Knowledge, Attitude and Acceptance of a COVID-19 Vaccine: A Global Cross-Sectional Study
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Munich Personal RePEc Archive Knowledge, Attitude and Acceptance of a COVID-19 Vaccine: A Global Cross-Sectional Study Kazi Abdul, Mannan and Khandaker Mursheda, Farhana Green University 2020 Online at https://mpra.ub.uni-muenchen.de/105236/ MPRA Paper No. 105236, posted 13 Jan 2021 13:53 UTC
1
Knowledge, Attitude and Acceptance of a COVID-19 Vaccine: A
Global Cross-Sectional Study
Dr Kazi Abdul Mannan1
Adjunct Professor
Faculty Business Studies
Green University of Bangladesh
And
Dr Khandaker Mursheda Farhana
Assistant Professor
Department of Sociology & Anthropology
Shanto-Mariam University of Creative Technology
Abstract
The COVID-19 pandemic continues to ravage the world, with the United States being highly affected.
A vaccine provides the best hope for a permanent solution to controlling the pandemic. Several
coronavirus disease (COVID-19) vaccines are currently in human trials. However, to be effective, a
vaccine must be accepted and used by a large majority of the population. This study aimed to investigate
the acceptability of COVID-19 vaccines and its predictors in addition to the attitudes towards these
vaccines among public. This study did an online survey during the period June-September 2020, were
collected from 26,852 individuals aged 19 years or older across six continents as part of 60 nationally
representative surveys to determine potential acceptance rates and factors influencing acceptance of a
COVID-19 vaccine. Results revealed that two-thirds of respondents were at least moderately worried
about a widespread COVID-19 outbreak. Differences in acceptance rates ranged from almost 93% (in
Tonga) to less than 43% (in Egypt). Respondents reporting higher levels of trust in information from
government sources were more likely to accept a vaccine and take their employer’s advice to do so.
Systematic interventions are required by public health authorities to reduce the levels of vaccines’
hesitancy and improve their acceptance. These results and specifically the low rate of acceptability is
alarming to public health authorities and should stir further studies on the root causes and the need of
awareness campaigns. These interventions should take the form of reviving the trust in national health
authorities and structured awareness campaigns that offer transparent information about the safety and
efficacy of the vaccines and the technology that was utilized in their production.
Keywords: Novel Coronavirus, COVID-19, pandemic, outbreak, vaccine, knowledge, attitude,
acceptance
1
Corresponding Author Email: drkaziabdulmannan@gmail.com2
INTRODUCTION contributed to increased worry about the
virus (Han et al 2006). These findings
Vaccines are a key strategy to stop the speak to the importance of distributing
escalation of the COVID19 pandemic. As accurate health information about
of April 8, 2020, there were more than 100 COVID-19 through a variety of sources
COVID-19 vaccine candidates being (news, social media, and government
developed (Pogue et al 2020). This websites) to reach the general population
vaccine development is proceeding at a and correct misinformation.
fast pace; prior to March 30, 2020, two
vaccine candidates had entered Phase 1 The effect of media exposure may be
clinical trials (Lurie et al 2020) while on related to the provision of important health
April 9, five vaccine candidates in total information about the pandemic. Although
were in Phase 1 clinical trials (Thanh Le et media exposure early in the outbreak
al 2020). Understanding vaccine appears to have facilitated health-
acceptance is important, given the large protective behaviors, media fatigue—
population and because it has relatively where people become desensitized to
high vaccine hesitancy for existing ongoing messaging—may reduce this
vaccines and relatively low vaccination effect as the pandemic continues
coverage (van Doremalen et al 2020; (Collinson et al 2015). Repeated media
Harapan et al 2019). Characterizing how exposure may also lead to heightened
vaccine efficacy could impact acceptance stress and anxiety, which can have longer-
is also important, given that actual or term health effects, as well as contributing
perceived vaccine efficacy could be to excessive or misplaced health-
relatively low. protective behaviors such as presenting for
diagnostic testing when actual risk of
The high usage of news media is exposure is low (Garfin et al 2020).
concerning given the potential for
alarming, sensationalist portrayals of the Emerging evidence from groups with
pandemic (Klemm et al 2016). In addition, widespread testing for the SARS-CoV-2
myths, rumors and misinformation can virus indicates that between 2 and 8 out of
quickly spread online, particularly via every 10 infections may be asymptomatic
social media (Vosoughi et al 2018). (Mizumoto et al 2020; Nishiura et al
Reliance on social media might have 2020). Despite being asymptomatic, those
contributed to uncertainty around COVID- infected are still able to transmit the virus
19, for example, about whether people to others (Bai et al 2020; Zou et al 2020).
have natural immunity and whether In addition, people appear to be infectious
specific home remedies (garlic, vitamins, and asymptomatic during the incubation
and rinsing noses with saline) help protect period (Lauer et al 2020). People
against coronavirus. It may also explain commonly rely on symptoms to indicate
some uncertainty around whether the virus illness and assume that the absence of
was human-made and deliberately symptoms means they are well
released. Uncertainty and rapidly (Diefenbach & Leventhal 1996). Such
changing information may have assumptions in the COVID-19 pandemic3
could have serious consequences, in terms getting infected or transmit the disease to
of both community transmission and others (Blakey & Abramowitz 2017), but
reduced health-protective behaviors. they suffered societal and economic
Therefore, public health communication concerns due to the measures that were
campaigns about COVID-19 need to undertaken by the governments to confine
address these misconceptions. the pandemic and stopping the human-
human transmission of the disease (Nicola
There is an evident uncertainty clouding
et al 2020). These measures include
the COVID-19 vaccines. Firstly, the new
enforcement of curfews and lockdowns
mRNA-based vaccines as a novel
(the largest throughout history), social
technology could be received with some
distancing and self-isolation, schools and
skepticism since no prior experience or
universities closures, borders’ shutdowns,
successes with such approach have been
travel restrictions, and quarantine
reported in the past. Also, the speed of
(Mannan & Farhana 2020; Nicola et al
vaccine development and registration in
2020).
less than a year may have mediated a role
in lowering the acceptance level. Another LITERATURE REVIEW
global phenomenon that negatively
contributed to such a low level is the Holingue et al showed in a population-
numerous campaigns launched by anti- based study of US adults that the fears and
vaccinationists fueled by the new anxiety of getting infected with and die
technology and short span of vaccine from COVID-19 were associated with
development. Such campaigns on social increased mental distress (Holingue et al
media with fabricated, false, and 2020). Moreover, the personal hygienic
sometimes misleading translations feed precautions that were undertaken by
the conspiracy beliefs of some people. individuals to avoid infecting others had
Some factors that are specific to the increased the probability of becoming
country and the region could also play a mentally distressed (Holingue et al 2020).
role in this. For example, there is a sector A systematic review and meta-analysis of
of the public who had their trust shaken in the psychological and mental impact of
local authorities and/or disapprove the COVID-19 showed that the prevalence of
overall handling of the pandemic. Some anxiety and depression was 33% and 28%,
people expresses their frustration as many respectively (Luo et al 2020). During the
decisions could be unwelcomed, COVID-19 pandemic, people used
disproportional with the pandemic status, multiple information resources to gain
not justified or backed with science. knowledge and health information about
the disease, including television, radio,
COVID-19 pandemic as with other newspapers, social media, friends, co-
previous pandemics is associated with workers, healthcare providers, scientists,
feelings of fears, anxiety, and worries governments, etc. (Ali et al 2020). Since
(Blakey & Abramowitz 2017; Wheaton et such information sources can shape
al 2012). However, it is unique in terms peoples’ acceptance or refusal of COVID-
that people are not worried only about 19 vaccines[44], it is crucial to4
disseminate transparent and accurate 2011; Jarrett et al 2015). The numerous
information about vaccines' safety and surveys, focus groups, in-depth qualitative
efficacy to gain the trust of the population research, and large scale digital media
especially the hesitant and skeptical ones analytics (Larson et al 2016; 2015; 2014),
(Siegrist, & Zingg 2014). Hence, gaining as well as convened expert roundtables
an understanding of the resources that and workshops to understand context
people trust the most to get information specific attitudes to vaccines among the
about COVID-19 vaccines is critical for general public (Larson et al 2018; 2016),
the success of any future national health-care professionals and providers
vaccination campaign. (Larson et al 2018), and pregnant women
(Wilson et al 2015). It continues to
In a further study, COVID-19 vaccine
research the roots, trends, and impacts of
acceptance among college students in
vaccine confidence issues at national and
South Carolina was found to be affected
supranational levels to inform policy and
by the information resources. Students
trust-building activities and mitigate the
largely trusted scientists (83%), followed
need for crisis management in
by healthcare providers (74%), and then
immunisation programmes.
health agencies (70%) (Qiao et al 2020). In
a study from France, vaccination practices These studies have focused that a
and acceptance toward MMR and HBV multiplicity of factors influencing vaccine
vaccines were better when parents had decisions (SAGE 2014), key drivers of
reported getting the information from their public confidence in vaccines were
healthcare providers compared with identified as trust in the importance,
parents getting information from the safety, and effectiveness of vaccines,
internet or their relatives (Charron et al along with compatibility of vaccination
2020). Recent research from China with religious beliefs (Larson et al 2015).
indicates that engaging in hand hygiene These findings have resulted in the
and other health protective behaviors was development of a Vaccine Confidence
associated with reduced psychological Index survey tool to measure individual
impact of the COVID-19 outbreak, perceptions on the safety, importance,
including lower stress and anxiety (Wang effectiveness, and religious compatibility
et al 2020). These findings highlight the of vaccines. The research questionnaire
importance of encouraging the public to has the primary focus of measuring
engage with such behaviors not only to confidence across multiple countries while
reduce the risk of infection but also to being minimal, thus allowing ready
reduce anxiety associated with COVID- integration into existing global surveys.
19. The survey is one of a diverse set of
metrics and indices used to measure
Over the past decade, it has
confidence or hesitancy such as the Parent
comprehensively explored the landscape
Attitudes About Childhood Vaccines
of vaccine confidence issues and
Survey, which measures vaccine hesitancy
experiences in managing confidence crises
among parents (Opel et 2013); the
around the world (Larson et al 2018; 2014;
Vaccination Confidence Scale, which5
measures confidence in adolescent the HPV vaccine (Simms et al 2020). As a
vaccination (Gilkey et al 2014); the 5-C result of this vaccine safety scare, HPV
scale such as confidence, complacency, vaccination coverage decreased from
constraints, calculation, and collective 68•4–74•0% in the 1994–98 birth cohort to
responsibility, which identifies 0•6% in the 2000 birth cohort.36 The news
psychological barriers of vaccination of Japan suspending their proactive
behavior (Betsch et al 2018); and the recommendation of the HPV vaccine has
SAGE Vaccine Hesitancy Scale, which travelled globally through online media
has been deployed across multiple and social media networks, being
countries (Wagner et al 2019; Shapiro et al applauded by ant vaccination groups but
2018; Domek et al 2018; Masters et al not by the global scientific community
2018; Ren et al 2018). (Larson et al 2014).
In 2017, the vaccine manufacturer Sanofi Moreover, Indonesia witnessed a large
announced that their newly introduced drop in confidence between 2015 and
dengue vaccine Dengvaxia posed a risk to 2019, partly triggered by Muslim leaders
individuals who had not previously been questioning the safety of the measles,
exposed to the virus, prompting outrage mumps, and rubella (MMR) vaccine, and
and panic across the population where ultimately issuing a fatwa—a religious
nearly 850 000 children had been given the ruling—claiming that the vaccine was
new vaccine the previous year. As the haram and contained ingredients derived
research measured a baseline confidence from pigs and thus not acceptable for
value in 2015, that were able to measure Muslims. Local healers promoting natural
the change in confidence following the alternatives to vaccines also contributed to
vaccine scare and found a significant drop the waning confidence in vaccines
in confidence in vaccine importance, (Rochmyaningsih 2018; Yufika et al
safety, effectiveness (Larson et al 2019). 2020). In addition, In South Korea and
The survey study tool has detected a rise in Malaysia, online mobilization against
confidence across the country—although vaccines has been identified as a key
confidence is not back to 2015 levels— barrier to vaccination (Wong et al 2020;
indicating a possible recovery and Chang & Lee 2019). In South Korea, an
highlighting the value of the tool in online community named ANAKI
assessing the effectiveness of national- (Korean abbreviation of ‘raising children
level policy. without medication’) has been strongly
advocating against childhood
Japan ranked among the countries with the
immunization (Park et al 2018). The
lowest vaccine confidence in the world:
internet is a main source of vaccination
this might be linked to the human
information in Malaysia, where
papillomavirus (HPV) vaccine safety
misinformation has been identified as
scares that started in 2013, and following
influencing vaccine reluctance (Mohd
the decision by the Japanese Ministry of
Azizi et al 2017). In Georgia, unfounded
Health, Labour and Welfare in June, 2013,
vaccine safety concerns, amplified by the
to suspend proactive recommendation of
media, were found to profoundly affect a6
nationwide MMR vaccine campaign in framing their risk perception. In addition,
2008 (Khetsuriani et al 2010). less social media use might also be
associated with less knowledge among the
Furthermore, other studies in Asia have
elderly and this could affect their
found that perceived risk or perceived
perceived risk and vaccine acceptance.
susceptibility to an infection is associated
with positive support for vaccination METHODOLOGY
(Rajamoorthy et al 2019; Rajamoorthy et
al 2018; Sundaram et al 2015). Another Due to limitations in doing face-to-face
study also found that high perceived risk research during the current active COVID-
was associated with COVID-19 vaccine 19 outbreak, this study did an online
acceptance among general community survey during the period June-September
members in Saudi Arabia (Padhi & 2020, were collected from 26,852
Almohaithef 2020) and among HCWs in individuals aged 19 years or older across
China (Fu et al 2020). Low perceived risk six continents as part of 60 nationally
may not only be correlated with vaccine representative surveys. This grouped
acceptance, but also adherence to social countries and territories by WHO regional
distancing measures and other public classification. Online, and telephone
health countermeasures. These survey methodologies were used. In
relationships may be complicated—for addition to probing individuals’
example, an individual highly compliant knowledge, attitude and acceptances on
with social distancing measures may vaccine confidence across the globe, the
perceive their risk to be low but still want study was also surveyed individuals on a
to obtain a vaccine. Lower vaccine range of factors including sources of trust,
acceptance among the retired population and information-seeking behaviours. The
might be influenced by lower perceived surveys were weighted by sex and age
risk. Although the elderly are more according to national distributions, with
vulnerable to COVID-19, most of the equal sex representation in most surveys.
retired population in Southeast Asian The questionnaire used in this study was
countries have low mobility and spend developed based on literature review and
more time at home with less travel. These discussion within the research team. The
behaviors may lead them to having a lower questionnaire was reviewed by experts in
perceived risk of being infected with survey research for face validity.
SARS-CoV-2, and eventually may lead to Participants were asked to indicate if they
lower acceptance of a vaccine. Moreover, were infected with COVID-19 or knew
their acceptance might also be influenced anyone who was infected with
by knowledge about the disease. Much of confirmation of diagnosis using standard
the information about COVID-19 is spread laboratory testing protocols. Another
through social media or online media, question item was dedicated to surveying
which is less frequently accessed by older participants who believe they may have
adults. Therefore, older adults might have contracted the virus but without a
less exposure to information about confirming test. Participants were asked to
COVID-19 that could contribute to7
indicate their most trusted sources when regression was performed. In the binary
seeking knowledge of COVID-19 logistic regression model, the participants
vaccines. Besides, participants were asked were dichotomized as acceptable or not
about their concerns during the COVID-19 acceptable. In both models, the odds ratio
pandemic. Participants were asked (OR) values and their 95% confidence
whether they accept to receive COVID-19 intervals (95% CI) were calculated. A p-
vaccines when they are approved and value of less than .05 was considered
available. The attitudes towards COVID- statistically significant. The analysis was
19 vaccines’ section consists of 10 carried out using the Statistical Package
statements with a 5-point Likert scale for Social Sciences (SPSS).
(5=strongly agree, 4=agree, 3=neutral,
To assess knowledge, participants were
2=disagree, 1=strongly disagree), with
asked to respond to a series of statements
questions about hesitancy and concerns
about the COVID19 coronavirus and
regarding COVID-19 vaccines.
whether these statements were true or false
Categorical variables were presented as
or they were unsure of the answer (Farhana
numbers and percentages, while
& Mannan 2020). Correctly answered
continuous variables were presented as
items were summed to generate a general
median.. The univariate analysis was
virus knowledge subscale score.
performed using an independent Mann–
Participants were asked to identify the
Whitney U test for continuous variables
most common symptoms of COVID-19
and Chi-square test for categorical
infection, based on information provided
variables as appropriate. For analysis,
to the public at the time: fever, cough, sore
responses to the attitudes section were
throat, and shortness of breath. More
combined.
recent information includes fatigue or
The main outcome of the study was the tiredness, which were not included in the
public acceptance of COVID-19 vaccines. survey. Three uncommon symptoms were
To determine the factors that affect the included: diarrhea, vomiting, and nausea
acceptance of the population to receive (Guan et al 2020). The number of correctly
COVID-19 vaccines, both multinomial answered items was summed to generate a
and binary logistic regressions were symptoms knowledge subscale score.
performed. At first, potential predictors for Transmission knowledge items asked
COVID19 vaccines were screened using about the ways the virus can potentially be
univariable analysis, and variables with spread, including droplets spread through
p8
item assessed knowledge of recommended complete few questions. Firstly, they were
face mask use, with advice to the public at a single-item measure assessing their self-
that time being that only people who were rated heath (Idler & Benyamini, 1997),
sick should be wearing masks to stop them with responses on Likert scale. Secondly,
spreading the virus. respondents were an item assessing
whether they had received a flu vaccine in
RESULTS AND DISCUSSIONS the previous year (yes, no, don’t know).
Information was collected on participants’ For the purposes of analysis, no and don’t
age group, gender, ethnicity, highest level know responses were combined to form a
of education, and region of residence dichotomous measure. Finally,
around six continents as shown in Table participants were asked whether they, or
1.1. Participants were also asked to any family members or friends, had caught
COVID-19 (yes, no, and don’t know).9
Table 1.1 Demographic characteristics of the sample with number (percentage) of
respondents
Respondents were asked to a series of routes of transmission. The percentage of
true–false questions to assess their more true, false, and don’t know responses can
general knowledge of COVID-19. be seen in Table 1.2. Total general virus
Knowledge questions were also asked knowledge subscale scores ranged from 1
relating to most common symptoms and to 16.10
Table 1.2 Percentage of true, false, and unsure responses to general knowledge
Respondents were more accurate in commonly mentioned in public health
recognizing the symptoms that have been information provided to the public at this
linked with COVID-19 and less certain of time. Respondents typically recognized
whether the other symptoms were transmission routes associated with
indicative of illness. Symptoms droplet spread but were less certain of
knowledge subscale scores ranged from 1 whether the virus can also spread via air,
to 8. The subscale score was, indicating water, or insects. Transmission knowledge
good recognition of the symptoms subscale scores ranged from 1 to 6.11
Table 1.3 Percentage of yes, no, and don’t know responses to symptoms and
transmission
The results of the survey provide serious the symptoms of coronavirus
information on public knowledge in the would be, should they contract COVID-
early period of the COVID-19 pandemic. 19. There is a clear discrepancy between
Majority of respondents were at least respondents’ perceived severity of
moderately worried about the possibility symptoms and current data on rates of
of a widespread outbreak. These rates are asymptomatic infection. The results also
commensurate with past pandemics such provide insights into where residents are
as SARS (Bults et al 2011; Wheaton et al seeking their information about COVID-
2012). Recent research from China 19 and their level of knowledge about the
indicates that engaging in hand hygiene virus and is transmission. While it was
and other health protective behaviors was promising to see sourced information from
associated with reduced psychological official and government websites,
impact of the COVID-19 outbreak, mainstream news media was the most
including lower stress and anxiety popular, and social media use was also
(Mannan et al 2020; Wang et al 2020). high.
These findings highlight the importance of
This paper provided important insights
encouraging the public to engage with
into what participants expected in terms of
such behaviors not only to reduce the risk
how serious the symptoms of coronavirus
of infection but also to reduce anxiety
would be, should they contract COVID-
associated with COVID-19. This study
19. There is a clear discrepancy between
also provide important insights into what
respondents’ perceived severity of
participants expected in terms of how12
symptoms and current data on rates of of both community transmission and
asymptomatic infection. Very few reduced health-protective behaviors.
participants believed that they would Therefore, public health communication
experience no symptoms. In contrast, campaigns about COVID-19 need to
emerging evidence from groups with address these misconceptions.
widespread testing for the SARS-CoV-2
Majority (81.5%) of the participants were
virus indicates that between 2 and 8 out of
strongly agreed that it is important to get a
every 10 infections may be asymptomatic
vaccine to protect people from COVID-19.
(Mizumoto et al 2020; Nishiura et al
Besides, less than 59% of the participants
2020). Despite being asymptomatic, those
agreed that pharmaceutical companies will
infected are still able to transmit the virus
be able to develop safe and effective
to others (Bai et al 2020; Zou et al 2020).
COVID-19 vaccines. Moreover, about half
In addition, people appear to be infectious
of the respondents (51.6%) reported that
and asymptomatic during the incubation
side effects will prevent them from taking
period (Lauer et al., 2020). People
a COVID-19 vaccine and that 52.1% will
commonly rely on symptoms to indicate
refuse to take COVID-19 vaccines once
illness and assume that the absence of
licensed. Importantly, around a quarter of
symptoms means they are well
all respondents were neutral regarding
(Diefenbach & Leventhal, 1996). Such
most attitudes as shown in Table 1.4
assumptions in the COVID-19 pandemic
could have serious consequences, in terms
Table 1.4. Attitudes toward COVID-19 vaccines in percentage13
Further, the trust in the manufacturer that lowest proportion of responses from Egypt
provides effective and noncontaminated (43.55%) when asked if they would take a
products is another important determinant ‘when vaccine will available in your
of confidence. About two-thirds of country’. Participants from Asian
respondents in the current study had continent, China gave the highest
confidence in pharmaceutical companies proportion of positive responses (87.42 %)
to develop safe and effective COVID19 and the lowest proportion of responses
vaccines. However, the source of the from Afghanistan (47.22%) when asked if
vaccine affects the perceived safety, as they would take a ‘when vaccine will
only one-third of the participants in the available in your country’. Respondents
current study perceived that COVID-19 from Australian continent, Tonga gave the
vaccines that were manufactured in highest proportion of positive responses
Europe or America were safer than those (92.88%) and the lowest proportion of
made in other countries. This is rather responses from Fiji (87.21%) when asked
lower than the reported percentage by if they would take a ‘when vaccine will
Pogue and colleagues where ~55% and available in your country’. There was
36% of participants stated that they were considerable variation by country, with
more comfortable with vaccines made in Tonga from Australian continent again
the USA and Europe, respectively (Pogue having the highest proportion of positive
et al 2020). responses (92.88%) and the lowest
proportion of responses in Egypt (43.55
Respondents from African continent,
%) from African continent. The proportion
Mauritius gave the highest proportion of
of positive responses for all three
positive responses (82.76%) and the
continents can be found in Table 1.5
Table 1.5 COVID-19 Vaccine Acceptance in the Scale of Strongly Agreed in Africa,
Asia and Australia Continents
Respondents from North American would take a ‘when vaccine will available
continent, Panama gave the highest in your country’. Participants from South
proportion of positive responses (87.44%) American continent, Brazil gave the
and the lowest proportion of responses highest proportion of positive responses
from Canada (62.55%) when asked if they (86.24%) and the lowest proportion of14
responses from Paraguay (67.66%) when country’. There was considerable variation
asked if they would take a ‘when vaccine by country, with Panama from North
will available in your country’. American continent again having the
Respondents from European continent, highest proportion of positive responses
England gave the highest proportion of (87.44%) and the lowest proportion of
positive responses (69.33%) and the responses in Russia (51.34%) from
lowest proportion of responses from African continent. The proportion of
Russia (51.34%) when asked if they would positive responses for all three continents
take a ‘when vaccine will available in your can be found in Table 1.6
Table 1.6 COVID-19 Vaccine Acceptance in the Scale of Strongly Agreed in North
America, South America and Europe Continents
Our findings provide insights into the et al 2016). In contrast to previous
demographic behaviors in the early stages research, perceived likelihood and severity
of a pandemic disease outbreak. The of infection were only marginally
results of this study shed light on how associated with intentions to get a vaccine
many respondents plan to get a COVID-19 (Weinstein et al 2007; Bish & Michie
vaccine if available. Concern about the 2010). Previous research has typically
outbreak, greater media exposure, and focused on personal risk. In the case of
higher knowledge predicted vaccination COVID-19, the personal risk to most
intentions. These findings are in line with individuals is low, and behavior may be
previous research showing that concern driven primarily by perceived risk to
and knowledge were associated with others, which was not assessed in the
increased Ebola vaccine intentions (Petrie current study.15
Table 1.7 Predictors of likelihood of getting vaccinated against COVID-19 if a vaccine
becomes available
The current study is strengthened by a and risk variables that predict health
large sample size and a good behaviors and vaccine intentions, they
representation of participants from cannot establish causality and must be
different educational backgrounds from interpreted with caution. Given the large
the world. Respondents were recruited sample, the relationships between some of
through Social Network and as such are the significant predictors are likely to be
not representative of the general small and may not be clinically
population. The pattern of results may be meaningful.
generalize to the broader population. To
The current results provide information on
maximize convenience sampling, we used
the public responses to the COVID-19
solely self-report measures, which may
pandemic, including information sources
lead to biased effects. While the results of
and engagement, knowledge, and vaccine
the regression analyses provide interesting
intentions. The findings show that there
starting points to identify the demographic
was a critical mismatch between expected16
severities of symptoms versus data on how concerns about the vaccine once it being
COVID-19 is experienced, which needs to available as indicated by their concerns
be addressed in government education about related side effects. This is
campaigns. Without a vaccine currently consistent with Pogue and colleagues
available, encouraging widespread and finding where the majority of participants
sustained engagement with hygiene and (~63%) in the USA stated that they were
distancing behaviors is critical to worried about the side effects of the
successfully manage the COVID-19 COVID-19 vaccines (Pogue et al 2020).
pandemic, flatten the curve of infections, Most of the participants in the current
and protect vulnerable individuals and study stated that receiving the vaccine is
overburdened healthcare systems. The important to protect against COVID-19.
results of the current study provide However, almost half of them agreed that
important insights into psychological and most people would refuse to take the
behavioral responses early in the outbreak vaccine. This discrepancy could be due to
of this COVID-19. The findings point to their concerns about the vaccine’s side
types of information that may be effects. Our results supported such
particularly effective and groups that may perceived viewpoints, where those who
benefit from clear and targeted messaging did not believe in a conspiracy behind
to promote engagement with health- COVID-19 were more likely to accept
protective behaviors. COVID-19 vaccines. An important factor
to consider when exploring vaccine
Vaccine hesitancy could threaten the
acceptability is vaccine convenience in
efficiency of COVID-19 vaccines once
terms of its availability and affordability
they become commercially available
(MacDonald 2015).
worldwide (French et al 2020). There are
contrasting reports of gender effects in the CONCLUSION
literature, wherein some males were more
likely to accept the vaccine (Malik et al The determinants of vaccine uptake across
2020), compared to others reporting higher the globe show strong consistency, with
acceptance among females (Lazarus et al being male or having fewer years of
2020; Al-Mohaithef & Padhi 2020). In our education associated with decreased
study, males were more likely to take the chances of uptake. Positive information-
vaccine, in agreement with studies seeking behaviours and trusting health-
reported elsewhere (Malik et al 2020). care workers more than other sources such
Interestingly, males were more likely to as one’s social circle for medical and
participate in COVID-19 vaccine clinical health advice were associated with
trials compared to females in 2020 (Abu- increased chances of uptake. Results from
Farha et al 2020). The low acceptance our survey can inform the need for further
level of COVID-19 vaccines among them research, to explore why certain countries
can be attributed to multi factors, some of might experience sudden increases or
which are shared with the wide global decreases in confidence. We have
community. The current study revealed highlighted countries with marked
that half of the participants had safety decreases in percentages reporting that17
they strongly agree that vaccines are safe comparison is crucial to understanding
and countries with significant increases in these changing trends over time, which
those strongly disagreeing that vaccines can serve as an early warning system to
are safe. These countries are candidates for prompt needed intervention to avert drops
more nuanced follow-up surveys to in vaccine confidence and acceptance.
understand the precise drivers of
confidence and the link between Declaration of Conflicting Interests
confidence and uptake. The author declared no potential conflicts
of interest with respect to the research,
There is a study limitation to note. As not
authorship, and/or publication of this
all surveys used have consistent responses,
article.
we have made a key assumption that,
presented with different options between Funding
the extreme categories of “strongly agree”
and “strongly disagree” (which are Project Funded by Migration Research
consistent across all surveys), respondents Development and Society of Bangladesh
with the strongest sentiment will fall into (MRDSB)
one of these extreme groups regardless of
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