Temporal shifts in public perceptions of influenza and its vaccine before, during, and after COVID-19 in a fragile nation

BACKGROUND: Since the emergence of the COVID-19 pandemic, co-infection with COVID-19 and influenza has been associated with adverse health and economic outcomes. Emerging evidence suggests that the COVID-19 pandemic has influenced public perception of infections, including influenza, and acceptance of its vaccine. OBJECTIVES: To assess temporal shifts in public knowledge of influenza and attitudes toward its vaccine before (Phase-I), during (Phase-II), and after (Phase-III) the COVID-19 pandemic in Yemen, a low-income, fragile nation. METHODS: A survey questionnaire was distributed to the public in Yemen, and a total of 1,856 participants completed the survey (Phase-I = 433, Phase-II = 981, Phase-III = 442). RESULTS: There was an overall increase in influenza awareness in Phases-II and III compared to Phase-I. This rise was paralleled by a change in the source from which participants gathered information about influenza. Although awareness increased, a decline in future influenza vaccine acceptance was observed. However, participants in Phases II and III showed greater willingness to receive the vaccine if it was endorsed by the government and doctors, confirmed to be safe and effective, and provided at no cost by the authorities. Logistic regression and machine-learning models highlighted predictors of high influenza awareness and future vaccine acceptance among participants in each phase. CONCLUSION: The findings illustrate vaccine behaviour dynamics in a fragile country across the pandemic timeline and provide actionable insights for health authorities for designing effective vaccination campaigns and implementing vaccination policies tailored to the unique challenges faced during pandemics and health crises.