Hesitancy in COVID-19 vaccine uptake and its associated factors among the general adult population: a cross-sectional study in six Southeast Asian countries

Roy Rillera Marzo; Waqas Sami; Md Zakiul Alam; Swosti Acharya; Kittisak Jermsittiparsert; Karnjana Songwathana; Nhat Tan Pham; Titik Respati; Erwin Martinez Faller; Aries Moralidad Baldonado; Yadanar Aung; Sharmila Mukund Borkar; Mohammad Yasir Essar; Sunil Shrestha; Siyan Yi

doi:10.1186/s41182-021-00393-1

Hesitancy in COVID-19 vaccine uptake and its associated factors among the general adult population: a cross-sectional study in six Southeast Asian countries

Trop Med Health. 2022 Jan 5;50(1):4. doi: 10.1186/s41182-021-00393-1.

Authors

Roy Rillera Marzo^{1

2

3}, Waqas Sami^{4

5}, Md Zakiul Alam⁶, Swosti Acharya⁷, Kittisak Jermsittiparsert⁸, Karnjana Songwathana⁹, Nhat Tan Pham^{10

11}, Titik Respati¹², Erwin Martinez Faller¹³, Aries Moralidad Baldonado¹⁴, Yadanar Aung^{15

16}, Sharmila Mukund Borkar¹⁷, Mohammad Yasir Essar¹⁸, Sunil Shrestha¹⁹, Siyan Yi^{20

21

22}

Affiliations

¹ Department of Community Medicine, International Medical School, Management and Science University, Shah Alam, Selangor, Malaysia.
² Department of Community Medicine, Faculty of Medicine, Asia Metropolitan University, Masai, Johor, Malaysia.
³ Global Public Health, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Jalan Lagoon Selatan, 47500, Subang Jaya, Selangor, Malaysia.
⁴ Department of Community Medicine and Public Health, College of Medicine, Majmaah University, Almajmaah, 11952, Saudi Arabia.
⁵ Azra Naheed Medical College, Superior University, Lahore, 54000, Pakistan.
⁶ Department of Population Sciences, University of Dhaka, Dhaka, Bangladesh.
⁷ Department of Nursing, Nepal Health Research and Innovation Foundation, Lalitpur, Province Bagmati, Nepal.
⁸ College of Innovative Business and Accountancy, Dhurakij Pundit University, Bangkok, Thailand.
⁹ Faculty of Economics and Investment, Bangkok University, Bangkok, Thailand.
¹⁰ International University, Ho Chi Minh City, Vietnam.
¹¹ Vietnam National University Ho Chi Minh City, Ho Chi Minh City, Vietnam.
¹² Department of Public Health, Faculty of Medicine and Faculty of Graduate Studies, Universitas Islam Bandung, Bandung, Indonesia.
¹³ Department of Pharmacy, Faculty of Pharmacy, San Pedro College, Davao City, Philippines.
¹⁴ College of Nursing, Saint Alexius College, Koronadal, South Cotabato, Philippines.
¹⁵ Medical Statistics Division, Department of Medical Research, Pyin Oo Lwin, Myanmar.
¹⁶ Institute for Population and Social Research, Mahidol University, Bangkok, Thailand.
¹⁷ Department of Economics, Sridora Caculo College, Mapusa, Goa, India.
¹⁸ Kabul University of Medical Sciences, Kabul, Afghanistan. yasir.essar@gmail.com.
¹⁹ Department of Pharmaceutical and Health Service Research, Nepal Health Research and Innovation Foundation, Lalitpur, Province Bagmati, Nepal.
²⁰ Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore.
²¹ KHANA Center for Population Health Research, Phnom Penh, Cambodia.
²² Center for Global Health Research, Touro University California, Vallejo, California, USA.

Abstract

Background: Vaccines are effective and reliable public health interventions against viral outbreaks and pandemics. However, hesitancy regarding the Coronavirus disease (COVID-19) vaccine is evident worldwide. Therefore, understanding vaccination-related behavior is critical in expanding the vaccine coverage to flatten the infection curve. This study explores the public perception regarding COVID-19 vaccination and identifies factors associated with vaccine hesitancy among the general adult populations in six Southeast Asian countries.

Methods: Using a snowball sampling approach, we conducted a descriptive cross-sectional study among 5260 participants in Indonesia, Malaysia, Myanmar, Philippines, Thailand, and Vietnam between February and May 2021. Binary logistic regression analysis with a backward conditional approach was applied to identify factors associated with COVID-19 vaccine hesitancy.

Results: Of the total, 50.6% were female, and the median age was 30 years (range: 15-83 years). The majority of the participants believed that vaccination effectively prevents and controls COVID-19 (81.2%), and 84.0% would accept COVID-19 vaccines when they become available. They agreed that health providers' advice (83.0%), vaccination convenience (75.6%), and vaccine costs (62.8%) are essential for people to decide whether to accept COVID-19 vaccines. About half (49.3%) expressed their hesitancy to receive the COVID-19 vaccines. After adjustment for other covariates, COVID-19 vaccine hesitancy was significantly associated with age, residential area, education levels, employment status, and family economic status. Participants from Indonesia, Myanmar, Thailand, and Vietnam were significantly more likely to express hesitancy in receiving COVID-19 vaccines than those from Philippines.

Conclusions: In general, participants in this multi-country study showed their optimistic perception of COVID-19 vaccines' effectiveness and willingness to receive them. However, about half of them still expressed their hesitancy in getting vaccinated. The hesitation was associated with several socioeconomic factors and varied by country. Therefore, COVID-19 vaccination programs should consider these factors essential for increasing vaccine uptake in the populations.

Keywords: Acceptance; Immunization; Multi-country study; Pandemic; Southeast Asia; Vaccine hesitancy.