Prevalence and determinants of SARS-CoV-2 vaccine hesitancy in Hong Kong: A population-based survey

Tzu Tsun Luk, Shengzhi Zhao, Yongda Wu, Janet Yuen-Ha Wong, Man Ping Wang, Tai Hing Lam, Tzu Tsun Luk, Shengzhi Zhao, Yongda Wu, Janet Yuen-Ha Wong, Man Ping Wang, Tai Hing Lam

Abstract

Background: Although vaccination against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the most desired solution to end the coronavirus disease (COVID-19) pandemic, there are growing concerns that vaccine hesitancy would undermine its potential. We examined the intention to receive vaccination against SARS-CoV-2 and the associated factors in a representative sample of Chinese adults in Hong Kong.

Methods: We did a dual-frame (landline and mobile) cross-sectional survey of a random sample of 1501 Hong Kong residents aged 18 years or older (53.6% females) in April 2020. We collected data on the intention to receive SARS-CoV-2 vaccine when it becomes available (yes/ no/ undecided), knowledge and perceptions of COVID-19, smoking, alcohol drinking, and sociodemographic factors. Prevalence estimates were weighted by the sex, age, and education of the general population of Hong Kong.

Results: Overall, 45.3% (95% CI: 42.3-48.4%) of the participants had intentions to vaccinate against SARS-CoV-2 when it becomes available, 29.2% (26.5-32.1%) were undecided, and 25.5% (22.9-28.2%) had no intention. The most common reason for vaccine hesitancy (undecided or no intention) was safety concerns (56.5%). Multivariable partial proportional odds model showed higher vaccine hesitancy in males, younger adults, those with no chronic disease, current smokers, and non-alcohol drinkers. After adjusting for sociodemographic and other factors, inadequate knowledge of SARS-CoV-2 transmission (adjusted ORs ranged from 1.27 to 2.63; P < 0.05) and lower perceived danger of COVID-19 (adjusted ORs ranged from 1.62 to 2.47; P < 0.001) were significantly associated with vaccine hesitancy.

Conclusions: In a representative sample of Chinese adults in Hong Kong, only 45.3% of the participants intended to vaccinate against SARS-CoV-2 when available. Vaccine hesitancy was associated with inadequate knowledge about SARS-CoV-2 transmission and lower perceived danger of COVID-19, which needed to be addressed to improve vaccination uptake.

Keywords: COVID-19; Chinese; Coronavirus; Vaccine acceptance; Vaccine hesitancy.

Conflict of interest statement

Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Copyright © 2021 Elsevier Ltd. All rights reserved.

Figures

Fig. 1
Fig. 1
Reasons for undecided or no intention to vaccinate against SARS-CoV-2 (N = 810). Percentages were weighted sex, age and education of the general population of Hong Kong.

References

    1. Stringhini S., Wisniak A., Piumatti G., Azman A.S., Lauer S.A., Baysson H., et al. Seroprevalence of anti-SARS-CoV-2 IgG antibodies in Geneva, Switzerland (SEROCoV-POP): a population-based study. Lancet. 2020;396(10247):313–319.
    1. Pollán M., Pérez-Gómez B., Pastor-Barriuso R., Oteo J., Hernán M.A., Pérez-Olmeda M., et al. Prevalence of SARS-CoV-2 in Spain (ENE-COVID): a nationwide, population-based seroepidemiological study. Lancet. 2020;396(10250):534–544.
    1. Xu X., Sun J., Nie S., Li H., Kong Y., Liang M., et al. Seroprevalence of immunoglobulin M and G antibodies against SARS-CoV-2 in China. Nat Med. 2020;26:1193–1195.
    1. Havers F.P., Reed C., Lim T., Montgomery J.M., Klena J.D., Hall A.J., et al. Seroprevalence of Antibodies to SARS-CoV-2 in 10 Sites in the United States, March 23-May 12, 2020. JAMA Intern Med. 2020;180(12):1576–1586.
    1. Lurie N., Saville M., Hatchett R., Halton J. Developing Covid-19 vaccines at pandemic speed. N Engl J Med. 2020;382(21):1969–1973.
    1. MacKenna B, Curtis HJ, Morton CE, Inglesby P, Walker AJ, Morley J, et al. Trends, regional variation, and clinical characteristics of COVID-19 vaccine recipients: a retrospective cohort study in 23.4 million patients using OpenSAFELY. medRxiv. 2021:2021.01.25.21250356.
    1. MacDonald N.E. Vaccine hesitancy: Definition, scope and determinants. Vaccine. 2015;33(34):4161–4164.
    1. World Health Organization. Ten threats to global health in 2019 [Available from: .
    1. Sanche S., Lin Y.T., Xu C., Romero-Severson E., Hengartner N., Ke R. High contagiousness and rapid spread of severe acute respiratory syndrome coronavirus 2. Emerg Infect Dis. 2020;26(7):1470–1477.
    1. Dodd R.H., Cvejic E., Bonner C., Pickles K., McCaffery K.J., Ayre J., et al. Willingness to vaccinate against COVID-19 in Australia. Lancet Infect Dis. 2021;21(3):318–319.
    1. The COCONEL Group A future vaccination campaign against COVID-19 at risk of vaccine hesitancy and politicisation. Lancet Infect Dis. 2020;20(7):769–770.
    1. Fisher K.A., Bloomstone S.J., Walder J., Crawford S., Fouayzi H., Mazor K.M. Attitudes Toward a Potential SARS-CoV-2 Vaccine: A Survey of U.S. Adults. Ann Intern Med. 2020;173(12):964–973.
    1. Leung G.M., Hedley A.J., Ho L.M., Chau P., Wong I.O., Thach T.Q., et al. The epidemiology of severe acute respiratory syndrome in the 2003 Hong Kong epidemic: an analysis of all 1755 patients. Ann Intern Med. 2004;141(9):662–673.
    1. Cowling B.J., Ali S.T., Ng T.W.Y., Tsang T.K., Li J.C.M., Fong M.W., et al. Impact assessment of non-pharmaceutical interventions against coronavirus disease 2019 and influenza in Hong Kong: an observational study. Lancet Public Health. 2020;5(5):e279–e288.
    1. Lau J.T.F., Yeung N.C.Y., Choi K.C., Cheng M.Y.M., Tsui H.Y., Griffiths S. Acceptability of A/H1N1 vaccination during pandemic phase of influenza A/H1N1 in Hong Kong: population based cross sectional survey. BMJ. 2009;339 b4164-b.
    1. Liao Q., Cowling B.J., Lam W.W.T., Fielding R. Factors affecting intention to receive and self-reported receipt of 2009 pandemic (H1N1) vaccine in Hong Kong: a longitudinal study. PLoS ONE. 2011;6(3)
    1. Chor J.S., Ngai K.L., Goggins W.B., Wong M.C., Wong S.Y., Lee N., et al. Willingness of Hong Kong healthcare workers to accept pre-pandemic influenza vaccination at different WHO alert levels: two questionnaire surveys. BMJ. 2009;339
    1. Luk T.T., Zhao S., Weng X., Wong J.Y., Wu Y.S., Ho S.Y., et al. Exposure to health misinformation about COVID-19 and increased tobacco and alcohol use: a population-based survey in Hong Kong. Tob Control. 2020 doi: 10.1136/tobaccocontrol-2020-055960.
    1. Census and Statistics Department. Thematic household survey report no. 69: Personal computer and Internet penetration Hong Kong Special Administrative Region: Census and Statistics Department; 2020 [Available from: .
    1. World Health Organization. Risk Communication and Community Engagement Action Plan Guidance: COVID-19 Preparedness and Response: Interim guidance 2020 [Available from: .
    1. World Health Organization. Modes of transmission of virus causing COVID-19: implications for IPC precaution recommendations: scientific brief 2020 [Available from: .
    1. Census and Statistics Department. 2016 Population By-census: main results Hong Kong SAR: Census and Statistics Department; 2017 [Available from: .
    1. Williams R. Generalized Ordered Logit/Partial Proportional Odds Models for Ordinal Dependent Variables. Stata J. 2006;6(1):58–82.
    1. Chu D.K., Akl E.A., Duda S., Solo K., Yaacoub S., Schünemann H.J., et al. Physical distancing, face masks, and eye protection to prevent person-to-person transmission of SARS-CoV-2 and COVID-19: a systematic review and meta-analysis. Lancet. 2020;395(10242):1973–1987.
    1. Thorpe S., VanderEnde K., Peters C., Bardin L., Yount K.M. The influence of women’s empowerment on child immunization coverage in low, lower-middle, and upper-middle income countries: A systematic review of the literature. Matern Child Health J. 2016;20(1):172–186.
    1. Wu Z., McGoogan J.M. Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72 314 cases from the Chinese Center for Disease Control and Prevention. JAMA. 2020;323(13):1239–1242.
    1. World Health Organization. Smoking and COVID-19: Scientific brief June 2020 [Available from: .
    1. Adam D., Wu P., Wong J., Lau E., Tsang T., Cauchemez S., et al. Clustering and superspreading potential of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections in Hong Kong. Nat Med. 2020;26:1714–1719.
    1. Johnson N.F., Velásquez N., Restrepo N.J., Leahy R., Gabriel N., El Oud S., et al. The online competition between pro-and anti-vaccination views. Nature. 2020;582:230–233.
    1. Reiter P.L., Pennell M.L., Katz M.L. Acceptability of a COVID-19 vaccine among adults in the United States: How many people would get vaccinated? Vaccine. 2020;38(42):6500–6507.
    1. Carfì A., Bernabei R., Landi F. Persistent symptoms in patients after acute COVID-19. JAMA. 2020;324(6):603–605.
    1. Leng A., Maitland E., Wang S., Nicholas S., Liu R., Wang J. Individual preferences for COVID-19 vaccination in China. Vaccine. 2021;39(2):247–254.

Source: PubMed

3
Sottoscrivi