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Malawi faces a growing concern about vaccine hesitancy. This threatens to undermine significant strides in the fight against infectious diseases in the country. Vaccine hesitancy in Malawi is driven by multiple factors. This short communication discusses the extent of vaccine hesitancy in Malawi and its main drivers according to SAGE's (Strategic Advisory Group of Expert) 3Cs (confidence, complacency and convenience) model of vaccine hesitancy. As an escalating health concern, it is imperative to address it urgently. It is imperative to address it urgently through comprehensive and sustainable awareness campaigns that should aim to increase acceptance and demand for vaccines.

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OBJECTIVE: We investigated the extent to which a voluntary-use range and bearing line (RBL) tool improves return-to-manual performance when supervising high-degree conflict detection automation in simulated air traffic control. BACKGROUND: High-degree automation typically benefits routine performance and reduces workload, but can degrade return-to-manual performance if automation fails. We reasoned that providing a voluntary checking tool (RBL) would support automation failure detection, but also that automation induced complacency could extend to nonoptimal use of such tools. METHOD: Participants were assigned to one of three conditions, where conflict detection was either performed: manually, with RBLs available to use (Manual + RBL), automatically with RBLs (Auto + RBL), or automatically without RBLs (Auto). Voluntary-use RBLs allowed participants to reliably check aircraft conflict status. Automation failed once. RESULTS: RBLs improved automation failure detection - with participants intervening faster and making fewer false alarms when provided RBLs compared to not (Auto + RBL vs Auto). However, a cost of high-degree automation remained, with participants slower to intervene to the automation failure than to an identical manual conflict event (Auto + RBL vs Manual + RBL). There was no difference in RBL engagement time between Auto + RBL and Manual + RBL conditions, suggesting participants noticed the conflict event at the same time. CONCLUSIONS: The cost of automation may have arisen from participants' reconciling which information to trust: the automation (which indicated no conflict and had been perfectly reliable prior to failing) or the RBL (which indicated a conflict). APPLICATIONS: Providing a mechanism for checking the validity of high-degree automation may facilitate human supervision of automation.

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Given that automation complacency, a hitherto controversial concept, is already used to blame and punish human drivers in current accident investigations and courts, it is essential to map complacency research in driving automation and determine whether current research can support its legitimate usage in these practical fields. Here, we reviewed its status quo in the domain and conducted a thematic analysis. We then discussed five fundamental challenges that might undermine its scientific legitimation: conceptual confusion exists in whether it is an individual versus systems problem; uncertainties exist in current evidence of complacency; valid measures specific to complacency are lacking; short-term laboratory experiments cannot address the long-term nature of complacency and thus their findings may lack external validity; and no effective interventions directly target complacency prevention. The Human Factors/Ergonomics community has a responsibility to minimise its usage and defend human drivers who rely on automation that is far from perfect.Practitioner summary: Human drivers are accused of complacency and overreliance on driving automation in accident investigations and courts. Our review work shows that current academic research in the driving automation domain cannot support its legitimate usage in these practical fields. Its misuse will create a new form of consumer harms.

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BACKGROUND: Although patients recovered from COVID-19 already have immunity gained from natural infection, they are still at risk of reinfection due to the emergence of new variants of COVID-19 and the diminishing of naturally acquired immunity over time. Vaccination is associated with efficacious protection against COVID-19 infection and could boost infection-acquired immunity; however, various COVID-19 survivors have not been vaccinated due to vaccine hesitancy. OBJECTIVE: The aim of this study was to investigate COVID-19 vaccine hesitancy and related factors among COVID-19 survivors. METHODS: A cross-sectional questionnaire survey was conducted among patients who recovered from COVID-19 infection in Wuhan, China, between June 10 and July 25, 2021. The questionnaire included sociodemographic information, items on COVID-19 infection, the COVID-19 vaccine hesitancy scale based on the 3Cs (complacency, convenience, and confidence) model, trust in vaccine manufacturers and health facilities, and reasons for the decision to accept COVID-19 vaccination. Multivariate logistic regression analysis was used to assess the factors influencing COVID-19 vaccine hesitancy. RESULTS: Among the 1422 participants, 538 (37.8%) were not vaccinated against COVID-19. The COVID-19-recovered patients who self-reported having a current unhealthy status expressed more hesitancy about the COVID-19 vaccine than those who perceived themselves to be healthy (odds ratio [OR] 0.45, 95% CI 0.28-0.71). Compared to the asymptomatic patients, patients with mild symptoms were more likely to receive a COVID-19 vaccine (OR 1.67, 95% CI 1.02-2.82). Regarding the 3Cs model, high complacency (P=.005) and low convenience (P=.004) were significant negative factors for COVID-19 vaccination. Trust in vaccine manufacturers and health facilities was a significant positive factor for COVID-19 vaccination (OR 1.14, 95% CI 1.09-1.19). "Self-needs" was the main reason for patients to receive the COVID-19 vaccine, whereas "already have antibodies and do not need vaccination" was the main reason for patients to not receive the COVID-19 vaccine. CONCLUSIONS: Among the three major factors of vaccine hesitancy, complacency proved to be the most notable among COVID-19-recovered patients. Therefore, educational campaigns can focus on raising the awareness of risk of infection and the benefits of vaccination to reduce complacency toward vaccination among this population. In particular, for individuals who have recovered from COVID-19, improving factors related to convenience such as transportation, the environment of vaccination, and providing door-to-door service was also deemed necessary to facilitate their vaccination. In addition, addressing the concerns about vaccination of COVID-19-recovered patients could foster trust and promote their uptake of vaccination.

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This paper seeks to explore the concept of complacency as a barrier to the sense of urgency within product innovation, by investigating the concept on behalf of interfirm project partners. More specifically, the study aims to understand complacency within the context of an industrial research project in Norway subject to material substitution of an energy transmission tower. As such, the study seeks to give a contextual understanding of complacency for innovation realization (e.g., innovation speed) from a single case study. The study identified different complacency mechanism asymmetries on behalf of the actors, as well as the varying reasons (drivers) to why urgency gaps may occur among actors. The urgency gaps were found to impact a sense of urgency and thus innovation speed negatively. The asymmetries are presented from the drivers: role understanding, competence, project intent, risk and trust. Moreover, the urgency gaps' implications for interorganizational project collaboration, and how they contribute to theory on industrial product innovation, are explained. The findings contribute with new insights on important mechanisms for how a sense of urgency may be enhanced in research projects subject to interorganizational innovation. Theoretical contributions thus relate to enhanced understanding of complacency asymmetry in product innovation collaboration, and how trust is an important dimension for urgency creation.

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BACKGROUND: Older adults are particularly at risk from infectious diseases, including serve complications, hospitalization, and death. OBJECTIVE: This study aimed to explore the drivers of vaccine hesitancy among older adults based on the "3Cs" (confidence, complacency, and convenience) framework, where socioeconomic status and vaccination history played the role of moderators. METHODS: A cross-sectional questionnaire survey was conducted in Jiangsu Province, China, between June 1 and July 20, 2021. Older adults (aged ≥60 years) were recruited using a stratified sampling method. Vaccine hesitancy was influenced by the 3Cs in the model. Socioeconomic status and vaccination history processed through the item parceling method were used to moderate associations between the 3Cs and hesitancy. Hierarchical regression analyses and structural equation modeling were used to test the validity of the new framework. We performed 5000 trials of bootstrapping to calculate the 95% CI of the pathway's coefficients. RESULTS: A total of 1341 older adults participated. The mean age was 71.3 (SD 5.4) years, and 44.7% (599/1341) of participants were men. Confidence (b=0.967; 95% CI 0.759-1.201; P=.002), convenience (b=0.458; 95% CI 0.333-0.590; P=.002), and less complacency (b=0.301; 95% CI 0.187-0.408; P=.002) were positively associated with less vaccine hesitancy. Socioeconomic status weakened the positive effect of low complacency (b=-0.065; P=.03) on low vaccine hesitancy. COVID-19 vaccination history negatively moderated the positive association between confidence (b=-0.071; P=.02) and lower vaccine hesitancy. CONCLUSIONS: Our study identified that confidence was the more influential dimension in reducing vaccine hesitancy among older adults. COVID-19 vaccination history, as well as confidence, had a positive association with less vaccine hesitancy and could weaken the role of confidence in vaccine hesitancy. Socioeconomic status had a substitution relationship with less complacency, which suggested a competitive positive association between them on less vaccine hesitancy.

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This study examines how favourable attitudes towards autonomous vehicle technology and automation-induced complacency relate to unsafe driving behaviours using semi-autonomous vehicles as an exemplar. The sample consisted of 441 college students and a repeated measures design was used to examine the relationships between psychological attitudes and susceptibility to risky driving behaviours across three scenarios. Linear regression analyses were conducted for hypothesis testing. Study 1 showed that favourable attitudes towards autonomous vehicle technologies were not significantly associated with susceptibility to risky driving behaviours. Study 2 replicated this finding, however, automation-induced complacency was significantly associated with susceptibility to risky driving behaviours. Additionally, evidence was found for the incremental validity of automation-induced complacency over favourable attitudes towards autonomous features. In distinguishing favourable attitudes towards autonomous features from automation-induced complacency, future research and policy-making can separately address these constructs for the promotion of traffic safety and policy-making.Practitioner summary: We aimed to assess inclinations towards risky driving behaviours in semi-autonomous vehicles. Using vignettes, we found that favourable attitudes towards autonomous vehicles are not associated with risky behaviours, but automation-induced complacency was. Our findings suggest policies like educational programs can be implemented to prevent misuse of semi-autonomous vehicles.

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OBJECTIVE: Examine the impact of expected automation reliability on trust, workload, task disengagement, nonautomated task performance, and the detection of a single automation failure in simulated air traffic control. BACKGROUND: Prior research has focused on the impact of experienced automation reliability. However, many operational settings feature automation that is reliable to the extent that operators will seldom experience automation failures. Despite this, operators must remain aware of when automation is at greater risk of failing. METHOD: Participants performed the task with or without conflict detection/resolution automation. Automation failed to detect/resolve one conflict (i.e., an automation miss). Expected reliability was manipulated via instructions such that the expected level of reliability was (a) constant or variable, and (b) the single automation failure occurred when expected reliability was high or low. RESULTS: Trust in automation increased with time on task prior to the automation failure. Trust was higher when expecting high relative to low reliability. Automation failure detection was improved when the failure occurred under low compared with high expected reliability. Subjective workload decreased with automation, but there was no improvement to nonautomated task performance. Automation increased perceived task disengagement. CONCLUSIONS: Both automation reliability expectations and task experience played a role in determining trust. Automation failure detection was improved when the failure occurred at a time it was expected to be more likely. Participants did not effectively allocate any spared capacity to nonautomated tasks. APPLICATIONS: The outcomes are applicable because operators in field settings likely form contextual expectations regarding the reliability of automation.

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Large scale vaccination of population is widely accepted to be the key to recovery from the devastating economic and public health impacts of the COVID-19 pandemic. However, low uptake of vaccine has challenged vaccination efforts in many parts of the world. The paper explores the determinants of demand for COVID-19 vaccination - specifically, the prevalence dependence hypothesis - that identifies infection prevalence and mortality as the key drivers of individual preventive behavior against infectious diseases. Using daily disease tracking and vaccination data from 47 European countries the paper finds strong evidence that COVID-19 infection rate and mortality rate drive future vaccination uptake. Specifically, results from fixed effects models suggest that while lagged infection prevalence induce vaccination uptake by 0.18 to 0.24 percent, while the effect of lagged mortality is significantly larger, ranging between 1.10 to 1.53 percent. The results highlight the critical role of behavioral response to epidemiological outcomes and are of critical significance for COVID-19 mitigation policies, especially as they relate to achieving vaccine-induced herd immunity and economic reopening.

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Vaccine hesitancy is an important feature of every vaccination and COVID-19 vaccination is not an exception. During the COVID-19 pandemic, vaccine hesitancy has exhibited different phases and has shown both temporal and spatial variation in these phases. This has likely arisen due to varied socio-behavioural characteristics of humans and their response towards COVID 19 pandemic and its vaccination strategies. This commentary highlights that there are multiple phases of vaccine hesitancy: Vaccine Eagerness, Vaccine Ignorance, Vaccine Resistance, Vaccine Confidence, Vaccine Complacency and Vaccine Apathy. Though the phases seem to be sequential, they may co-exist at the same time in different regions and at different times in the same region. This may be attributed to several factors influencing the phases of vaccine hesitancy. The complexities of the societal reactions need to be understood in full to be addressed better. There is a dire need of different strategies of communication to deal with the various nuances of all of the phases. To address of vaccine hesitancy, an understanding of the societal reactions leading to various phases of vaccine hesitancy is of utmost importance.

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INTRODUCTION: Vaccine hesitancy (VH) is a leading cause of suboptimal vaccine uptake rates worldwide. The interaction between patients and health-care providers (HCPs) is the keystone in addressing VH. However, significant proportions of HCPs, including those who administer vaccines, are personally and professionally vaccine-hesitant. AREAS COVERED: This narrative review sought to characterize the nature, extent, correlates, and consequences of VH among HCPs. We included 39 quantitative and qualitative studies conducted in Western countries, published since 2015, that assessed VH among HCPs in general, for several vaccines. Studies were reviewed using the WHO 3Cs model - (lack of) confidence, complacency, and (lack of) convenience. EXPERT OPINION: Despite the lack of validated tools and substantial heterogeneity in the methods used to measure VH among HCPs, this review confirms its presence in this population, at frequencies that vary by country, profession type, setting, and level of medical education. Lack of knowledge and mistrust in health authorities/pharmaceutical industry/experts were among its principal drivers. Improving the content about vaccination in HCPs' training programs, facilitating access to reliable information for use during consultations, and developing and validating instruments to measure HCPs' VH and its determinants are key to addressing VH among HCPs.

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The authorization of several high-efficacy vaccines for use against the novel SARS-CoV2 virus signals a transition in the global COVID-19 response. Vaccine acceptance is critical for pandemic control and has a variety of context- specific drivers that operate at the individual, group, and sociopolitical levels. Social and behavior change interventions can influence individual knowledge, attitudes, and intentions as well as community norms to facilitate widespread vaccine uptake. While considerable research has been done to explore vaccine confidence in high-income populations as well as with respect to childhood vaccinations, much work remains to be done in understanding attitudes and intentions in low and middle income countries for adult or novel vaccines. We conducted in-depth interviews with individuals who had recovered from COVID-19 (n = 8), people who had lost a family member to COVID-19 (n = 4), and health providers (n = 17). We also conducted focus group discussions with members of the general population (n = 24 groups) to explore social norms and community perceptions related to COVID-19, including prevention behaviors, stigma, and vaccines. Researchers collected data in Abidjan, Côte d'Ivoire, in November 2020. In considering whether to accept a future COVID-19 vaccine or not, individuals in the study weighed perceived risk of the vaccine against the severity of the disease. Perceived severity of rumored side effects or safety issues of vaccines were also a factor. Convenience was a secondary, albeit also important, consideration. While concerns about vaccine safety tended to produce an expressed intention to delay vaccination, conspiracy theories about those developing and promoting vaccines and their motives led people to say they would opt out entirely. Behavior change interventions must raise awareness and address misunderstandings about the purpose of vaccines, transparently communicate about vaccine safety and development processes, and engage trusted influencers to build an enabling environment for COVID-19 vaccine roll out.

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This article provides an overview of recent research on latent fingerprint evidence featured in reported legal decisions from England and Wales, Australia and New Zealand. The research casts doubts on the effectiveness of adversarial criminal procedure. Rather, than engage with the methodological foundations - e.g. validity and reliability - and the actual abilities of fingerprint examiners, for more than a century, challenges were based on legal considerations and the meaning of categorical identification for the specific proceedings. Lawyers challenged fingerprint evidence based on the circumstances in which reference prints were collected, whether fingerprint records were hearsay, whether relying on a fingerprint record is unfair because it suggests prior criminality, whether the jurors could make their own comparison and so forth. There is no reported consideration of the validity and reliability of fingerprint comparison, and no requirement for fingerprint examiners to qualify the significance of a match decision, even after the abandonment of point standards and the appearance of critical reports from the United States and Scotland, and advice from the Forensic Science Regulator. To the extent that they considered the admissibility and probative value of this prominent forensic science evidence, lawyers and judges relied heavily on proxies such as training, experience and long use. In consequence, the article considers how we should understand adversarial legal practice, the performance of lawyers and judges, as well as the implications for forensic scientists and their evidence.

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Introduction: Vaccine hesitancy could undermine efforts to reduce incidence of coronavirus disease 2019 (COVID-19). Understanding COVID-19 vaccine hesitancy is crucial to tailoring strategies to increase vaccination acceptance. This study aims to investigate the prevalence of and the reasons for COVID-19 vaccine hesitancy in Malang District, Indonesia. Methods: Data come from a cross-sectional study among individuals aged 17-85 years old (N = 3,014). Multivariate ordered logistic regression was used to identify factors associated with postponing or refusing COVID-19 vaccines. The Oxford COVID-19 vaccine hesitancy scale was used to measure vaccine hesitancy. A wide range of reasons for hesitancy, including coronavirus vaccine confidence and complacency, vaccination knowledge, trust and attitude in health workers and health providers, coronavirus conspiracy, anger reaction and need for chaos, populist views, lifestyle, and religious influence, was examined. Results and discussion: The results show that 60.2% of the respondents were hesitant to receive the COVID-19 vaccine. Low confidence and complacency beliefs about the vaccine (OR = 1.229, 95% CI = 1.195-1.264) and more general sources of mistrust within the community, particularly regarding health providers (OR = 1.064, 95% CI = 1.026-1.102) and vaccine developers (OR = 1.054, 95% CI = 1.027-1.082), are associated with higher levels of COVID-19 vaccine hesitancy. Vaccine hesitancy is also associated with anger reactions (OR = 1.019, 95% CI = 0.998-1.040), need for chaos (OR = 1.044, 95% CI = 1.022-1.067), and populist views (OR = 1.028, 95% CI = 1.00-1.056). The findings were adjusted for socio-demographic factors, including age, sex, education, marital status, working status, type of family, household income, religious beliefs, and residency. The results suggest the need for an effective health promotion program to improve community knowledge of the COVID-19 vaccine, while effective strategies to tackle "infodemics" are needed to address hesitancy during a new vaccine introduction program.

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BACKGROUND: Vaccine hesitancy, associated with medical mistrust, confidence, complacency and knowledge of vaccines, presents an obstacle to the campaign against the coronavirus disease 2019 (COVID-19). The relationship between vaccine hesitancy and conspiracy beliefs may be a key determinant of the success of vaccination campaigns. This study provides a conceptual framework to explain the impact of pathways from conspiracy beliefs to COVID-19 vaccine hesitancy with regard to medical mistrust, confidence, complacency and knowledge of vaccines. METHODS: A non-probability study was conducted with 1015 respondents between 17 April and 28 May 2021. Conspiracy beliefs were measured using the coronavirus conspiracy scale of Coronavirus Explanations, Attitudes, and Narratives Survey (OCEANS), and vaccine conspiracy beliefs scale. Medical mistrust was measured using the Oxford trust in doctors and developers questionnaire, and attitudes to doctors and medicine scale. Vaccine confidence and complacency were measured using the Oxford COVID-19 vaccine confidence and complacency scale. Knowledge of vaccines was measured using the vaccination knowledge scale. Vaccine hesitancy was measured using the Oxford COVID-19 vaccine hesitancy scale. Confirmatory factor analysis (CFA) was used to evaluate the measurement models for conspiracy beliefs, medical mistrust, confidence, complacency, and knowledge of vaccines and vaccine hesitancy. The structural equation modeling (SEM) approach was used to analyze the direct and indirect pathways from conspiracy beliefs to vaccine hesitancy. RESULTS: Of the 894 (88.1%) respondents who were willing to take the COVID-19 vaccine without any hesitancy, the model fit with the CFA models for conspiracy beliefs, medical mistrust, confidence, complacency and knowledge of vaccines, and vaccine hesitancy was deemed acceptable. Conspiracy beliefs had significant direct (ß = 0.294), indirect (ß = 0.423) and total (ß = 0.717) effects on vaccine hesitancy; 41.0% of the total effect was direct, and 59.0% was indirect. Conspiracy beliefs significantly predicted vaccine hesitancy by medical mistrust (ß = 0.210), confidence and complacency (ß = 0.095), knowledge (ß = 0.079) of vaccines, explaining 29.3, 11.0, and 13.2% of the total effects, respectively. Conspiracy beliefs significantly predicted vaccine hesitancy through the sequential mediation of knowledge of vaccines and medical mistrust (ß = 0.016), explaining 2.2% of the total effects. Conspiracy beliefs significantly predicted vaccine hesitancy through the sequential mediation of confidence and complacency, and knowledge of vaccines (ß = 0.023), explaining 3.2% of the total effects. The SEM approach indicated an acceptable model fit (χ2/df = 2.464, RMSEA = 0.038, SRMR = 0.050, CFI = 0.930, IFI = 0.930). CONCLUSIONS: The sample in this study showed lower vaccine hesitancy, and this study identified pathways from conspiracy beliefs to COVID-19 vaccine hesitancy in China. Conspiracy beliefs had direct and indirect effects on vaccine hesitancy, and the indirect association was determined through medical mistrust, confidence, complacency, and knowledge of vaccines. In addition, both direct and indirect pathways from conspiracy beliefs to vaccine hesitancy were identified as intervention targets to reduce COVID-19 vaccine hesitancy.

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Context: Immunization coverage counts among the priorities of public health services. To identify factors that motivate or fail to motivate patients to update their vaccination status would help to design future strategies and awareness campaigns. Objective: Our aim was to assess the impact of primary care physicians on the immunization status of their adult patients, and to explore possible explanations. Methods: We invited students and collaborators of Geneva University to bring their paper vaccination records to receive an assessment of their immunization status and personalized vaccination recommendations. Participants completed a first questionnaire at the recruitment phase, and a second 2-3 months later. We assessed their immunization status with the viavac algorithms based on the Swiss national immunization plan. Results: Having a primary care physician did not correlate with better immunization status: only 22.5% patients who reported having a physician and 20% who reported having no physician were up-to-date (n = 432; p > 0.5). A linear regression indicates that the frequency of medical consultations did not affect patients' immunization status either. Even the participants who recently showed their vaccination record to their primary care physician did not have a better vaccination status. We explored possible explanatory factors and found evidence for the patients' overconfidence about their own immunization status: 71.2% of the participants who predicted that they were up-to-date were wrong about their actual status, and 2-3 months after having received their immunization assessment, 52.8% of the participants who "remembered" having received the assessment that they were up-to-date were wrong: they had in fact received the opposite information that they were not up-to-date. This substantial proportion of wrong beliefs suggests that adult patients are unworried and overconfident about their own immunization status, which is likely to induce a passive resistance toward vaccination updating. Conclusions: This study indicates that the vaccination coverage and beliefs of adults about their immunization status is suboptimal, and that primary care physicians need further support to improve their health-protection mandate through routine immunization check-ups. We highlight that the current covid vaccination campaigns offer a rare opportunity to update patients' immunization status and urge physicians to do so.

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INTRODUCTION: Portugal has one of the highest vaccine coverage rates among European countries, associated with excellent vaccine convenience and confidence levels. Considering both the high rate of pediatric vaccination in Portugal and the excellent indicators of vaccine convenience established, an analysis of confidence and complacency indicators could help understand this positive example. This study aimed to characterize parental beliefs according to the intention to vaccinate a next child and identify cognitive and demographic predictors of that intention in a Portuguese sample. METHODS: We measured perceptions of vaccines' safety and efficacy, perceptions of the severity of vaccine-preventable diseases, beliefs related to conspiracy theories, attitudes towards immunization requirements, perceptions of social norms as predictors of the intention to vaccinate a subsequent child. We also inquired if parents had previously refused a recommended vaccine. The authors disseminated the questionnaire online to reach a diverse population of parents of 0-12 years old children. The final sample included 1,118 parents, 96.9% reported their intention to vaccinate the next child, and 3.6% had previously refused a vaccine. Two additional open-ended questions regarding motives to vaccinate or refuse a future baby's vaccination were answered by 886 parents. RESULTS: All the evaluated parental cognitive dimensions were significantly different between the group of parents who would vaccinate a next child and those who expressed the intention not to vaccinate. Beliefs about the safety and efficacy of vaccines and having fewer children were significant predictors of that intention. CONCLUSION: The vast majority of parents reported attitudes and beliefs favorable to pediatric vaccination with high consistency in all cognitive dimensions assessed. Concerns regarding pediatric vaccines' safety need to be sensitively and actively addressed by health providers to maintain excellent vaccination coverage rates.

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BACKGROUND: Seasonal influenza vaccination is recommended for patients with chronic respiratory conditions, but uptake is suboptimal. We undertook a comprehensive mixed methods study in order to examine the barriers and enablers to influenza vaccination in patients with chronic respiratory conditions. METHODS: Mixed methods including a survey (n = 429) which assessed sociodemographics and the psychological factors associated with vaccine uptake (ie confidence, complacency, constraints, calculation and collective responsibility) with binary logistic regression analysis. We also undertook focus groups and interviews (n = 59) to further explore barriers and enablers to uptake using thematic analysis. RESULTS: The survey analysis identified that older participants were more likely to accept the vaccine, as were those with higher perceptions of collective responsibility around vaccination, lower levels of complacency and lower levels of constraints. Thematic analysis showed that concerns over vaccine side effects, lack of tailored information and knowledge, and a lack of trust and rapport with healthcare professionals were key barriers. In contrast, the importance of feeling protected, acceptance of being part of an at-risk group and feeling a reduced sense of vulnerability after vaccination were seen as key enablers. CONCLUSIONS: Our findings showed that the decision to accept a vaccine against influenza is influenced by multiple sociodemographic and psychological factors. Future interventions should provide clear and transparent information about side effects and be tailored to patients with chronic respiratory conditions. Interactions between patients and their healthcare providers have a particularly important role to play in helping patients address their concerns and feel confident in vaccination.

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Influenza vaccination has been available under Peru's national immunization program since 2008, but vaccination coverage has decreased lately. Surveys and focus groups were conducted among four risk groups (pregnant women, mothers of children aged <6 years, adults with risk factors, and adults aged ≥65 years) to identify factors affecting influenza vaccine hesitancy in Peru. The 3Cs model (Confidence, Complacency, and Convenience) was used as a conceptual framework for the study. Most pregnant women and mothers of young children (70.0%), but less than half (46.3%) of older adults and adults with risk factors were vaccinated against influenza. Vaccine confidence and complacency were positively associated with educational level. Complacency was the most deficient of the 3Cs. Pregnant women and mothers were the most informed and least complacent among risk groups. Focus groups revealed the misconceptions behind the high level of complacency observed, including the perception of influenza risk and the role assigned to vaccination in preventing the disease. Interviews with officials identified that most strategies are directed to vaccination availability and hence to convenience, with opportunities for strategies to improve vaccination uptake and community engagement. The results highlight the importance of implementing in Peru communication strategies to increase perceptions of vaccine safety and effectiveness thus improving confidence and reducing complacency. The establishment of explicit incentives should also be considered to increase vaccination uptake, particularly to health personnel.

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A novel Coronavirus (SARS-CoV-2) causing a cluster of respiratory infections (Coronavirus Disease 2019, COVID-19) first discovered in Wuhan, China, is responsible for a new illness that has been found to affect the lungs and airways of patients with associated symptoms of fever, cough and shortness of breath. In the light of few cases recorded so far in West Africa there is tendency for complacency. The region needs to make strategic plans based on available evidence to enable them effectively deal with this rapidly evolving pandemic. At this very moment countries like China, Italy, France, Spain, Iran, UK and many others are witnessing sustained and intensive community transmission of this virus and increasing numbers of severe disease and death particularly among elderly patients with other comorbidities. The reality of the seriousness of this pandemic is alarming. Government of member states of ECOWAS need to prepare themselves by building capacity as well as implement evidenced-based steps to mitigate this rapidly evolving pandemic by testing persons presenting with symptoms (fever, cough and shortness of breath), isolating and treating those found positive, tracing and quarantining contacts, implementing social distancing as well as optimizing human and material endowment to allow healthcare workers offer safe quality clinical care for affected patients to prevent secondary infection among healthcare workers.

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