COVID-19 vaccine acceptance and its determinants: A cross-sectional study among the socioeconomically disadvantaged communities living in Delhi, India

COVID-19 vaccine acceptance and hesitancy in Indian context: a systematic review and meta-analysis

Vaccination against COVID-19 is vital for achieving herd immunity, and the Government of India has adopted several strategies to achieve coverage. Vaccine hesitancy was identified as a potential obstacle in combating COVID-19. This study aimed to review the COVID-19 vaccine acceptance and hesitancy, and factors associated with vaccine hesitancy based on studies conducted in Indian populations. The data sources (PubMed, Scopus, and Google Scholar) were searched by following PRISMA guidelines, and the search was done in September 2022. We performed a meta-analysis through a random effect model to estimate pooled hesitancy rate with 95% confidence intervals (CI). A total of 3,339 records were searched, of which 46 studies were found to be eligible for inclusion in the review. The included studies covered 65,551 respondents, 55% were female. Studies reported COVID-19 vaccine acceptance rate of 65.7% in January-February 2021, which increased to 92.8% in May-August 2021. Likewise, the rate of vaccine hesitancy in December 2020 was 37%, dropping to 12.1% through November 2021. The estimated pooled COVID-19 vaccine hesitancy was 31% [95% CI: 27% - 36%, I2 = 99.3%]. Most studies highlighted that fear of the vaccine's side effects, efficacy, and safety were major barriers to vaccine acceptance. However, as the review indicates, it is important to consider and address all factors contributing to vaccine hesitancy.

Integrating health belief model and theory of planned behavior to assess COVID-19 vaccine acceptance among urban slum people in Bangladesh

INTRODUCTION

The vaccination against coronavirus disease 2019 (COVID-19) has been identified as a promising strategy to reduce the severity of the pandemic. Despite the safe and effective COVID-19 vaccines, bringing socioeconomically disadvantaged people under vaccination coverage has been challenging for developing countries like Bangladesh. Therefore, this study explored the determinants of vaccine acceptance among urban slum residents of Bangladesh using the Health Belief Model (HBM) and Theory of Planned Behavior (TPB).

METHODS

A face-to-face survey of 400 urban slum dwellers in two large cities in Bangladesh was conducted between July 5 to August 5, 2021. The questionnaire included vaccine acceptance, socio-demographics, health-related characteristics, trust in health authorities, reasons for vaccine hesitancy, and dimensions of HBM and TPB frameworks. Hierarchical logistic regression was performed to evaluate the association between these characteristics and vaccination acceptance.

RESULTS

Around 82% (n = 327) of respondents were willing to accept the COVID-19 vaccine. In a fully adjusted model, respondents with secondary level education had higher intention (OR = 46.93, 95%CI = 1.21-1807.90, p < 0. 05) to accept COVID-19 vaccine. Respondents with bad (OR = 0.11, 95%CI = 0.01-0.35, p<0.05) or very bad (OR = 0.01, 95%CI = 0.01-0.35, p<0.05) health conditions were less interested in the COVID-19 vaccination. In regard to HBM dimensions, greater perceived susceptibility (OR = 1.75, 95% CI = 1.12-2.75, p < 0.05), and perceived benefits (OR = 3.28, 95% CI = 1.17-6.00, p < 0.001) were associated with a greater willingness to get vaccinated. In regard to TPB, higher self-efficacy in preventing illness without the vaccine increased the desire to get vaccinated (OR = 1.55, 95% CI = 1.02-2.37, p < 0.05). Fear of unknown side effects, religious beliefs, contraindications to vaccination, and insufficient information on the vaccine were the main reasons for vaccine hesitancy.

CONCLUSIONS

These findings offer valuable insights for policymakers in Bangladesh to design targeted interventions that address vaccine hesitancy and increase vaccination acceptability among socially disadvantaged individuals in urban areas. Strategies should focus on providing accurate and accessible information about the vaccine, communicating its positive impact effectively, engaging with religious leaders to address misconceptions, and tailoring vaccination campaigns to meet the unique needs of different demographic groups.

Acceptance of COVID-19 Vaccines in India: A Systematic Review and Meta-Analysis

This systematic review and meta-analysis sought to evaluate the acceptability levels for COVID vaccine(s) in various states in India. Published articles in PubMed/Scopus/Cochrane/DOAJ/the Web of Science that focused on assessing COVID-19 vaccine hesitation/vaccine acceptance using a survey/questionnaire were included. After extensive research, 524 records were found, and after screening on the basis of eligibility criteria, only 23 papers were added to this review. Increased vaccine assumption percentage (>70%) among the population was found in two surveys nationwide (92.8%) and in Delhi (79.5%). For pooled estimates of COVID-19 vaccine acceptance and heterogeneity, twenty-three studies (23) consisting of 39,567 individuals reported for acceptance of COVID 19 vaccine in India.. Out of these, 26,028 individuals accepted the COVID-19 vaccine, giving a pooled estimate of 62.6% (95% CI: 55.6-69.4) with considerable heterogeneity (χ² = 3397.3, p < 0.0001; I² = 99.40%). The results of this study give a brief insight into the percentage acceptance and hesitancy among the Indian population regarding COVID-19 vaccine immunisation. Future research and vaccine education initiatives can be steered by the findings of this work as a starting point.

COVID-19 vaccination acceptance in underserved urban areas of Islamabad and Rawalpindi: results from a cross-sectional survey

BACKGROUND

Urban slums are home to a significant number of marginalized individuals and are often excluded from public services. This study explores the determinants of willingness and uptake of COVID-19 vaccines in urban slums in Pakistan.

METHODS

The study uses a cross-sectional survey of 1760 respondents from five urban slums in twin cities of Rawalpindi and Islamabad carried out between June 16 and 26, 2021. Pairwise means comparison tests and multivariate logistic regressions were applied to check the associations of socio-demographic factors and COVID-19 related factors with willingness to get vaccinated and vaccination uptake.

RESULTS

Only 6% of the sample was fully vaccinated while 16% were partially vaccinated at the time of survey. Willingness to receive vaccination was associated with higher education (aOR: 1.583, CI: 1.031, 2.431), being employed (aOR: 1.916, CI: 1.423, 2.580), prior infection in the family (but not self) (aOR: 1.646, CI: 1.032, 2.625), family vaccination (aOR: 3.065, CI: 2.326, 4.038), knowing of and living close to a vaccination center (aOR: 2.851, CI: 1.646, 4.939), and being worried about COVID-19 (aOR: 2.117, CI: 1.662, 2.695). Vaccine uptake was influenced by the same factors as willingness, except worriedness about COVID-19. Both willingness and vaccination were the lowest in the two informal settlements that are the furthest from public facilities.

CONCLUSIONS

We found low lived experience with COVID-19 infection in urban slums, with moderate willingness to vaccinate and low vaccination uptake. Interventions that seek to vaccinate individuals against COVID-19 must account for urban poor settlement populations and overcome structural barriers such as distance from vaccination services, perhaps by bringing such services to these communities.

Factors associated with COVID-19 vaccine hesitancy: a community-based household survey in Pune district of Maharashtra, India

Background

In the wake of the coronavirus (COVID-19) pandemic, the development of the COVID-19 vaccine became a game-changing tool. However, the rapid development of the COVID-19 vaccine gave rise to various myths, misconceptions and hesitancies among people.

Methods

A community-based household survey was conducted by the trained healthcare workers, i.e., Accredited Social Health Activist (ASHA) and Anganwadi Worker (AWW) in their respective villages. Information on socio-demographic profile, vaccination status and reasons for vaccine hesitancy in community members was collected during the survey. Details of the vaccination status of community members were cross-examined with government vaccination data. After survey administration, continuous sensitisation to every individual was carried out by trained healthcare workers making people aware and motivating them to vaccinate. Healthcare workers constantly followed up on individuals showcasing hesitancy, thereby building up vaccine confidence in them.

Results

Out of the total study population (N=12,812), 90.1% were found eligible for COVID-19 vaccination (>18 years), 57.8% individuals had received both doses of COVID-19 vaccine, and 23.2% had received only the first dose (partially vaccinated), whereas 9.1% were unvaccinated. The most reported vaccine hesitancy response was being worried about vaccine side effects at 9.2%. The other set of reasons reported among aged 60 years and above were being old (1.6%) and having a co-morbid condition (1.1%). Having an underlying illness was also reported in both age groups (45-60 years, and 60 years and older). Additionally, 18.2% of the unvaccinated and partially vaccinated eligible individuals reported planning to get vaccinated soon.

Conclusions

The study reported many myths and misconceptions, and hesitancies related to the COVID-19 vaccine among the community members being a major lag in the vaccine acceptance and uptake. Therefore, adequate vaccine education is much needed to engage the non-medical group, as they mostly tend to have positive interactions with the community members. On that account, sustained community-based health promotion intervention can be effective.