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Table of Contents
Year : 2022  |  Volume : 13  |  Issue : 4  |  Page : 209-210

Is the fight against COVID-19 falling prey to vaccine hesitancy?

Department of Medicine, Lady Hardinge Medical College and Associated Hospitals, New Delhi, India

Date of Submission15-Nov-2022
Date of Acceptance15-Nov-2022
Date of Web Publication18-Nov-2022

Correspondence Address:
Dr. Anupam Prakash
Department of Medicine, Lady Hardinge Medical College and Associated Hospitals, New Delhi - 110 001
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/injms.injms_131_22

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How to cite this article:
Prakash A, Aggarwal R. Is the fight against COVID-19 falling prey to vaccine hesitancy?. Indian J Med Spec 2022;13:209-10

How to cite this URL:
Prakash A, Aggarwal R. Is the fight against COVID-19 falling prey to vaccine hesitancy?. Indian J Med Spec [serial online] 2022 [cited 2023 Jun 7];13:209-10. Available from: http://www.ijms.in/text.asp?2022/13/4/209/361527

With over 2 years into the COVID-19 pandemic, new cases have consistently been at low levels, with minimum rate of admissions due to COVID-19. Besides, mortality levels attributable to COVID-19 infection are also at the lower end of the spectrum. New COVID-19 variants have continuously been emerging and are an expected outcome. An interesting aspect of the behavior of these new variants is that even though they might be more infectious, they have been found to be less virulent with less severity of disease and/or lesser mortality rates. This is a win–win situation for both the virus and the human beings, because the virus with its higher infectivity is infecting more people, thus surviving but with its low virulence is not resulting in increased admissions or deaths.

The pertinent question that comes to mind is what has resulted in the waning of numbers, waning of severity, and waning of mortality in COVID. Is the pandemic ebbing in its natural way, or is it the effect of vaccines? The possibility that everyone got infected and has developed immunity is remote since people have been getting recurrent infections, and it is amply clear that the immunity is not long lasting. Although there is no specific answer to this, definitely there is evidence to suggest that mass vaccination strategies have resulted in reduced severity and reduced mortality among the vaccinated. However, of late, a diminished interest for the booster dose or the preventive dose as it has been called in India is being observed.

With the enthusiasm to get repeat vaccinations dwindling and skepticism rising about the efficacy of vaccines, more so, as many people are repeatedly getting mild COVID-19 infections, “vaccine hesitancy” for COVID-19 vaccines has become an issue. Vaccine hesitancy is a common phenomenon observed with many other vaccines also. While eradicating poliomyelitis from India, some regional pockets remained where resistance to getting vaccinated with the polio vaccine was high. Similarly, vaccine hesitancy is a general concept, and is applicable to COVID-19 vaccination too.

In 2015, a concrete definition of vaccine hesitancy was enunciated,[1] referring to it as a delay in acceptance or refusal of vaccination despite the availability of vaccination services. The working group acknowledged that vaccine hesitancy is complex and context specific, which varies with time, place, and vaccines. The major factors that influence vaccine hesitancy can be grouped as 3 Cs, namely, complacency, convenience, and confidence.

As new COVID-19 numbers recede, people are learning to live with it, with fear going out of their minds, contributing to complacency. Consequently, vaccine hesitancy creeps in and getting people vaccinated becomes increasingly difficult. There is an inherent belief in many people that nothing can happen to them, call it confidence or overconfidence or unjustified confidence, and these people do not take any precautions or vaccines. This belief in itself contributes to vaccine hesitancy. On the contrary, there are some people who are very much fearful of the disease, but these people may also be fearful of the vaccine, and so may form a subgroup population with vaccine hesitancy. Some people just delay their vaccinations, for not-so-obvious reasons or reasons that may be beyond explanation, or may be waiting for a more opportune time to get vaccinated, as per their “convenience” the third C. At times, people may be fearful of needles/injections in general or may be averse to taking any form of allopathic medicines, be it vaccines, or maybe having misconceptions or are vulnerable to taboos. Misinformation campaigns abound, namely, vaccines may have long-term detrimental effects, may cause impotence, or vaccines have been rapidly pushed through and not properly tested, because of nexus with pharmaceutical or manufacturing firms, and other beliefs like these are commonplace, and contribute to vaccine hesitancy. Suggestions by some persons to make COVID-19 vaccines compulsory, on the plea that we were amidst a pandemic, could have proved counterproductive. One must realize that these are welfare measures, and counseling, education, awareness, and perseveration play important roles in overcoming vaccine hesitancy. Using the support of social or village elders, celebrities, and respectable community leaders is also helpful in rectifying public misconceptions.

An exploratory analysis of COVID-19 vaccine coverage in India[2] reported the vaccine acceptance rate in India to be 84%, which is higher than Pakistan (66.5%), the USA (64.6%), and Russia (30.4%). One percentage increase in vaccine hesitancy can reduce vaccination coverage by 30%. Furthermore, an increase in the number of people living in poverty reduces COVID-19 vaccination coverage. Additional factors such as the use of digital platforms for registration in India may have influenced the population exhibiting vaccine hesitancy. Female gender, with poor literacy status and poor digital access or ability to use digital technologies, may have been factors because of which female gender was reported to be associated with vaccine hesitancy. Variable vaccination hesitancy rates have been reported across countries, the US – 21%, the UK – 25%, Russia – 45%, Poland – 44%, France – 41%, Kuwait – 76%, and Jordan – 71%.

A meta-analysis reported the global prevalence of COVID-19 vaccine hesitancy as 25%.[3] The determinants of COVID-19 vaccine hesitancy were reported to be female gender, age <50 years, being single, unemployment, living in a household with five or more individuals, education level less than an undergraduate degree, having a non-healthcare-related job, and considering COVID-19 vaccines as unsafe. On the contrary, the meta-analysis reported that the risk of vaccine hesitancy was lower in those who have had COVID-19, were living with children at home, were maintaining physical distancing norms, and had influenza vaccination in the past few years.

In a recent systematic review[4] on COVID-19 vaccine hesitancy, the most predominant predictors of vaccine hesitancy were a lower perceived risk of getting infected, a lower level of institutional trust, not being vaccinated against influenza, a lower level of perceived severity of COVID-19, or stronger beliefs that the vaccination may be unsafe.

Vaccine hesitancy is a complex phenomenon. Understanding it requires a detailed analysis of sociodemographic factors and behavioral factors, and at times, geographic commonalities may exist. Several strategies have been designed and evaluated to combat vaccine hesitancy which includes behavioral modifications, information, education, and communication (IEC) campaigns, and social marketing, while at times, interventions may target directly the vaccine-hesitant individuals rather than the community at large.

Although vaccine hesitancy may be inherent to all vaccines, it is standing in the way of achieving universal vaccination with COVID-19 vaccines, despite a plethora of COVID-19 vaccines being presently available. It is pertinent to study the factors, which may be contributing to this hesitancy, and simultaneously attempts should be stepped up to provide adequate vaccinations, and use IEC campaigns to reduce vaccine hesitancy. Governments must ensure that COVID-19 vaccines are available as other vaccines, providing a definite time for booster dosing, just like the annual influenza vaccine. This shall go a long way to encourage people to get vaccinated by removing the uncertainty which crops up because of a lack of a definite vaccination schedule.

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Conflicts of interest

There are no conflicts of interest.

  References Top

MacDonald NE, SAGE Working Group on Vaccine Hesitancy. Vaccine hesitancy: Definition, scope and determinants. Vaccine 2015;33:4161-4.  Back to cited text no. 1
Dhalaria P, Arora H, Singh AK, Mathur M, S AK. COVID-19 vaccine hesitancy and vaccination coverage in India: An exploratory analysis. Vaccines (Basel) 2022;10:739.  Back to cited text no. 2
Fajar JK, Sallam M, Soegiarto G, Sugiri YJ, Anshory M, Wulandari L, et al. Global prevalence and potential influencing factors of COVID-19 vaccination hesitancy: A meta-analysis. Vaccines (Basel) 2022;10:1356.  Back to cited text no. 3
Pires C. Global predictors of COVID-19 vaccine hesitancy: A systematic review. Vaccines (Basel) 2022;10:1349.  Back to cited text no. 4


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