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Table of Contents
Year : 2021  |  Volume : 12  |  Issue : 3  |  Page : 151-154

Perceptions and beliefs on vaccination for COVID-19 in Delhi: A cross-sectional study

Department of Medicine, University College of Medical Sciences and GTB Hospital, Delhi, India

Date of Submission30-Apr-2021
Date of Decision28-Jun-2021
Date of Acceptance04-Jul-2021
Date of Web Publication20-Jul-2021

Correspondence Address:
Dr. Anshuman Srivastava
C-8/452, Sector - 8 Rohini, Delhi - 110 085
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/injms.injms_57_21

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Introduction: It is believed that despite all the measures taken to curb the contagion, a vaccine will be the most effective tool in preventing the spread and complications of coronavirus disease-2019 (COVID-19) and achieving a state of normalcy again. Scientists from worldwide have been successful in developing the vaccine against SARS-CoV-2, but COVID-19 vaccination faces several challenges which may impact its success. Methodology: A cross-sectional study was done to determine the beliefs and perceptions of people on COVID-19 vaccination in Delhi in the month of March–April 2021 with the help of a questionnaire which was distributed online. It contained 22 questions and was finalized after the review through a pilot study and content validation. Statistical analysis was performed using Microsoft Excel 2007. Results: A total of 286 participants were analyzed, of which 55% were female. The mean age was 33.4 years. Intention of people for taking vaccination was analyzed with relation to different age groups, and positive trend was seen in people with advancing age and it was also statistically significant (P = 0.002). It was seen that people with higher education and of higher socioeconomic status were more inclined to get vaccination; however, in our study, 39.1% of the participants were concerned about the safety of the vaccine. Conclusions: Our study demonstrated that despite repeated assurance about the safety of vaccine, people still had doubts and misconceptions which were evident from our study. Hence, this study may help the administrators to understand the community concerns, tweaking current policies, and increasing the awareness campaign so that people gather more knowledge about vaccine benefits and community trust is built.

Keywords: Beliefs, coronavirus, coronavirus disease-2019, perceptions, vaccine

How to cite this article:
Sharma A, Srivastava A. Perceptions and beliefs on vaccination for COVID-19 in Delhi: A cross-sectional study. Indian J Med Spec 2021;12:151-4

How to cite this URL:
Sharma A, Srivastava A. Perceptions and beliefs on vaccination for COVID-19 in Delhi: A cross-sectional study. Indian J Med Spec [serial online] 2021 [cited 2023 Jan 30];12:151-4. Available from: http://www.ijms.in/text.asp?2021/12/3/151/321978

  Introduction Top

Since the beginning of the coronavirus disease-2019 (COVID-19) pandemic, it is believed that despite all the measures taken to curb the contagion, a vaccine will be the most effective tool in preventing the spread and complications of COVID-19 and achieving a state of normalcy again.[1],[2] India is among the many countries in the world that have started the drive to vaccinate its population. The country rolled out the vaccination programme on January 16, 2021 after selecting the beneficiaries as decided by National Expert Group on Vaccine Administration for COVID-19 (NEGVAC) and approved by the Government of India.[3]

Initially started with health-care workers and frontline workers, the beneficiaries of the vaccination drive have been subsequently extended to a much larger section of population with current inoculation being given to all those above 18 years of age. The government is taking all the necessary steps in form of advertisement, social media, tele-media to educate, sensitize, and encourage the citizens about the vaccine. The threat of COVID-19 is still not showing any signs of an end, rather is looming large with new mutations and variants of SARS CoV-2 emerging with every passing month.[3] Vaccination is a ray of hope in such unprecedented times that could pave a way to transition out this phase of the pandemic. Without them, many scientists believe that natural herd immunity would not be sufficient to restore society to a state of normalcy. However, COVID-19 vaccination faces several challenges which may impact its success. With new scientific endeavors, new questions, misconceptions and myths also emerge. It is important to know what people feel and think about it so that the hesitancy and fears can be alleviated and tweaks in policies can be done to achieve maximal vaccination coverage. One major potential barrier to the success of COVID-19 vaccinations is a negative public opinion of the vaccine that is leading to low rates of coverage despite adequate availability. There had been reports about the wastage of vaccines at various centers across different states in India that has been attributed mainly to low turnout of the beneficiaries.[4] This challenge can be overcome by educating the public about the importance of COVID-19 vaccination and being transparent about the development of the vaccine along with the prevalence of potential adverse events. Educating people helps to build trust in the decision to offer vaccinations, without which, the world will not be able to overcome the pandemic and return to “normal” life. Hence, for this reason, this study was conceived to determine the common perceptions and beliefs of people in different subsection of Delhi with a broader objective of ensuring a correct balance between demand and supply.

Aim of the study

The aim of this study is to determine the perceptions and beliefs on vaccination for COVID-19 in Delhi.

  Methodology Top

The present study was conducted in Delhi in the month of March–April 2021. In a cross-sectional analysis, we distributed a questionnaire through online platform through Google forms (Alphabet Inc. California, USA). People aged more than 18 years were selected for the study. Random sampling using convenience was done, and the questionnaires were distributed to the equal number of males and females. Demographic details such as age, sex, family income, and educational level were recorded followed by a set of questions in a predesigned format enquiring about knowledge, perception, and belief regarding the COVID-19 vaccination.

A structured questionnaire with 24 questions was designed initially using the Google forms and was reviewed by two independent reviewers. Questions were constructed with a background of media reports, literature, and researchers compiling day-to-day queries from acquaintances and patients. The questionnaire was written in the English language. The questionnaire was reviewed by a panel of experts, and the content validation was done using the predictive value of questions to forecast the perceptions and beliefs of participants toward vaccination. A pilot study was conducted with eight participants whose responses were analyzed and necessary changes in the questions were done to make them more reliable. The participants in the aforementioned pilot study were not included in the main study. The revised questionnaire with 22 questions was finalized after the review which will be sent to individuals for filling up the responses. Informed consent was included in the forms, agreeing to which was required before proceeding for the questions. The study was approved by the ethical committee and the institutional review board.

Data collection and analysis

Data were collected online by providing a link of Google form to fill the questionnaire. It was circulated online through E-mail and WhatsApp messenger (Facebook Inc., California, USA) randomly. The collected data were summarized and analyzed using Microsoft Excel 2007.

  Results Top

A total of 286 participants were analyzed, of which 55% were females. The mean age was 33.4 years. Perceptions and beliefs of participants to various questions asked in the questionnaire are depicted in [Table 1].
Table 1: Perceptions and beliefs of participants to various questions asked in the questionnaire

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Intention of people for taking vaccination was analyzed with relation to different age groups, and positive trend was seen in people with advancing age and it was also statistically significant (P = 0.002). People's intention for getting vaccinated was analyzed with respect to family income. Here also a trend was seen with more participants opting for vaccination who had higher income, but it was not statistically significant.

The study participants were divided into three groups based on their education levels and were compared with their intention to getting immunized. The Chi-square test was applied and P value was found to be 0.51 which was not significant. Beliefs and perceptions of different participants regarding postvaccination complications were analyzed, and it was observed that 60% of participants believed that there is no chance of any complication and 28% of participants believed that abnormal blood clots causing stroke or heart attack might occur postvaccination. Six percent of participants believed that the nervous system might be affected adversely after receiving the jab.

  Discussion Top

Till date, more than 320 million people in India have been vaccinated. Amidst hopes and apprehensions when the vaccination drive becomes all-inclusive, it would be helpful to predict the dynamics of inoculation with our study. To the best of our knowledge, it is the first study in India on perception and beliefs of different sections of population on COVID-19 vaccination. In our study, female participation was 55% which was found to be similar to the previous studies done in the different parts of the world where women participation was found to be more than that of men.[5],[6],[7],[8] 76.8% of the participants were in favor of getting a vaccine shot in our study which was similar to the online surveys done in various European countries, for example, Ward et al. in France (74%) and Caserotti et al. in Italy (69.7%). [8,9] In the United States, it was found to be 69% in a study done by Reiter et al., whereas Harapan et al. in Indonesia and Wang J in China reported a higher acceptance of >90% in their surveys.[9],[10],[11],[12],[13],[14]

We found that 39.1% of the participants were concerned about the safety of the vaccine. Safety concerns were far lower in our study than the ones which were conducted in the USA, Bangladesh, Saudi Arabia, Germany, and China which vary between 48% and 89%.[6],[7],[14],[15] It may be possible that these surveys were done during a time when the vaccination program was not launched anywhere in the world, and many candidate vaccines were in the trial phases, but in our survey, the vaccination drive had already begun, and steps for motivating the population have been taken by the government, media, and medical health professionals which might have a role in alleviating their concerns. The most important safety concern was an allergic reaction to the vaccine which was mentioned by 51.4% of the participants while 1.7% of them had a perception that the vaccine is unsafe and they would not get it administered at all. Abnormal blood clot formation in the body (28.8%) and central nervous system-related disease (2%) were the complications about which the participants were aware while 10.4% of the participants believed that COVID-19 vaccine could alter the recipients DNA. 7.8% of the participants also believed that vaccine will have effect on their fertility so they were hesitant to take the vaccine. This could be because of a rumor against poliovaccine which was prevalent in India in 1990s and early 2000 which said that OPV is associated with impotency; however, this myth was busted with the help of communication plan involving a multi-agency Social Mobilization Network which included UNICEF, CORE, and Rotary.[16] These factors could also contribute toward the apprehension the participants harbor when thinking about receiving a vaccine dose. Interestingly, 22.9% of the participants believed that the lack of side effect means that vaccine is not effective. 18.5% people believed that if they have had the COVID-19 infection in the past, they do not need to take the vaccine suggesting that they prefer natural immunity. The people may have this notion that they will have life-long immunity against COVID-19 if they have had the disease as seen after varicella infection. A study conducted by Abdul K in Germany[15] showed that 34.6% of the participants in their survey preferred natural immunity. This percentage was much higher in that area probably because of unforeseen impact and mistrust in vaccine was higher among them. However, the concept of herd immunity is well-known in our country because of the enthusiastic drive to eradicate polio; hence, we observed much larger percentage of population who were more in favor of vaccination even after having COVID-19.

80.2% of the participants believed that if someone had a comorbidity they should take the vaccine which was similar to the study done in Australia by Seale et al. where 85% of their study group supported the administration of the vaccine to people with comorbidities or risk factors.[5] Despite extensive awareness campaigns run by the government and different media houses, 13% of the participants believed that they can take one dose of a particular vaccine and second dose of different vaccine available in the country. UK's National Health Service is conducting the research (com-COV study) to see the efficacy of combining two different vaccines, but efficacy is not yet established as research is under process.[16] Since there are no scientific data regarding the safety of COVID-19 vaccine in pregnant and lactating women, we raised the question in our survey and found that 35% of the participants believed that the vaccine is safe for pregnant women and 42.2% of the participants believed that it is safe to vaccinate lactating mothers. In India, vaccination drives have been a regular feature in every household since the Universal Immunization Program which started in 1985 and became a part of child survival and safe motherhood program since 1992. Furthermore, pregnant women in our country are being vaccinated under tetanus immunization program which is an established concept since 1983.[4] Hence, that probably is a factor which provides a sense of trust and belief toward vaccination in these vulnerable groups.

In our study, 26.7% of the participants believed that vaccine itself may be a cause of COVID-19 infection and 55.6% believed that they can be carrier of the disease after vaccination. Previously few cases of vaccine-associated paralytic poliomyelitis following OPV were reported which might be a plausible explanation for this perception in the population.[17] Furthermore, knowledge acquired through unreliable sources such as social media and various other platforms can be a harbinger of this disbelief. 65.7% believed that they can still be infected after vaccination which was far more than what was found in a study done in Saudi Arabia where 23.4% of the participants believed that there is a chance of infection after vaccination.[6] 91.7% of the participants in our study believed that they should wear mask and follow social distancing norms till the majority of population is fully vaccinated while 8.3% believed to follow these norms only till they are vaccinated. This shows that the Indian population believes that the protection of self is a vital cog in the wheel toward a society free of COVID. This is an encouraging sign, especially when there have been the reports of protests against wearing masks sighting, infringement of privacy, personal freedom, and insinuations against the institutions to force these habits (mask wearing) on the population in the various parts of the world. Similar to the study done by Seale et al. in Australia[5] where the older age group was more in favor of the vaccination (91%), we found that there is an inclination to get COVID-19 vaccination in older age group, which meant they understood that this disease is severe in older populations as shown in various studies and are more motivated to get vaccinated. It was contrary to the trend shown in the studies conducted in the USA,[10] Italy,[9] and Saudi Arabia[6] where younger population was more enthusiastic for vaccination.

It was seen that people with higher education and of higher socioeconomic status were more inclined to get vaccination which was similar to the study done in the USA,[10] Saudi Arabia,[6] and Bangladesh.[7] Although health insurance and socioeconomic factors played a role as a deciding factor in these countries, in our country, vaccination is being administered by the government free of cost, so income and insurance would not play a role but better access to information which is available and understandable in every corner of our country should be a starting point to motivate the people of this country regarding the importance of preventive strategy like vaccination.

This study has some limitations. First, as it was a self-administered questionnaire, it precludes in person interactions or we could not get the responses from people who are not well versed with internet facilities or who are illiterate. Second, participance in the survey was skewed toward the younger population. Therefore, in this regard, more studies are warranted that can cover wider age group and subsections of the society.

  Conclusions Top

Our study showed that there are some misconceptions and gaps in knowledge in general public understanding about the vaccine and similar perceptions are also prevalent throughout the world when other studies were analyzed and compared. This study demonstrates that despite so much effort by health-care facilities and awareness campaign by the Government of India, there still exist a lack of understanding and prevalence of some myths that are preventing normal population from receiving the vaccination. In the past, vaccines as public health tools have an undisputable track record that has helped eradicating smallpox, containing polio to just three endemic countries and greatly reducing many other diseases. Hence, for combating the pandemic of COVID-19, vaccine is going to be the most valuable and cost-effective weapon. Our study may help the administrators to understand the community concerns, tweaking current policies, and increasing the awareness campaign so that people gather more knowledge about vaccine benefits, myth is busted and a community trust is built leading to strengthened immunization system that is more resilient and responsive.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Centers for Disease Control and Prevention (CDC): Coronavirus Disease 2019 (COVID-19) Situation Summary. Available from: https://wwwcdcgov/coronavirus/2019-ncov/summaryhtml. [Last accessed on 2021 Apr 25].  Back to cited text no. 1
World Health Organization. Novel Coronavirus (2019-nCoV) Technical Guidance. Available from: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/technical-guidance. [Last accessed on 2021 Apr 25].  Back to cited text no. 2
Ministry of Health and Family Welfare, Government of India Official Website. Available from: https://www.mohfw.gov.in/Covid19. [Last accessed on 2021 Apr 25].  Back to cited text no. 3
Sheriff K. Understanding COVID-19 Vaccine Wastage in India. Kolkata: The Indian Express; 2021.  Back to cited text no. 4
Seale H, Heywood AE, Leask J, Sheel M, Durrheim DN, Bolsewicz K, et al. Examining Australian public perceptions and behaviors towards a future COVID-19 vaccine. BMC Infect Dis 2021;21:120.  Back to cited text no. 5
Magadmi RM, Kamel FO. Beliefs and barriers associated with COVID-19 vaccination among the general population in Saudi Arabia. Res Square 2020. doi: 10.21203/rs.3.rs-48955/v1.  Back to cited text no. 6
Islam MS, Siddique AB, After R, Tasnim R, Sujan MS, Ward PR. Knowledge, attitudes and perceptions towards COVID-19 vaccinations: A cross-sectional community survey in Bangladesh. medRxiv 2021;16:2125180.  Back to cited text no. 7
Ward JK, Alleaume C, Peretti-Watel P, COCONEL Group. The French public's attitudes to a future COVID-19 vaccine: The politicization of a public health issue. Soc Sci Med 2020;265:113414. doi: 10.1016/j.socscimed.2020.113414.  Back to cited text no. 8
Caserotti M, Girardi P, Rubaltelli E, Tasso A, Lotto L, Gavaruzzi T. Associations of COVID-19 risk perception with vaccine hesitancy over time for Italian residents. Soc Sci Med 2021;272:113688.  Back to cited text no. 9
Reiter PL, Pennell ML, Katz ML. Acceptability of a COVID-19 vaccine among adults in the United States: How many people would get vaccinated? Vaccine 2020;38:6500-7.  Back to cited text no. 10
Coconel Group. A future vaccination campaign against COVID-19 at risk of vaccine hesitancy and politicisation. Lancet Infect Dis 2020;20:769-70.  Back to cited text no. 11
Neumann-Böhme S, Varghese NE, Sabat I, Barros PP, Brouwer W, van Exel J, et al. Once we have it, will we use it? A European survey on willingness to be vaccinated against COVID-19. Eur J Health Econ 2020;21:977-82.  Back to cited text no. 12
Harapan H, Wagner AL, Yufika A, Winardi W, Anwar S, Gan AK, et al. Acceptance of a COVID-19 vaccine in Southeast Asia: A cross-sectional study in Indonesia. Front Public Health 2020;8:381.  Back to cited text no. 13
Wang J, Jing R, Lai X, Zhang H, Lyu Y, Knoll MD, et al. Acceptance of COVID-19 Vaccination during the COVID-19 Pandemic in China. Vaccines (Basel) 2020;8:482.  Back to cited text no. 14
Abdul K, Khandekar M, Farhana M. Knowledge, attitude and acceptance of a COVID-19 vaccine: A global cross-sectional study. Int Res J Bus Soc Sci 2020;6:1-23.  Back to cited text no. 15
Chaturvedi S, Dasgupta R, Adhish V, Ganguly KK, Rai S, Sushant L et al. Deconstructing social resistance to pulse polio campaign in two North Indian districts. Indian Pediatr. 2009 Nov;46(11):963-74.  Back to cited text no. 16
Platt LR, Estívariz CF, Sutter RW. Vaccine-associated paralytic poliomyelitis: A review of the epidemiology and estimation of the global burden. J Infect Dis 2014;210 Suppl 1:S380-9.  Back to cited text no. 17


  [Table 1]

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