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| ORIGINAL ARTICLE |
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| Year : 2022 | Volume
: 3
| Issue : 3 | Page : 63-67 |
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Vaccine hesitancy and risk perception among health-care workers in a tertiary hospital in North-East India
Bishwalata Rajkumari, Avinash Keisam, Ningthoukhongjam Shugeta Devi, Samurailatpam Priyanka Devi, Regina Wahengbam, Mangvung Mangboi Haokip
Department of Community Medicine, Jawaharlal Nehru Institute of Medical Sciences, Imphal, Manipur, India
| Date of Submission | 01-Oct-2021 |
| Date of Acceptance | 05-Feb-2022 |
| Date of Web Publication | 14-Sep-2022 |
Correspondence Address:
Dr. Avinash Keisam
Department of Community Medicine, JNIMS, Porompat, Imphal East-795005, Manipur
India
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/jphpc.jphpc_28_21
Context: Vaccine hesitancy is an important threat to public health and a major setback for achieving herd immunity especially during the COVID 19 pandemic. Health-care workers are a major reckoning force in making the vaccines acceptable to the general population and the question is why there is vaccine hesitancy among them. Aims: The study plans to determine the reasons of vaccine hesitancy among health-care workers and to assess the association between their risk perception and variables of interest. Settings and Design: A cross-sectional study was conducted among doctors, nurses and other support staff in a tertiary hospital in North-East India, who were hesitant to take the vaccine when it was their turn. Methods and Material: Using convenience sampling method, data collection was done using a pre-tested interview schedule after obtaining informed verbal consent. Ethical clearance was obtained from the Institutional ethics committee. Statistical analysis used: Descriptive statistics like Mean, SD and percentages were used. Chi-square and Fisher's exact tests were used for association. Results: There were 160 participants out of which 30 (18.8%) had low risk perception of COVID-19 infection. Three (1.87 %) of the respondents said they were never going to be vaccinated against the disease and 59 (36.87%) said they may get the vaccine maybe at a later date. While 56 (35%) of the individuals were scared of common AEFI's like fever, chills and rigor; 21 (13.12%) were scared of unknown side effects. Fifteen percent of the respondents had trust issues with the vaccines. Conclusions: Though majority of the respondents had high-risk perception of COVID-19 infection, but almost one-sixth had trust issues with the vaccine. Trust building for the vaccine and information, education, and communication must be in the forefront for making the vaccination drive a success.
Keywords: COVID-19, health-care providers, hesitancy, vaccine
How to cite this article:
Rajkumari B, Keisam A, Devi NS, Devi SP, Wahengbam R, Haokip MM. Vaccine hesitancy and risk perception among health-care workers in a tertiary hospital in North-East India. J Public Health Prim Care 2022;3:63-7 |
How to cite this URL:
Rajkumari B, Keisam A, Devi NS, Devi SP, Wahengbam R, Haokip MM. Vaccine hesitancy and risk perception among health-care workers in a tertiary hospital in North-East India. J Public Health Prim Care [serial online] 2022 [cited 2023 Mar 26];3:63-7. Available from: http://www.jphpc.org/text.asp?2022/3/3/63/354818 |
| Introduction | |  |
Vaccine hesitancy refers to delay in acceptance or refusal of vaccination despite the availability of vaccination services. Vaccine hesitancy is complex and context-specific, varying across time, place, and vaccines. It is influenced by factors such as complacency, convenience, and confidence.[1] Risk perception is the perception of risk by the community to any situation they are exposed to and their understanding and response to risk in terms of behavior for tackling the situation.[2] With the country reeling under the second wave of COVID-19, a critical step in extinguishing the pandemic will be vaccination of a high proportion of the population with vaccines that have high levels of effectiveness.[3] COVID-19 vaccination has been launched in India from January 16, 2021 with the vaccines being provided in a phase-wise manner with either of the two vaccines approved for restricted emergency use.[4] As of June 5, 2021, a total of 180,972,102 persons constituting 13.3% of the population have received at least one dose of the vaccine and 44,599,042 individuals have received 2 doses constituting 3.3% of the population in India. For Manipur state, as of June 7, 2021, a total of 435,172 constituting 15.2% of the population have received at least one dose and 80,952 constituting 2.83% have received two doses of the COVID-19 vaccine.[5],[6] With the vaccination drive completing almost 5 months since inception the coverage still remains very low. Various studies indicate that vaccine compliance remains variable and inconsistent.[7],[8],[9],[10],[11],[12] The question rises why people are reluctant to get vaccinated. Is it that they doubt the vaccine efficacy or due to the rumors going around in social media platforms or due to its presumed side effects or is it because of their low-risk perception of COVID-19 or due to some other reason? The Government of India has stated that vaccine hesitancy is a globally accepted phenomenon and it should be addressed by scientifically studying the issue at the community level.[13],[14] Health-care workers are at the forefront of fighting the pandemic and it has been reported that the risk for COVID-19 infection is much higher among frontline health-care workers compared with the general community.[15],[16],[17] This study plans to estimate the risk perception of the health-care worker population to COVID-19 and explore the reasons for vaccine hesitancy as well as identify the issues and challenges faced by the health-care providers, which may help, in identifying suitable strategies for enhancing vaccine uptake.
| Subjects and Methods | | |
This cross-sectional study was conducted from April 2021 to June 2021, among the unvaccinated health-care workers in a Tertiary Care Medical Institution in Manipur, North-east India. Refusals to participate and unavailability on two contacts were excluded from the study. Details of unvaccinated health-care workers were obtained from the vaccination registration list of the institution with permission from the site in charge.
Sample size and sampling
Using a prevalence of vaccine hesitancy of 72.3%[18] and at 95% precision with an absolute error of 7%, the calculated sample size was found to be 157 rounded off to 160. Eligible study participants were sequentially recruited using the convenience sampling method till the required sample size is reached.
Study tool and technique
The study tool used was a pretested semi-structured interview schedule. The questionnaire comprised of domains such as sociodemographic variables, history of the presence of co-morbidities, opinion on statements about COVID-19 and its vaccination based on a 5-point Likert scale ranging from strongly disagree to strongly agree, and the reasons for vaccine hesitancy. Questions were asked for reasons of vaccine hesitancy and their opinion to increase vaccine acceptance for which multiple answers were allowed.
Statistical analysis
Data analysis was performed in IBM SPSS software version 22 (IBM Corp., Armonk, NY, USA). Descriptive statistics such as mean, standard deviation, and proportions were generated. Chi-square and Fishers exact tests were performed to see the association between risk perception and variables of interest. A P < 0.05 was taken as a level of significance.
Ethical issues
The Institutional Ethics Committee approved the study with Proposal No. 298/15/2021_v 01 submitted on April 20, 2021. Verbal informed consent was taken. All collected data were coded and stored in password-protected computer files for maintaining anonymity and confidentiality.
| Results | | |
As of April 19, 2021, 1032 health-care workers were hesitant to take the vaccine out of which 160 participants who consented were recruited for the study. There was no refusal. The mean age of the participants was 28.44 ± 6.271. There were 12 currently lactating women with six having a child <6 months of age and none were currently pregnant. Only three (1.9%) of the respondents were current smokers.
Most of the respondents (61.9%) were of 19-28 years age group with majority (64.4) belonging to urban areas. Males (51.9%)were slightly more than females. Majority of them were doctors (87.5%), unmarried (72.5%), Hindu (62.5%), contractual workers (83.8%), and of average local built (91.9%) [Table 1].
[Table 2] shows that among the respondents 69 (43.2%) were of the opinion that too much fuss is made about the risk of coronavirus, 10 (6.2%) of them felt that they will be immune to coronavirus, 101 (63.2%) opined that coronavirus vaccination should be mandatory for everyone who is eligible, 21 (13.1%) felt that only people who are at risk of serious coronavirus illness should get vaccinated, 10 (6.3%) didn't believe the vaccine will protect them from coronavirus, 8 (5%) thought that a coronavirus vaccination could give them coronavirus infection and 14 (8.8%) felt that widespread coronavirus vaccination is just a way to make money for vaccine manufacturers. | Table 2: Opinion of the respondents on Coronavirus disease and COVID-19 vaccine
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Risk perception on Covid-19 was significantly higher among those hailing from rural areas 93% (p value = 0.005) and unmarried health workers 86.2% (p value = 0.009) [Table 3]. | Table 3: Association between risk perception and sociodemographic variables
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Fear of side effects was the main reason (41.8%) for vaccine hesitancy among the health-care workers. This was followed by busy schedule (16.2%), trust issue of new vaccine (15.6%) and not feel like taking vaccine (15%) [Table 4].
The respondents felt that people in general are not getting vaccinated for Covid-19 due to fear of side effects 83 (51.8%), trust issue 15 (9.4%), lack of awareness 15 (9.3%) etc [Table 5].  | Table 5: Response to why people in general are not getting vaccinated for COVID-19
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The vaccine side-effects of concerns by the respondents were mainly fever, chills and rigor 56(35%), anaphylaxis 27(16.8%), unknown ones 24(15.3%) and allergy 19(11.9%) [Table 6].
Majority of the respondents suggested that mass vaccination campaign 48 (30%) and awareness campaign 47 (29.40%) could improve COVID-19 vaccination coverage [Table 7]. | Table 7: Measures suggested by the respondents to improve COVID-19 vaccination coverage
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There was one case (0.6%) each of chronic kidney disease, chronic liver disease, hypertension, cancer; three cases (1.9%) of respiratory disease (asthma, chronic obstructive pulmonary disease, bronchitis, etc.); 23 (14.4%) participants had allergy/hypersensitivity condition.
Thirteen (8.1%) had any COVID-19-related symptoms like fever/shortness of breath/loss of smell and taste sensation in the past 6 months and 147 (91.9%) did not have any symptoms.
Twenty-four (15.0%) had ever tested positive for SARS-CoV-2 and 136 (85.0%) were never tested positive. Of the 160 individuals, 30 (18.8%) had a low-risk perception of COVID-19 infection and 130 (81.3%) had a high-risk perception of COVID-19 infection.
| Discussion | | |
The world is reeling under the pressure of COVID-19 pandemic. When the pandemic started, all the countries and WHO were trying to develop a vaccine against COVID-19. It was a race against time and the pharmaceutical companies were in a hurry to develop a vaccine against the disease. When a race starts and when the human feeling for the vaccine is that it has been developed in a hurry, a distrust for the vaccine develops along with the feeling that the people themselves will be the guinea pigs.[19] The strategy of lockdown and opening of lockdown measures to reduce the spread of the disease has been adopted by India for quite some time now. Such a strategy reduces the number of people who have the disease. However, this strategy implies that it relies on vaccination as the safest and most cost-effective way to achieve herd immunity. Herd immunity is going to be developed when at least 55%–82% of the people in the community are immunized.[20]
As prioritized by the government, health-care workers should be getting the vaccines in the first round. This helps in two ways. It ensures that the health workers do not get the disease so that the workforce remains in place and they do not spread the disease to other people who are sick and people who come with them provided they follow COVID safety protocols.[21]
Even after the government has given them priority to receive the vaccines, there are health-care providers who are still hesitant to get the vaccines. The problem when health-care workers do not vaccinate is that, for every other vaccination program before, the health-care workers have been the major driving force for spreading awareness and making other people believe in vaccination.
In our study, even though 81.3% of the individuals had a high-risk perception that they may get infected with COVID-19, they were still hesitant to take the vaccine at the first opportunity. In a study conducted by İkiışık et al., around 60.7% thought that COVID-19 disease was risky for their health.[22] Our study showed that 61.25% felt that they will definitely get the vaccine and 36.87% said that they may get the vaccine at a later date. In other studies, 54.7% to 58.5% declared that they would get the vaccine.[3],[7],[23] They may be waiting for other people to get the vaccine first and wait for reports of any side effects which is human nature. Fear of side effects was there in 41.87% of the respondents. Only 3 (0.03%) said that they won't be taking the vaccine at all. For them, they may have some deep-rooted beliefs against vaccines, which need to be explored further by doing qualitative studies. One-sixth of the health-care providers had trust issues with the vaccine, which may be because of the race for vaccine development and the rapidity by which the vaccines have been authorized for emergency use.
The health-care workers are of the opinion that, fear of side effects (51.87%) was the major reason that people, in general, were not going for vaccination and 9.37% felt that people had trust issues with the vaccine. While 9 (5.62%) said that people are relying on natural immunity to protect them from the disease. Another 9 (5.62%) of the individuals felt that there was a false media report or hyped-up risk. However, 6.87% of the respondents said that people who have underlying diseases or contra-indications are not likely to take the vaccines. In a study conducted by Ditekemena et al., among the 1821 participants not willing to receive a COVID-19 vaccine, the majority (60.6%) did not trust the vaccine, others (14.4%) believed that the vaccine is made to kill people in Africa, and 5.9% believed that the vaccine is made to sterilize people.[23]
Some of the measures suggested for improving the COVID-19 vaccination coverage were mass vaccination campaigns, awareness campaigns about the vaccine through media, social media, sharing of experience from vaccinated people, increase availability of vaccine, and increase accessibility to vaccine.
The limitation of the study is that a convenience sampling method was used which would have been better if probability sampling was used. However, the study highlighted some of the important aspects of vaccine hesitancy among health-care workers. Further qualitative studies need to be conducted to explore and have an in-depth picture about the problem.
| Conclusion and Recommendations | | |
Eighty-one percent of the respondents had a high-risk perception of COVID-19 infection. Fifteen percent of the respondents had trust issues with the vaccines and 41% of the respondents were afraid of side effects. Trust building for the vaccine, and information, education, and communication must be a priority for making the vaccination drives a success. Vaccination cannot be coerced, but people need to believe that vaccination against COVID-19 will save lives and will produce herd immunity, which will further save the lives of their near and dear ones.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7]
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