Attitudes towards COVID-19 vaccination, vaccine hesitancy and intention to take the vaccine

Keywords: COVID-19 Vaccines, Immunization Programs, Vaccination, Vaccination Refusal, Attitude, Health Knowledge, Attitudes, Practice, COVID-19, SARS-CoV-2, Pandemics, Health Belief Model, Cross-Sectional Studies, Malta

Abstract

Background: The pandemic is at a paradoxical stage, with vaccine roll out initiated but a significantly elevated level of infection and death. Hope for recovery lies in high equitable vaccine uptake.

Objective: The study aimed to: i) explore attitudes and factors influencing attitudes, towards the COVID-19 vaccine amongst people living in Malta, ii) identify the reasons as to why individuals are unsure or unwilling to take the vaccine.

Methods: Two consecutive, short, anonymous online surveys using social media platforms were used to gather data from adult individuals. The first study was open to residents in Malta, while the second study invited international participation. Study 1 consisted of 17 questions inspired by the Theories of Planned Behaviour and Reasoned Action. Study 2 asked participates whether they were willing, unwilling or unsure of taking the vaccine and their reasons for being unsure or unwilling.

Results: A total of 2,529 individuals participated in Study 1 and 834 in Study 2. In both studies respondents were predominantly female having a tertiary education. Over 50% declared that they were willing to take the vaccine, with males being more willing (t=5.83, df=1164.2, p<0.00005). Opinions of significant others- family and friends (r=0.22, p<0.005) and health professionals (r=0.74, p<0.005) were associated with willingness to take the vaccine. Vaccine hesitancy was present in the study population with 32.6% being unsure and 15.6% declaring that they were not willing to take the vaccine. Females were more likely to be unsure (Chi-squared=14.63, df=4, p=0.006). Lack of vaccine safety was the main reason cited for unwillingness to take the vaccine. Predictors for willingness to take the vaccine were: i) The belief that the COVID-19 vaccine will protect the health of the people who take it; ii) Valuing the advice of health professionals regarding the effectiveness of COVID-19 vaccine; iii) Having taken the influenza vaccine last year and; iv) Encouraging their elderly parents to take the vaccine.

Conclusions: COVID-19 vaccination information campaigns should promote group strategies, focusing on emphasising the safety of the vaccine and offer reassurance, especially to women.

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References

World Health Organisation. Corona Virus Disease (COVID-19) Pandemic. https://www.who.int/emergencies/diseases/novel-coronavirus-2019?gclid=CjwKCAiAgc-AB-hA7EiwAjevj6mGRzsdtzqbpPQn8DNH3x2WdMmdAG_RIGyG4xdUt4nKnXgMwoXdYRoCVDEQAvD_BwE (accessed Feb 4, 2021)

Our World in Data. Corona Virus (COVID-19) Vaccinations. https://ourworldindata.org/covid-vaccinations (accessed Feb 4, 2021)

European Centre for Disease Control and Prevention (ECDC). Overview of COVID-19 vaccina-tion strategies and vaccination deployment plans in EU/EEA technical report. https://www.ecdc.europa.eu/en/publications-data/overview-implementation-covid-19-vaccination-strategies-and-vaccine-deployment (accessed Feb 4, 2021)

Hodgson SH, Mansatta K, Mallett G, Harris V, Emary KRW, Pollard AJ. What defines an efficacious COVID-19 vaccine? A review of the challenges assessing the clinical efficacy of vaccines against SARS-CoV-2. Lancet Infect Dis. 2021;21(2):e26-e35. https://doi.org/10.1016/s1473-3099(20)30773-8

European Centre for Disease Control and Prevention (ECDC). Risk related to SARS-CoV-2 var-iants of concern in EU /EEA. First update. https://www.ecdc.europa.eu/en/publications-data/covid-19-risk-assessment-spread-new-variants-concern-eueea-first-update?fbclid=IwAR0UPcRtV6JOyTu3vCOICv3KOgQneGJ_Uyw3XBQbNe2TvaReFcaDnKX21Bc (accessed Feb 4, 2021)

World Health Organisation. Corona Virus Disease (COVID-19) Dashboard. https://covid19.who.int/?gclid=CjwKCAiAgc-ABhA7EiwAjev-jyX27VnkHYh_Muqsztk1IApJ2DI8LWEyMneN01KfS4x_H3Z_JtbMZxoC_8sQAvD_BwE (accessed Feb 2021)

European Centre for Disease Control and Prevention (ECDC). COVID-19 Situation Dashboard. https://qap.ecdc.europa.eu/public/extensions/COVID-19/COVID-19.html#global-overview-tab (accessed Feb 4, 2021)

Kluge H. The pandemic paradox: hope and hardship in equal measure. World Health Organi-sation, Regional Office for Europe 2021. https://www.euro.who.int/en/media-centre/sections/statements/2021/statement-update-on-covid-19-the-pandemic-paradox-hope-and-hardship,-in-equal-measure (accessed Feb 4, 2021)

Swaminathan S. The WHO's chief scientist on a year of loss and learning. Nature. 2020;588(7839):583-585. https://doi.org/10.1038/d41586-020-03556-y

Cakmakli C, Demiralp S, Kalemli-Ozcan S, Yesiltas S, Yildirim MA. The economic case for global vaccinations: An epidemiological model with international production networks. ICC Research Foundation commissioned study. https://iccwbo.org/publication/the-economic-case-for-global-vaccinations/ (accessed Feb 4, 2021)

Fontanet A, Cauchemez S. COVID-19 herd immunity: where are we?. Nat Rev Immunol. 2020;20(10):583-584. https://doi.org/10.1038/s41577-020-00451-5

Ashby B, Best A. Herd immunity. Curr Biol. 2021;31(4):R174-R177. https://doi.org/10.1016/j.cub.2021.01.006

MacDonald NE; SAGE Working Group on Vaccine Hesitancy. Vaccine hesitancy: Definition, scope and determinants. Vaccine. 2015;33(34):4161-4164. https://doi.org/10.1016/j.vaccine.2015.04.036

World Health Organisation. Ten threats to global health in 2019. https://www.who.int/news-room/spotlight/ten-threats-to-global-health-in-2019 (accessed Feb 4, 2021)

Kim HK, Ahn J, Atkinson L, Kahlor LA. Effects of COVID-19 information on information seeking, avoidance and processing: A multi-country comparative study. Sci Comm. 2020;42(5):586–615. https://doi.org/10.1177%2F1075547020959670

Chou WS, Gaysynsky A, Vanderpool RC. The COVID-19 Misinfodemic: Moving Beyond Fact-Checking. Health Educ Behav. 2021;48(1):9-13. https://doi.org/10.1177/1090198120980675

Eysenbach G. Infodemiology and infoveillance: framework for an emerging set of public health informatics methods to analyze search, communication and publication behavior on the Internet. J Med Internet Res. 2009;11(1):e11. https://doi.org/10.2196/jmir.1157

World Health Organisation. Early AI supported Response with Social Listening (EARS). https://whoinfodemic.citibeats.com/ (accessed Feb 4, 2021)

World Health Organisation. Infodemic manager training. https://www.who.int/teams/risk-communication/infodemic-management/1st-who-training-in-infodemic-management (accessed Feb 4, 2021)

Ajzen, I. From intentions to actions: A theory of planned behaviour. In: Kuhn J, Beckman J, eds. Action Control: from cognition to behaviour. New York: Springer Verlag;1985.

LaPiere RT. Attitudes vs Actions. 1934. Int J Epidemiol. 2010;39(1):7-11. https://doi.org/10.1093/ije/dyp398

Wicker AW. Attitudes versus actions: The relationship of verbal and overt behavioural responses to attitude objects. J Soc Issues. 1969:25(4);41-78. https://doi.org/10.1111/j.1540-4560.1969.tb00619.x

Crano WD, Prisli R. Attitudes and persuasion. Annu Rev Psychol 2006:57;345-374. https://doi.org/10.1146/annurev.psych.57.102904.190034

Fishbein M, Ajzen I. Beliefs, attitude, intention and behaviour: An introduction to theory and research. Reading, MA: Addison-Wesley 1975. https://people.umass.edu/aizen/f&a1975.html (accessed Feb 4, 2021)

Ajzen I. Models of human social behaviour and their application to Health. Psychol Health. 1998:13(4);735-739. https://doi.org/10.1080/08870449808407426

Beck L, Ajzen I. Predicting dishonest actions using the theory of planned behaviour. J Res Person. 1991;25(3):285-301. https://doi.org/10.1016/0092-6566(91)90021-H

Du X. A Brief Introduction of Skopos Theory. Theory Pract Lang Stud. 2012;2(10):2189-2193. https://doi.org/10.4304/TPLS.2.10.2189-2193

R Core Team. R: A language and environment for statistical computing. R Foundation for Sta-tistical Computing, Vienna, Austria 2020. https://www.R-project.org/ (accessed Feb 4, 2021)

Neumann-Böhme S, Varghese NE, Sabat I, et al. Once we have it, will we use it? A European survey on willingness to be vaccinated against COVID-19. Eur J Health Econ. 2020;21(7):977-982. https://doi.org/10.1007/s10198-020-01208-6

Freeman D, Loe BS, Chadwick A, et al. COVID-19 vaccine hesitancy in the UK: the Oxford coronavirus explanations, attitudes, and narratives survey (Oceans) II. Psychol Med. 2020;1-15. https://doi.org/10.1017/s0033291720005188

Lazarus JV, Ratzan SC, Palayew A, et al. A global survey of potential acceptance of a COVID-19 vaccine [published correction appears in Nat Med. 2021 Jan 11;:]. Nat Med. 2021;27(2):225-228. https://doi.org/10.1038/s41591-020-1124-9

Khubchandani J, Sharma S, Price JH, Wiblishauser MJ, Sharma M, Webb FJ. COVID-19 Vaccination Hesitancy in the United States: A Rapid National Assessment. J Community Health. 2021;46(2):270-277. https://doi.org/10.1007/s10900-020-00958-x

Detoc M, Bruel S, Frappe P, Tardy B, Botelho-Nevers E, Gagneux-Brunon A. Intention to participate in a COVID-19 vaccine clinical trial and to get vaccinated against COVID-19 in France during the pandemic. Vaccine. 2020;38(45):7002-7006. https://doi.org/10.1016/j.vaccine.2020.09.041

Faasse K, Newby J. Public Perceptions of COVID-19 in Australia: Perceived Risk, Knowledge, Health-Protective Behaviors, and Vaccine Intentions. Front Psychol. 2020;11:551004. https://doi.org/10.3389/fpsyg.2020.551004

COCONEL Group. A future vaccination campaign against COVID-19 at risk of vaccine hesitancy and politicisation. Lancet Infect Dis. 2020;20(7):769-770. https://doi.org/10.1016/s1473-3099(20)30426-6

Ward JK, Alleaume C, Peretti-Watel P; COCONEL Group. The French public's attitudes to a future COVID-19 vaccine: The politicization of a public health issue. Soc Sci Med. 2020;265:113414. https://doi.org/10.1016/j.socscimed.2020.113414

World Health Organisation. Citibeats Malta. https://whoinfodemic.citibeats.com/country/mlt?cat=7CYMF9PJ2hQ7oJ2GNoTkWE&fbclid=IwAR2hDk5MI0DRXR2aasGZ2Ddv51p91b_qJ4ZUsI0XQQZ78gGB0AwzPe4vnDE (accessed Feb 4, 2021)

Fisher KA, Bloomstone SJ, Walder J, Crawford S, Fouayzi H, Mazor KM. Attitudes Toward a Potential SARS-CoV-2 Vaccine : A Survey of U.S. Adults. Ann Intern Med. 2020;173(12):964-973. https://doi.org/10.7326/m20-3569

Callaghan T, Moghtaderi A, Lueck JA, et al. Correlates and disparities of intention to vaccinate against COVID-19. Soc Sci Med. 2021;272:113638. https://doi.org/10.1016/j.socscimed.2020.113638

Khubchandani J, Saiki D, Kandiah J. Masks, gloves, and the COVID-19 pandemic: Rapid assessment of public behaviours in the United States. Epidemiologia. 2020;1(1):16-22; https://doi.org/10.3390/epidemiologia1010004

Wong LP, Alias H, Wong PF, Lee HY, AbuBakar S. The use of the health belief model to assess predictors of intent to receive the COVID-19 vaccine and willingness to pay. Hum Vaccin Immunother. 2020;16(9):2204-2214. https://doi.org/10.1080/21645515.2020.1790279

Murphy J, Vallières F, Bentall RP, et al. Psychological characteristics associated with COVID-19 vaccine hesitancy and resistance in Ireland and the United Kingdom. Nat Commun. 2021;12(1):29. https://doi.org/10.1038/s41467-020-20226-9

Galasso V, Pons V, Profeta P, Becher M, Brouard S, Foucault M. Gender differences in COVID-19 attitudes and behavior: Panel evidence from eight countries. Proc Natl Acad Sci U S A. 2020;117(44):27285-27291. https://doi.org/10.1073/pnas.2012520117

Byrnes JP, Miller DC. Gender differences in risk taking; A meta-analysis. Psychol Bull 1999;125(3):367-383. https://doi.org/10.1037/0033-2909.125.3.367

Inglehart R. Norris P. The developmental theory of the gender gap: women’s and men’s voting behavior in global perspective. Int Polit Sci Rev 2000:21(4);441-463. https://doi.org/10.1177%2F0192512100214007

Szilagyi PG, Thomas K, Shah MD, et al. National Trends in the US Public's Likelihood of Getting a COVID-19 Vaccine-April 1 to December 8, 2020. JAMA. 2020;325(4):396-398. https://doi.org/10.1001/jama.2020.26419

Guidry JPD, Laestadius LI, Vraga EK, et al. Willingness to get the COVID-19 vaccine with and without emergency use authorization. Am J Infect Control. 2021;49(2):137-142. https://doi.org/10.1016/j.ajic.2020.11.018

O’Keefe DJ. Persuasion: Theory and Research. Newbury Park CA: Sage;1990.

Sherif CW. Social categorization as a function of latitude of acceptance and series range. J Abnorm Soc Psychol. 1963;67:148-156. https://doi.org/10.1037/h0043022

Johnson BT, Eagly AH. Effects of involvement on persuasion: A meta-analysis. Psycho Bull.1989:106(2);290-314. https://doi.org/10.1037/0033-2909.106.2.290

Sherif M, Hovland CI. Social judgment: Assimilation and contrast effects in communication and attitude change. New Haven: Yale University Press; 1961.

Brinol P, Rucker DD, Petty RE. Naïve theories about persuasion. Implications for information processing and consumer attitude change. Int J of Advert 2015:34(1):85-106 https://doi.org/10.1080/02650487.2014.997080

Published
2021-03-21
How to Cite
1.
Cordina M, Lauri MA, Lauri J. Attitudes towards COVID-19 vaccination, vaccine hesitancy and intention to take the vaccine. Pharm Pract (Granada) [Internet]. 2021Mar.21 [cited 2021Apr.19];19(1):2317. Available from: https://pharmacypractice.org/journal/index.php/pp/article/view/2317
Section
Original Research

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