Acceptance and awareness of COVID-19 vaccine among healthcare professionals and students in India. A questionnaire based study

ABSTRACT

Background:

The availability of vaccines against SARS-CoV-2 has met with reports of variations in knowledge concerning it, awareness as well as precipitation of the same in health professionals as well as the common public.

Aim:

This study aimed to evaluate knowledge, acceptance, and precipitation of COVID-19 vaccination among dental students as well as practitioners in India.

Materials and Methods:

This cross-sectional and observational questionnaire-based survey was conducted on 100 Dentistry students and 100 Dental practitioners. Inclusion criteria were a) age equal or above 18 years, b) individuals with familiarity with internet usage and social media sites; c) English language proficiency, and d) Voluntary participation. Exclusion criteria were a) students of other professional courses; b) other health-care professionals; c) no willingness to participate and d) Non-responsive subjects.

Statistical Analysis:

Responses obtained were statistically evaluated by SPSS software Version 21.0. Descriptive statistical analysis was performed for frequency, percentages, mean, and standard deviation computation. Pearson’s ‘Chi-Square’ and Fisher’s Exact Tests were used for the level of significance (P < 0.05).

Results:

All subjects had the knowledge and were aware of vaccination. However, there were a few misconceptions regarding the vaccine constitution. Precipitation (acceptance) was high in this study.

Conclusion:

A larger and wider sample distribution must be examined for a full understanding of the mindset of the targeted population.

Introduction

The causative agent of COVID-19 viral infection is the severe acute respiratory syndrome-CoV-2’ (SARS-CoV-2) virus. This disease turned out to be a pandemic that had been associated with severe morbidity and mortality. This led to severe panic all over the globe.[1] Though various vaccines have been introduced, a major problem associated is vaccine-associated hesitancy that can be attributed to a low level of public awareness. This may be one of the primary sources of serious public health-related threats. This particular problem requires thorough study among different groups of the population mainly among students pursuing dentistry.[2]

Professionals associated with health care specialists, especially dentists have frequent exposure to environmental conditions associated with higher levels of occupation-related hazards as their area of work is oro-pharynx also, high exposure to aerosols-related procedures which generate droplets that confer extra risks associated with exposure to this particular virus and transmission of COVID-19 disease infection.[3]

Dental students are a special class of sub-group amongst all healthcare professionals. Dental students have an important part to play as influencers over patients and their peers in creating favorable attitudes toward health-related awareness and incorporating appropriate behavioral patterns for improvements in their quality of life.[4]

Vaccine hesitancy (VH) is defined by the World Health Organization (WHO) Strategic Advisory Group of Experts on Immunization (SAGE) as “delay in acceptance or refusal of vaccination despite the availability of vaccination services”.[5]

VH is increasingly recognized as a serious public health threat that requires thorough investigation among various population groups to fully understand its prevalence. However, there is a lack of worldwide evidence on COVID-19 VH levels and their association with the economy. In a recent Italian cross-sectional study, the recovered COVID-19 patients showed substantial levels of VH towards the COVID-19 vaccine (59.2%) and influenza vaccine (54.6%). Older age and previous 2019 influenza shots were the main predictors of positive attitudes toward vaccination.[6]

There appears a wide variation among dentists toward acceptance of anti-COVID-19 vaccinations. This may be due to a variety of reasons like lacking awareness, phobia associated with complications of vaccines, doubts, and related hesitation over the safety of newly available vaccines as a result of the absence of safety data, no clarity over protocols related to vaccines in medically compromised subjects and vaccine’s effectiveness over newly emerging variants or strains of SARS-CoV-2.[7]

Thus, early COVID-19 vaccination must be achieved especially among dental professionals as well as students of Dentistry.[8] A low acceptance has been observed from Health professionals from other countries. However, there is no literature available that analyzes the acceptance as well as perception regarding the COVID-19 vaccine among Dental or other healthcare professionals in India.

Hence, this study aimed to study knowledge, acceptance as well as precipitation of COVID-19 vaccination among dental students and dental practitioners in India. The objectives were 1) To assess the level of knowledge among students and practitioners of Dentistry regarding COVID-19 vaccines; b) To evaluate the level of acceptance regarding COVID-19 vaccine among the particular segment of the population and c) to perform an assessment of precipitation among this particular group of individuals concerning COVID-19 vaccines.

Materials and Methods

Study design and settings

This cross-sectional and observational study was a questionnaire-based survey conducted amongst 100 students of Dental courses in various dental colleges and 100 professionals of Dentistry to assess the level of knowledge, awareness, and precipitation concerning COVID-19 vaccines.

Study participants and sampling

The sample size was estimated by using the ‘Epi Info™’ software. It was considered that there were approximately 100 dentists who were practicing dentistry in surrounding areas. The minimal size of the sample calculated was found to be 100 along with an expected 50% prevalence with a 95% confidence level and a 5% margin of error.

The study protocol was permitted by the Institutional Ethical Committee. The structured pre-validated questionnaire which comprised twenty questions drafted in the English language was prepared. This questionnaire comprised of both selective responses to some questions along with a few close-ended questions (Yes or No). Google Forms were created and distributed using electronic mail and the Watts App.

Inclusion criteria

a) Subjects age ≥18 years, b) individuals who were familiar with internet usage along with social media sites; c) Subjects well versed with the English language and d) Who can read and understand the English language and e) subjects who voluntarily participated in the survey.

Exclusion criteria

a) Students pursuing other professional streams; b) non-dental healthcare professionals; c) Individuals who were not willing to participate in this study and d) Those who did not return the filled questionnaire.

Statistical analysis

Responses obtained were recorded and statistically evaluated using SPSS software Version 21.0. The validity of the responses received was checked using the Cronbachα reliability score which was found to be significant (score = 0.718). Descriptive statistical analysis was performed for frequency and percentages. Pearson’s ‘Chi-Square’ and Fisher’s Exact Tests were used to assess the level of significance (P < 0.05).

Results and Observations

Demographic characteristics

There were 65 male and 35 female participants in this study which was a statistically significant difference (P = 0.04).

a) Knowledge and awareness: It was observed that all study participants had knowledge as well as awareness regarding the availability of COVID-19 vaccination. However, only 60% of the studied study sample had received its first dose which was statistically significant (P = 0.05) at the time of the study while statistically significant numbers of study participants i.e. 65% had received the second dose as well (P = 0.03). Only 13% had received the third or booster dose. This was found to have statistical significance (P = 0.043).

79% of the studied population considered vaccination as a mandatory process and it was a significant (P = 0.02) number. A significant number of the studied population (P = 0.03), 28% believed that patients who had prior exposure to SARS-CoV-2 did not require COVID-19 vaccination.

57% believed that the vaccine could alter one’s DNA permanently. However, this was found to be a nonsignificant difference (P = 0.78) while 54% believed that this vaccine contained antibiotics. However, this was found to have no significant influence (P = 0.061).

56.4% of studied participants had no awareness regarding protocols for COVID-19 vaccination in patients who were diagnosed with any bleeding disorder (P = 0.075, statistically non-significant). 41.25% agreed that these vaccines have effectiveness against any new type of variant. On the other hand, the remaining 58.75% were not aware of any effect of the vaccine on newer variants. This was found to have no significance (P = 0.97).

Only 40% of study participants considered getting pregnant women vaccinated for COVID-19. However, these subjects had no statistically significant difference (P = 0.062) Only 15% thought it to be safe for children below 10 years of age, which was a statistically small portion of the population studied (P = 0.05).

Only 13% of participants believed in continuously following COVID-19 health measures such as wearing masks and following other precautionary measures against the spread of COVID-19. This was found to be statistically significant (P = 0.04).

Most of the study respondents (72%) had strong beliefs about the occurrence of complications related to blood clotting that can occur due to COVID-19 vaccines though there was no significant effect of such belief on overall studied participants (P = 0.25). 87% of patients considered controlling blood sugar levels in diabetics important before receiving the vaccination. This belief was held by a statistically significant population (P = 0.035).

Only 8% of study participants believed that individuals who tested positive or were suspected of being infected could receive vaccination and 14.1% believed that subjects who recently got infected with SARS-CoV-2 could receive the COVID-19 vaccine (P = 0.001).

81% of study group participants were aware of the fact that one can still get infected with SARS-CoV-2 even after vaccination especially, those individuals who had received only a single dose (P = 0.12).

94% of study subjects had awareness of Mucormycosis or black fungus among patients who had recovered from COVID-19 infection, which was statistically significant (P = 0.04). Only 6% of patients had no awareness regarding black fungus among patients who had recovered from COVID-19 [Table 1 and Graph 1].

Table 1.

Questionnaire used in the study

Questions	Responses		Chi-Square	P
Do you know about the availability of the COVID-19 vaccine?	Yes	100%	60.12	0.04
	No	0%
Have you undergone vaccination for COVID19?	Yes	75%	54.1	0.023
	No	25%
Have you received the first dose of the COVID-19 vaccine?	Yes	60%	7.54	0.05
	No	40%
Have you been vaccinated with a second dose of the COVID-19 vaccine?	Yes	65%	17.34	0.03
	No	25%
Have you received a third or precautionary dose of the vaccine?	Yes	13%	57.14	0.043
	No	87%
Is it required to get vaccinated with the COVID-19 vaccine?	Yes	79%	13.67	0.02
	No	11%
Is it mandatory for any person who has recovered from COVID-19 to take Vaccination against this disease?	Yes	28%	12.98	0.03
	No	72%
Can any individual who had a recent infection with COVID-19 receive vaccination?	Yes	14.1%	23.76	0.012
	No	85.9%
Are antibiotics components of COVID-19 vaccines?	Yes	54%	12.45	0.061
	No	46%
Can any person who is suffering from bleeding disorders receive COVID-19 vaccine?	Yes	56.4%	13.27	0.075
	No	43.6%
Can the COVID-19 vaccine alter any person’s DNA?	Yes	57%	45.12	0.78
	No	43%
Is it safe for pregnant females to be vaccinated against COVID-19 infection?	Yes	40%	56.1	0.062
	No	60%
Is it safe for children less than 10 years to receive the COVID-19 vaccine?	Yes	15%	14.53	0.05
	No	85%
Is it important to check blood glucose levels in diabetics before vaccination?	Yes	87%	34.23	0.035
	No	13%
Can any individual who is confirmed or is suspected of COVID-19 infection receive the vaccination?	Yes	08%	47.89	0.001
	No	92%
Are newer emerging variants of SARS-CoV-2 resistant to currently availablevaccines against COVID-19?	Yes	41.25%	59.34	0.97
	No	58.75%
Can a person get infected with COVID-19 even when vaccinated, especially after receiving only the first dose?	Yes	81%	19.98	0.12
	No	19%
Can COVID-9 vaccination result in clotting of blood?	Yes	72%	45.12	0.25
	No	18%
Are you aware of cases of black fungus in patients who have recovered from COVID-19 infection?	Yes	94%	108.1	0.04
	No	06%
Are you aware that following precautionary measures such as wearing face masks is still important after receiving the COVID-19 vaccine?	Yes	13%	99.13	0.04
	No	97%

Graph 1.

Graph showing P values obtained from questionnaire

b) Perception: 85% of practicing dental specialists had the willingness to receive the COVID-19 vaccine. More than 70% of respondents including dental residents (i.e. post-graduate students) as well as 20% of dental under-graduate students showed willingness for inoculation. In our study, the overall acceptance rate for COVID-19 vaccination was found to be 82%, which was found to be extremely significant (P = 0.001). Similarly, extremely statistically significant (P = 0.001) numbers of study participants had awareness regarding predisposing systemic conditions to be considered before vaccination [Table 2 and Graph 2].

Table 2.

Table showing acceptance and perception among study participants regarding COVID-19 vaccination

Questionnaire items	Students	Dental professionals	P
Are you willing to get vaccinated against COVID-19?	78%	85%	0.001
Are you aware of predisposing factors involved before getting vaccinated?	79%s	89%	0.001

Graph 2.

Graph showing P values of acceptance and perception regarding COVID-19 vaccine

Discussion

Hesitant behavior toward accepting any vaccine is a chronic issue that presents significant health threats to public health. This has been seen in the form of resurging infectious conditions such as measles, polio, and pertussis.[9,10,11]

The development of effective as well as safe vaccines against COVID-19 in a brief period of time is a remarkable achievement.[12]

According to predictions on the COVID-19 pandemic, it has been assumed that 60% to 75% of the general population should receive vaccination to halt the progression of the spread of SARS-CoV-2 in the community. Overcoming hesitant behavior towards the vaccine is mandatory for successfully overcoming the COVID-19 pandemic.

Estimation of the acceptance rate for the COVID-19 vaccine will help in reaching higher numbers in inoculation programs which can aid in planning future courses of action as well as preventive programs that are required for increasing knowledge, raising awareness as well and providing assurance to an individual’s concerning the safety of COVID-19 vaccines. Following mass vaccinations, one can expect monitoring of transmission of SARS-CoV-2 and expect a reversal in health-related and other issues linked with this viral pandemic.[13,14]

Demographic characteristics

This study comprised students pursuing Dentistry as well as Dental practitioners who represented all four zones i.e. Northern, Southern, Eastern, and Western Indian states. The age range varied from 18 to 45 years.

Knowledge

In the present study, an acceptance rate of 82% for receiving COVID-19 was observed among dental students as well as dental professionals. Also, all study participants knew about COVID-19 vaccines. However, there appeared to be certain misconceptions due to poor knowledge regarding the constitution of the COVID-19 vaccine as a sizable number considered it to be capable of altering DNA and containing antibiotics as its constituent.

Sheela et al. (2022)[15] in their study reported that 52.56% of study participants were unaware of various protocols followed for COVID-19 vaccination in patients suffering from bleeding disorders. This is in contradiction to our study where all study respondents had awareness as well as knowledge regarding COVID-19 vaccination.

In the same study by Sheela et al.,[15] 60.90% of study subjects opined that immunologically compromised individuals can be vaccinated while 80.77% thought that levels of blood sugar must be controlled before vaccination among diabetic individuals. In our study, 87% of study participants believed that diabetic subjects must have their blood sugar levels checked before getting vaccinated.

Sheela et al.[15] reported that 55.77% and 80.13% of respondents believed that COVID-19 vaccination must be avoided in pregnant females as well as children, respectively. However, in the present study, it was seen that 40% of study participants thought that pregnant females could be vaccinated while only 15% considered vaccination of children aged 10 years age group.

Felten et al. (2021)[16] Boekel et al. (2021)[17] and El-Elimat et al. (2021)[18] have suggested that COVID-19 vaccines have a significant association with fear as the main factor for hesitant acceptable behavior.

Pal et al. (2021)[19] reported extremely mild adverse reactions following COVID-19 vaccination. They also recommended that COVID-19 vaccination must have priority in patients suffering from type I and type II diabetes as these subjects are at higher risk and usually their prognosis is poor.

Acceptance and perception

In significant contrast to our study, Kabamba et al. (2020)[20] in their study on Congolese healthcare professionals reported an acceptance rate of 27.7% which was very low. This may be due to the timing of surveying very little scientific validation of both COVID-19 as well as the effectiveness of the vaccine was available. Also, there was a lot of misinformation circulating in social networking sites which added to lesser acceptance of the vaccine.

Similarly, a study conducted by Shekhar et al. (2021)[21] reported a low rate of acceptance among healthcare professionals in the United States. In this study, only 36% of respondents showed their willingness to vaccination as soon as it was available. On the other hand, 56% of the studied sample showed hesitancy towards vaccination and preferred waiting till data associated with COVID-19 vaccination became available. These investigators based on their study had classified healthcare individuals into 4 main groups 1) The first group included healthcare practitioners who dealt with patients directly and had a high rate (49%) of vaccine acceptance b) The Second group comprised patient healthcare providers who were having relatively lower rate (27%) of vaccination acceptance of which approximately two-thirds (62%) chose postponing vaccination till data on vaccine safety was available, and 3) administrative health-care staff (34%) reported with vaccine acceptance.

Various attempts are ongoing to control the ‘COVID-19’ pandemic. The major emphasis has been put on successful vaccination programs as these might prove to be the most effective as well as a preventive measure against this virus spread.[22]

Thus, the primary finding in our study was higher knowledge, acceptance as well as precipitation of COVID-19 vaccination among Indian Dental students and Dental professionals. A positive mindset and acceptance level among Dental professionals as seen in this study can be channeled for motivating the general population to get vaccinated against COVID-19 as healthcare professionals are themselves flagships of positive change in society. Dentists have high levels of vaccine acceptance, and findings from this study can guide improvements in continuing to maintain high levels of infection control to prevent the spread of COVID-19 from patients. Finally, dentists can play a role in advocating for the uptake of the COVID-19 vaccine.

Limitations

However, due to the relatively smaller sample distribution in this study which was a major limitation, a further larger and more widely circulated survey must be conducted to evaluate the vaccination rate as well as its effect on other dental health care practitioners as well as students alike.

Conclusion

The present study has demonstrated comparatively higher levels of knowledge as well as awareness as well as precipitation for COVID-19 vaccination among students pursuing Dentistry as well as practitioners of Dentistry. Since dental healthcare professionals constitute primary healthcare workers, this high level of finding is very important. This heightened awareness among Dental students and Practitioners can be used for educating patients visiting dental colleges using display and open seminars for general public awareness. This may have greater as well as further implications for the general public that might lead to greater acceptance as well as awareness in public. Since knowledge regarding COVID-19 vaccination has been found to have an association with vaccine acceptance, attempts must be made to improve as well as update oneself for the increasing rate of acceptance.

Conflicts of interest

There are no conflicts of interest.

Funding Statement

Nil.