Journal of Education and Health Promotion

Abstract BACKGROUND: The World Health Organization (WHO) states that vaccine hesitancy is one of
the top 10 threats to global public health. Evidence shows that vaccine hesitancy studies in India
are limited and targeted toward individual vaccines. The study aimed to fill this gap by exploring the
relationship between demographics and SAGE factors toward vaccine hesitancy.
MATERIALS AND METHODS: A hospital‑based, cross‑sectional, analytical study was conducted
in a non‑governmental organization (NGO) hospital with 330 beds, located in Bathalapalli,
Andhra Pradesh, India. Mothers of under‑five children who attended outpatient departments of
pediatrics or obstetrics and gynecology were included. A total of 574 mothers were enrolled and
vaccine hesitancy was determined by reviewing the mother–child protection card for the presence
of delay or refusal of the recommended vaccine. A face‑to‑face interview was conducted to obtain
demographics and WHO–SAGE variables from the participants. Binary logistic regression analysis
was performed to associate independent variables (demographics and SAGE variables) with the
dependent variable (vaccine hesitancy).
RESULTS: Out of 574 respondents, 161 mother’s children were noted as vaccine‑hesitant (refusal = 7;
delay = 154); and the prevalence of vaccine hesitancy was 28.05%. The delay was observed in all
recommended vaccines, but the refusal or reluctance was seen in only four vaccines (hepatitis B
birth dose = 1; IPV 1 and 2 = 2; Measles 1 and 2 = 3; and Rota 1, 2, and 3 = 1). The respondents’
demographics like no or lower parent education (OR = 3.17; 95%CI = 1.50–6.72) and fewer antenatal
visits (OR = 2.30; 95%CI = 1.45–3.36) showed higher odds, whereas the upper socioeconomic
status showed lower odds (OR = 0.09; 95%CI = 0.02–0.36) toward vaccine hesitancy. The WHO–
SAGE dimensions like awareness (OR = 0.14; 95%CI = 0.03–0.53), poor access (OR = 7.76;
95%CI = 3.65–16.51), and low acceptability of the individual (OR = 07.15; 95%CI = 1.87–27.29),
community (OR = 6.21; 95%CI = 1.58–24.33) were significantly associated with vaccine hesitancy.
CONCLUSION: The study concludes that the prevalence of vaccine hesitancy was high. Vaccine
safety and children’s health are primary concerns for parents’ refusal/reluctance. To achieve 100%
immunization coverage, policymakers need to reduce vaccine hesitancy by developing strategies
based on demographic and WHO–SAGE working group predictors.

Abstract BACKGROUND AND AIM: Vaccination has been appraised to be one of the most significant public 
health achievements in human history. However, in countries like Nigeria, vaccine hesitancy is a 
public health challenge that has consistently forestalled concerted efforts made by health authorities 
to curb the spread of communicable diseases such as COVID‑19. To improve COVID‑19 vaccine 
acceptance via targeted interventions, it is imperative to examine the public’s perception. Thus, 
this study aims to evaluate vaccine hesitancy among university students in Southwestern Nigeria.
MATERIALS AND METHODS: The study utilized a descriptive cross‑sectional design. 
A self‑administered questionnaire was administered to a total of 366 respondents who were recruited 
using the convenience sampling technique and snowball approach. Data were entered and analyzed 
using SPSS.
RESULTS: The majority of the respondents were over 18 years (88%) and were between their first 
and third years (81%). Over a tenth of the respondents reported having at least a loved one that 
had tested positive for the virus, while only 88% believed the virus is real. Furthermore, only 17% 
of the students had a positive attitude toward the vaccine. Although 90% of the respondents were 
aware of the administration of COVID‑19 vaccine in Nigeria, only around a quarter were willing to take 
the vaccine, while 5.5% had been vaccinated. The major reasons for COVID‑19 vaccine hesitancy 
highlighted by the respondents were concerns about vaccine side effects (21.3%), lack of trust in the 
authorities (26.5%), vaccine efficacy (13.1%), and diverse mystical possibilities (39.1%).
CONCLUSION: The results indicate that a significant communication gap exists between the 
respondents and local health authorities. To enhance the acceptance of COVID‑19 vaccines, extensive 
and targeted health promotion campaigns are required to allay specific concerns raised by the public.

Abstract BACKGROUND: Vaccine hesitancy leads to an increase in morbidity, mortality, and health‑care 
burden. Reasons for vaccine hesitancy include anti‑vax group statements, misinformation about 
vaccine side effects, speed of vaccine development, and general disbelief in the existence of viruses 
like COVID‑19. Medical students are future physicians and are key influencers in the uptake of 
vaccines. Hence, investigating vaccine hesitancy in this population can help to overcome any barrier 
in vaccine acceptance.
METHODS: In this paper, we review five articles on COVID‑19 vaccine hesitancy in medical students 
and consider potential future research. All published papers relevant to the topic were obtained 
through extensive search using major databases. Inclusion criteria included studies that specifically 
investigated COVID‑19 vaccine hesitancy in medical students published between 2020 and 2021. 
Exclusion criteria included studies that investigated vaccine hesitancy in health‑care professionals, 
allied health, and viruses apart from COVID‑19. A total of 10 studies were found from our search.
RESULTS: Based on our exclusion criteria, only five studies were included in our review. The sample 
size ranged from 168 to 2133 medical students. The percentage of vaccine hesitancy in medical 
students ranged from 10.6 to 65.1%. Reasons for vaccine hesitancy included concern about serious 
side effects, vaccine efficacy, misinformation and insufficient information, disbelief in public health 
experts, financial costs, and belief that they had acquired immunity.
CONCLUSION: These results suggest that vaccine hesitancy is an important cause of the incidence 
and prevalence of COVID‑19 cases. Identifying the barriers of vaccine hesitancy in prospective 
physicians can help increase vaccination uptake in the general public. Further research is necessary 
to identify the root cause of these barriers.

Abstract BACKGROUND: Vaccine hesitancy presents a major challenge during the COVID‑19 pandemic. It 
is crucial to address the factors contributing to vaccine hesitancy necessary to control the associated 
morbidity and mortality. This study aimed to investigate the impact of professional medical guidance 
on the likelihood of receiving the COVID‑19 vaccine in immigrants of USA and Canada.
MATERIALS AND METHODS: A total of 92 immigrants in the USA and Canada who predominantly 
spoke Malayalam were recruited using social media platforms. An online survey was administered 
investigating participants’ confidence in receiving the COVID‑19 vaccine. Following, a short 
webinar was conducted by a medical professional explaining the efficacy and safety of the vaccine. 
A postwebinar survey was immediately given assessing the confidence and likelihood of receiving 
the vaccine. SPSS was used to generate descriptive statistics and Pearson Chi‑square analysis 
where appropriate.
RESULTS: Results revealed that participants who attended the webinar reported greater confidence 
in receiving the COVID‑19 vaccine. There was a statistically significant difference between pre‑ and 
postwebinar confidence scores for the COVID‑19 vaccine, 2 (12, n = 80) = 43.34, P < 0.01.
CONCLUSION: Results from the current study demonstrate the successful delivery of professional 
medical guidance to the general public through online small‑group sessions to help address the 
misconceptions surrounding the COVID‑19 vaccine and combat vaccine hesitancy among vulnerable 
populations. Future studies should focus on interventions addressing vaccine hesitancy in larger and 
diverse populations and analyze other barriers to vaccination.

Abstract BACKGROUND: Vaccine hesitancy is seen, globally, as a major factor that will determine future 
coronavirus disease‑19 (COVID‑19) spread and its effective management. This study aimed to 
identify COVID‑19 vaccine perception, acceptance, confidence, hesitancy, and barriers among the 
general population.
MATERIALS AND METHODS: This was an online survey which was developed and shared through 
social media platforms among the general population of Kashmir. The survey captured demographic 
data and used a validated hesitancy measurement tool. We analyzed the data using descriptive 
statistics and multivariable logistic regression using Stata 15 (Stata Corp. 2017. Stata Statistical 
Software: Release 15. College Station, TX, USA: Stata Corp LLC).
RESULTS: A total of 835 responses were received. Most participants were males, with females 
compromising of 19.5% participants. 65.1% of participants were in the age group of 30–50, whereas 
19.2% were below 30 years of age. 52.70% of respondents were willing to take the vaccine when 
available, while 32.5% of respondents were unsure about their decision of inoculation. The most 
cited reason for willingness to get vaccinated was an understanding of the disease and vaccination. 
41.70% felt that the vaccines developed against COVID‑19 have not been fully tested; therefore, 
concerns around the safety and its longer‑term side effects were the reasons cited. Public health 
messaging should be tailored to address these concerns.
CONCLUSIONS: Vaccine hesitancy is a global threat undermining the control of preventable 
infections. The government should take proactive steps to address the factors that may potentially 
impact the benefits expected from the introduction of a COVID‑19 vaccine in the union territory.