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ORIGINAL ARTICLE
Year : 2023 | Volume
: 9
| Issue : 1 | Page : 4-10
A community-based study on willingness and predictors to receive precautionary dose of COVID-19 vaccine in Puducherry
Senkadhirdasan Dakshinamurthy, Lalithambigai Chellamuthu, Govindaraj Rajendran
Department of Community Medicine, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth, Puducherry, India
Correspondence Address:
Dr. Lalithambigai Chellamuthu
Department of Community Medicine, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth, Puducherry - 607 402
India
Source of Support: None, Conflict of Interest: None
CheckDOI: 10.4103/ijam.ijam_79_22
Introduction: World Health Organization has proposed yearly boosters for high-risk adults and biannual boosters for the general population. Research on the acceptance of current COVID-19 immunization has been done, but only a little information is available on booster dose acceptance in India. The objectives of this study were to assess the willingness to receive precautionary doses of the vaccine among adults and to identify the sociodemographic predictors to receive precautionary doses of the vaccine among adults who have been fully vaccinated against COVID-19 in Puducherry.
Methods: A community-based, cross-sectional study was conducted for 2 months in the field practice area of a private medical college in Puducherry. Individuals, ≥18 years residing for >6 months in the selected villages/wards and willing to give consent were included in the study. Individuals with absolute/relative contraindications for COVID-19 vaccination were excluded from the study. The sample size was 632, and a multistage sampling technique was employed. A semi-structured questionnaire was utilized for face-to-face interviews.
Results: Among 632, 86.4% were vaccinated with two doses of COVID-19 vaccines. Out of 609 adults who have been fully vaccinated against COVID-19, 83.6% exhibited willingness to receive precautionary doses of the vaccine. Common factors influencing willingness to receive precautionary doses of the vaccine among adults who have been fully vaccinated against COVID-19 which were fear of postvaccine complications in 37%, less awareness about the precautionary dose among 14%, waiting for others to get vaccinated first in 7%, and 2% expressed as their personal desire for not being vaccinated. Education and socioeconomic status of the individuals were found to be significantly associated (P < 0.05) with the willingness to receive precautionary doses. Gender, marital status, and residence of the study population were significantly associated with higher odds for willingness to receive precautionary doses.
Conclusion: Most of the adult population in this study completed the second dose of the COVID-19 vaccine and were willing to receive a third dose.
The following core competencies are addressed in this article: Practice-based learning and improvement, Patient care and procedural skills, Systems-based practice, Medical knowledge, Interpersonal and communication skills, and Professionalism.
Keywords: Community-based study, COVID-19 precautionary dose, predictors, vaccination, willingness
Since the outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections in late 2019, the world has been trapped in a deadly race with a virus that has claimed 664 million confirmed cases and over 6.7 million fatalities have as of January 2023.[1] To limit the disease's spread, various measures such as social distancing, cleanliness habits, and the use of repurposed medications have been used. These measures were successful in slowing the virus's spread, but they had disastrous effects for the health-care system and the economy. Furthermore, a thorough search for a suitable treatment has been unsuccessful.[2] Vaccination is now the game-changing strategy that outperforms all other containment strategies.[3] The COVID-19 vaccine has been shown to minimize the risk of severe sickness, hospitalization, and death. Its amount of protection varies based on the vaccine administered, the period between doses, individual circumstances, and viral variety.[4] Furthermore, investigations have revealed that humoral immunity levels might diminish and possibly vanish over time.[5] Many nations decided to offer booster doses after reports of a steady fall in protection after immunization and the positive effect of a booster dose 6 months after the initial vaccination.[6] COVID-19 vaccination is presently the highest priority in terms of global health.[7] India has begun giving booster injections to health-care and frontline employees, as well as individuals over 60 with comorbidities, or other health issues on January 10, 2022.[3] As of January 10, the booster dosage provides priority, and sequencing is based on completing 9 months or 39 weeks from the date of the second dose, as per recommendations.[8] Approximately 76% of eligible individuals have been completely vaccinated, and more than 90% have gotten at least one of the nine approved vaccination thus far.[9] According to an Indian study, the adjusted efficacy of the two-dose Covaxin (inactivated vaccination) at least 14 days before testing was 47%, implying that the poor effectiveness might be attributed to the high prevalence of the circulating delta variant in India.[10] Because the duration of protection against circulating new variants and improving immunity levels is unknown, infectious disease experts have carefully weighed the need for booster shots for certain vulnerable groups or the entire population to protect against the circulating new variants and improve immunity levels.[11] COVID-19 vaccine protection fades with time, global and national health authorities are actively exploring ways to maintain immunity through vaccination booster (usually third) doses.[12] As worries regarding variations and protection duration continue to raise awareness about the significance of booster doses, it is critical to plan ahead of time to understand the requirements for booster vaccination. According to studies, booster doses give high immunity and protection against COVID-19.[13] The World Health Organization has also proposed yearly boosters for high-risk adults and biannual boosters for the general population.[14] Various research on acceptance of current COVID-19 immunization has shown that acceptance varies significantly around the globe, but only a little information is available on booster acceptance in India. Whether the COVID-19 vaccine demands annual (or regular) doses to maintain high levels of protection against both the original virus and variants, similar to annual seasonal influenza vaccines, is another area of dispute in the current discussion.[15] As a result, there is an urgent need to assess the public acceptability of COVID-19 boosters to plan successful advertising efforts.[16]
With this background, the aim of the study was to assess the willingness to receive precautionary doses of the vaccine among adults who have been fully vaccinated against COVID-19 and to identify the sociodemographic predictors for the same in Puducherry, South India.
MethodsA community-based, cross-sectional study was conducted for a period of 2 months (March to April 2022) in the urban and rural field practice area of a private medical college and hospital in Puducherry district, South India. Individuals who were ≥18 years residing for more than 6 months in the selected villages/wards and willing to give consent for the study were included in the study. Individuals with absolute/relative contraindications for COVID-19 vaccination were excluded from the study. Sample size was calculated using the following formula,[17]n = (DEFF × Np [1 − p])/([d2/Z21-α/2 × (N − 1) + p × (1 − p)),[17] where n = sample size, Z = Z statistic for a level of confidence (for 95% confidence interval [CI], Z = 1.96), P = proportion of uncertain or unwilling for booster dose vaccination = 8%,[18]q = 92%, d = relative precision (4%), population size (N) = 30,983, population correction factor (p): 8% ± 4, and design effect = 2. Considering a CI of 99%, taking a nonresponse rate of 5%, the minimum required sample size was found to be 632. A multistage sampling technique was followed. The cumulative population of all selected villages/wards was estimated to be 30,983. The rural and urban field practice area comprises eight villages and six wards, respectively. The field practice areas were stratified into urban and rural areas. Five villages and five wards were selected from each stratum (rural and urban field practice areas) using simple random sampling. The population proportion to size (PPS) method was used to determine the number of study participants to be chosen from each village/ward. The households from each of the selected areas were included using a systematic random sampling technique. Households in each village/ward were studied in a sequence till the inclusion of subjects as per PPS. The selected households were excluded from the study if they were unable to be contacted after three visits. From each household, if more than one eligible study participant was available, only one person was selected using simple random sampling (KISH grid technique).[19] A predesigned, pretested, semi-structured questionnaire was utilized for face-to-face interviews to assess the basic demographic profile, vaccination status, date of vaccination, past COVID infection, reinfection, other determinants, and risk factors of COVID infection. Data were captured using Epi-Collect_5 (v4.2.0; Centre for Genomic Pathogen Surveillance) application and the data were analyzed using Statistical Package for the Social Sciences (SPSS_v16.0; IBM Corp, Armonk, New York) software. The data were presented in the form of frequencies and percentages for qualitative variables and mean standard deviation or median interquartile range for quantitative variables. Chi-square test was applied to assess the significance of the study findings, and P < 0.05 was considered statistically significant. Institute Research and Ethics Committee approval was obtained before the commencement of the study. Written informed consent was sought from all participants. Confidentiality of the data collected was maintained and used only for the purpose of research.
ResultsA total of 632 people has participated in this study. Equal number of subjects was included from both urban and rural regions. The mean age of the study participants was found to be 42 ± 16. Around 82.6% of the study participants were married. The mean family size was 4 ± 1. The sociodemographic profile of the respondents is provided in [Table 1].
Among 632 individuals interviewed for this study, 155 (24.5%) had past history of COVID-19 infection. In those respondents, 151 (23.9%) had reported that they were infected with COVID-19 only once and 4 (0.6%) expressed that they acquired the infection twice. About 81 (12.8%) of the participants were infected before the first dose of the COVID-19 vaccine, 51 (8.1%) tested positive for COVID-19 after the first dose of the vaccine and 27 (4.3%) reported positive for COVID-19 after the second dose of vaccine. The distribution of respondents based on uptake of the COVID-19 vaccine and reasons for not opting for the vaccine are shown in [Figure 1] and [Figure 2].
Figure 1: Distribution of participants based on uptake of COVID-19 vaccineOut of 632 individuals included in the study, 311 (49.2%) had no existing comorbidities while 67 (10.6%) had hypertension, 61 (9.7%) had diabetes mellitus, 48 (7.6%) had cardiovascular disease, 40 (6.3%) had both diabetes and hypertension, 4 (0.6%) had thyroid disorder, and 101 (16.0%) had other chronic diseases.
In 632 subjects, 154 (24.4%) and 215 (34.0%) individuals had reported positive COVID-19 history among family and friends, respectively. In addition, the participants were asked to describe their perceived vulnerability for acquiring COVID-19 in the future based on a five-point Likert scale (options given in the Likert scale: strongly agree, agree, neither agree nor disagree, disagree, and strongly disagree = 0, 1, 2, 3, 4, and 5). The responses recorded were 15 (2.4%) strongly agree, 236 (37.4%) individuals agree, 221 (35.0%) neither agree nor disagree, 113 (17.9%) disagree, and 47 (7.4%) strongly disagree.
Among 609 adults who have been fully vaccinated against COVID-19, 509 (83.6%) exhibited willingness and the remaining 100 (16.4%) had shown an unwillingness to receive precautionary doses of vaccine. Out of those 100 individuals, the common factors for unwillingness to receive precautionary dose were fear of postvaccine complications in 37.0%, less awareness about the precautionary dose among 14.0%, waiting for others to get vaccinated first in 7.0%, and 2.0% expressed their personal desire for not being vaccinated. The association between willingness to receive precautionary doses of the COVID-19 vaccine and factors related to COVID-19 infection in the past among study participants is depicted in [Table 2].
Table 2: Association between willingness to receive precautionary dose of COVID-19 vaccine and factors related to COVID-19 infection in the past among study participantsSociodemographic predictors for willingness to receive precautionary doses of the vaccine among adults who have been fully vaccinated against COVID-19 are illustrated in [Table 3]. Education and socioeconomic status of the individuals were found to be significantly associated (P < 0.01) with willingness to receive precautionary doses of the vaccine among adults who have been fully vaccinated against COVID-19. Gender, marital status, and residence of the study population were associated with higher odds ratio (OR of gender, marital status, and residence found to be 1.11 [0.72–1.72], 0.75 [0.44–1.20], and 1.71 [1.10–2.65], respectively for willingness to receive precautionary doses of the vaccine. However, it was statistically not significant as P < 0.01.
Table 3: Sociodemographic predictors for willingness to receive precautionary dose of vaccine among adults who have been fully vaccinated against COVID-19 Discussion In the present research, nearly half of the participants (46.2%) were males and nearly one-fifth of the respondents (23.7%) were educated up to high school. A large proportion (86.4%) of the respondents completed two doses of COVID-19 vaccines. Moreover, among 609 adults who have been fully vaccinated against COVID-19, the majority (83.6%) exhibited willingness to receive precautionary doses of the vaccine in the current study. Similar findings were observed in a study conducted by Sugawara et al. in Japan on willingness for COVID-19 precautionary doses among medical students through online surveys.[20] Studies from China also reported similar findings on the acceptance of the third dose of the COVID-19 vaccine.[21],[22],[23]
Contrary to the present study findings, a study by Lounis et al. to determine the acceptance of the COVID-19 vaccine booster and its associated factors in the Algerian population published that 51.6%, 25%, and 23.8% of respondents, respectively, accepted, rejected, or were hesitant about the COVID-19 vaccine booster. Only 13.2%, however, confirmed receiving the booster dose. In addition, 58.2% of the respondents said they felt relieved after receiving the primer immunization and 11.4% of them said they regretted getting the shot.[24]
In the present study, predominant number of subjects was willing to get vaccinated with the third dose (83.9% among adults have not suffered with COVID-19 infection in the past and 82.7% among those who have had the infection earlier). Major part of the respondents gave acceptance for booster doses of the vaccine among whom had never been positive for COVID-19 (83.9%) and those who had acquired the infection once in the past (83.6%).
Three-fourth of participants expressed fear of existing comorbidities as the reason for not opting for the COVID-19 vaccine while fear of vaccine complications was the reason in the remaining 25% in this research. Furthermore, the common factors for unwillingness to receive precautionary dose were determined as the following: fear of postvaccine complications in 37.0%, less awareness about the precautionary dose among 14.0%, waiting for others to get vaccinated first in 7.0%, and 2.0% expressed as their personal desire for not being vaccinated. Similar reasons were outlined in previous studies.[21],[25],[26] In another study, reasons for rejection of booster dose of the COVID-19 vaccine were cited as a belief that primer doses are sufficient or lack of trust in vaccination.[24]
Education and socioeconomic status of the individuals were found to be significantly associated with willingness to receive precautionary doses of the vaccine among adults who have been fully vaccinated against COVID-19 in this study. Gender, marital status, and residence of the study population were associated with higher OR for willingness to receive precautionary doses of the vaccine among adults who have been fully vaccinated against COVID-19.
Previous literature showed that confidence in vaccines, relaxation of mobility restrictions, and concern about the sustainability of immunity motivated the willingness to receive a third dose of the COVID-19 vaccine.[20] Respondents who expressed significantly higher acceptance of a booster dose were aged 25–54 years old, male, nonhealthcare workers, and less educated. Moreover, those who had been vaccinated against influenza, who believed herd immunity would be effective against SARS-CoV-2 infection, or who reported reduced anxiety after vaccination were more likely to report planning to receive a booster dose.[23] Furthermore, males, older individuals, those with chronic comorbidities or a history of COVID-19 infection, nonhealthcare workers, and those with low educational levels were associated with significantly higher odds for booster acceptance.[24]
The strengths of the study being first of its kind in Southern India and a community-based study so that we get a true estimate of the acceptance of booster doses of COVID-19.
Limitations
This study was subject to some limitations. First being the epidemic relatively stable when the survey was conducted and therefore not causing a great amount of panic among members of the public, which suggests that this sample provided some insight to public willingness to get a booster dose. Second, acceptance of a COVID-19 vaccine booster could also be influenced by information spread in the media and on social networks, including the local number of daily confirmed cases, the capacity of healthcare services, and relevant policies in different areas. Further investigation is, therefore, needed in the future.
ConclusionMost of the adult population in this study completed the second dose of the COVID-19 vaccine and were willing to receive a third dose. Education and socioeconomic status of the individuals were found to be significantly associated with willingness to receive booster. Gender, marital status, and residence of the study population were significantly associated with higher odds for willingness to receive precautionary doses.
We would like to recommend that booster shot of the COVID-19 vaccine could be widely accepted in India if communicating to the public the effectiveness of COVID-19 vaccines and the impact of COVID-19 infection on one's health could increase individuals' willingness to receive a booster dose. We consider these results to emphasize the importance and need of awareness campaigns that accentuate the process and uptake of COVID-19 precautionary doses among adults.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
Research quality and ethics statement
The institute's scientific and ethics committee approval were obtained before the commencement of the study (Ref No.: IEC/58/2022).
References
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