COVID-19 Vaccine Booster Hesitancy in Malaysia: A Web-Based Cross-Sectional Study

Abstract

Vaccination is a key public health strategy that is known to be effective in mitigating the risk of infection and severe disease. However, in the context of the COVID-19 pandemic, the percentage (<50%) of Malaysians who have received a booster for the COVID-19 vaccine has remained stagnant over a year. This study aimed to determine the prevalence of and the factors associated with hesitancy toward the second dose of booster for the COVID-19 vaccine. A web-based cross-sectional study was conducted from August to November 2022. The Oxford Vaccine Hesitancy Scale was used to assess the hesitancy toward the second dose of booster for the COVID-19 vaccine. Simple and multiple factors logistic regressions were used to determine the predictors of hesitancy. A p-value less than 0.05 was considered to be statistically significant. Data from 798 respondents were included in the analysis. The prevalence of hesitancy toward the second booster of the COVID-19 vaccine was 26.7%. The predictors of second-booster hesitancy were older age (AOR = 1.040, 95 CI = 1.022, 1.058), having received the third dose (first booster) because of instruction by the government (AOR = 2.125, 95% CI = 1.380, 3.274), concern about serious long term side effects of the vaccine (AOR = 4.010, 95% CI = 2.218, 7.250), and opinions of close friends and immediate family members that the booster is harmful (AOR = 2.201, 95% CI = 1.280, 3.785). Conversely, factors that appear to reduce vaccine booster hesitancy were acceptance of the third dose due to the high number of cases and the increasing rate of infection (AOR = 0.548, 95% CI = 0.317, 0.947), the belief that the vaccine will decrease the risk of getting the infection (AOR = 0.491, 95% CI = 0.277, 0.870), and opinions of close friends and immediate family members that the booster is helpful (AOR = 0.479, 95% CI = 0.273, 0.840). In conclusion, more than one-fifth of Malaysians were hesitant to take the second booster of the COVID-19 vaccine. This suggests that appropriate steps that increase vaccine acceptance, taking into consideration the findings of the present study, are needed to address this issue and to foster more positive attitudes toward vaccination. The survey was available in three main languages but limited to people with internet access; hence, it would likely be biased toward younger adults and social media users and exclude those with limited or no internet access, in particular older people. Therefore, the results are not representative of the Malaysian population at large and caution should be exercised when interpreting the findings.

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“…The possible reason behind strong recommendations to family members could be the high number of cases when the survey was conducted. Similarly, a previous study has reported a higher number of cases and belief that vaccine reduces the risk of infection and opinions from friends and family members that booster is helpful to have a higher impact in increasing the acceptance of booster dose ( Lee et al, 2023 ). Similarly, in this study, 53.9% of participants believe the risk of getting sick with COVID-19 is bigger than the vaccine's side effects.…”

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“…Others have also found that vaccine hesitancy is more common among the Muslims due to concerns of safety, and the 'halal' status of the vaccines [25]. Nevertheless, augmenting clinical studies on COVID-19 booster doses, providing guidance from healthcare professionals or policymakers and addressing side effect concerns could bolster public confidence and vaccine uptake [26,27].…”

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“…However, due to concerns about the safety of the vaccine, there was a significant decline in the intention to vaccinate immediately [ 39 ]. Vaccine hesitancy was also reported but with lower frequency among the Malaysian population, as more than 20% of the participants in the study showed hesitancy to get the second booster of the COVID-19 vaccine [ 40 ].…”