Editorial: Vaccine Education and Promotion

Graça S. Carvalho^1*Carlos Alberto De Oliveira Magalhães Júnior²

• ¹University of Minho, Braga, Portugal
• ²State University of Maringá, Maringá, Paraná, Brazil

The determinants of vaccination are diverse but can be broadly categorised into three groups (MacDonald, 2015): (i) Contextual factors, including historical, socio-cultural, environmental, health system/institutional, economic, and political influences; (ii) Individual and group influences, such as perceptions of vaccines and the impact of social or peer environments; (iii) Vaccine-and vaccination-specific issues, factors directly related to the vaccine or the act of vaccination itself. Vaccination uptake also varies across risk populations, with distinct determinants potentially influencing behaviour in each group (Doornekamp, 2020). As such, a thorough understanding of these factors is essential for designing targeted interventions to improve immunisation coverage (Woudneh, 2024). The 13 papers included in this section, Determinants of Vaccination, are organised across three issues:1.1. Seven papers look at communication and engagement for vaccination: Chang and collaborators compared USA public vaccination decisions for newly-developed and established vaccines, and recognised the need for clear communication and community engagement as critical strategies for addressing public concerns and misinformation; Rahman and collaborators looked at the perceptions of Nigerian persons with disabilities regarding the COVID-19 pandemic and the vaccine and identified the need for culturally and religiously sensitive communication strategies, and tailored educational programs by social workers; Xu and collaborators analysed "vaccine science popularization" in the Chinese social media Weibo during the COVID-19 pandemic where publishers were divided into individuals, organizations, media, government, and scientists, and verified that Weibo scientists' arguments were those that more positively influenced the effect of vaccine popularization; Hijazi and collaborators identified the Israeli Ministry of Health communication strategies regarding vaccines during COVID-19 pandemic and how healthcare workers shaped their professional socialisation processes within the health system, leading to a reliance on established communication strategies and informational channels; Shumba and collaborators analysed community health volunteers experiences of implementing COVID-19 vaccine education and promotion in Kenya during the pandemic, showing they contributed to the high uptake of primary vaccines and boosters; Wrenger and collaborators used a protocol (INFORMed) in Germany to identify the wish for advice in hesitant and no-hesitant new-born's parents and the comparison of parents in terms of their respective information needs; and Smith and collaborators addressed a community engagement framework that can provide a roadmap to navigate the dynamic and multifaceted nature of equity-related work by paving the way for meaningful interventions to mitigate health disparities.1.2. Four papers look at socioeconomics discrepancy: Tao and collaborators found substantial racial and socioeconomic disparities in influenza vaccination uptake among United States adults aged 65 years or older; Zhao and collaborators investigated the extent of influenza vaccine coverage in south China adults aged 60 years or older and identified the factors influencing vaccine uptake; Ramphul and collaborators identified areas in Texas, USA, with high and low HPV vaccination rates and explored differences in neighbourhood characteristics, showing that vaccination coverage rates depend on the community's income level; and Ye and Anselm explored the factors related to public health campaigns, in Wuxi region of China, that can improve vaccination rates in low socioeconomic groups and rural areas, to contributing to better public health strategies.Canadian survey about parents/guardians' perspectives on influenza immunisation and identified the main factors influencing low rates of children's vaccination, such as residing in rural areas, lower parental education and lower household income; Dires and collaborators looked at the factors influencing childhood immunisation status in East Africa, which varied among countries and regions, and found that mothers attending antenatal care played a key role in children's vaccination; and Assefa and collaborators evaluated the determinants of pneumonia conjugate vaccine (PCV) dropout among children aged 12-23 months in Ethiopia and identified the significant factors influencing PCV dropout, such as having a health card, having received the PCV 2 vaccinations, and region.Vaccine hesitancy refers to the delay in acceptance or outright refusal of vaccines despite the availability of vaccination services; it is a complex and context-specific phenomenon that varies across time, location, and type of vaccine (ECDC, n.d.). It has been linked to declining vaccination coverage and a heightened risk of outbreaks and epidemics of vaccine-preventable diseases (Dubé et al., 2013). The 8 papers in the Vaccination Hesitancy section are distributed across two issues: 2.1. Five papers address vaccination hesitancy in the community: Osaghae and collaborators leveraged long-standing community-academic partnerships in two cities to develop a curriculum for interventions to decrease COVID-19 vaccine hesitancy within Black communities in the USA; Muis and collaborators examined the effectiveness of three different messages for persuading Canadian individuals to get vaccinated against COVID-19, and the role that emotions play in persuasion, verifying that emotions mediated relations between vaccine confidence/hesitancy and willingness; Pauly and collaborators identified COVID-19 vaccine hesitant groups from adolescence to late adulthood and explored their motivations for and against vaccination in a nationwide Luxembourgish population, being the vaccination hesitancy higher in the younger age groups; Zilver and collaborators studied barriers and facilitators for Netherlander pregnant women's choice and motivation regarding vaccination against COVID-19 during pregnancy, verifying that they needed clear, unambiguous information concerning health consequences, particularly for their offspring; and Wang and collaborators conducted a qualitative survey using Vaccine Hesitancy Determinants Matrix and 5C model to understand and improve Herpes zoster vaccination rates among middle-aged and older adults in China.Low and collaborators investigated parents' vaccine hesitancy rates in Malaysia and Singapore, and explored whether these rates were associated with parents' health beliefs, having found that the prevalence of perceived parental vaccine hesitancy was higher in Malaysia; Handayani and collaborators conducted a study in Indonesia aiming to develop guidance for in-depth interviews for a future qualitative study based on a crosssectional quantitative study of parents with school-age children and found a significant association between parents' intention to vaccinate their children and the perceived benefits and perceived barriers to vaccination; and Suragh and collaborators conducted a study on vaccine hesitancy among USA white parents with higher education and socioeconomic statuses, showing they had reliance on information from specialised doctors and scientists, distrust in public health authorities, high risk perception of COVID-19 vaccines, and low risk-perception of COVID-19 disease.Vaccination among students is a critical public health concern, as this population often lives, studies, and socialises in close contact, increasing the risk of infectious disease transmission (Geng et al., 2022). Students may face unique barriers to vaccination, including lack of awareness, limited access to healthcare services, or misconceptions about vaccine safety and necessity (Jiang et al., 2021). Understanding the specific drivers and challenges of vaccination in student populations is essential for developing effective strategies to improve uptake and prevent outbreaks in educational settings (Geng et al., 2022). The 7 papers in the Vaccination Among Students section are distributed across two issues:3.1. Four papers address students' perceptions about vaccination: Simonovic and collaborators compared USA and Israeli college students' vaccine attitudes, emotions, and behaviour, having found that Israeli (vs. American) participants reported higher perceived ambiguity, worry, fear, and anger, and lower perceived severity; Song and collaborators explored the circumstances of college students in China's ethnic minority regions concerning their awareness, attitudes, and practices related to the HPV vaccine, aiming to provide a scientific basis for future health education and HPV vaccine promotion; Li and collaborators investigated the awareness of HPV and its vaccine among college students in Zhengzhou (China), and to explored the factors influencing their awareness of HPV vaccine, to understand college students' willingness to receive the vaccine; and Schlopsna and Scheersoi conducted a study involving interviews with Germany secondary school students, experienced educators, and vaccination experts, showing focal areas of students' interest in the topic and the value of involving students in lesson planning.Gaspi and collaborators identified and analysed Brazilian primary school children's social representations of vaccination, showing the need to prevent children's fear of needles at the first vaccination experience and the importance of discussing the subject of vaccination in science teaching; Kwella and collaborators conducted a study in German school biology classes to enable students to engage in an in-depth examination of the vaccination complex socio-scientific issue and promoted enhancement of their argumentation and decision-making skills; and Martínez-Pena and collaborators presented a design on vaccination for secondary education teaching, in Spain, to develop students' integral understanding of vaccines role and to apply critical ignorance as part of criticality to avoid vaccine hesitancy and raise trust in science.The research presented in these 29 papers published in the Public Health research topic "Vaccine Education and Promotion" came from 15 countries of the various continents, demonstrating how live and pertinent is this field of research worldwide, presenting different approaches and perspectives that enrich this large, contemporary and relevant research field, which is still open to wide-ranging and diverse future research.