Vaccine hesitancy is an important feature of every vaccination and COVID-19 vaccination is not an exception. During the COVID-19 pandemic, vaccine hesitancy has exhibited different phases and has shown both temporal and spatial variation in these phases. This has likely arisen due to varied socio-behavioural characteristics of humans and their response towards COVID 19 pandemic and its vaccination strategies. This commentary highlights that there are multiple phases of vaccine hesitancy: Vaccine Eagerness, Vaccine Ignorance, Vaccine Resistance, Vaccine Confidence, Vaccine Complacency and Vaccine Apathy. Though the phases seem to be sequential, they may co-exist at the same time in different regions and at different times in the same region. This may be attributed to several factors influencing the phases of vaccine hesitancy. The complexities of the societal reactions need to be understood in full to be addressed better. There is a dire need of different strategies of communication to deal with the various nuances of all of the phases. To address of vaccine hesitancy, an understanding of the societal reactions leading to various phases of vaccine hesitancy is of utmost importance.

Our paper examines the key determinants of COVID-19 vaccination coverage in India and presents an analytical framework to probe whether vaccine hesitancy, socioeconomic factors and multi-dimensional deprivations (MPI) play a role in determining COVID-19 vaccination uptake. Our exploratory analysis reveals that COVID-19 vaccine hesitancy has a negative and statistically significant impact on COVID-19 vaccination coverage. A percentage increase in vaccine hesitancy can lead to a decline in vaccination coverage by 30 percent. Similarly, an increase in the proportion of people living in multi-dimensional poverty reduces the COVID-19 vaccination coverage. A unit increase in MPI or proportion of people living in acute poverty leads to a mean decline in vaccination coverage by 50 percent. It implies that an increase in socioeconomic deprivation negatively impacts health outcomes, including vaccination coverage. We additionally demonstrated that gender plays a significant role in determining how access to digital technologies such as the internet impacts vaccine coverage and hesitancy. We found that, as males’ access to the internet increases, vaccination coverage also increases. This may be attributed to India’s reliance on digital tools (COWIN, AAROGYA SETU, Imphal, India) to allocate and register for COVID-19 vaccines and the associated digital divide (males have greater digital excess than females). Conversely, females’ access to the internet is statistically significant and inversely associated with coverage. This can be attributed to higher vaccine hesitancy among the female population and lower utilization of health services by females.

et al. Setting up an epidemiological surveillance system for vaccine hesitancy outbreaks and illustration of its steps of investigation.

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