COVID-19 Vaccination Willingness and Reasons for Vaccine Refusal

Abstract

ImportanceHong Kong was held as an exemplar for pandemic response until it recorded the world’s highest daily COVID-19 mortality, which was likely due to vaccine refusal. To prevent this high mortality in future pandemics, information on underlying reasons for vaccine refusal is necessary.ObjectivesTo track the evolution of COVID-19 vaccination willingness and uptake from before vaccine rollout to mass vaccination, to examine factors associated with COVID-19 vaccine refusal and compare with data from Singapore, and to assess the population attributable fraction for vaccine refusal.Design, Setting, and ParticipantsThis cohort study used data from randomly sampled participants from 14 waves of population-based studies in Hong Kong (February 2020 to May 2022) and 2 waves of population-based studies in Singapore (May 2020 to June 2021 and October 2021 to January 2022), and a population-wide registry of COVID-19 vaccination appointments. Data were analyzed from February 23, 2021, to May 30, 2022.ExposuresTrust in COVID-19 vaccine information sources (ie, health authorities, physicians, traditional media, and social media); COVID-19 vaccine confidence on effectiveness, safety, and importance; COVID-19 vaccine misconceptions on safety and high-risk groups; political views; and COVID-19 policies (ie, workplace vaccine mandates and vaccine pass).Main Outcomes and MeasuresPrimary outcomes were the weighted prevalence of COVID-19 vaccination willingness over the pandemic, adjusted incidence rate ratios, and population attributable fractions of COVID-19 vaccine refusal. A secondary outcome was change in daily COVID-19 vaccination appointments.ResultsThe study included 28 007 interviews from 20 waves of longitudinal data, with 1114 participants in the most recent wave (median [range] age, 54.2 years [20-92] years; 571 [51.3%] female). Four factors—mistrust in health authorities, low vaccine confidence, vaccine misconceptions, and political views—could jointly account for 82.2% (95% CI, 62.3%-100.0%) of vaccine refusal in adults aged 18 to 59 years and 69.3% (95% CI, 47.2%-91.4%) of vaccine refusal in adults aged 60 years and older. Workplace vaccine mandates were associated with 62.2% (95% CI, 9.9%-139.2%) increases in daily COVID-19 vaccination appointments, and the Hong Kong vaccine pass was associated with 124.8% (95% CI, 65.9%-204.6%) increases in daily COVID-19 vaccination appointments.Conclusions and RelevanceThese findings suggest that trust in health authorities was fundamental to overcoming vaccine hesitancy. As such, engendering trust in health care professionals, experts, and public health agencies should be incorporated into pandemic preparedness and response.

Preliminary Report of Nationwide COVID-19 Vaccine Compensation in Taiwan

“…To compensate individuals who experience serious AEFI potentially linked to COVID-19 vaccines, many countries have established VICPs. Due to the rapid development of the pandemic, COVID-19 vaccines were swiftly authorized for emergency use, further raising doubts about their safety [5]. Taiwan's VICP stands out for its unique features, offering free and easy application processes and providing subsidies for autopsies in suspected vaccine-related deaths.…”

“…The most documented reactions associated with COVID-19 vaccines include thrombosis/TTS [11,12], myocarditis/pericarditis [13,14], GBS [14,15], and anaphylaxis [16]. TTS, a rare but serious adverse event linked mostly to the AZ vaccine, is characterized by low platelet counts and blood clots in large blood vessels [5]. Previous studies suggest two main mechanisms: the action of anti-platelet factor 4 antibodies and direct interaction between the adenovirus vector and platelets [17,18].…”

“…This skepticism has been exacerbated by a surge of reports on vaccinerelated complications [3,4]. Vaccine refusal could be a ributable to distrust in health authorities, low confidence in vaccines, misconceptions, and political beliefs [5]. In Taiwan, applications for the Vaccine Injury Compensation Program (VICP) are free and easy to access, leading to a relatively high number of applications compared to other countries.…”

Knowledge, Attitudes, and Coverage of Recommended Vaccinations in Individuals with Chronic Medical Conditions: A Cross-Sectional Telephone Survey in Italy

“…To vaccinate people with chronic medical conditions, the clinical care pathway must be considered at different levels, including hospital, outpatient visits, and home and territorial care with active promotion and easy access. However, a critical aspect is the patients’ adherence; there are several motivations behind the decision making to not get vaccinated, such as safety and efficacy concerns, low perceived risk of illness, lack of knowledge, and lack of information [ 12 , 13 , 14 ]. To the best of our knowledge, the number of studies in the current literature that have been conducted to assess the knowledge, attitudes, and behaviors of the recommended vaccines among individuals with chronic medical conditions in Italy are lacking [ 15 , 16 , 17 ].…”

Preliminary Report of Nationwide COVID-19 Vaccine Compensation in Taiwan

“…This skepticism has been exacerbated by a surge in reports on vaccine-related complications [3,4]. Vaccine refusal could be attributable to distrust in health authorities, low confidence in vaccines, misconceptions, and political beliefs [5]. In chronic diseases were identified in more than three-fourths (76.6%) of these individuals.…”