of countries and institutions in this field.

Figure 2 shows the trend of published papers on the COVID-19 vaccines during 2019–2021. The results indicate that the trend of publications has increased significantly compared to the beginning years of the COVID-19 virus epidemic, so that the number of related publications has increased from 17 documents in 2019 to 5708 documents in 2021. The widespread outbreak of the COVID-19 virus worldwide, increasing deaths, and more deadly new mutations, have prompted researchers to conduct more research on the production and effectiveness of vaccines to control this disease.

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Object name is jcm-11-00750-g002.jpg

The Annual distribution of in COVID-19 vaccine research.

Figure 3 and Table 1 show the co-authorship network and details of the most active authors in COVID-19 vaccine studies. More than 32,800 authors co-authored publications on vaccines. Table 1 lists the authors who have published at least 18 documents in this field. In Figure 3 , the nodes represent the authors and links indicate the number of co-authorships formed between the authors. Furthermore, the researchers who collaborated on at least three studies are shown in Figure 3 . This network consists of 1491 nodes and 5834 links. T Lambe, SC Gilbert, M Voysey, and AJ Pollard from the University of Oxford had the highest number of co-authorship. According to Table 1 , Pollard AJ and Lambe T published most of the publications in this field and are located in the first and second places. However, Pollard AJ and Lambe T, with 3583 and 3579 citations, which are in the first and second places in terms of scientific publications in this field, were able to obtain the highest citation rate and H-index score among their peers. The important point in Table 1 of the year of publication of the authors’ documents is that Wiwanitkit V, with the publication of 23 documents in 2021, is the only active author who has been able to publish this number of documents in this period.

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Object name is jcm-11-00750-g003.jpg

Authors’ collaboration network in COVID-19 vaccine research.

The most prolific authors in COVID-19 vaccine research. (NP: Number of Publications, TC: Total Citations).

Rank	Authors	H-Index	G-Index	HC-Index	NP	TC	PY_Start
1	Pollard AJ	13	36	17	36	3583	2020
2	Lambe T	13	29	18	29	3579	2020
3	Gilbert SC	11	24	16	24	3238	2020
4	Baden LR	4	23	6	23	1823	2020
5	Wiwanitkit V	1	4	1	23	21	2021
6	Voysey M	10	22	13	22	3210	2020
7	Temsah MH	3	4	4	20	19	2021
8	Terpos E	6	10	11	20	118	2021
9	Halwani R	3	3	4	19	14	2021
10	Klimek L	4	8	8	19	81	2021
11	Dimopoulos MA	6	10	10	18	115	2021
12	Hotez PJ	8	18	12	18	400	2020
13	Talbot HK	10	18	13	18	599	2020

Figure 4 illustrates a three-field plot in the research on the COVID-19 vaccines, focusing on the relationships between authors, countries, and keywords. In Figure 4 , rectangles represent each entity (authors on the left, countries in the middle, and keywords on the right). The height of the rectangles refers to the number of studies conducted by countries, authors, and research fields, and the greater the number of studies by each of these entities, the size and height of the rectangles will be more. Lines of communication also reflect the links made between authors and countries, as the more research that was conducted by authors and countries on the subject, the thickness of the links will be greater.

An external file that holds a picture, illustration, etc.
Object name is jcm-11-00750-g004.jpg

Three-field plot for the relationships among authors, countries, and author keywords in COVID-19 vaccine research. (AU: Author, Au_CO: Author country, DE: Document keyword).

The analysis showed that the US, Italy, China, and the United Kingdom (UK) conducted the most research on COVID-19 vaccines, and the height of the countries’ rectangles indicates that. Furthermore, most of the US studies have focused on COVID-19, COVID-19 Vaccination, COVID-19 Vaccines, Vaccine hesitancy, and COVID-19 Vaccines BNT162B2; these studies have been led by many researchers. Additionally, most Italia research has focused on topics, such as COVID-19, COVID-19 Vaccination, COVID-19 Vaccines, Vaccine hesitancy, COVID-19 Vaccines BNT162B2, and COVID-19 Pandemic; these studies have been conducted mostly by researchers such as AJ Pollard, T Lambe, L Kilmek, PK Aley, and M Voysey. However, Chinese and UK researchers, similarly to American researchers, focused on COVID-19, COVID-19 Vaccination, COVID-19 Vaccines, Vaccine hesitancy, and COVID-19 Vaccines BNT162B2.

Figure 5 and Table 2 show the most active organizations in publishing studies on the COVID-19 vaccines. In total, more than 8000 institutions and universities around the world collaborated independently or in groups. Figure 5 indicates the institutions that cooperated at least in three documents together. This network consists of 1396 nodes and 13,428 links. The results presented in Table 2 and Figure 5 show that many of these studies are the result of collaboration between researchers from European, Asian, and American universities. As shown in Figure 5 , the University of Oxford in the UK and the Harvard Medical School in the US, as the most active organizations, played a greater role than other institutions in publishing these studies, and this is visible in Figure 5 and Table 2 .

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Object name is jcm-11-00750-g005.jpg

Institutional collaboration network in COVID-19 vaccine research.

The most prolific institutions in COVID-19 vaccine research.

Rank	Institutions	NP	TC	Country	Location
1	University of Oxford	151	5546	UK	Oxford
2	Harvard Medical School	144	2050	US	Boston
3	Tel Aviv University	119	1633	Israel	Tel Aviv
4	University of Washington	99	2128	US	Seattle, Washington
5	London School of Hygiene & Tropical Medicine	87	3171	UK	Bloomsbury, London
6	University College London	83	2993	UK	London
7	Imperial College London	80	2331	UK	London
8	Johns Hopkins University	79	1328	US	Baltimore, Maryland
9	University of Pennsylvania	78	754	US	Philadelphia, Pennsylvania
10	Emory University	76	4008	US	Atlanta, Georgia
11	Stanford University	70	963	US	Stanford, California
12	University of Toronto	60	422	Canada	Toronto

Additionally, based on the results of Table 2 , it can be argued that the US and the UK universities played a prominent role in publishing studies on the COVID-19 vaccines. Overall, from the 12 universities listed in Table 2 , the US with 6, the UK with 4, and Canada and Israel with one university, were the most participating institutions in this field. However, Table 2 shows that the documents published by the University of Oxford and Emory University have had the greatest citation impact on the scientific community. It should be noted that the 151 studies published by researchers at the University of Oxford received 5546 citations, and the 76 studies published by researchers at the London School of Hygiene & Tropical Medicine obtained 4008 citations.

To analyze the bibliographic information from documents on the COVID-19 vaccines, a three-field plot of institutions, keywords, and journals was designed, which allows us to identify institutions that have studied topics on the COVID-19 vaccines and provides the possibility to identify the field of journals that published such studies. As shown in Figure 6 , institutions are on the left, keywords in the middle, and journals on the right. Figure 6 indicates the higher outputs of institutions, such as Oxford University, Harvard Medical Sciences, Tel Aviv University, National and Kapodistrian University of Athens, Johns Hopkins University, Stanford University, and Washington University, which are examined related fields to COVID-19, COVID-19 vaccination, COVID-19 vaccines, public health, COVID-19 vaccine acceptance, and COVID-19 vaccines bnt162b2. Generally, most of the research on vaccines at these institutions has been published in journals of Vaccines , Vaccine , Human Vaccines & Immunotherapeutics .

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Three-field plot of the relationships between institutions, authors’ keywords, and sources in the research of the COVID-19 vaccine. (AU_UN: Author university, DE: keyword, SO: Source).

Figure 7 shows the geographical distribution of the research on the COVID-19 vaccines. The results of Figure 7 indicate how the topic of study on the COVID-19 vaccines has been developed on five continents. Perhaps less of a topic addressed by all researchers worldwide, COVID-19 and the development of the vaccine have led to a global collaboration to eradicate it, and researchers in all countries are trying to achieve this by studying and investigating in this field. In Asia, China and India conducted the most research in this field. The US and Canada from the Americas and the UK and Italy from Europe published the highest number of articles on this topic. Australia from Oceania and South Africa from Africa also had the most studies on COVID-19 vaccines.

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The Geographical map of countries prolific in COVID-19 vaccine research (Dark blue color: countries with a high number of articles related to the COVID-19 vaccine, light blue color: countries with a low number of articles related to the COVID-19 vaccine, gray color: countries without articles related to the COVID-19 vaccine).

In total, 122 countries contributed to the publication of studies on the COVID-19 vaccine, and the findings of the most active countries are presented in Table 3 . Only four countries in the US, the UK, Italy, and China, with a publication of 61% of the total research conducted, were the most important and main countries producing publications on the COVID-19 vaccines, which played a prominent role in this field. The United States also had the greatest impact on the scientific community in this field by publishing 2104 studies and receiving 32,958 citations. Generally, the efforts of major pharmaceutical companies in the US, the UK, and China to study and investigate the production of the COVID-19 vaccine have been effective in increasing their publications in this field.

The most prolific countries in COVID-19 vaccine research.

Rank	Countries	NP	TC
1	US	2104	32,958
2	UK	776	15,269
3	Italy	521	3078
4	China	435	5671
5	Germany	391	9389
6	India	280	1836
7	Canada	263	2869
8	Australia	259	2003
9	France	247	1871
10	Israel	217	3000
11	Spain	205	1589
12	Switzerland	172	1702

Figure 8 shows the geographical distribution of countries participating in the research on the COVID-19 vaccine around the world. As can be seen in Figure 8 , the orange links indicate the wide range of collaborations that have taken place over the last three years since the beginning of the COVID-19 epidemic; authors from 153 countries have conducted studies related to the COVID-19 vaccine. Generally, most countries collaborated in publishing these studies so that the US–UK (192), the US–China (116), the US–Canada (95), and the US–Germany (86) have recorded the highest amount of scientific collaborations.

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The Geographical map of the collaboration of countries in the research of the COVID-19 vaccine research (Dark blue color: countries with a high number of articles related to the COVID-19 vaccine, light blue color: countries with a low number of articles related to the COVID-19 vaccine, gray color: countries without articles related to the COVID-19 vaccine).

The results of Table 4 show that the Vaccines journal with 425 articles and the Vaccine journal with 185 articles had the highest number of publications in the field of COVID-19 vaccines. Studies published in the New England Journal of Medicine and the Lancet had the greatest citation impact on the scientific community, receiving 12,861 citations and 6776 citations, respectively, which could obtain significant citations in this field. The results of Table 4 also indicate that all 14 journals publishing research on the COVID-19 vaccines have an impact factor and are among the qualified journals in their field. According to the results of Table 4 , the highest impact factor belongs to the New England Journal of Medicine with IF 91,245, and the lowest impact factor belongs to the International Journal of Environmental Research and Public Health with IF 3.39. Among them, 10 journals were Q1, 2 journals Q2 and Q3. Furthermore, Table 4 reveals that Nature Publishing Group and MDPI played the most role in this field with two journals.

The most prolific journals in COVID-19 vaccine research. (IF: Impact factor, Q: Quarterly journal).

Rank	Journal	NP	TC	IF	Q	Publisher
1	Vaccines	425	2450	4.422	2	MDPI
2	Vaccine	185	1745	3.641	3	Elsevier
3	Human Vaccines & Immunotherapeutics	174	664	3.452	3	Taylor & Francis
4	Lancet	140	6776	79.321	1	Elsevier
5	New England Journal of Medicine	135	12861	91.245	1	Massachusetts Medical Society
6	British Medical Journal	103	679	17.215	1	BMJ
7	Jama-Journal of the American Medical Association	85	1744	56.272	1	American Medical Association
8	International Journal of Environmental Research and Public Health	82	253	3.39	2	MDPI
9	Nature	61	2621	49.962	1	Nature Publishing Group
10	Journal of the European Academy of Dermatology and Venereology	59	231	6.166	1	Wiley
11	MMWR-Morbidity and Mortality Weekly Report	59	1414	17.586	1	Centers for Disease Control and Prevention
12	Frontiers in Immunology	54	446	7.561	1	Frontiers Media S.A.
13	Lancet Infectious Diseases	53	1239	25.071	1	Lancet Publishing Group
14	Nature Medicine	51	1807	53.44	1	Nature Publishing Group

Continuing to review the results of the publication of studies by journals, Figure 9 depicts the time trend of publication at the beginning of the COVID-19 epidemic in 2019 until now and informs us how to publish studies on the COVID-19 vaccines in journals. Figure 9 shows that since 2020, the trend for publishing studies in the Vaccines journal has been on an upward trend, which shows the special attention of this journal to the publication of studies on COVID vaccines. Overall, the journal has increased its number of studies from 13 in 2020 to 411 in 2021. It is followed by Vaccine and Human Vaccines & Immunotherapeutics , which were other research channels for researchers to publish studies on the COVID-19 vaccines in these years. These journals published 30 and 29 studies in 2020 and 155 and 145 studies in 2021, respectively.

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Annual occurrences of the most prolific journals in COVID-19 vaccine research.

According to the results presented in Table 5 , the US Department of Health and Human Services with 437 studies and the National Institutes of Health NIH US with 408 studies had the highest support for the publication of scientific research on the COVID-19 vaccines. Note that the National Institutes of Health (NIH) is an affiliate of the US Department of Health and Human Services that plays a very important role in improving the national health of this country. Therefore, the presence of the National Institute of Allergy Infectious Diseases (NIAID) among the institutions supporting research on the COVID-19 vaccines is self-confirming. However, the European Commission and UK Research Innovation UKRI are in the next level with 169 and 143 studies, respectively. Given the extensive activities of these institutions and organizations, their outstanding efforts and support for research related to this field should not be overlooked because this support had a great impact on the production and manufacture of the COVID-19 vaccines.

Active funding agencies in COVID-19 vaccine research.

Rank	Funding Agencies	Record Count	% of 6288
1	US Department of Health & Human Services	437	6.9%
2	National Institutes of Health (NIH) US	408	6.5%
3	European Commission	169	2.7%
4	UK Research Innovation UKRI	143	2.3%
5	NIH National Institute of Allergy Infectious Diseases NIAID	119	1.9%
6	National Natural Science Foundation of China NSFC	114	1.8%
7	Medical Research Council UK MRC	92	1.4%
8	National Institute For Health Research NIHR	78	1.2%
9	Bill Melinda Gates Foundation	67	1.1%
10	National Science Foundation NSF	63	1.0%

The findings of Table 6 on the subject area of published studies on the COVID-19 vaccines reveal that more than 19% of this research are in the Immunology area, which could probably indicate that researchers in this field, in addition to treating and producing vaccines for this epidemic, also examined the types of immune responses to these vaccines. Furthermore, General & Internal Medicine with 1054 and Research Experimental Medicine with 834 studies were other active areas in this field. In total, researchers in these three areas played an influential role in the research outputs on the COVID-19 vaccines by publishing more than 49 percent of the studies. Additionally, the situation of other active and productive areas in this field is presented in Table 6 . In other words, studies on the COVID-19 vaccines have not been ineffective in broadening the horizons of specialists, researchers, and physicians to control the disease.

Active research areas in COVID-19 vaccine research.

Rank	Research Areas	Record Count	% of 6288
1	Immunology	1244	19.8%
2	General & Internal Medicine	1054	16.8%
3	Research Experimental Medicine	834	13.3%
4	Public Environmental Occupational Health	627	10.0%
5	Infectious Diseases	382	6.1%
6	Science Technology Other Topics	298	4.7%
7	Pharmacology Pharmacy	295	4.7%
8	Multidisciplinary Sciences	259	4.1%
9	Neurosciences & Neurology	247	3.9%
10	Biotechnology Applied Microbiology	215	3.4%

Figure 10 illustrates the research focus of researchers in the field of COVID-19 vaccines based on the cloud label. Cloud tags show the extent to which researchers pay attention to topics; the higher the frequency of keywords used in research by researchers, the larger the tags, and the lower the frequency, the smaller the tags [ 22 ]. Figure 10 illustrates topics, such as COVID-19, COVID-19 vaccination, COVID-19 vaccines, vaccine hesitancy, COVID-19 pandemic, public health, COVID-19 vaccines bnt162b2, COVID-19 vaccine safety, healthcare workers, and vaccine acceptance.

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Word cloud map authors keywords in COVID-19 Vaccine research.

Figure 11 shows the trend of research on the COVID-19 vaccines based on the time zone view. In the linkage of Figure 11 , the trend between nodes is moving from left to right, and in a way that indicates what topics the researchers have focused on and what topics they have tended to recently [ 23 ]. In addition, the time zone map represents the amount of attention of researchers to the topics in different time periods [ 23 ]. In 2019, topics, such as Spike protein, COVID-19, receptor binding domain, immunogenicity, safety of COVID-19 vaccines, infection, antibody, and neutralizing antibody are more visible in the researches of researchers in this period. The trend of research in 2020 confirms that in this period, researchers have reduced their research on the identification of this virus and focused their research on topics, such as spike, influenza COVID-19 vaccination, health, protection, COVID-19 vaccination, acute respiratory syndrome, respiratory syndrome COVID-19, immunization, influenza, immunity COVID-19 vaccines safety, disease, and behavior. However, the research trends of researchers in 2021 indicate that topics, such as COVID-19 infection, vaccine hesitancy COVID-19 vaccines, attitude, adult, and mortality have been more prominent than other topics in the studies of this period.

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The time zone visualization map of co-occurring keywords in COVID-19 Vaccine research.

Figure 12 and Figure 13 show a linking map of countries and institutions. Based on this map, it is possible to examine the relationship between each country and institution, as well as the research fields that countries are studying. Figure 12 and Figure 13 not only show the communication status and research areas of countries and institutions, but also indicates the timeline of their studies in the field of the COVID-19 vaccine. Therefore, the time period of the study of countries and institutions in the field of the COVID-19 vaccine on the horizontal axis and the research fields of their studies on the vertical axis are shown. Based on Figure 12 , it can be argued that the US, as one of the leading countries in the COVID-19 vaccine, started its activity in the field of vaccine production in 2019, and its activities have continued with more intensity in recent years, which is seen from the red and yellow colors around the ring of the US. Additionally, the fact that this country is in the #1 cluster can confirm that the US has not only paid attention to the issue of vaccine production but has also pursued the issue of sociodemographic factor.

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Timeline map of countries in COVID-19 vaccines research based on Authors keywords.

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Timeline map of institutions in COVID-19 vaccines research based on Authors keywords.

England (the UK) and Germany, on the other hand, are other productive countries in this field, which is in the #1 cluster called the sociodemographic factor. China is also the source of the corona outbreak in cluster #2, and Italy and Russia in clusters #4 and #0 called the effective COVID-19 genomics and COVID-19 vaccines, are paying close attention to aspects of new strains and variants COVID-19 and COVID-19 vaccines.

Figure 13 also consists of twelve clusters. In Figure 13 , the University of Oxford, Harvard Medical School, London School of Hygiene & Tropical Medicine, Tel Aviv University, and Washington University formed the core of research institutes related to the COVID-19 vaccines in the clusters of public health, COVID-19 vaccines, COVID-19 vaccines hesitancy, and COVID-19 vaccination, which in itself can indicate that these institutions have conducted extensive work in these areas. However, in the link map, the Chinese Academy of Sciences, and the University of Texas Medical Branch had the highest citation flourishing scores, and in a way, the research conducted by researchers from these institutes have been able to attract the most attention of the scientific community.

Table 7 shows that vaccines of AZD1222 (Oxford-AstraZeneca), BNT162b2 (Pfizer-BioNTech), Ad26.COV2.S (Johnson and Johnson), and mRNA-1273 (Moderna) have been injected by more countries. In total, these vaccines were licensed for use in 134, 132, 101, and 85 countries, respectively (See Appendix B ). Additionally, the three BNT162b2, mRNA-1273, and AZD1222 vaccines with 940, 545, and 403 certificates, respectively, had the highest number of publications in the WoS database. It should be noted that according to the results of Table 7 , China with 5, Russia and Iran each with 4, US with 3, and India with 2 vaccines, were the leading countries in vaccine production. Moreover, most of the values prepared are related to the two vaccines of BNT162b2 with 4,921,729,970 doses and mRNA-1273 with 3,078,314,353 doses.

Information on COVID-19 vaccines, type of vaccine, procured dose, approval satus, publications in WoS.

Name of Vaccine	Primary Developers	Type of Vaccine	Country of Origin	No. Procured Doses	Status of Approving Countries	No. Publications WoS
AZD1222	Oxford-AstraZeneca	Non-Replicating Viral Vector	UK	2,039,354,959	134	403
BNT162b2	Pfizer-BioNTech	RNA	Multinational	4,921,729,970	132	940
mRNA-1273	Moderna	RNA	US	3,078,314,353	85	545
Ad26.COV2.S	Johnson & Johnson	Non-Replicating Viral Vector	US/Netherlands	1,327,811,478	101	18
BBIBP-CorV	Sinopharm (Beijing)	Inactivated	China	787,536,122	85	44
WIBP-CorV	Sinopharm (Wuhan)	Inactivated	China	4,420,000	2	1
Sputnik V	Gamaleya	Non-Replicating Viral Vector	Russia	243,543,406	74	44
Sputnik Light	Gamaleya	Non-Replicating Viral Vector	Russia	889,800	24	-
CoviVac	Chumakov Center	Inactivated	Russia	1,356,000	3	2
CoronaVac	Sinovac	Inactivated	China	1,150,377,05	51	86
Covaxin (BBV152)	Bharat Biotech	Inactivated	India	384,620,00	13	26
Soberana 02	Finlay de Vacunas	Protein Subunit	Iran/Cuba	16,000,000	4	2
NVX-CoV2373	Novavax	Protein Subunit	US	870,418,000	31	30
COVAX-19 (Spikogen)	CinnaGen	Protein Subunit	Iran	12,000,000	1	1
Ad5-nCoV (Convidicea)	CanSino	Non-Replicating Viral Vector	China	23,853,699	10	13
COVIran Barekat	Shifa Pharmed	Inactivated	Iran	300,000,000	1	1
EpiVacCorona	FBRI	Protein Subunit	Russia	1800	4	2
FakhraVac (MIVAC)	Organization of Defensive Innovation and Research	Inactivated	Iran	Not Available	1	1
QazVac	Kazakhstan RIBSP	Inactivated	Kazakhstan	Not Available	2	2
ZyCoV-D	Zydus Cadila	DNA	India	Not Available	1	3
MVC-COV1901	Medigen	Protein Subunit	Tiwan	Not Available	2	2
ZF2001	Anhui Zhifei Longcom	Protein Subunit	China/Uzbekistan	Not Available	3	4

References: 1 primary developers, Type of vaccine and Status of approving countries ( https://covid19.trackvaccines.org/vaccines/approved/ ) 2 Country of Origin ( https://www.raps.org/news-and-articles/news-articles/2020/3/covid-19-vaccine-tracker ) 3 No. procured doses ( https://app.powerbi.com/view?r=eyJrIjoiMWNjNzZkNjctZTNiNy00YmMzLTkxZjQtNmJiZDM2MTYxNzEwIiwidCI6ImY2MTBjMGI3LWJkMjQtNGIzOS04MTBiLTNkYzI4MGFmYjU5MCIsImMiOjh9 ). (All data extracted in 19 January 2022).

4. Discussion

Due to the widespread prevalence of COVID-19 worldwide and its new mutations, many studies have been conducted by researchers on therapeutic and pharmacological methods to treat COVID-19 and to develop a vaccine to control the disease. According to the latest statistics approved by the World Health Organization, the number of patients with “COVID-19” disease in the world has reached 270,791,973 people, and the deaths of 5,318,216 people have been confirmed due to this disease. On 15 December 2021, more than 8,200,642,671 people worldwide had been vaccinated against the virus [ 9 ]. Therefore, the results indicate that by the end of 13 December 2021, 6288 studies related to the COVID-19 vaccines have been published in the Web of Science citation index.

The findings related to the trend of publications related to the COVID-19 vaccines indicate a significant increase compared to 2019 and 2020, meaning that more than 90 percent of these publications have been produced in 2021. Therefore, a reason for the significant increase in releasing research related to COVID-19 vaccines in 2021 may be the decline in global resilience faced with this epidemic and a more deadly strain of the virus, which prompted researchers to conduct further studies on the field of making and producing vaccines and finally controlling and eradicating this disease. Overall, the findings of researchers and institutions with the highest number of research publications showed that Pollard AJ and Lambe T of the University of Oxford had the highest number of publications on studies related to the COVID-19 vaccines. The findings from the most active research institutes also indicated that the University of Oxford in the UK and the Harvard Medical School in the US, as the most active institutions, played a more prominent role than other institutes in studies on the COVID-19 vaccines. The above results agree with the findings of Ay et al. [ 18 ].

The findings from leading countries in studies on the COVID-19 vaccines showed that researchers from the US published the most publications in this field; the results of Surulinathi et al. [ 24 ] and Ay et al. [ 18 ] confirm the findings of this study. The UK, Italy, and China also played a key role in the dissemination of the scientific documents. In other words, researchers from these four countries together played an important role in this field by publishing more than 61 percent of the research. The results of scientific collaboration between countries also showed that the highest level of scientific collaboration has been formed between researchers from the US–UK and the US–China. Note that countries that had the most scientific collaborations were countries that could publish most publications in this field.

The results of the journals that published research on the COVID-19 vaccines showed that the researchers published their scientific publications in 1321 journals. Among them, the Vaccines and Vaccine journals published the largest number of studies on the COVID-19 vaccines during the desired period. These journals are published by MDPI and Elsevier publications, respectively, and in terms of ranking of the Web of Science journals, they are ranked Q2 and Q3, respectively, and are in a good position in terms of impact factor. However, a review of support organizations for COVID-19 vaccine studies showed that the U.S. Department of Health & Human Services, with 437 studies, and the National Institutes of Health (NIH) from the US, with 408 studies, provided the most support from published studies on the COVID-19 vaccines. Additionally, the results related to the thematic fields of published studies showed that researchers in the field of Immunology with 1244 studies (19.8%), the field of General & Internal Medicine with 1054 studies (16.8%), and the field of Research Experimental Medicine with 834 studies (13.3%) percentage) had the most scientific publications in this field, which in the study Ay et al. [ 18 ], these three subject areas were also the leading thematic fields in studies on COVID-19 vaccines.

The state of research on the COVID-19 vaccines based on the time zone map showed that the initial studies in 2019 were more focused on identifying the COVID-19 virus and ways to combat it (COVID-19 vaccines efficacy, immunogenicity). However, the scientific research of researchers in 2020 has led to topics, such as COVID-19 and vaccines (COVID-19 vaccination, COVID-19 vaccines safety, and influenza COVID-19 vaccination), which indicates their serious attention to the development of vaccines to control and treat the disease. Finally, the research trend of studies in 2021 on topics, such as COVID-19 vaccines and their types and effects, vaccines hesitancy, the role of healthcare workers in COVID-19, as well as discussions on these vaccines on social media has been more than other studies.

Findings on the interconnected map of countries and research institutes showed that the US has paid serious attention to scientific activities about the production of COVID-19 vaccine, vaccination, and sociodemographic factor. The universities of Oxford, Harvard Medical School, Tel Aviv, Washington, and the London School of Hygiene & Tropical Medicine have also been major research institutes in the field of COVID-19 vaccines.

5. Conclusions

Generally, this study examined the trend of publications on the COVID-19 vaccines from the perspective of scientometric and depicted the topics and fields of study of countries, institutions, and researchers and the collaboration between them in this field. The findings of this study can be valuable through the identification and analysis of the most important actors (country, institution, researcher, and channel of release of COVID-19 vaccines), the research process and fields of study in the COVID-19 vaccine for researchers, countries, and policymakers in the fields of medical sciences and health to make better decisions and understand and ultimately progress in this field. There may also be more research in the future on other types of vaccines and comparing their effectiveness on mutated strains of the virus, vaccine acceptance, long-term side effects of these vaccines, COVID-19 vaccination from various perspectives, and other related topics due to the more prominent keywords, such as “COVID-19 vaccine” and “COVID-19 vaccination”, which can also increase the upward trend of publication compared to recent years. Finally, there is a need to increase opportunities for financial support, more scientific collaborations, understanding and analyzing research of leading countries, and emulating them from different angles to make appropriate decisions.

TS = (“Coronavirus Vaccin*” OR “SARS Coronavirus Vaccin*” OR “SARS Virus Vaccin*” OR “Coronaviridae Vaccin*” OR “COVID-19 Vaccin*” OR “COVID 19 Vaccin*” OR “COVID-2019 Vaccin*” OR “nCoV-19 Vaccin*” OR “nCoV19 Vaccin*” OR “2019-nCoV Vaccin*” OR “MERS-CoV Vaccin*” OR “MERSCoV Vaccin*” OR “MERS Virus Vaccin*” OR “MERS coronavirus Vaccin*” OR “SARS-CoV Vaccin*” OR “SARSCoV Vaccin*” OR “CoronaVac Vaccin*” OR “CoronaVac” OR “Sinovac COVID-19 Vaccin*” OR “Sputnik V*” OR “Sputnik Light*” OR “BBIBP-CorV” OR “Sinopharm COVID-19 Vaccin*” OR “Sinopharm*” OR “WIBP-CorV” OR “AstraZeneca COVID-19” OR “AZD1222*” OR “Oxford-AstraZeneca COVID-19 Vaccin*” OR “AZD1222 COVID-19 Vaccin*” OR “ChAdOx1-nCoV” OR “Covishield” OR “Oxford COVID-19 Vaccin*” OR “Moderna COVID-19 Vaccin*” OR “COVID-19 Vaccin* Moderna” OR “mRNA COVID-19 Vaccin*” OR “mRNA-1273” OR “Spikevax” OR “Bharat Biotech” OR “Covaxin” OR “BBV-152” OR “pfizer-BioNTech COVID-19 Vaccin*” OR “Pfizer COVID-19 Vaccin*” OR “Biontech COVID-19 Vaccin*” OR “BNT162b2” OR “Johnson & Johnson COVID-19 Vaccin*” OR “Ad26.COV2.S COVID-19” OR “Convidecia” OR “AD5-nCOV” OR “CanSinoBIO” OR “CureVac” OR “CVnCoV” OR “Novavax” OR “NVX-CoV2373” OR “EpiVacCorona” OR “ZF2001” OR “CoviVac” OR “QazCovid*” OR “SARS-CoV-2 Sclamp” OR “CoVLP Vaccin*” OR “SOBERANA 02” OR “BIV1 CovIran*” OR “COVIran Barekat*” OR “FAKHRAVAC” OR “COVAX-19 Vaccin*” OR “ZyCoV-D” OR “MVC-COV1901*” OR “GRAd-COV2 Vaccin*” OR “INO-4800 COVID-19 Vaccin*”).

Timespan: 2019–2021. Indexes: SCI-EXPANDED, SSCI, A&HCI.

All Language.

All document types.

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Object name is jcm-11-00750-g0A1a.jpg

Four vaccines of AZD1222 (Oxford-AstraZeneca), BNT162b2 (Pfizer-BioNTech), Ad26.COV2.S (Johnson and Johnson), and mRNA-1273 (Moderna) have been injected by more countries. In total, these vaccines were licensed for use in 134, 132, 101, and 85 countries, respectively.

Author Contributions

A.N., B.G., S.G., S.J., R.F., A.S. and A.A.S.: conceived and designed the study, collected the data, analysis and graphs, contributed to data analysis, interpretation and manuscript preparation, literature review, writing manuscript, and proofreading. All authors have read and agreed to the published version of the manuscript.

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Conflicts of Interest

The authors declare no conflict of interest.

Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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Safety and adverse effects of current COVID-19 vaccines. As shown in Table I, current vaccines have demonstrated considerable efficacy in diminishing mild, moderate and severe cases with a low risk of adverse events 21.For some of these vaccines [such as Convidicea (AD5-nCoV), Janssen (Ad26.COV2.S), Sinopharm (BBIBP-CorV), Covaxin (BBV152) and Sinovac (CoronaVac)], there is the information ...
Public attitudes toward COVID-19 vaccination: The role of vaccine
While efficacious vaccines have been developed to inoculate against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2; also known as COVID-19), public vaccine hesitancy could still ...
Global research on RNA vaccines for COVID-19 from 2019 to 2023: a
The core journals were Vaccines, Frontiers in Immunology, and Viruses-Basel. The most frequently used author's keywords were COVID-19, SARS-CoV-2, and vaccine. Recent COVID-19 RNA vaccine-related topics included mental health, COVID-19 vaccines in humans, people, and the pandemic. Harvard University was the top-ranked institution.
More Questions and Answers About COVID-19 Vaccines
In the case of [COVID-19 vaccines], we had a lot of urgency and all the money was put up, up front. The companies didn't have to find the money for each stage—they were just able to just proceed from the safety study to the effectiveness study very quickly. This let the coronavirus vaccines go to the front of the line because of the urgency.
10 facts about Americans and coronavirus vaccines
The coronavirus pandemic has claimed more than 670,000 lives in the United States as of Sept. 20, and the spread of the highly transmissible delta variant has added new urgency to the federal government's efforts to vaccinate all Americans against the virus. As the drive to inoculate more people continues, here are 10 facts about Americans and COVID-19 vaccines, based on an August Pew ...
Coronavirus (COVID-19)
How Americans View the Coronavirus, COVID-19 Vaccines Amid Declining Levels of Concern. Just 20% of the public views the coronavirus as a major threat to the health of the U.S. population and only 10% are very concerned about getting a serious case themselves. In addition, a relatively small share of U.S. adults (28%) say they've received an ...
Updated COVID-19 Vaccines for Use in the United States Beginning in
FDA's Vaccines and Related Biological Products Advisory Committee (VRBPAC) met on June 5, 2024, to discuss and make recommendations on the selection of the 2024-2025 Formula for COVID-19 vaccines ...
A Systematic REVIEW of Autopsy findings in deaths after covid-19
If the alarmingly high number of reported deaths are indeed causally linked to COVID-19 vaccination, the implications could be immense, including: the complete withdrawal of all COVID-19 vaccines from the global market, suspension of all remaining COVID-19 vaccine mandates and passports, loss of public trust in government and medical ...
NIH Vaccine Research Center Leads the Way to ...
The Moderna vaccine for COVID-19 may seem like it developed quickly, but it was built on decades of research by NIH's Dale and Betty Bumpers Vaccine Research Center (VRC). The scientists of the VRC have learned from experience by studying the immune system and working on vaccines for other infectious diseases that pose major threats to human ...
COVID-19 & Science
About nine-in-ten (88%) Americans say, overall, the benefits of childhood vaccines for measles, mumps and rubella outweigh the risks, identical to the share who said this before the coronavirus outbreak. U.S. adults are less confident in COVID-19 vaccines: Fewer than half rate them as having high health benefits and a low risk of side effects.
COVID-19 Vaccination Acceptance and Its Associated Factors Among a
1 Department of Pharmacy, Al-Zaytoonah University of Jordan, Amman, Jordan; 2 Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan; Background: The Coronavirus disease 2019 (COVID-19) pandemic is a major threat to public health and has had a significant impact on all aspects of life. An effective vaccine is the most anticipated ...
The top 100 most cited articles on COVID-19 vaccine: a bibliometric
This study aimed to uncover the current major topics regarding COVID-19 vaccine, and systematically evaluate the development trends for future research. The top 100 most cited original articles on COVID-19 vaccine from January 2020 to October 2022 were identified from Web of Science Core Collection database. ... This study analyzed the top 100 ...
New study involving nearly 185,000 patients recommends strengthening
More information: Lazar, F., Effectiveness of COVID-19 Vaccines Against Severe COVID-19 Among Patients with Cancer in Catalonia, Spain, Nature Communications (2024). DOI: 10.1038/s41467-024-49285 ...
Past COVID infections may help protect against certain colds. Could it
If you've been sick with COVID-19, you may have some protection against certain versions of the common cold. A new study suggests previous COVID-19 infections lower the risk of getting colds caused by milder coronavirus cousins, which could provide a key to broader COVID-19 vaccines. "We think there's going to be a future outbreak of a coronavirus," said Dr. Manish Sagar, senior author ...
Study did not link excess deaths to COVID-19 vaccines
The claim: A study identified COVID-19 vaccines as a cause of excess deaths. A June 5 Facebook post (direct link, archive link) claims a new study has revealed alarming news about the COVID-19 ...
Supreme Court won't hear RFK Jr.'s anti-vaccine group's COVID appeals
Children's Health Defense had challenged the Food and Drug Administration's emergency authority of COVID-19 vaccines. The group said the vaccines were ineffective and hadn't been properly ...
Treatments and Vaccines
Combat COVID-19. You can help find ways to prevent and treat COVID-19—whether you've never had COVID-19, you have COVID-19 now, or you had it in the past. Learn how you can join a vaccine or treatment clinical trial, or donate your plasma to help others who are diagnosed with COVID-19. Learn More.
Supreme Court social media posts decision is a win for Biden
The 6-3 decision, led by Justice Amy Coney Barrett, was a response to a suit that came during a hot-button period when social media was thick with contentious posts over COVID-19, vaccines, top ...
Vaccines
About nine-in-ten (88%) Americans say, overall, the benefits of childhood vaccines for measles, mumps and rubella outweigh the risks, identical to the share who said this before the coronavirus outbreak. U.S. adults are less confident in COVID-19 vaccines: Fewer than half rate them as having high health benefits and a low risk of side effects.
Current and Future Perspectives on the COVID-19 Vaccine: A
Therefore, the current research aims to draw the present and future perspective of the COVID-19 vaccine studies by identifying the most important actors and their scientific fields, trends in research topics, and relationships between different entities. Some studies by [ 2, 14, 18, 19] in particular, examined the field of COVID-19 vaccines ...
Of interest? New research: Investigating the predictors of COVID-19
New research: Investigating the predictors of COVID-19 vaccine decision-making among parents of children aged 5-11 in the UK researchgate.net Open Share

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