COVID-19 Vaccine Hesitancy in a City with Free Choice and Sufficient Doses

Abstract

Background: Vaccine hesitancy represents one of the major global health issues around the world. We examined the perception, attitude, perceived barriers and facilitation measures of receiving the COVID-19 vaccine in a Chinese population with free vaccine choices (Sinovac [Coronavac] vs. BioNTech/Fosun [Comirnaty]) and adequate doses. Method: We conducted a random telephone survey of the general population in 1195 subjects aged 18 years or above from 23 April 2021 to 8 May 2021 after two months of vaccine rollout. A descriptive analysis of the levels of enabling factors, obstacles and perception of COVID-19 vaccination was conducted using ANOVA and Chi-square tests for trend. Results: Only 10.1% and 13.5% had received one and two COVID-19 vaccine doses, respectively. Among those who had not received any COVID-19 vaccine (75.4%), only 25.1% expressed their intention to receive in the coming 6 months. The barriers with the highest scores included “having heard of cases with serious adverse events or death after vaccination” (score: 8.17 out 10, 95% C.I. 7.99, 8.35), “lack of confidence on governmental recommendations” (7.69, 95% C.I. 7.47, 7.91), and “waiting for a better vaccine” (7.29, 95% C.I. 7.07, 7.52). The highest score for the impact of various incentives for vaccination was for “vaccine passports for overseas travel” (4.44, 95% C.I. 4.18, 4.71). Conclusions: Vaccine hesitancy is commonly observed in this Chinese population despite adequate provision of vaccine doses and choices. No single incentive is strong enough to promote vaccination, and multiple facilitation measures for different groups of population are needed to encourage vaccine uptake. Active clarification and promotion by medical professionals together with a variety of incentives are needed to drive vaccine uptake.

Opposing Mechanisms Involving Perceived Benefits versus Safety Partially Explained an Increase in COVID-19 Vaccination Intention among Unvaccinated Chinese Adults during a Post-Rollout Period: Results of Two Serial Surveys

“…This study observed a fairly low prevalence of COVID-19 vaccination intention in the next six months among unvaccinated and unscheduled adults aged 18-70 in Hong Kong (14.5% and 22.8% at about three and six months since the vaccine rollout, respectively). The latter was comparable to the 25.1% reported in another local study among unvaccinated adults who had been surveyed two months after the beginning of the rollout [17]. People with a low vaccination intention might be hesitating, waiting to see [15], or refusing COVID-19 vaccination firmly [6].…”

“…This study is the first one reporting a significant association between the perceived travel-related advantage and COVID-19 vaccination intention, which was stronger in this study than the widely reported association between the perceived benefits of protection and vaccination intention [31,35]. Consistently, another local study found that "vaccine passports for overseas travel" was the strongest among a list of incentives for COVID-19 vaccination (e.g., relaxation of social distancing and granting work leave to vaccinated people) [17]. The pandemic has made international travel difficult.…”

“…The perceived efficacy of protection is a key perceived benefit that is strongly associated with COVID-19 vaccination intention [2,3,15]. The convenience of travel, another type of perceived benefits, has provided the strongest incentive to COVID-19 vaccination among Hong Kong adults [17]. These perceptions regarding COVID-19 vaccination might have changed due to recent developments.…”

Governmental Incentives, Satisfaction with Health Promotional Materials, and COVID-19 Vaccination Uptake among Community-Dwelling Older Adults in Hong Kong: A Random Telephone Survey

“…Hong Kong government also offered some incentives to motivate people to get vaccinated, such as lottery for winning prizes, exemption of regular COVID-19 testing, allowing visits to elderly homes and hospitals, entering bars/clubs, reducing quarantine duration, and walk-in vaccination services without prior booking [ 3 ]. One study showed that vaccine passports for cross-border travel was most valued by people aged 18 years or above in Hong Kong, followed by allowance to enter entertainment venues [ 29 ]. However, these incentives were not designed specifically for older adults in Hong Kong.…”

Levels and factors derived from the Health Action Process Approach of behavioral intentions to take up COVID-19 vaccination: A random population-based study

“…The prevalence of behavioral intention of COVID-19 vaccination remained low in Hong Kong during the initial post-rollout period (25.1%) [41] while similar data was unavailable in other countries for comparisons. The actual vaccination rate during the initial rollout period in Hong Kong (say May 2021) was lower than those of some seriously affected countries (e.g., U.S. and U.K.) but was comparable to or even higher than others (e.g., Australia, Singapore, Japan, and Thailand) [3] .…”