The Association between Risk Perception and Hesitancy toward the Booster Dose of COVID-19 Vaccine among People Aged 60 Years and Older in China

Abstract

Background: Given the prevalence of the omicron variant and decreased immunity provided by vaccines, it is imperative to enhance resistance to COVID-19 in the old population. We planned to explore the hesitancy rate toward the booster dose of the COVID-19 vaccine and the association between risk perception and the abovementioned rate among people aged 60 and older. Methods: This national cross-sectional study was conducted in mainland China from 25 May to 8 June 2022, targeting people who were 60 years old or above. Four dimensions were extracted from the Health Belief Model (HBM) to assess participants’ perceived risk levels, including perceived susceptibility, perceived severity, perceived barriers, and perceived benefit. An independent Chi-square test was used to compare the vaccine hesitancy rates among different groups stratified by characteristics. Univariable and multivariable logistic regression models were performed to explore the associations between risk perception and hesitancy rate. Results: Of 3321 participants, 17.2% (95% CI: 15.9–18.5%) were hesitant about booster shots of COVID-19 vaccines. Believing that they were ineligible for vaccination due to certain illnesses (38.3%), concern about vaccine safety (32.0%), believing the booster shots were unnecessary (33.1%), and their limitation on movements (28.0%) were the main reasons for vaccine hesitation. Adjusted by all the selected covariates, people with low perception level of susceptibility (aOR = 1.39, 95% CI: 1.00–1.92) and benefit (low: aOR = 3.31, 95% CI: 2.01–5.45; moderate: aOR = 2.23, 95% CI: 1.75–2.85) were less likely to receiving the booster dose, and the same results were found in people with higher perceived barriers (moderate: aOR = 2.67, 95% CI: 2.13–3.35; high: aOR = 2.04, 95% CI: 1.14–3.67). Our estimates were stable in all four models. Conclusions: In total, 17.2% of the people aged 60 years and older in China were hesitant about booster dose of COVID-19 vaccines, and it was closely associated with a lower level of perceived susceptibility and benefit, as well as a higher level of perceived barriers. Concerns about contraindications, vaccine safety, and limited movements were the main reasons for vaccine hesitancy. Targeted public health measure is a priority to improve the understanding of the elderly on their own susceptibility and vulnerability and clear the obstacles to vaccination.

Booster dose of COVID-19 vaccination: Perception among elderly

“…Concerns about vaccine safety, vaccine efficacy, and lack of confidence were possible underlying causes of vaccine doubt (Vellappally et al, 2022). Vaccine hesitancy became one of the top ten global health threats in 2019, referring to people's reluctance or refusal to be vaccinated, especially among the elderly population (Qin et al, 2022). With the availability of vaccines with proven safety and efficacy, vaccination and non-pharmacological measures had become important resources for managing pandemics and controlling the spread of the virus (Vellappally et al, 2022).…”

“…COVID-19 vaccination was considered a public health intervention that could control the infectious disease (SARS-CoV-2) and reduced the mortality rate (Cao, 2020;Vellappally et al, 2022). Data from the United States, Germany, and South Korea show that COVID-19 vaccination could save most lives and remaining life expectancy (Qin et al, 2022;Vellappally et al, 2022).…”

“…Based on data, the percentage of vaccination coverage in each stage had decreased. World data shows that up to June 20, 2022, 26.4% of the world's population had received booster doses of vaccine and 35.2% of the elderly in China had not received booster doses of vaccine (Qin et al, 2022). Likewise, data from the Ministry of Health of the Republic of Indonesia as of October 30, 2022 stated that the first dose of vaccination was 87.42%, the second dose was 73.24%, the third dose was 27.70%, and the fourth dose was 0.28%.…”

The importance of booster vaccination in the context of Omicron wave

“…In line with this, Lewnard and colleagues found that hospital admissions with the Omicron were half of those with the Delta variant ( 17 ). Therefore, doubts have been raised about the necessity of vaccination ( 18 , 19 ). However, the pathogenicity of Omicron might be underestimated due to increased levels of herd immunity via previous infections and vaccinations.…”

Health-Related Rumor Control through Social Collaboration Models: Lessons from Cases in China during the COVID-19 Pandemic

“…As a country where the virus was first reported, China has received a lot of attention in academia. For example, past literature has discussed mental health issues during the pandemic [ 6 , 7 ], the impact of lockdown policies on different industries [ 8 , 9 ] and vaccination-related issues among various populations [ 10 , 11 , 12 ].…”