|Ahead of print publication
Perception and acceptance of coronavirus disease-2019 vaccines among doctors
Arun Kumar Yadav1, Nikunj Kumar Kansara1, Sonal Nimbhorkar1, Atul Kotwal2, Subhadeep Ghosh3, Saurabh Bobdey1
1 Department of Community Medicine, Armed Forces Medical College, Pune, Maharashtra, India
2 Executive Director, NHSRC, Delhi, India
3 Dir AFMS Health, Armed Forces Medical Services, Ministry of Defence, New Delhi, India
|Date of Submission||27-Dec-2020|
|Date of Decision||22-Feb-2021|
|Date of Acceptance||22-Feb-2021|
Arun Kumar Yadav,
Department of Community Medicine, Armed Forces Medical College, Wanowrie, Pune - 411 040, Maharashtra
Source of Support: None, Conflict of Interest: None
Introduction: Numerous vaccine candidates are in the race of successful clinical trials in response to the ongoing coronavirus disease-2019 (COVID-19) pandemic. This study was conducted to assess the perception and hesitancy among the physicians of major cities of India toward the upcoming COVID-19 vaccine. Methodology: A cross-sectional online survey was conducted between November 25, and December 25, 2020, among the frontline physicians, and they were asked if they would get vaccinated as soon as the vaccine is available in the market. Associations between sociodemographic characteristics and acceptance and hesitancy of an upcoming COVID-19 vaccine were analyzed. Results: Among 139 respondents who gave consent, the majority was male (121, 83.4%). Seventy-six (54.7%) respondents would like to get vaccinated as soon as the vaccine is available. Fifty-six (40.28%) participants had shown fear against the new vaccines, and self-perceived knowledge about the vaccine was found low (79, 56.83%). The majority of the physicians agreed to get vaccinated once reverse transcription–polymerase chain reaction positive or recovered in the past. Self-perceived protection of the new COVID-19 vaccine was high (102, 73.4%), and most physicians thought it safe for humans (89, 64%). Conclusion: The acceptance among the physicians positively influences the approval of a COVID-19 vaccine in the general population. Failure to address physicians' hesitancy leaves immunization programs at significant risk of any country.
Keywords: Acceptance, coronavirus disease-2019, severe acute respiratory syndrome coronavirus-2, vaccination, vaccine
|How to cite this URL:|
Yadav AK, Kansara NK, Nimbhorkar S, Kotwal A, Ghosh S, Bobdey S. Perception and acceptance of coronavirus disease-2019 vaccines among doctors. Med J DY Patil Vidyapeeth [Epub ahead of print] [cited 2021 Jun 13]. Available from: https://www.mjdrdypv.org/preprintarticle.asp?id=315912
| Introduction|| |
The ongoing coronavirus disease-2019 (COVID-19) pandemic has challenged all the countries, especially the South Asian Association for Regional Cooperation to contain the spread of the severe acute respiratory syndrome coronavirus-2. The development of a COVID-19 vaccine exemplifies the divine treasure for health organizations globally, eventually accelerating the ongoing efforts to flatten the epidemic curve. However, the success of the vaccine strategy would solely rely upon the acceptance of the vaccine among the population.
The world has faced catastrophic economic consequences, including a threat to the public health system due to the ongoing pandemic. The draft landscape of COVID-19 candidate vaccines was updated by the World Health Organization (WHO) on December 22, 2020. One hundred seventy-two vaccines are in preclinical development, and 61 vaccines are in clinical development. Oxford/AstraZeneca COVID vaccines will be available for emergency use for people most at risk by early 2021. However, public perception toward COVID-19 vaccine uptake is not known. Vaccine hesitancy may hamper all the global efforts in vaccine development. Abundant studies show numerous aspects accountable for vaccine acceptancy when any new vaccine is launched in the market. These studies comprise the safety and efficacy of the vaccine, adverse events following immunization (AEFI), misconceptions regarding the necessity for vaccination, the nonexistence of faith in the health-care system, and the absence of adequate knowledge in the community of vaccine-preventable diseases. Vaccination uptake among health-care workers (HCWs) always remains low.
Vaccine hesitancy refers to “delays in acceptance or refusal of vaccination despite the availability of vaccination services.” Vaccine hesitancy is the most significant barrier to any vaccination drive success, and HCWs are known to play a decisive role in promoting vaccine acceptance among the vaccine hesitant. Health-care providers are expected to be well informed about any new vaccine's hazards and benefits in the market. HCWs should also be able to pass the correct information to their clientele timely.
WHO, in its value framework, has identified HCWs as a priority group for vaccination. The Indian government, in its operational guidelines, has recognized them as the primary group for immunization. However, the acceptance of vaccination among doctors is not known. Hence, the study was conducted to estimate the degree of vaccine hesitancy and acceptance and specific knowledge and attitudes toward upcoming COVID-19 vaccines.
| Methodology|| |
A questionnaire-based cross-sectional survey was conducted among doctors from November 25, 2020, to December 25, 2020. The questionnaire was designed on the Google Form platform. The nonprobability convenient sampling using snowball sampling strategy was used to recruit study participants. The study population was doctors present all over India. Initially, the study investigators shared the link in social media (WhatsApp and telegram channels) and through e-mails by sending a link to the known treating physicians, postgraduates, and superspecialists. After that, concerned physicians were asked to further the link in their concerned hospital to physician staff.
A draft questionnaire was devised after the literature review.,, The draft questionnaire was prepared in the English language. It consisted of sections on sociodemographic, perception and acceptance toward new COVID-19 vaccine, history of reverse transcription–polymerase chain reaction (RT-PCR) testing and results, and finally about their opinion about the risks and benefits of the vaccination. Participants were asked about the source of their knowledge about COVID-19 vaccines and their willingness to accept the COVID-19 vaccine if it is available in future. The questionnaire was kept short in length so that it can be quick to complete and easy to follow. Questionnaire's content and clarity was assessed by the psychiatrists working in the same institute of the author. The draft questionnaire was pilot tested among 25 doctors of the authors' institute (selected by convenience). The final questionnaire was developed based on Cronbach's alpha values (>0.70). The finding of the pilot testing was excluded from the final analysis. The questionnaire was self-administered. The participants were instructed to select one/multiple options from the list of responses (Yes/No/Maybe). On receiving and clicking the link, participants got auto-directed to the informed consent page, followed by the survey questionnaires.
The sample size was calculated based on prevalence of vaccine hesitancy of 43%, 95% confidence interval, and relative error of 20%. The calculated sample size was 130. Taking into consideration that 10% of forms may have missing data in variables or others, the total considered sample size was 145.
Ethical clearance was obtained from the institutional ethical committee vide their letter number IEC/2020. The data was collated in MS Excel. Descriptive statistics were conducted to create summary tables for variables, and cross-tabulation analysis was performed using Chi-square tests to examine the distribution of characteristics of COVID-19 vaccine with respondents' sociodemographic characteristics. The data was analyzed using StataCorp. 2019. Stata Statistical Software: Release 16. College Station, TX, USA: StataCorp LLC. The P < 0.05 was taken as significant.
| Results|| |
Of 145 survey invitees, 139 (96.52%) provided informed consent and returned the survey. [Table 1] shows the summary statistics of the sociodemographic profile of the study participants. Most of the respondents, 73 (50.3%), were aged more than 45 years and male 121 (83.4) [Table 1]. The majority 72 (49.7%) of the study participants were MBBS graduates and belonged to medical colleges (70, 48.3%).
All participants agreed that vaccination is an important means of protecting public health. Nearly 98 (70.5%) agree/strongly agree that drug company will push for vaccination even if they are not effective, 33 (23.7%) were neutral, and only 8 (5.76%) feel that the drug company would not do so. A total of 127 (91.4%) agree/strongly agree that the vaccination should be provided free of cost to all personnel providing health care. A similar number agreed that they would get their children vaccinated if the vaccine proved to be effective.
[Table 2] shows bivariate associations between sociodemographic characteristics and acceptance (Serial number 3–7), fear (Serial number 2), and hesitancy (Serial number 1) to receive the COVID-19 vaccine. Of the 139 respondents, 76 (54.7%) intended to get vaccinated as soon as the vaccine is available in the market, only 16 (11.5%) reported hesitancy toward the COVID-19 vaccine, and 47 (33.8%) said “Maybe” about their intention [Table 2]. Of the 139 respondents, 56 (40.3%) reported fear of the new COVID-19 vaccine. A total of 60 (43.2%) reported a lack of self-perceived knowledge regarding the COVID-19 vaccine. The majority of the 74 (53.2%) participants preferred intradermal/subcutaneous route over intranasal or oral. Ninety-three (66.9%) participants agreed to take vaccination even after positive RT-PCR test results and 102 (73.4%) participants reported that the vaccine would protect them.
|Table 2: Perception and acceptance about the vaccine by various factors (n=139)*|
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| Discussion|| |
The vaccine against COVID-19 is on Horizon. India's government is planning to roll out vaccination for the priority group soon. HCWs, including doctors, will get vaccinated first for the COVID-19. In the past, acceptancy for the vaccine has varied with time, place, sociodemographic variables, culture, and circumstantial human behavior.,, There have been minimal studies available to know the intention to get vaccinated when the COVID-19 vaccine will be available in the current ongoing pandemic, especially in India. Fu et al. in their study in China reported 72.5% of the general population's decided to get COVID-19 vaccine in future, whereas the study conducted in the United States reported 80% acceptance of the COVID-19 vaccine among the study population., In our study, 54.67% of study participants showed their willingness to get vaccinated as and when COVID-19 vaccine will be available. This percentage is lower than the study conducted in both China and the US. A total of 33.8% answered as maybe. This means that they would require a little bit of assurance before the vaccination drive is carried out.
Nguyen et al. also mentioned in their systematic review that there was no constant association with their study participants' demographic variables (age and sex) with vaccine uptake behavior. There was a significant association between vaccine acceptance and fear regarding vaccine safety with the gender. Male gender had more vaccine acceptability in spite of more concern with vaccine safety.
Doctors also showed fear associated with the COVID-19 vaccination, which is natural before accepting any new vaccine. HCWs are essential for the general population to make the decisions to receive the vaccination, further increasing vaccine coverage. Knowledge and acceptance were found to increase in the readiness to suggest vaccination among the physicians. A study in China done by Zhang et al. reported that nurses with high knowledge scores were more likely to recommend influenza vaccine to their parents and more willing to recommend vaccination to parents in future. Wamai et al. performed a study on HPV vaccination in Cameroon, in which the most important factor considered was the understanding of the effectiveness and safety of the vaccine. Hence, it is essential to allay fears among HCWs by continuous information, education, and communication campaigns among doctors. However, most of the study participants have accepted intramuscular/intradermal route of administration and expected more severe adverse effects following immunization (AEFIs), which will be the route of the administration.
Acceptance of the new COVID-19 vaccine might also be influenced by the correct knowledge about the disease as well as efficacy of the vaccine. Usually, efficacy of the newer vaccine varies between the types of vaccine, therefore, choosing the correct candidate among all the available vaccines also requires correct knowledge. Much of the information about COVID-19 vaccine is available on the WHO and MoHFW websites, social media, or online media, which was used by our study participants. Safety perceptions can also increase in the uptake of newer vaccines in the market and influence acceptance. Cost may also play a significant concern in the acceptance of newer COVID-19 vaccine. Another way of increasing intake is to make the vaccine mandatory. However, it may be negatively perceived.
In the present study, we found that around 45% of doctors would not take the vaccine as soon as it is available. Furthermore, the percentage of doctors with adequate self-perceived knowledge regarding the upcoming COVID-19 vaccine was found insufficient. Hence, we recommend that an advocacy for vaccination should be done among doctors and HCWs. IEC campaign including messages on mass media, webinars, to increase awareness about the vaccine among doctors should be conducted.
The study has several limitations due to the sampling technique. Generalizability of the survey results may be limited due to convenience sampling. Selection bias could also be associated with the sampling technique. Acceptance was assessed using a hypothetical vaccine, which may vary from the participants' self-perceived preferences in a real-life condition. The acceptance and fear may change over time as more data and experience with vaccine become available.
| Conclusion|| |
The planning and implementation of strategies aimed at physicians or HCWs to increase the ratio of vaccination is vital prior to implementing the COVID-19 vaccination in our country. It is always essential to consider the various characteristics and variables as well as organizational behaviors. The government will have to introduce more strategies to disseminate the knowledge and diminish the fear among the physicians.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2]