Evaluating Rates and Determinants of COVID-19 Vaccine Hesitancy for Adults and Children in the Singapore Population: Strengthening Our Community’s Resilience against Threats from Emerging Infections (SOCRATEs) Cohort

Abstract

COVID-19 vaccines are crucial for achieving sufficient immunisation coverage to manage the pandemic, but vaccine hesitancy persists. This study aimed to investigate the prevalence and determinants of vaccine hesitancy in adults and in parents for vaccinating their children using an integrated social cognition model. A community-based cohort in Singapore [N = 1623] completed a survey (wave 25) between June and July 2021 which measured their risk perceptions, distress, trust, vaccination beliefs, and vaccine intentions/behaviours. Results indicated low rates of hesitancy (9.9%) for own vaccination, with most concerns citing side effects, safety, and hasty development. Remaining respondents were vaccinated (69%) or intended to vaccinate (21%). The multivariable model (non-vaccinated respondents) indicated that, living with people in poor health, subjective norm, moral norm, benefits, and necessity of vaccination were associated with lower vaccine hesitancy (R2 Cox & Snell: 51.4%; p < 0.001). Hesitancy rates were higher for children’s vaccination (15.9%), with male gender, lower perceived vaccine benefits, high COVID-19 risk perceptions, vaccination concerns, and necessity beliefs associated with higher odds of parental vaccine hesitancy (R2 Cox & Snell = 36.4%; p < 0.001). While levels of vaccine acceptance are high, more targeted messages are needed. For adults’ vaccination, more emphasis should be on benefits and social gains, while for parental hesitancy, messages related to safety should be prioritised.

Factors associated with COVID-19 vaccination intent in Singapore, Australia and Hong Kong

“…While vaccine development usually takes over 10-15 years to ensure safety and efficacy [55] , [56] , U.S. FDA gave its full approval to the first COVID-19 vaccine on 23rd August 2021, less than two years after SARS-CoV-2 was first identified. Despite proven safety and efficacy of COVID-19 vaccines, low vaccine intent or hesitancy can be attributed to side effects and hasty vaccine development [18] , [57] . Perception towards long-term side-effects and the duration of vaccine effectiveness need to be studied to understand its impact on vaccine intent..…”

The Health Belief Model Applied to COVID-19 Vaccine Hesitancy: A Systematic Review

“…Perceived barriers and perceived benefits were the most common determinants that were significantly associated with vaccine hesitancy. Perceived benefits was inversely associated with COVID-19 vaccine hesitancy in twelve studies [6,[11][12][13][15][16][17][18]20,22,23]. A positive association between perceived barriers and vaccine hesitancy was reported by twelve studies [6,[11][12][13][15][16][17][18][19][20]22,24].…”

“…Perceived benefits was inversely associated with COVID-19 vaccine hesitancy in twelve studies [6,[11][12][13][15][16][17][18]20,22,23]. A positive association between perceived barriers and vaccine hesitancy was reported by twelve studies [6,[11][12][13][15][16][17][18][19][20]22,24]. Perceived susceptibility was negatively correlated with COVID-19 vaccine hesitancy in eight studies [10,12,14,[16][17][18]20,23]; however, Chen et al [11] reported a positive correlation between perceived susceptibility and vaccine hesitancy.…”

“…Other HBM components that are inversely related were cues to action in nine studies [6,10,11,16,17,19,21,22,24], perceived severity in six studies [14,16,17,19,23,24], and selfefficacy in one study [11]. Griva et al [13] and Guillon and Kergall [6] found a negative effect of perceived threat (i.e., a combined measure of perceived susceptibility and severity) on vaccine hesitancy.…”

The Impact of the COVID-19 Pandemic on the Practice of Forensic Medicine: An Overview

“…The scientific community is convinced that, without a broad and comprehensive vaccination program, it will be impossible to overcome COVID-19. However, following some severe adverse events, a growing lack of confidence developed in many European countries, slowing down the worldwide vaccination program [ 98 , 99 ]. Similar to the case of the definition of the main pathophysiological aspects of the SARS-CoV-2 infection, post-mortem investigations have been instrumental in identifying the cause of death in fatal cases following vaccine administration [ 100 , 101 , 102 , 103 ].…”