A cross sectional study to examine factors influencing COVID-19 vaccine acceptance, hesitancy and refusal in urban and rural settings in Tamil Nadu, India

Abstract

The second wave of the COVID-19 pandemic left the Indian healthcare system overwhelmed. The severity of a third wave will depend on the success of the vaccination drive; however, even with a safe and effective COVID-19 vaccine, hesitancy can be an obstacle to achieving high levels of coverage. Our study aims to estimate the population’s acceptance of the COVID-19 vaccine in an Indian district. A pilot community-based cross-sectional study was conducted from March-May 2021. The data was collected from eight primary health centres in Tamil Nadu. The eligible study participants were interviewed using a self-constructed questionnaire. A total of 3,130 individuals responded to the survey. Multinomial logistic regression was performed to assess the factors influencing COVID-19 vaccine hesitancy and refusal. Results of our study showed that 46% percent (n = 1432) of the respondents would accept the COVID-19 vaccine if available. Acceptance for the COVID-19 vaccine was higher among males (54%), individuals aged 18-24years (62%), those with higher education (77%), having the higher income (73%), and employed (51%). Individuals with no education (OR: 2.799, 95% CI = 1.103–7.108), and low income (OR: OR: 10.299, 95% CI: 4.879–21.741), were significant predictors of vaccine hesitancy (p < 0.05). Living in urban residence (OR: 0.699, 95% CI = 0.55–0.888) and age between 18 to 25 years (OR: 0.549, 95% CI = 0.309–0.977) were protective factor of COVID-19 vaccine hesitancy. While individuals in the age group 25-54years (OR = 1.601, 95%CI = 1.086–2.359), fewer education (OR = 4.8, 95% CI = 2.448–9.412,), low income (OR = 2.628, 95% CI = 1.777–3.887) and unemployment (OR = 1.351, 95% CI = 1.06–1.722) had high odds of refusing the COVID-19 vaccine. Concerns and suspicions about the safety of the COVID-19 vaccine (63%) was the major reasons causing hesitancy towards the COVID-19 vaccine The public health authorities and government need to design, develop and implement targeted interventions to enhance awareness about COVID-19 vaccines, and barriers and enablers to vaccine acceptance among individuals across diverse settings. Emphasis on involving local and religious leaders, ASHA workers, community healthcare workers, Anganwadi workers, and auxiliary nurse midwives can help to overcome context-specific barriers in areas of low COVID-19 vaccine acceptance, especially in rural settings.

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

“…Those with lower levels of schooling, wage stagnation, and aged 25 to 54 had a higher likelihood of denying the COVID-19 vaccine. Concerns and postponements about the safety of immunisation were the primary reasons for fostering scepticism about the acceptance of immunisation for COVID-19 [ 19 ]. In another study by Chandania S et al, 25% of people were either oblivious to immunisations or unsure about receiving them, and 10% said they would not accept the vaccine.…”

“… Acceptance of the COVID-19 vaccine in India according to residence, as shown in the form of a forest plot [ 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 ]. …”

Vaccination coverage against COVID-19 among rural population in Haryana, India: A cross-sectional study

“…Previous studies have reported that an increase in the proportion of people living in multidimensional poverty reduces COVID-19 vaccination coverage [25]. Also, vaccine hesitancy tends to be influenced by numerous factors like gender, education, occupation, and socio-economic status, which usually leads to a rural disadvantage [26][27][28].…”

Identifying the determinants of non-injection of covid-19 vaccine: A qualitative study in Urmia, Iran

“…According to research on risk perception and behavior, those who do not have a favorable attitude toward COVID-19 vaccination find the virus less threatening ( 11 ). The intention to be vaccinated is also included under the influence of cognitive assessments (probability of outcome) ( 18 ), race and ethnicity ( 19 – 21 ), perceptions of risk and susceptibility to COVID-19 ( 22 ), ease of availability and access ( 23 , 24 ) and socio-economic and socio-demographic status ( 15 , 18 , 22 ).…”

“…There are lots of reason to reject, delay, hesitancy and refusal of COVID-19 vaccine: Fear of short or long term applications to health, not considering being in a risk group, pregnancy, risk pregnancy, recent abortion, breastfeeding period ( 25 ), misinformation beliefs ( 26 , 27 ), not having enough vaccine-related information ( 26 – 28 ), concerns over vaccine safety ( 18 , 19 , 26 , 28 , 29 ), structural barriers ( 28 , 30 ), personal experience with the disease ( 31 , 32 ), possible unknown future adverse effects of the vaccine ( 32 , 33 ), social determinants of health ( 23 ), low health literacy ( 23 , 34 ), not trusting the drug companies ( 23 , 27 , 29 ), political ideologies ( 11 , 23 , 35 ), distrust of science and the government ( 19 , 26 , 29 , 33 ). Also, various social media made people hesitate to inject the vaccine by spreading false rumors about the COVID-19 vaccine harms, which could create a major challenge for the health system ( 36 , 37 ).…”