You Are The Reason I Live: How to Download and Stream this Romantic Song

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I will lift my hands upI will raise my voice highI will shout of Your loveTill the day that I dieEverything that I haveAll my worship I bringYou're the reason I liveYou're the reason I sing

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My children are the reason for living. My Grandkids, and my grant grandkid are the reason too. That's What Makes Our Day Sometime Just To Hear Their Voices. They are world to me & They are so precious to us.

Vaccination against COVID-19 has been available in Germany since December 2020. However, about 30% of the population report not wanting to be vaccinated. In order to increase the willingness of the population to get vaccinated, data on the acceptance of vaccination and its influencing factors are necessary. Little is known about why individuals refuse the COVID-19 vaccination. The aim of this study was to investigate the reasons leading to rejecting vaccination, based on posts from three social media sites.

Based on 333 posts written by 323 contributing users, we identified six main categories of reasons for refusing a COVID-19 vaccination: Low perceived benefit of vaccination, low perceived risk of contracting COVID-19, health concerns, lack of information, systemic mistrust and spiritual or religious reasons. The analysis reveals a lack of information among users and the spread of misinformation with regard to COVID-19 and vaccination. Users feel inadequately informed about vaccination or do not understand the information available. These information gaps may be related to information not being sufficiently sensitive to the needs of the target group. In addition to limited information for the general population, misinformation on the internet can also be an important reason for refusing vaccination.

According to the Health Belief Model, preventive behavior such as receiving a vaccination depends on the perceived risks of disease as well as the perceived effectiveness, benefits and costs associated with this behavior [7]. The COSMO COVID-19 Snapshot Monitoring shows that confidence in the safety of the vaccines used is the most relevant factor for a positive attitude of the population towards vaccination. In addition, the intention to get vaccinated is higher among older individuals, individuals whose families generally support vaccination, and individuals who are worried about infection [8]. A German telephone survey on the willingness to receive a COVID-19 vaccination also revealed that belonging to a population group at high risk for a severe course of COVID-19, a previous COVID-19 diagnosis and the expectation of severe complications are important factors associated with positive attitudes towards a COVID-19 vaccination [9]. Concerns about potential side effects were identified as one of the reasons for refusing vaccination [9]. According to a study by Taylor et al., perceived low benefits, concerns about potential long-term consequences, criticism towards financial interests of pharmaceutical companies and a preference for natural immunity against COVID-19 were also associated with low willingness to get vaccinated [10].

The German-language versions of the online platforms Instagram, Twitter and the comments section of YouTube were searched for reported reasons for rejecting a COVID-19 vaccination. The search terms used to identify relevant postings were the following keywords in German: "Corona vaccination", "COVID-19 vaccination", "SARS-CoV-2 vaccination", "BioNTech-Pfizer", "Moderna", "AstraZeneca", "Johnson & Johnson". The search terms were not combined using operators. The keywords were entered in the search field of the respective platforms one by one. Relevant posts in German language were extracted into a text document. Posts in closed groups were not included. Data was extracted until a saturation effect could be observed. Inclusion criteria aside from the aforementioned keywords were: the posts had to be written in German language and had to report hesitancy or refusal with respect to the COVID-19 vaccination. The data included posts created from January 20, 2020 to May 2, 2021. This time frame roughly covers the period from the first reports of the spread of SARS-CoV-2 up to the general availability of vaccines against COVID-19 in Germany. This period includes the initial stages of the development of the respective vaccines, their approval and introduction in Germany through specialized vaccination centers and the subsequent extension of the vaccination strategy to also include vaccination through general practitioners and family physicians. The beginning of May 2021 also marked the end of the prioritization of specific vulnerable groups for receiving the Vaxzevria vaccine, the first widely available vaccine against COVID-19 in Germany [11]. Facebook, Instagram and Twitter are the most widely used freely accessible social media forums in Germany, and accordingly the highest numbers of posts are available on these sites, therefore these social media forums were selected [12, 13]. Moreover, social media are frequently used communication channels to disseminate both high-quality information and misinformation [14].

Our analysis revealed six main categories of reasons for refusing a COVID-19 vaccination. Reasons include low perceived benefits of getting vaccinated, a low subjective risk, concerns of potential adverse effects from the vaccine, poor health literacy, mistrust and spiritual and religious beliefs (see Table 1).

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"I am asthmatic, but I would never be vaccinated against Corona. I don't have to weigh that. We have an immune system. I live a healthy life with lots of vitamins. I don't deny Corona, but I'm not afraid of it." [User 47]

Another reason to refuse vaccination were users' concerns about various potential side effects and possible vaccine-related damage. Some users justified rejecting vaccination citing the lack of long-term studies and insufficient reliable information about side effects and consequential damages. Among others, these fears were related to the risk of getting cancer, changes and damages to their genetic makeup, infertility and death. These concerns were often associated with past vaccine and drug scandals.

Our analysis also showed that vaccination was refused due to other pre-existing health conditions and allergies, as only little information was available on possible interactions between existing health impairments and COVID-19 vaccines. Personal experiences with physical reactions or vaccine damages from past vaccinations were further reported reasons that led to rejection of the vaccines.

Furthermore, the rapid development and approval of the vaccines compared to previous vaccines against other diseases was another reason given by users for refusing vaccination. They expressed concern that the vaccines were not sufficiently tested and that long-term negative physical consequences could not be ruled out. The partial emergency approval of the vaccines also led to concerns.

The COVID-19 pandemic has had far-reaching consequences for the society at large, with people having to reduce social contacts or even spending prolonged periods of time in isolation and quarantine as a result of infection control measures. This may have had a negative impact on the mental health of those affected, leading to an increase in depression and anxiety [17, 18]. Vaccination is one of the most important strategies for the long-term management of the COVID-19 pandemic [19]. Given that considerable proportions of the populations in many countries are still hesitant to get vaccinated [20], insights into reasons for poor vaccine acceptance are needed in order to inform public health measures aiming to further increase COVID-19 vaccination rates in the population.

The present study investigated reasons that users of Instagram, Twitter and YouTube presented for rejecting vaccination against COVID-19. In our analysis, six main categories of reasons were identified, which reflect different opinions and views.

Our analysis points to a lack of information among users and the spread of misinformation with regard to COVID-19 and vaccination. Users feel inadequately informed about vaccination or do not understand the information available. These information gaps may be related to information not being sufficiently sensitive to the needs of the target group. For example, information provided by the Robert Koch-Institute in the Frequently Asked Questions section on the topic of COVID-19 and vaccination (as of 28/12/2021) is not barrier-free and is available neither in simple language nor in major foreign languages spoken by immigrants in Germany [21]. Information from the Federal Ministry of Health regarding questions and answers on COVID-19 vaccination is available in sign language, simple language and English (as of 28/12/2021). However, information materials in other languages frequently spoken in Germany, such as Turkish or Russian, are missing [22]. The Federal Ministry of Health also refers to the Paul Ehrlich Institute for information on potential side effects of COVID-19 vaccination, which are not easily comprehensible by laypersons [23]. This demonstrates the need for more low-threshold and target group-specific communication addressing laypersons as well as people who are not fluent in German. One approach to address these aspects is a comprehensive booklet on COVID-19 vaccination which was jointly published only recently by the Federal Centre for Health Education and the Robert Koch-Institute and which is available in several languages ( -und-persoenlicher-infektions-schutz/3537/das-impfbuch-fuer-alle-1/). In addition to limited information for the general population, misinformation on the internet can also be an important reason for refusing vaccination. Betsch et al. confirm our findings by noting that even a short visit to a website with vaccine-skeptical content can influence the perception of vaccination risks and the willingness to get vaccinated. Consequently, perceived health risks from vaccination may increase and the intention to get vaccinated as well as perceived risks in case of non-vaccination may be reduced [24]. While the German government has recently introduced laws to address hate speech and misinformation in social media, the effectiveness and impact of these laws have yet to be evaluated. These findings emphasize the relevance of low-threshold, accessible, transparent and quality-controlled information on COVID-19 and vaccination. A low perceived benefit of the vaccination and a low subjective risk of getting COVID-19 can also be counteracted by providing laypersons with easily understandable and transparent information about the etiology as well as the course of the disease and possible sequelae of an infection such as Long-COVID.