COVID-19 Vaccination Readiness and Hesitancy among the Patients with Chronic Diseases in a Teaching Hospital in Ekiti State, Nigeria

1. INTRODUCTION

Coronavirus disease 2019 (COVID-19), which belongs to the family of viruses that can cause extremely intense respiratory syndrome coronavirus 2 (SARS-CoV-2) in humans, has continued to be a global concern [1]. The emergence of SARS-CoV-2 was first reported in late 2019 in the Wuhan province of Hubei, China, and, after that, quickly became a viral threat afflicting over 220 countries [2, 3]. The devastating consequences of the virus have prompted the call for policies and strategies to mitigate and contain the effect of the pandemic [4].

The initial response instigated by most countries so as to minimize or prevent COVID-19 transmission includes the use of non-pharmaceutical interventions, such as mandatory use of masks, hands sanitization, social distancing, travel bans, closure of schools, and other public places [5]. However, it was noted that these non-pharmaceutical interventions could only reduce the disease progression, but the most affordable public health interventions to limit the pandemic and diminish related mortality and morbidity rates is through the use of effective, safe, and affordable antiviral agents and vaccines [6-8]. COVID-19 ravaged the world from late 2019 to date, disrupting the global health system and its economy, however, the COVID-19 vaccine was quickly developed to control the deadly disease globally, but people from different regions of the world developed apathy to the acceptance of the vaccine. Hesitancy to vaccine uptake is not only for COVID-19 vaccination but is a usual occurrence. Almost twenty years ago, before the approval of the COVID-19 vaccine, the WHO identified hesitancy to the vaccine as part of the ten essential dangers to worldwide well-being [9].

Despite its imminent accessibility, public opinion on the new COVID-19 vaccine is still uncertain. The survey conducted by Lin et al. [10] reviewed the declining rate of vaccine acceptance, The study observed that the vaccine acceptance rate dropped from 70% in March 2020 to below 50% in October 2020, citing the following factors: demographic, socioeconomic, and partisan for the divides. A review carried out in January 2021 among 15 countries revealed that France is one of the nations with the lowest vaccine intention rate [11]. Moreover, the denial of COVID-19 by various sections may have influenced COVID-19 vaccine hesitancy (VH), considering the information on the accessibility of COVID-19 vaccines in certain countries. Aside from the conviction that the COVID-19 vaccine may be apolitical in the absence of confidence in the pharmaceutical industry or its non-mandatory administration, the vaccine also has religious reservations, as some referred to it as the “mark of the beast” [12].

Also, ongoing global outbreaks of generally wiped-out vaccine-preventable illnesses, such as the recurrent measles epidemics in Europe and the United States of America (USA), have been, to a great extent, credited to vaccine hesitancy among the populace [13]. The low open acknowledgment of immunization against the 2009 H1N1 pandemic flu was revealed in the USA and the United Kingdom [14], contentions around the human papillomavirus (HPV) vaccine in India and Japan [15] and the 2003-2004 polio vaccine blacklisted in Nigeria [16] are some of the reasons for vaccine hesitancy, doubt and opposition on a global scale.

The series collection of research tends to suggest that vaccine indecision is becoming a problem in Nigeria. For instance, vaccine hesitancy among guardians was observed as one of the fundamental difficulties confronting vaccination programmes as shown in a study conducted in 2009 among State and National Managers of Expanded Programme on Immunization (EPI) managers [17]. Vaccine hesitancy was likewise featured as a critical part of the different measles outbreaks that occurred in South Africa from 2003 and 2011. However, notwithstanding the growing proof of evidence, vaccine hesitation is still a major problem with an uncertain solution [17]. Currently, many COVID-19 vaccines have been approved and endorsed to prevent COVID-19, such as the Pfizer-BioNTech vaccine, Moderna’s and Janssen's vaccines and many others. Phase 3 of COVID-19 large-scale clinical trials was on as of February 2021 in the United States with vaccines like AstraZeneca and Novavax [18]. Almost 63 million dosages of these vaccines have been dispersed in the U.S., as stated by the Centre for Disease Control, while more than 43.2 million doses have been given [18, 19]. In the UK, a complete number of 12,844,193 individuals have been vaccinated since the commencement of COVID-19 vaccination. There is a global increase in the rollout of COVAX vaccines. The main COVID-19 vaccination crusades in Africa utilizing COVAX started in Ghana and Côte d'Ivoire. Whereas Africa's most populous country, Nigeria, has received its first consignments of COVID-19 vaccines, becoming the third African country to have access to COVAX [20].

The explanations behind COVID-19 vaccine acknowledgment and reluctance remain complex and can be credited to the intersection of a few variables: questions about the genuine requirement for vaccines, worries about the safety of the vaccine, side effects, past pessimistic encounters with vaccines, doubt if the vaccine will be effective, experimental reasoning, and other issues might be involved [21]. Wang et al. [22] asserted that independent risk factors such as; diabetes, hypertension, pulmonary disease, and cardiovascular disease were responsible for severe COVID-19 disease and complicated conditions.

As of 19th October 2021, COVID-19-related deaths of about 4,903,911 people have been recorded globally, while there are 242,460,000 reported cases of COVID -19, and the condition most of the time resulted in deaths, especially when there is an underlying chronic diseases such as diabetes, asthma, hypertension, HIV/acquired immune deficiency syndrome, and others [2]. According to Nigeria's Centre for Disease Control, as of 22 April 2022, there are 255,670 confirmed cases of COVID-19 in Nigeria, 2,653 active cases, 249,874 discharged cases, 3,143 deaths and the disease is spreading very fast day by day. Therefore, there is a need for the study to assess the COVID-19 vaccination hesitancy among patients with chronic diseases in a teaching hospital.

2. MATERIAL AND METHODS

3. RESULTS

4. DISCUSSION

Findings showed that the majority of the study participants were within the age group of 20-40 years, which is consistent with a similar study conducted by Elhadi et al. [24] in Libya, where 56.4% of the participants were within the age 20-40 years. Also, another similar study conducted in the United States by Fridman et al. [25-27] had 62.3% of participants between the ages of 20-40 years. As revealed in the current study, most of the participants were females and had secondary education and above. These findings are consistent with the results of an earlier study by Rzymski et al. [26] on the perception and attitudes of patients in Poland towards COVID-19 vaccines.

The majority of participants with the exception of participants with HIV/RVD, had poor knowledge of the COVID-19 vaccine and vaccination. This result supported earlier studies by Rzymski et al. [26] and Islam et al. [28], but was in contrast with another Nigerian study conducted to determine the factors influencing COVID-19 vaccine uptake among adults where 69.5% had satisfactory awareness of COVID-19 and vaccination exercise. Socio-demographic characteristics of participants showed significant relationships between knowledge of the COVID-19 vaccine and age (hypertensive patients), while disease duration was significant among patients with asthma. Conversely, these findings are in contrast to a study conducted by Adedeji-Adenola et al. [29] in which socio-demographic factors, such as occupation, prior diagnosis of COVID-19, education and religion were statistically significant to respondents’ awareness of COVID-19 vaccination exercise.

The study further revealed that most of the participants were indifferent in their readiness to accept the COVID-19 vaccine due to reasons such as individuals and groups and mode of vaccine administration. This outcome is supported by the findings of El-Elimat et al. [6], which examined the acceptance and attitudes towards the COVID-19 vaccine in Jordan, where most of the participants were not ready to take the COVID-19 vaccine. Likewise, another study by Solis et al. [30] on COVID-19 vaccine acceptance and hesitancy discovered that only 30.1% of people in Low and Medium-income countries were ready to take the COVID-19 vaccine. The study outcome is also in contrast to another similar study by Elhadi et al. [24] on knowledge, attitude, and acceptance of the COVID-19 vaccine by health workers and the public, which showed 60.6% of the study population were willing to receive the vaccine.

Moreover, the study further discovered that participants with HIV/RVD have the highest hesitancy among the patients’ categories in this order (HIV/RVD ˃asthmatic ˃ hypertensive ˃ diabetic), which conforms with a study by King et al. [25] in the USA on the time trends, factors associated with and reasons for COVID-19 vaccine hesitancy, a survey of US adults where findings showed that participants with weakened or compromised immune system have the highest hesitancy while participants with cancer, diabetes (type 1 and 2) and obesity have less hesitancy for COVID-19 vaccine. This may probably be due to fear of becoming sicker or contracting the virus since their immune system is already weakened. Furthermore, the majority of the participants were hesitant to take the COVID-19 vaccine, and this was due to several factors, including poor communication, religion, political and social factors, health system experience, the role of healthcare professionals and design of the vaccines as it is usually given through injection. This is consistent with the findings of a similar study conducted by King et al. [25], where participants were hesitant due to vaccine safety and lack of trust on the COVID-19 vaccine and the government.

Furthermore, Fridman et al. [27] found that vaccine attitudes and hesitancy are influenced by a variety of demographic and ideological factors, such as the perceptions of vaccine risk, which differ among individuals. This lends credence to the findings of the current study, where some of the participants’ socio-demographic characteristics (age, marital status, occupation and disease duration) were significantly associated with vaccine hesitancy. Political ideology is another well-documented determinant of vaccine-related attitudes and behaviors. Fridman et al. [27] concluded that political aspects play a significant role in vaccination hesitancy, and these conform with the findings of this study.

CONCLUSION

The study sought to assess the COVID-19 vaccination hesitancy among patients with chronic diseases in a teaching hospital. Findings revealed poor knowledge of the COVID-19 vaccine and vaccination among the participants, with poor readiness and high hesitancy. The majority of the study participants were indifferent and reluctant to take the COVID-19 vaccine. Several factors, such as vaccine risks, its safety, historical background, political influence, past vaccination attitudes, beliefs, and attitudes, were highlighted as the reasons for their hesitancy. Poor knowledge of COVID-19 vaccination influences acceptance, which in turn promotes hesitancy. The implication is that if patients are well educated and counseled, it would improve patient acceptance and reduce hesitancy against vaccines, hence curtailing the spread of COVID-19 infections.

REFERENCES