COVID-19 Vaccination Willingness and Reasons for Vaccine Refusal
Importance Hong Kong was held as an exemplar for pandemic response until it recorded the world’s highest daily COVID-19 mortality, which was likely due to vaccine refusal. To prevent this high mortality in future pandemics, information on underlying reasons for vaccine refusal is necessary. Objectiv...
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| Vydáno v: | JAMA network open Ročník 6; číslo 10; s. e2337909 |
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| Jazyk: | angličtina |
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American Medical Association
19.10.2023
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| ISSN: | 2574-3805, 2574-3805 |
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| Abstract | Importance Hong Kong was held as an exemplar for pandemic response until it recorded the world’s highest daily COVID-19 mortality, which was likely due to vaccine refusal. To prevent this high mortality in future pandemics, information on underlying reasons for vaccine refusal is necessary. Objectives To track the evolution of COVID-19 vaccination willingness and uptake from before vaccine rollout to mass vaccination, to examine factors associated with COVID-19 vaccine refusal and compare with data from Singapore, and to assess the population attributable fraction for vaccine refusal. Design, Setting, and Participants This cohort study used data from randomly sampled participants from 14 waves of population-based studies in Hong Kong (February 2020 to May 2022) and 2 waves of population-based studies in Singapore (May 2020 to June 2021 and October 2021 to January 2022), and a population-wide registry of COVID-19 vaccination appointments. Data were analyzed from February 23, 2021, to May 30, 2022. Exposures Trust in COVID-19 vaccine information sources (ie, health authorities, physicians, traditional media, and social media); COVID-19 vaccine confidence on effectiveness, safety, and importance; COVID-19 vaccine misconceptions on safety and high-risk groups; political views; and COVID-19 policies (ie, workplace vaccine mandates and vaccine pass). Main Outcomes and Measures Primary outcomes were the weighted prevalence of COVID-19 vaccination willingness over the pandemic, adjusted incidence rate ratios, and population attributable fractions of COVID-19 vaccine refusal. A secondary outcome was change in daily COVID-19 vaccination appointments. Results The study included 28 007 interviews from 20 waves of longitudinal data, with 1114 participants in the most recent wave (median [range] age, 54.2 years [20-92] years; 571 [51.3%] female). Four factors—mistrust in health authorities, low vaccine confidence, vaccine misconceptions, and political views—could jointly account for 82.2% (95% CI, 62.3%-100.0%) of vaccine refusal in adults aged 18 to 59 years and 69.3% (95% CI, 47.2%-91.4%) of vaccine refusal in adults aged 60 years and older. Workplace vaccine mandates were associated with 62.2% (95% CI, 9.9%-139.2%) increases in daily COVID-19 vaccination appointments, and the Hong Kong vaccine pass was associated with 124.8% (95% CI, 65.9%-204.6%) increases in daily COVID-19 vaccination appointments. Conclusions and Relevance These findings suggest that trust in health authorities was fundamental to overcoming vaccine hesitancy. As such, engendering trust in health care professionals, experts, and public health agencies should be incorporated into pandemic preparedness and response. |
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| AbstractList | Importance Hong Kong was held as an exemplar for pandemic response until it recorded the world’s highest daily COVID-19 mortality, which was likely due to vaccine refusal. To prevent this high mortality in future pandemics, information on underlying reasons for vaccine refusal is necessary. Objectives To track the evolution of COVID-19 vaccination willingness and uptake from before vaccine rollout to mass vaccination, to examine factors associated with COVID-19 vaccine refusal and compare with data from Singapore, and to assess the population attributable fraction for vaccine refusal. Design, Setting, and Participants This cohort study used data from randomly sampled participants from 14 waves of population-based studies in Hong Kong (February 2020 to May 2022) and 2 waves of population-based studies in Singapore (May 2020 to June 2021 and October 2021 to January 2022), and a population-wide registry of COVID-19 vaccination appointments. Data were analyzed from February 23, 2021, to May 30, 2022. Exposures Trust in COVID-19 vaccine information sources (ie, health authorities, physicians, traditional media, and social media); COVID-19 vaccine confidence on effectiveness, safety, and importance; COVID-19 vaccine misconceptions on safety and high-risk groups; political views; and COVID-19 policies (ie, workplace vaccine mandates and vaccine pass). Main Outcomes and Measures Primary outcomes were the weighted prevalence of COVID-19 vaccination willingness over the pandemic, adjusted incidence rate ratios, and population attributable fractions of COVID-19 vaccine refusal. A secondary outcome was change in daily COVID-19 vaccination appointments. Results The study included 28 007 interviews from 20 waves of longitudinal data, with 1114 participants in the most recent wave (median [range] age, 54.2 years [20-92] years; 571 [51.3%] female). Four factors—mistrust in health authorities, low vaccine confidence, vaccine misconceptions, and political views—could jointly account for 82.2% (95% CI, 62.3%-100.0%) of vaccine refusal in adults aged 18 to 59 years and 69.3% (95% CI, 47.2%-91.4%) of vaccine refusal in adults aged 60 years and older. Workplace vaccine mandates were associated with 62.2% (95% CI, 9.9%-139.2%) increases in daily COVID-19 vaccination appointments, and the Hong Kong vaccine pass was associated with 124.8% (95% CI, 65.9%-204.6%) increases in daily COVID-19 vaccination appointments. Conclusions and Relevance These findings suggest that trust in health authorities was fundamental to overcoming vaccine hesitancy. As such, engendering trust in health care professionals, experts, and public health agencies should be incorporated into pandemic preparedness and response. This cohort study uses interview data from Hong Kong residents to assess COVID-19 vaccination willingness and uptake and assess factors associated with vaccine refusal. Hong Kong was held as an exemplar for pandemic response until it recorded the world's highest daily COVID-19 mortality, which was likely due to vaccine refusal. To prevent this high mortality in future pandemics, information on underlying reasons for vaccine refusal is necessary.ImportanceHong Kong was held as an exemplar for pandemic response until it recorded the world's highest daily COVID-19 mortality, which was likely due to vaccine refusal. To prevent this high mortality in future pandemics, information on underlying reasons for vaccine refusal is necessary.To track the evolution of COVID-19 vaccination willingness and uptake from before vaccine rollout to mass vaccination, to examine factors associated with COVID-19 vaccine refusal and compare with data from Singapore, and to assess the population attributable fraction for vaccine refusal.ObjectivesTo track the evolution of COVID-19 vaccination willingness and uptake from before vaccine rollout to mass vaccination, to examine factors associated with COVID-19 vaccine refusal and compare with data from Singapore, and to assess the population attributable fraction for vaccine refusal.This cohort study used data from randomly sampled participants from 14 waves of population-based studies in Hong Kong (February 2020 to May 2022) and 2 waves of population-based studies in Singapore (May 2020 to June 2021 and October 2021 to January 2022), and a population-wide registry of COVID-19 vaccination appointments. Data were analyzed from February 23, 2021, to May 30, 2022.Design, Setting, and ParticipantsThis cohort study used data from randomly sampled participants from 14 waves of population-based studies in Hong Kong (February 2020 to May 2022) and 2 waves of population-based studies in Singapore (May 2020 to June 2021 and October 2021 to January 2022), and a population-wide registry of COVID-19 vaccination appointments. Data were analyzed from February 23, 2021, to May 30, 2022.Trust in COVID-19 vaccine information sources (ie, health authorities, physicians, traditional media, and social media); COVID-19 vaccine confidence on effectiveness, safety, and importance; COVID-19 vaccine misconceptions on safety and high-risk groups; political views; and COVID-19 policies (ie, workplace vaccine mandates and vaccine pass).ExposuresTrust in COVID-19 vaccine information sources (ie, health authorities, physicians, traditional media, and social media); COVID-19 vaccine confidence on effectiveness, safety, and importance; COVID-19 vaccine misconceptions on safety and high-risk groups; political views; and COVID-19 policies (ie, workplace vaccine mandates and vaccine pass).Primary outcomes were the weighted prevalence of COVID-19 vaccination willingness over the pandemic, adjusted incidence rate ratios, and population attributable fractions of COVID-19 vaccine refusal. A secondary outcome was change in daily COVID-19 vaccination appointments.Main Outcomes and MeasuresPrimary outcomes were the weighted prevalence of COVID-19 vaccination willingness over the pandemic, adjusted incidence rate ratios, and population attributable fractions of COVID-19 vaccine refusal. A secondary outcome was change in daily COVID-19 vaccination appointments.The study included 28 007 interviews from 20 waves of longitudinal data, with 1114 participants in the most recent wave (median [range] age, 54.2 years [20-92] years; 571 [51.3%] female). Four factors-mistrust in health authorities, low vaccine confidence, vaccine misconceptions, and political views-could jointly account for 82.2% (95% CI, 62.3%-100.0%) of vaccine refusal in adults aged 18 to 59 years and 69.3% (95% CI, 47.2%-91.4%) of vaccine refusal in adults aged 60 years and older. Workplace vaccine mandates were associated with 62.2% (95% CI, 9.9%-139.2%) increases in daily COVID-19 vaccination appointments, and the Hong Kong vaccine pass was associated with 124.8% (95% CI, 65.9%-204.6%) increases in daily COVID-19 vaccination appointments.ResultsThe study included 28 007 interviews from 20 waves of longitudinal data, with 1114 participants in the most recent wave (median [range] age, 54.2 years [20-92] years; 571 [51.3%] female). Four factors-mistrust in health authorities, low vaccine confidence, vaccine misconceptions, and political views-could jointly account for 82.2% (95% CI, 62.3%-100.0%) of vaccine refusal in adults aged 18 to 59 years and 69.3% (95% CI, 47.2%-91.4%) of vaccine refusal in adults aged 60 years and older. Workplace vaccine mandates were associated with 62.2% (95% CI, 9.9%-139.2%) increases in daily COVID-19 vaccination appointments, and the Hong Kong vaccine pass was associated with 124.8% (95% CI, 65.9%-204.6%) increases in daily COVID-19 vaccination appointments.These findings suggest that trust in health authorities was fundamental to overcoming vaccine hesitancy. As such, engendering trust in health care professionals, experts, and public health agencies should be incorporated into pandemic preparedness and response.Conclusions and RelevanceThese findings suggest that trust in health authorities was fundamental to overcoming vaccine hesitancy. As such, engendering trust in health care professionals, experts, and public health agencies should be incorporated into pandemic preparedness and response. |
| Author | Flores, Francis P. Leung, Kathy Subramaniam, Mythily Xiao, Xiao Ma, Tiffany S. W. Wu, Joseph T. Ni, Michael Y. Tsang, Tim K. Cowling, Benjamin J. Lun, Phyllis Tian, Linwei Leung, Gabriel M. Ning, Ke Abdin, Edimansyah Wang, Yishan |
| AuthorAffiliation | 1 School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China 5 Laboratory of Data Discovery for Health, Hong Kong Science Park, Hong Kong Special Administrative Region, China 7 Urban System Institute, The University of Hong Kong, Hong Kong Special Administrative Region, China 6 State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong Special Administrative Region, China 4 World Health Organization Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, The University of Hong Kong, Hong Kong Special Administrative Region, China 2 Research Division, Institute of Mental Health, Singapore 3 Saw Swee Hock School of Public Health, National University of Singapore, Singapore |
| AuthorAffiliation_xml | – name: 6 State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong Special Administrative Region, China – name: 1 School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China – name: 4 World Health Organization Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, The University of Hong Kong, Hong Kong Special Administrative Region, China – name: 5 Laboratory of Data Discovery for Health, Hong Kong Science Park, Hong Kong Special Administrative Region, China – name: 7 Urban System Institute, The University of Hong Kong, Hong Kong Special Administrative Region, China – name: 2 Research Division, Institute of Mental Health, Singapore – name: 3 Saw Swee Hock School of Public Health, National University of Singapore, Singapore |
| Author_xml | – sequence: 1 givenname: Phyllis surname: Lun fullname: Lun, Phyllis organization: School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China – sequence: 2 givenname: Ke surname: Ning fullname: Ning, Ke organization: School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China – sequence: 3 givenname: Yishan surname: Wang fullname: Wang, Yishan organization: School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China – sequence: 4 givenname: Tiffany S. W. surname: Ma fullname: Ma, Tiffany S. W. organization: School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China – sequence: 5 givenname: Francis P. surname: Flores fullname: Flores, Francis P. organization: School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China – sequence: 6 givenname: Xiao surname: Xiao fullname: Xiao, Xiao organization: School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China – sequence: 7 givenname: Mythily surname: Subramaniam fullname: Subramaniam, Mythily organization: Research Division, Institute of Mental Health, Singapore, Saw Swee Hock School of Public Health, National University of Singapore, Singapore – sequence: 8 givenname: Edimansyah surname: Abdin fullname: Abdin, Edimansyah organization: Research Division, Institute of Mental Health, Singapore – sequence: 9 givenname: Linwei surname: Tian fullname: Tian, Linwei organization: School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China – sequence: 10 givenname: Tim K. surname: Tsang fullname: Tsang, Tim K. organization: School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China, World Health Organization Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, The University of Hong Kong, Hong Kong Special Administrative Region, China, Laboratory of Data Discovery for Health, Hong Kong Science Park, Hong Kong Special Administrative Region, China – sequence: 11 givenname: Kathy surname: Leung fullname: Leung, Kathy organization: School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China, World Health Organization Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, The University of Hong Kong, Hong Kong Special Administrative Region, China, Laboratory of Data Discovery for Health, Hong Kong Science Park, Hong Kong Special Administrative Region, China – sequence: 12 givenname: Joseph T. surname: Wu fullname: Wu, Joseph T. organization: School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China, World Health Organization Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, The University of Hong Kong, Hong Kong Special Administrative Region, China, Laboratory of Data Discovery for Health, Hong Kong Science Park, Hong Kong Special Administrative Region, China – sequence: 13 givenname: Benjamin J. surname: Cowling fullname: Cowling, Benjamin J. organization: School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China, World Health Organization Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, The University of Hong Kong, Hong Kong Special Administrative Region, China, Laboratory of Data Discovery for Health, Hong Kong Science Park, Hong Kong Special Administrative Region, China – sequence: 14 givenname: Gabriel M. surname: Leung fullname: Leung, Gabriel M. organization: School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China, World Health Organization Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, The University of Hong Kong, Hong Kong Special Administrative Region, China, Laboratory of Data Discovery for Health, Hong Kong Science Park, Hong Kong Special Administrative Region, China – sequence: 15 givenname: Michael Y. surname: Ni fullname: Ni, Michael Y. organization: School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China, State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong Special Administrative Region, China, Urban System Institute, The University of Hong Kong, Hong Kong Special Administrative Region, China |
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| Snippet | Importance Hong Kong was held as an exemplar for pandemic response until it recorded the world’s highest daily COVID-19 mortality, which was likely due to... Hong Kong was held as an exemplar for pandemic response until it recorded the world's highest daily COVID-19 mortality, which was likely due to vaccine... This cohort study uses interview data from Hong Kong residents to assess COVID-19 vaccination willingness and uptake and assess factors associated with vaccine... |
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| SubjectTerms | COVID-19 vaccines Immunization Online Only Original Investigation Pandemics Population-based studies Public Health Vaccine hesitancy |
| Title | COVID-19 Vaccination Willingness and Reasons for Vaccine Refusal |
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