|Year : 2023 | Volume
| Issue : 1 | Page : 30-35
Attitude of adults toward COVID-19 vaccination in India: An online cross-sectional study
Bandana Rath, Amit Kumar Mishra
Department of Community and Family Medicine, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
|Date of Submission||24-Feb-2022|
|Date of Decision||15-Apr-2022|
|Date of Acceptance||22-Apr-2022|
|Date of Web Publication||19-Oct-2022|
Dr. Amit Kumar Mishra
Department of Community and Family Medicine, All India Institute of Medical Sciences, Raipur - 492 099, Chhattisgarh
Source of Support: None, Conflict of Interest: None
Introduction: As on January 12, 2022, India had 955,319 active cases and 484,655 COVID-19-related deaths. In this alarming situation, COVID-19 vaccination is the key in reducing morbidity and mortality. The vaccination could be a game-changer in India and it is critical to understand the attitude of the people toward currently available COVID-19 vaccines. Materials and Methods: An online cross-sectional study was conducted to assess the attitude of adults toward COVID-19 vaccination and reasons for vaccine acceptance/reluctance. A predesigned-pretested structured questionnaire was shared through WhatsApp with the target population and responses were recorded. The analysis was done using IBM Statistical Package for the Social Sciences (SPSS) Statistics for Windows, Version 21.0. (developed by IBM Corp, Armonk, New York), and results were presented in percentages/proportions. Results: In the current study, 552 responses were analyzed. Most of the participants (58.5%) were between 18 and 30 years of age with 55.4% males. Among the study participants, 96.6% already had received COVID-19 vaccine and 2.5% were waiting for their turn to come, only 5 participants (0.9%) were not interested for the vaccine. The most common reason for vaccine acceptance was that the vaccinated people can protect unvaccinated people from COVID-19 (43.7%) by breaking the chain-of-transmission. The reasons for vaccine reluctance were noted as the available vaccines had low efficacy and were associated with severe adverse events. Conclusion and Recommendations: The current study showed a high COVID-19 vaccine acceptance and a very low vaccine reluctance among the study participants. The factors associated with reluctance could be addressed by proper Institutional Ethics Committee practices. Information from the current study could be used to plan a better vaccination drive in the country.
Keywords: Acceptance, COVID-19, pandemic, reluctance, vaccine
|How to cite this article:|
Rath B, Mishra AK. Attitude of adults toward COVID-19 vaccination in India: An online cross-sectional study. J Public Health Prim Care 2023;4:30-5
|How to cite this URL:|
Rath B, Mishra AK. Attitude of adults toward COVID-19 vaccination in India: An online cross-sectional study. J Public Health Prim Care [serial online] 2023 [cited 2023 Mar 25];4:30-5. Available from: http://www.jphpc.org/text.asp?2023/4/1/30/358589
| Introduction|| |
The SARS-CoV-2 virus first identified in December/2019 in Wuhan, China, is the cause of COVID-19 pandemic. The WHO declared it as Public Health Emergency of International Concern on January 30, 2020 and later declared as the pandemic on March 11, 2020. As of January 11, 2022 globally, there have been 308458,509 confirmed COVID-19 cases, including 5,492,595 deaths. According to MoHFW/GoI, as on January 12, 2022, India had 955,319 active COVID-19 cases with 484,655 COVID-19 deaths.
In this alarming situation, vaccination against COVID-19 is the key to reduce morbidity and mortality. Vaccines impart active immunity; induce production of specific antibodies and/or cell-mediated immunity. Active immunization is more efficacious and longer-lasting than passive immunization, but the former needs more latent period, whereas the latter affords immediate protection but is costly. Ever since the advent of vaccinology in 1796 and the development of the smallpox vaccine in 1978, systemic implementation of mass immunization for various diseases has been observed in the world. According to the WHO, Smallpox and Rinderpest have been successfully eradicated due to effective vaccination programs. However, with vaccination, comes vaccine reluctance/hesitation by some people.
Vaccine hesitancy is as old as vaccination itself. The reluctance/refusal to vaccinate despite the availability of vaccines is a vaccine-specific phenomenon, which may be influenced by complex multiple factors such as historical, educational, occupational, political, social, and behavioral determinants.,, In view of the ongoing vaccination program on COVID-19, the current study was conducted with the objectives to assess the attitude of adults in India toward the ongoing COVID-19 vaccination and to find out the reasons for COVID-19 vaccine acceptance and reluctance among them.
| Materials and Methods|| |
As per the objectives stated above, a cross-sectional study was planned and conducted through an online mode to get representatives from the various parts of the country. The study was approved by the Institutional Ethics Committee. The sample size was calculated using the formula 4pq/d2, assuming the proportion for vaccine acceptance (p) as 80.5%, with a confidence level of 95% (α) and relative precision (d) of 5%, the sample size estimated was 388. A predesigned and pretested structured questionnaire was developed in the Google Form keeping in mind the study objectives. First, the questionnaire was prepared in English and later translated to Hindi by qualified Hindi translators. The questionnaire in the Google Form was both in English and Hindi language to get maximum response from study participants. The questionnaire contains three sections. The first section had five items about demographic information of the participants, the second section had 12 items about knowledge on vaccines and COVID-19 infection/disease; the third section had one multiple response item about the vaccine reluctance/acceptance based on the previous item responses. For completeness of responses, all items were marked as mandatory in the Google Form.
Nonprobability snowball sampling technique was used in the study to get participants for the study. The link for the questionnaire in the Google form was shared through the online mode (through various WhatsApp groups) and the participants were requested to forward the questionnaire through WhatsApp to other groups/interested contacts. The objectives and purpose of the study were mentioned/explained to the participants at the beginning of the Google Form containing the questionnaire. Participants responding to the Google Form were treated as the participant's consent to participate in the study. Participation in the study was purely voluntary. The participants also had the power to exit the survey at any point before submission of their responses to the questionnaire. The participants could review their responses to the items before submission. The participants could submit the responses once they respond to all the questions. Participants could not submit another response from the same link as the link for a second response was disabled in the Google forms settings. We maintain strict confidentiality. The personal data were never disclosed anywhere to anyone. After the closing of the Google form response, the data were examined for completeness and appropriateness. The responses which were not complete/appropriate were excluded from the database. The cleaned data were analyzed by IBM Statistical Package for the Social Sciences Statistics for Windows, Version 21.0 (developed by IBM Corp, Armonk, New York, USA) software. The results were presented as percentages and proportions. The association between the categorical variables was checked by the Chi-square test. The quantitative data were presented as mean with standard deviation. P < 0.05 was considered statistically significant.
| Results|| |
A total of 588 participants submitted responses from various parts of the country. The received responses were checked for completeness and 36 responses were excluded as they were incomplete or the responses were not relevant to the questions. After excluding the above responses, 552 responses were included and analyzed. More than half of the participants were between 18 and 30 years of age (58.5%) with 44.6% females and 55.4% males, and the majority of participants had a professional degree (46.6%) or were graduates (38.9%). Most of the participants (84.1%) were from urban localities. Most of the study participants (30.1%) were from Odisha [Table 1].
Most of the study participants had a positive attitude toward childhood vaccination with 93.3% participants were being vaccinated during their childhood. The attitude of the study participants regarding childhood vaccination and COVID-19 infection/vaccination were collected on a Likert scale of 1–5 where 1 was strongly disagree/unlikely/ineffective and 5 was strongly agree/highly likely/highly effective. As per the responses received, 92.9% of participants strongly agreed and 4.2% of participants were agreed to the concept of childhood vaccination for diseases such as tuberculosis, measles, and hepatitis B. When asked that healthy children won't need any vaccination, 74.6% of participants were strongly disagreed with the statement followed by 12.3% of participants who disagree with the statement. There was high trust among the study participants on vaccines against diseases such as polio and diphtheria, 78.4% considering it to be highly effective, 18.1% considering it effective. As represented in the graph [Figure 1], 56.2% of the participants considered it was highly likely for unvaccinated individuals to get infected with COVID-19 than vaccinated individuals, while 26.6% thought it was likely and 12.3% were neutral on the above statement. The vaccine against COVID-19 was considered effective by 42.2% followed by highly effective by 38.6% of study participants [Figure 1].
|Figure 1: Attitude of study participants towards childhood vaccination and COVID-19 infection/vaccination|
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In the current study, according to 90.6% of study participants, minor adverse events such as mild fever/body pain were expected as a response to any vaccination while 6% of study participants were not aware of the adverse events associated with any vaccination. Among the participants, 24.3% of participants believe that getting COVID-19 infection was safer than the adverse reactions of the COVID-19 vaccine while 67.4% of study participants believed that getting COVID-19 infection was not safer than the adverse reactions of the COVID-19 vaccine. Most of the study participants (84.2%) believe that a person already infected with the COVID virus may get the COVID-19 infection again in the future while 6% believe that the first COVID-19 infection prevents the subsequent infections with COVID-19 and 9.4% of study participants were not aware of the risk [Figure 2].
|Figure 2: Belief of study participants about COVID-19 infection and vaccination|
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The major source of information of the study participants about COVID-19 infection/disease and vaccination was news channels (55.6%), family doctors (55.6%), research articles (44.7%), social networking sites (36.2%), friends (31.7%), and for 1.6% of study participants the source of information were Google, neighbors, and government websites/circulars. Three-fourth (75.5%) of study participants were confident that they were well informed about vaccination and COVID-19 infection from the various sources [Table 2].
|Table 2: Major sources of information of COVID-19 infection and vaccination (n=552)#|
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Among all the study participants, 96.6% already had received their COVID-19 vaccine and 2.5% were waiting for their turn to come, only 5 participants (0.9%) were not interested in the COVID-19 vaccine. The major motivating factors or reasons regarding the acceptance of vaccines among the participants who were already vaccinated were collected in multiple responses, which showed that the most important factors were the protection of nonvaccinated individuals by vaccination of most people (43.7%) followed by availability of ample medical research papers on vaccine safety (43.5%), believe in mass vaccination programs by Government of India (38.6%), government intervention for vaccination and personal registration for the vaccination (33.7%), advertisements/communications regarding vaccination (25.5%) [Figure 3].
|Figure 3: Reasons for vaccine acceptance among study participants. *Others: Vaccination certificate required for classes or workplace, for traveling and to control the pandemic, etc.|
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In the current study, 5 (0.9%) study participants were not interested in vaccination, among them, three were shared that the available vaccines had low efficacy and associated with severe adverse events. Two participants were not interested in vaccination as they shared that the vaccines were not thoroughly tested and the vaccines were rushed for vaccination due to political reasons. The following options such as there was an increased risk at the vaccination centers due to overcrowding, the nontrusted international vaccine companies and government, nontrusted present construct of health-care professionals, and current vaccination strategy as a political agenda were recorded with a single response each [Table 3].
|Table 3: Reasons for vaccine reluctance among the study participants* (n=5)|
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Two participants each from <30 years and 31 to 40 years age group and one participant from 41 to 50 years were not interested in vaccination while all participants above 51 years were already vaccinated except one participant who was waiting for his/her turn to get vaccinated. All five participants who were not interested in vaccination were male. Two participants each with a professional degree and graduate degree were not interested in vaccination and one participant with high school qualification is not interested in vaccination. Among the five participants not interested in vaccination, 4 belonged to an urban area and 1 belonged to a rural area. It was found that the age, sex, and place of residence of study participants are not significantly associated with their decision for vaccine acceptance or reluctance while the educational status of study participants is statistically associated with their decision for COVID-19 vaccination [Table 4].
|Table 4: Factors associated with vaccine acceptance among study participants|
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| Discussion|| |
Vaccination has played a crucial role in the elimination of infectious diseases and control of any outbreak or epidemic in the past. Currently, as India is recovering from the second wave of COVID-19, it becomes critical to understand the attitude of the population toward the currently available vaccine against COVID-19 disease for which the current study was conducted. The vaccination of individuals could be a game-changer in controlling the epidemic of COVID-19 in India.
Out of the total participants, 96.6% were already vaccinated for COVID-19 and 2.5% were interested in getting vaccinated once their turns come or vaccine is available to them. These results showed significantly higher vaccine acceptance among the study participants relative to the study participants from other countries such as Bangladesh (74.6%), 37.4% in Jordan. In a study for vaccine hesitancy among university students in Italy during the COVID-19 pandemic, it was found that 86.1% of participants were interested in COVID-19 vaccination while 13.9% of participants had low intention to get vaccinated against COVID-19 disease. In a COVID19 vaccination hesitancy study in the United States, the response on the likelihood of getting a COVID-19 vaccine, 79% responded as “very likely and somewhat likely” while 22% responded as “not likely” and “definitely not.” However, the results are agreeing with the vaccination attitude of Indians in the survey regarding COVID-19 vaccine acceptance and hesitancy in low- and middle-income countries which showed a vaccine acceptance rate of about 88% in the Indian population. This high acceptance rate among Indians is not just limited to the COVID-19 vaccination, rather it was also observed for the childhood vaccination programs in India, with a 96% effectivity and 97% safety belief was noted in the participants from India in a study with low- and middle-income countries. Similarly, our study also suggests that there is very high acceptance toward childhood immunization with 78.4% participants choosing 5/5 on a Likert scale regarding the effectivity of childhood vaccination against polio, diphtheria, etc., and 18.1% participants choosing 4/5 on the same Likert scale. A similar pattern was not observed in the US, with trust in the effectiveness of childhood vaccination as 85%.
The major reason for the reluctance toward COVID-19 vaccination in the current study was the belief that the vaccine is associated with severe adverse events and the low efficacy of the available vaccine. Similar results have been obtained in other studies, a study with the medical students in a university in Egypt concluded that the major reasons for the vaccine reluctance were adverse effects of vaccination (96.8%) and ineffectiveness of the vaccine (93.2%). The mentioned research was conducted among medical students thus it shares a similar educational demographic as in the current study, with graduate (38.9%) or professional degree (46.6%). Another study conducted among the health-care workers in Yale medicine and Yale-New Haven Health system found that the top reasons for reluctance were long- and medium-term safety concerns. Thus, educational status is an important factor in determining the reasons for vaccination reluctance, and the current study also showed a statistically significant association between the educational status of study participants and their decision on COVID-19 vaccine acceptance or reluctance. In the present study, two participants out of 5 who were not interested in vaccination responded that the COVID vaccine is not thoroughly tested and may cause unforeseen effects in the next generations, a study conducted in Tamil Nadu, 22.1% of participants responded that COVID 19 is a new disease and vaccines have not been tested thoroughly and 38.7% were worried about serious unknown long-term effects of the COVID-19 vaccine in future. Two out of 5 participants responded that the vaccine was rushed due to political reasons, and in the Tamil Nadu study, 22.7% of participants responded that authorities promote the COVID-19 vaccine for political gain and financial gain.
A study conducted among American adults showed that older Americans were consistently more reluctant to accept a COVID-19 vaccine than were younger Americans. The current study finding was strikingly opposite to the above results as in the current study the most common age group for vaccine reluctance was <40 years. This difference can be attributed to the vaccine allocation strategies in India, which lead to the prioritization of the elderly population in India when the vaccination program in India was launched. This in turn manifested as a relative reduction in the number of deaths, irrespective of the vaccine efficacy. However, this high acceptance of the elderly toward COVID-19 was not seen in all parts of the country. A study conducted by the Directorate of Public health and Preventive Medicine, Tamil Nadu, revealed that vaccine acceptance was 72.2% among the elderly (>60 years), while that for 18–44 and 45–60 years' age group was 83.1% and 81.8%, respectively. For a successful vaccination drive, we have to focus/address this vaccine reluctance or hesitancy among the people to keep it the lowest level, for which we have to understand the factors related to this vaccine hesitancy/reluctance.
The current study aims to identify the intentions against vaccination of the study population to allow further facilitation of COVID-19 vaccination among the general population in the country and the study finding can be extended to better understand the factors governing booster doses that are administered to a vaccinated population that has completed a primary vaccination series when the immunity and clinical protection has fallen below a rate deemed sufficient for that population.
| Conclusion and Recommendations|| |
The current study showed a high COVID-19 vaccine acceptance rate and a very low vaccine reluctance among the younger population among the study participants. The vaccine reluctance was mainly due to their beliefs on adverse events associated with available vaccines and the low efficacy of the vaccines. Further, reluctance was reported among the younger population. The factors associated with reluctance could be addressed by proper information, education, and communication practices. As the COVID-19 pandemic is continuing and the available vaccines can be a game-changer in a country like India in controlling the pandemic and saving lives. In the current pandemic situation, the current study shows the attitude of adults toward COVID vaccination and the factors associated with vaccine acceptance and reluctance, the information could be used to plan a better vaccination drive in the country.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3]
[Table 1], [Table 2], [Table 3], [Table 4]