Beliefs, Concerns, and Issues toward COVID-19 Vaccination amongst the Adult Population: A North Indian Study

DISCUSSION

For years communicable diseases have been prevented by the use of vaccines and saved millions of lives. Today the world is facing the COVID-19 pandemic. To combat this pandemic, scientists all over the world have worked hard to develop a vaccine against the virus. The Government of India has approved the use of two vaccines, covishield and covaxin, and recently, a third vaccine called sputnik V was also approved. A portion of the population are keen to get this vaccination, while the other majority still have concerns regarding its efficacy. Hence a need was felt to explore the beliefs, concerns, and issues toward COVID-19 vaccination amongst the general public in the Northern region of India.

In the present study, only half (53.4%) of the respondents believed that everyone should take COVID-19 vaccine. Around 60% of subjects had faith in science and vaccine, whereas 32.8% had a neutral opinion. When enquired about protection by the vaccine for all strains of corona, 27.7% did not agree with the statement, whereas 38.1% had a neutral opinion, which indicates that people were not sure about the efficacy of the vaccine, and they still wanted to wait and watch till others took it. On the other hand, in an Italian survey on influenza vaccine, Domnich et al. reported that vaccines should be mandatory (74.8%) as these are crucial for public health.¹³

The vaccine is given free of charge in most countries. In the present study, 25.9% of the participants agreed to have the vaccine (Indian/foreign) if it is given free of cost, whereas 39.2% had a neutral opinion. In the survey conducted in Italy, reported by Domnich et al. in 2020 that half of the participants (53.2%) said that “they would personally pay if there was no free of charge vaccination offer.”¹³ Similarly in a study in Bangladesh reported that one-third (35%) of participants responded that “they would not purchase the vaccine at their own expense if it was not provided free of charge by the government.”¹⁴

People feel that vaccine is required to manage the pandemic. This is depicted in the responses of participants. Among them, three-fourths agreed with the fact that social distancing, masks, and hand hygiene are best, but the vaccine is required too. Nearly half of them were of the opinion that natural homemade immunity boosters (like kahra, giloye, etc) could not replace the vaccine. Around 65% of participants disagreed that corona is just like simple flu and people recover within 5–6 days, and there is no need to vaccinate.

Even if people were convinced that there is a need to have vaccination still, they were afraid of getting it. This was reflected in the response of half of the participants who agreed to vaccinate themselves in case anyone known around them has taken it and is healthy. They had some concerns and issues regarding vaccination. The most important concern was the safety of the vaccine, fear that the vaccine may cause severe complications, and worry about affording treatment in private hospitals in case of adverse reactions. Similar results were reported in the study of Di Gennaro et al., that the reasons why people were indecisive about taking the vaccine was because they received little (78%) or conflicting (69%) information about COVID-19 vaccines. Another reason was a lack of trust in vaccine safety (85%).¹⁵ While among respondents from the University of Malta, fear of injections was the main reason for being uncertain of taking the vaccine (82.5%, n = 275). More than half (56%) of the participants said that they required more information about the vaccine, and 50.1% did not want to be among the first to take the vaccine.¹⁶

The major issues that came to light were the speed with which the vaccine was prepared and government planning regarding handling adverse reactions. Many of them said that the vaccine is in trial stage and the long-term side effects are not studied. Nearly 42% of participants believed that this vaccine would not be effective for a longer period as new strains of coronavirus are emerging. Similar results were reported in a study in Bangladesh and showed that 26% considered that the vaccine available against COVID-19 is safe, 60% said that they would get the vaccine without hesitation, and two-thirds would motivate their friends and family members to receive the vaccine.¹⁴

When asked about the final state of mind about vaccinating themselves and family members, 43.7% were not able to decide, around 42% said they wanted to get vaccinated, whereas 15% denied taking the vaccine. It shows the uncertainty about vaccination. Different findings were reported by Di Gennaro et al. in a survey in Italy that overall, 67% of participants planned to get the vaccine, while 26% were unsure, and 7% refused it.¹⁵ Another study by Fisher et al. from the US reported that 57.6% participants (n = 571) said that they wanted to get vaccination, 31.6% (n = 313) were uncertain, and 10.8% (n = 107) did not want to get the vaccination.¹⁶ Just over half (51.0%) of the participants from the University of Malta said about their willingness to get the vaccine, 32.6% were uncertain, and 15.6% were unwilling to get the vaccine.¹⁷ Al-Qerem and Jarab among the Middle Eastern population reported that among 1,144 participants, 36.8% said “no” when asked about getting the vaccine if it was available, and 26.4% said, “not sure.” The main reasons why the participants were hesitant or refusing the vaccination were a lack of trust and apprehensions about the use of vaccines.¹⁸

The factors associated with the decision of taking vaccination were sex (male), place of stay (rural area), socioeconomic status (upper), and religion (Hindu). Further, people with a history of COVID-19 (54.7%) wanted to vaccinate themselves as compared to their counterparts. Age, educational status, marital status, type of family, and working in healthcare department had no impact on the decision to take the vaccine. While according to Fisher et al., the factors which were associated independently with hesitancy to get the vaccine (“no” or “not sure” response) involved black race, younger age, low level of education, and who have not received the influenza vaccine in the previous year.¹⁷ Another study by Cordina et al., reported that more females were unsure about getting the vaccine while males were more willing to take it (Chi-square = 14.63, df = 4, p = 0.006). Statistically different responses were from different age groups that is, 40–49 years old being more likely to state that ‘they were unsure whether to take the vaccine, and the participants 60 years and over were more likely to say that “they intended to take the vaccine” (Chi-square = 23.99, df = 10, p = 0.007).¹⁶ The study undertaken in the Middle Eastern population reported a significant negative impact of sample characteristics of participants’ intention to be vaccinated, including; being married, being female, and having postgraduate qualifications compared to university students.¹⁸

It is concluded that there was an urgent need to educate healthcare personnel regarding vaccination by involving mass media and social media so that information is spread at a faster speed. The data of the present study can help policymakers and governments to direct communication toward the COVID-19 vaccination campaign.