Panic in the Pandemic: Determinants of Vaccine Hesitancy and the Dilemma of Public Health Information Sharing during the COVID-19 Pandemic in Sri Lanka
Abstract
:1. Introduction
1.1. Overview of Vaccine Hesitancy
- Confidence—Lack of confidence in the vaccine’s effectiveness, efficacy, and safety, as well as the competency of health care workers (HCWs) who deliver the vaccines. The motivation and objectives behind the vaccination campaigns are often questioned.
- Convenience—Questions on being physically able to visit the site of vaccine delivery, affordability of the vaccine, understanding the instructions given (Health Literacy), and acceptance of vaccination within the cultural norms.
- Complacency—Ability to perceive the risk of getting infected with the disease vs. being protected by the vaccine.
- Collective Responsibility—Willingness to protect others.
- Calculations—Engagement in gathering extensive information.
- Contextual—Communication and media environment, influential leaders/gatekeepers, religion/culture/gender/economy/social status, politics, and policies.
- Individual/Group—Beliefs and attitudes on prevention, personal or family experiences in previous vaccinations, perceived risk and benefit, trust in the health care system and HCWs, etc.
- Vaccine/Vaccine Specific Influencers—Vaccine schedule, cost, design, and mode of delivery in the vaccination programme, reliability of vaccination equipment and the strength of recommendation by a health care professional.
1.2. COVID-19 Pandemic and Vaccination Status in Sri Lanka
2. Materials and Methods
2.1. Household Survey
2.2. Statistical Analysis
2.3. Semi-Structured Interviews
2.4. Ethical Considerations
3. Results
3.1. Factors Affecting Delayed Vaccination and Rejection of Vaccination by the Respondents
“I am newly married, and my husband and I are expecting a baby. We have been planning a baby for the past three years. We met several doctors and did some religious and ritualistic performances to have a child without further delay. Several of our colleagues and relatives advised us to consider this situation before getting a vaccine because many people suspect that vaccine impacts people’s fertility. This may be false or a rumour, but we have no option. No one knows what is happening…”(Female, age 27, urban, higher education, a public servant)
“I am suffering from high blood pressure, cholesterol and blood sugar. Also, I have gone through a stem treatment for blocking a valve in the heart. Several educated people, including some professionals, said that some vaccines make blood clots, which will harm patients with cardiovascular treatments. So, I went completely insane because of this information and even had a long time to get the first vaccine. After seeing people getting vaccines fearlessly, I decided to take the first two doses and did not get the third vaccine due to various concerns over different channels…”(Male, age 66, urban, higher education, a retired executive officer of public service)
“I was waiting to accept the second dose because many information sources informed that there were discrepancies of vaccine’s effectiveness as the vaccine has produced without enough trials…”(Male, age 25, higher education, urban)
“In the first stage, our community members hated to accept the vaccine because they thought it was against some religious principles. However, once cremation was started by the authorities, no one wanted to die as cremation was an extreme barrier to seeing the god. Thus, vaccine acceptance increased significantly…”(Religious leader, age 64, rural)
3.2. Knowledge of Vaccines and the Vaccination Process
3.2.1. Knowledge of Vaccine Development, Country of Origin, and Manufacturer Process
3.2.2. Knowledge of the Vaccine Outcomes
3.2.3. Knowledge of Potential Side Effects of the Vaccine
“I am 6 months pregnant. This is my first baby. I am scared because of side effects of vaccines that people talk about. I have a fear that if I take the vaccine, that will impact my baby…”(Female, age 25, rural, secondary education, no occupation)
“How can we believe the vaccine? There may be unseen side effects. Even paracetamol has side effects. Our peers were discussing the risk of malfunction or dysfunction of organs, especially genital organs (smiling). Many of my friends are afraid to take the vaccine due to this fact. We need to get married and have kids in the future. Who can guarantee that there are no such effects of the vaccines…(smiling)”(female, age 22, urban, tertiary education, IT officer in profession)
3.3. Public Health Information and Related Factors Affecting Vaccine Intake by the Respondents
“We have no idea about vaccines, the impact of vaccines, and presumed side effects, which people discuss in some informal forums. When we had something to confirm, we used to ask our younger son. He is searching Facebook and telling us what is right and wrong…”(Female, age 54, rural, secondary education, housemate).
Factors Affecting Satisfaction with Public Health Information Sharing among Respondents Regarding Vaccines
“I am involved in public health-related activities at the local level. We are a group that works closely with the community. People ask all doubtful matters from us as they trust us. However, we also faced a challenging situation due to the inconsistency of messages delivered by authorities and officers. We know that COVID-19 is a new challenge, and many of us are learning things by doing. However, we also experienced pathetic contradictions since several officials publicly shared different views on some significant issues associated with COVID-19 in the first half of the pandemic…”(Male, age 52, urban, higher education, public health inspector)
4. Discussion
- Low density of information: estate communities, Indigenous communities, and some communities in remote rural areas and low-income settings have comparatively limited access to information sources due to a lack of information infrastructures, such as internet facilities, devices, and accessibility to reliable data, and lack of public health professionals to engage in such information sharing and discussions. Further, people with insufficient education levels to understand health information shared by different sources also suffer from a scarcity of information on the cause. Hence, rumours are highly prevalent in such settings due to inadequate information, which causes a dilemma of “what to believe and what not”.
- High density of information: Youth, educated people, and some communities, such as urban, semi-urban, and rural areas near urban centres, have too much information coming from various sources, such as internet-based channels, electronic media, social media, professional networks, and primary community networks. In this milieu, people have too much information, complicating their decision-making.
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Vaccine | Dose | Number |
---|---|---|
AstraZeneca | 1st dose | 1,479,631 |
2nd dose | 1,418,593 | |
Sinopharm | 1st dose | 12,054,824 |
2nd dose | 11,267,138 | |
Sputnik V | 1st dose | 159,110 |
2nd dose | 155,812 | |
Pfizer | 1st dose | 2,645,395 |
2nd dose | 1,123,923 | |
1st booster | 8,220,002 | |
2nd booster | 202,571 | |
Moderna | 1st dose | 804,801 |
2nd dose | 787,361 |
District | DS Divisions |
---|---|
Kandy | Delthota, Pathadumbara, Yatinuwara, Nawalapitiya |
Galle | Baddegama, Karandeniya, Kosgoda, Ahungalle |
Matara | Mulatiyana |
Anuradhapura | Mihinthale, Anuradhapura |
Puttalam | Dankotuwa, Wennappuwa, Naththandiya |
Kurunegala | Ibbagamuwa, Mallwapitiya, Kurunegala |
Colombo | Padukka, Seethawaka, Thibirigasyaya, Athulkotte, Mahawatta |
Kalutara | Dodangoda, Walaliawita |
Badulla | Dambana, Rideemaliyadda |
Vaccine Dose | Responses |
---|---|
Only first dose | 7.53% |
Only up to the second dose | 55.25% |
Only up to the first booster | 32.47% |
None | 4.75% |
Reasons Admitted by Respondents | n | |
---|---|---|
1 | Lack of knowledge of vaccination | 4.27% |
2 | Fear of presumed side effects | 46.29% |
3 | Believing in traditional medicine or religious faith | 3.95% |
4 | Waiting to see the results of vaccines (wait and see) | 17.40% |
5 | Advised by someone not to take the vaccine | 4.44% |
6 | Receiving negative information about the vaccine | 12.46% |
7 | No vaccine centres nearby | 3.69% |
8 | No vaccines available | 3.06% |
9 | Lack of encouragement from authorities | 2.37% |
10 | Other | 1.67% |
Variables | Male (Reference) | Female | COR (95% CI) | p | AOR (95% CI) | p | |||
---|---|---|---|---|---|---|---|---|---|
Vaccine effectiveness | No knowledge (Ref) | 725 (53.19) | 927 (52.97) | ||||||
Very low | 308 (22.60) | 391 (22.34) | 0.99 | (0.81–1.17) | 0.94 | 1.05 | (0.87–1.24) | 0.58 | |
Low | 253 (18.56) | 294 (16.80) | 0.91 | (0.71–1.10) | 0.33 | 0.92 | (0.71–1.13) | 0.43 | |
Moderate | 69 (5.06) | 126 (7.20) | 1.43 | (1.12–1.74) | 0.02 | 1.31 | (0.96–1.65) | 0.13 | |
High | 8 (0.59) | 12 (0.69) | 1.17 | (0.27–2.07) | 0.73 | 1.29 | (0.38–2.20) | 0.59 | |
Side effects of the vaccine | No knowledge (Ref) | 527 (38.66) | 756 (43.20) | ||||||
Very low | 404 (29.64) | 457 (26.11) | 0.79 | (0.61–0.96) | 0.01 | 0.84 | (0.66–1.02) | 0.06 | |
Low | 269 (19.74) | 265 (15.14) | 0.69 | (0.48–0.89) | <0.01 | 0.74 | (0.53–0.95) | 0.01 | |
Moderate | 127 (9.32) | 194 (11.09) | 1.06 | (0.81–1.31) | 0.62 | 1.00 | (0.71–1.28) | 0.98 | |
High | 36 (2.64) | 78 (4.46) | 1.51 | (1.10–1.92) | 0.05 | 1.23 | (0.78–1.68) | 0.37 | |
Vaccine suitability against COVID-19 | No knowledge (Ref) | 895 (65.66) | 1101 (62.91) | ||||||
Very low | 254 (18.64) | 311 (17.77) | 1.00 | (0.81–1.18) | 0.96 | 1.02 | (0.83–1.22) | 0.83 | |
Low | 154 (11.30) | 205 (11.71) | 1.08 | (0.86–1.31) | 0.50 | 1.04 | (0.79–1.28) | 0.77 | |
Moderate | 50 (3.67) | 115 (6.57) | 1.87 | (1.53–2.21) | <0.01 | 1.81 | (1.43–2.18) | <0.01 | |
High | 10 (0.73) | 18 (1.03) | 1.46 | (0.69–2.24) | 0.34 | 1.50 | (0.71–2.29) | 0.32 | |
Decisions based on scientific information | Yes | 353 (25.90) | 561 (32.06) | ||||||
No | 553 (40.57) | 561 (32.06) | 0.64 | (0.46–0.82) | <0.01 | 0.654 | (0.47–0.84) | <0.01 | |
No idea | 457 (33.53) | 628 (35.89) | 0.87 | (0.69–1.04) | 0.11 | 0.829 | (0.63–1.03) | 0.065 |
Variables | Underprivileged (Reference) | Middle Income | COR (95% CI) | p | AOR (95% CI) | p | |||
---|---|---|---|---|---|---|---|---|---|
Vaccine effectiveness | No knowledge (Ref) | 1004 (64.73) | 648 (41.49) | ||||||
Very low | 308 (19.86) | 391 (25.03) | 1.97 | (1.79–2.15) | <0.01 | 1.58 | (1.39–1.78) | <0.01 | |
Low | 206 (13.28) | 341 (21.83) | 2.56 | (2.37–2.76) | <0.01 | 2.12 | (1.90–2.34) | <0.01 | |
Moderate | 31 (2.00) | 164 (10.50) | 8.20 | (7.80–8.59) | <0.01 | 8.16 | (7.72–8.59) | <0.01 | |
High | 2 (0.13) | 18 (1.15) | 13.94 | (12.48–15.41) | <0.01 | 9.85 | (8.37–11.33) | <0.01 | |
Side effects of the vaccine | No knowledge (Ref) | 795 (51.26) | 488 (31.24) | ||||||
Very low | 400 (25.79) | 461 (29.51) | 1.88 | (1.70–2.05) | <0.01 | 1.33 | (1.14–1.52) | <0.01 | |
Low | 225 (14.51) | 309 (19.78) | 2.24 | (2.03–2.44) | <0.01 | 1.49 | (1.27–1.71) | <0.01 | |
Moderate | 77 (4.96) | 244 (15.62) | 5.16 | (4.88–5.44) | <0.01 | 4.12 | (3.80–4.44) | <0.01 | |
High | 54 (3.48) | 60 (3.84) | 1.81 | (1.43–2.19) | <0.01 | 1.33 | (0.91–1.76) | 0.19 | |
Vaccine suitability against COVID-19 | No knowledge (Ref) | 1154 (74.40) | 842 (53.91) | ||||||
Very low | 234 (15.09) | 331 (21.19) | 1.94 | (1.75–2.13) | <0.01 | 1.85 | (1.64–2.06) | <0.01 | |
Low | 128 (8.25) | 231 (14.79) | 2.47 | (2.24–2.71) | <0.01 | 2.33 | (2.07–2.59) | <0.01 | |
Moderate | 32 (2.06) | 133 (8.51) | 5.70 | (5.30–6.09) | <0.01 | 6.06 | (5.63–6.50) | <0.01 | |
High | 3 (0.19) | 25 (1.60) | 11.42 | (10.22–12.62) | <0.01 | 16.37 | (15.00–17.73) | <0.01 | |
Decisions based on scientific information | Yes | 313 (20.18) | 601 (38.48) | ||||||
No | 625 (40.30) | 489 (31.31) | 0.41 | (0.23–0.59) | <0.01 | 0.42 | (0.23–0.62) | <0.01 | |
No idea | 613 (39.52) | 472 (30.22) | 0.40 | (0.22–0.58) | <0.01 | 0.64 | (0.43–0.85) | <0.01 |
Variables | Rural (Ref) | Urban | Estate | Urban | Estate | Urban | Estate | |||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
COR (95% CI) | p | COR (95% CI) | p | AOR (95% COI) | p | AOR (95% COI) | p. | |||||||||
Vaccine effectiveness | No knowledge (Ref) | 1043 (50.46) | 233 (40.66) | 376 (79.49) | ||||||||||||
Very low | 489 (23.66) | 143 (24.96) | 67 (14.16) | 1.31 | (1.07–1.54) | 0.02 | 0.38 | (0.10–0.66) | <0.01 | 1.29 | (1.04–1.54) | 0.04 | 1.01 | (0.66–1.37) | 0.94 | |
Low | 379 (18.34) | 147 (25.65) | 21 (4.44) | 1.74 | (1.50–1.97) | <0.01 | 0.15 | (−0.30–0.61) | <0.01 | 1.54 | (1.27–1.80) | <0.01 | 0.48 | (−0.04–1.01) | 0.01 | |
Moderate | 140 (6.77) | 46 (8.03) | 9 (1.90) | 1.47 | (1.11–1.83) | 0.04 | 0.18 | (−0.51–0.86) | <0.01 | 1.45 | (1.03–1.86) | 0.08 | 1.69 | (0.90–2.49) | 0.19 | |
High | 16 (0.77) | 4 (0.70) | 0 (0.0) | 1.12 | (0.01–2.22) | 0.84 | 0.00 | (0.00–0.00) | <0.01 | 1.41 | (0.28–2.54) | 0.55 | 0.00 | (0.00–0.00) | <0.05 | |
Side effects of the vaccine | No knowledge (Ref) | 769 (37.20) | 155 (27.05) | 359 (75.90) | ||||||||||||
Very low | 599 (28.98) | 192 (33.51) | 70 (14.80) | 1.59 | (1.35–1.83) | <0.01 | 0.25 | (−0.03–0.53) | <0.01 | 1.53 | (1.28–1.78) | <0.01 | 0.53 | (0.18–0.89) | <0.01 | |
Low | 394 (19.06) | 111 (19.37) | 29 (6.13) | 1.40 | (1.13–1.67) | 0.02 | 0.16 | (−0.24–0.56) | <0.01 | 1.38 | (1.09–1.67) | 0.03 | 0.38 | (−0.09–0.85) | <0.01 | |
Moderate | 219 (10.60) | 89 (15.53) | 13 (2.75) | 2.02 | (1.72–2.32) | <0.01 | 0.13 | (−0.45–0.70) | <0.01 | 1.92 | (1.57–2.26) | <0.01 | 0.87 | (0.21–1.53) | 0.68 | |
High | 86 (4.16) | 26 (4.54) | 2 (0.42) | 1.50 | (1.03–1.97) | 0.09 | 0.05 | (−1.36–1.46) | <0.01 | 1.21 | (0.68–1.74) | 0.48 | 0.24 | (−1.34–1.81) | 0.07 | |
Vaccine suitability against COVID-19 | No knowledge (Ref) | 1300 (62.89) | 334 (58.29) | 362 (76.53) | ||||||||||||
Very low | 383 (18.53) | 101 (17.63) | 81 (17.12) | 1.03 | (0.78–1.28) | 0.84 | 0.76 | (0.49–1.03) | 0.04 | 1.10 | (0.83–1.36) | 0.49 | 2.68 | (2.32–3.03) | <0.01 | |
Low | 248 (12.00) | 91 (15.88) | 20 (4.23) | 1.43 | (1.16–1.70) | 0.01 | 0.29 | (−0.18–0.76) | <0.01 | 1.46 | (1.16–1.76) | 0.01 | 1.61 | (1.04–2.18) | 0.10 | |
Moderate | 117 (5.66) | 41 (7.16) | 7 (1.48) | 1.36 | (0.99–1.74) | 0.11 | 0.21 | (−0.56–0.99) | <0.01 | 1.48 | (1.05–1.91) | 0.07 | 3.09 | (2.24–3.94) | 0.01 | |
High | 19 (0.92) | 6 (1.05) | 3 (0.63) | 1.23 | (0.30–2.15) | 0.66 | 0.57 | (−0.66–1.79) | 0.36 | 1.49 | (0.54–2.45) | 0.41 | 3.97 | (2.42–5.53) | 0.08 | |
Decisions based on scientific information | Yes | 663 (32.08) | 203 (35.43) | 48 (10.15) | ||||||||||||
No | 767 (37.11) | 232 (40.49) | 115 (24.31) | 0.99 | (0.77–1.20) | 0.91 | 2.07 | (1.72–2.42) | <0.01 | 1.06 | (0.82–1.30) | 0.63 | 0.79 | (0.33–1.25) | 0.31 | |
No idea | 637 (30.82) | 138 (24.08) | 310 (65.54) | 0.71 | (0.47–0.95) | 0.01 | 6.72 | (6.40–7.05) | <0.01 | 0.79 | (0.52–1.06) | 0.09 | 2.97 | (2.55–3.39) | <0.01 |
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Kamalrathne, T.; Jayasekara, J.R.; Amaratunga, D.; Haigh, R.; Kodituwakku, L.; Rupasinghe, C. Panic in the Pandemic: Determinants of Vaccine Hesitancy and the Dilemma of Public Health Information Sharing during the COVID-19 Pandemic in Sri Lanka. Int. J. Environ. Res. Public Health 2024, 21, 1268. https://doi.org/10.3390/ijerph21101268
Kamalrathne T, Jayasekara JR, Amaratunga D, Haigh R, Kodituwakku L, Rupasinghe C. Panic in the Pandemic: Determinants of Vaccine Hesitancy and the Dilemma of Public Health Information Sharing during the COVID-19 Pandemic in Sri Lanka. International Journal of Environmental Research and Public Health. 2024; 21(10):1268. https://doi.org/10.3390/ijerph21101268
Chicago/Turabian StyleKamalrathne, Thushara, Jayasekara R. Jayasekara, Dilanthi Amaratunga, Richard Haigh, Lahiru Kodituwakku, and Chintha Rupasinghe. 2024. "Panic in the Pandemic: Determinants of Vaccine Hesitancy and the Dilemma of Public Health Information Sharing during the COVID-19 Pandemic in Sri Lanka" International Journal of Environmental Research and Public Health 21, no. 10: 1268. https://doi.org/10.3390/ijerph21101268