key: cord-1048638-3zt0ubrh authors: Diaz, Parris; Reddy, Pritika; Ramasahayam, Reshna; Kuchakulla, Manish; Ramasamy, Ranjith title: COVID‐19 vaccine hesitancy linked to increased internet search queries for side effects on fertility potential in the initial rollout phase following Emergency Use Authorization date: 2021-06-28 journal: Andrologia DOI: 10.1111/and.14156 sha: 08035ddda38b63665af01edd926ceec438b022e2 doc_id: 1048638 cord_uid: 3zt0ubrh The Emergency Use Authorization (EUA) of the COVID‐19 vaccine on December 11, 2020 has been met with hesitancy for uptake with some citing potential impacts on future fertility. We hypothesised that irrespective of sex, fertility‐related queries would markedly increase during the 48 days following EUA of the coronavirus vaccine. We sought to objectively identify trends in internet search queries on public concerns regarding COVID‐19 vaccine side effects on fertility that might impact vaccine uptake. We used Google Trends to investigate queries in Google's Search Engine relating to the coronavirus vaccine and fertility between 10/24/2020 and 1/27/2021. The five most queried terms were identified as: ‘COVID Vaccine Fertility’, ‘COVID Vaccine and Infertility’, ‘COVID Vaccine Infertility’, ‘COVID Vaccine Fertility CDC’, and ‘COVID 19 Vaccine Infertility’ with an increase of 710.47%, 207.56%, 264.35%, 2,943.7%, and 529.26%, respectively, all p < .001. This study indicates that there was an increase in online COVID‐19 vaccine‐related queries regarding fertility side effects coinciding with the Emergency Use Authorization (EUA) on December 11, 2020. Our results objectively evidence the increased concern regarding the vaccine and likely demonstrate a major cause for hesitancy in vaccine uptake. Future studies and counselling with patients should be undertaken to help mitigate these concerns. The coronavirus disease 2019 (COVID-19) caused by SARS-CoV-2 is an ongoing global health emergency. COVID-19 infection has been shown to impact multiple organ systems with varying outcomes (Zaim et al., 2020) . Solutions to mitigate the impact of COVID-19 have steadily been underway, with a major focus being on the development of vaccines. Unprecedented efforts from scientists with advances in technology and government support led to the successful completion of several vaccine candidates. As a means to catalyse the utilisation of these vaccine candidates in the USA, the FDA granted Emergency Use Authorization (EUA) for the first COVID-19 vaccine on December 11, 2020. Although excitement ensued following this milestone, a significant portion of the population reports that they are unwilling to be vaccinated (Chevallier et al., 2021) . While it is clear that the general public has significant hesitations with vaccination, objective information characterising the increased concern is unavailable. Public concern regarding vaccine side effects has long been an issue encountered by healthcare providers since the advent of the smallpox vaccine in 1798. Due to the expedited process for vaccine approval, potential harm to recipients from the vaccine is one of the most commonly reported concerns (Chevallier et al., 2021) . Specifically, the impact of vaccine candidates on future fertility has been commonly raised by patients due to the lack of long-term data evaluating this outcome. While COVID-19 infection has been shown to have the ability to affect sperm parameters in the acute phase of infection, the impact on fertility from vaccine uptake is largely uncertain (Best et al., 2021) . We hypothesised that irrespective of sex, fertility-related queries would markedly increase during the 48 days following Emergency Use Authorization of the coronavirus vaccine. We sought to objectively identify trends in internet search queries on public concerns regarding COVID-19 vaccine side effects on fertility that might impact vaccine uptake. A retrospective study was conducted to investigate the influence of COVID-19 vaccine Emergency Use Authorization (EUA) on online queries regarding the coronavirus vaccine and fertility. As Google Trends is considered publicly available data, it fulfils criteria for Institution Review Board (IRB) exemption, and an IRB waiver was obtained. With Google Trends we hoped to compare the proportion of searches or SVI for each identified search term 48 days before and after the first COVID-19 vaccine Emergency Use Authorization (EUA) in the United States. In addition, we hoped to identify the geographic distribution of each search term during this time period domestic and abroad. Mean search volume index (SVI) before and after EUA was done using paired t-test (Garijo et al., 2021) . Data were analysed using Microsoft Excel Version 16.43. The results of our study demonstrate that internet search queries The authors have nothing to disclose. The data that support the findings of this study are available in United Kingdom (100) United States(47) United Arab Emirates (29) United States (100) United Kingdom (44) OH (36) N/A COVID vaccine infertility 1 SD (100) United States (100) KS (99) 2. Ireland (63) United Kingdom (56) Delaware(70) New Hampshire (62) COVID vaccine fertility CDC 1 United States (100) United Kingdom (33) New York (91) United States (33) Illinois (64) N/A 3 Evaluation of SARS-CoV-2 in human semen and effect on TOTAL Sperm number: A prospective observational study. 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