Covid-19 vaccine, acceptance, and concern of safety from public perspective in the state of Odisha, India

ABSTRACT

Introduction: No medication or therapies were found to be effective in controlling the covid-19 pandemic. The fast-track development of covid-19 vaccine brought some hope among health practitioners globally. The major challenge seems to be safety, efficacy, and acceptance of the vaccine. A cross-sectional survey was conducted among the community of the state of Odisha, India, to find out the concerns of safety and acceptance for the vaccine.

Methods: A self-administered multiple-choice questionnaire containing 23 items with three sections was prepared in Google form and deployed following snow ball sampling method. The participants recruited were above 18 years of age residing in Odisha. The participation in the survey was completely voluntary. The survey was conducted during February 2021.

Results and discussion: In total, 359 members participated in the survey. Majority of the respondent strongly agree/agree that covid-19 vaccine is safe for adults and children. Significant variation among all the groups was found regarding acquisition of higher immunity following infection rather by vaccination, effectiveness in infection prevention, safety in children, provision of mandatory vaccination by government, and public health protection following government guidelines.

Conclusion: The major barrier to the covid-19 vaccination was found to be safety and awareness. But there is well acceptance to covid-19 vaccine among the community of Odisha, India, and further efforts to create awareness concerning safety and vaccination will be instrumental in the eradication of this infection.

Introduction

Microorganisms are an integral part of the cosmos, some are beneficial and some are harmful to us. The defense system of animal provides protection against the pathogens. To aid the survival, we have developed many chemical agents, vaccines, and antibodies. The Corona-19 virus strain originated from Wuhan city, China, has posed the greatest challenge to the humans,^1,2 leading to the longest era of pandemic extending for more than a year. Physicians tried several combinations of drug therapy during this pandemic, but all of them were of little or no output.^3,4 Vaccine has been proved to be infallible for many viral infections, so the scientists around the globe tried hard to develop a vaccine for Covid-19.⁵ In the context of emergency, the clinical trial period was shortened, which raised concern and question about the safety of the vaccine among the public. There are reports of concern to vaccination among the population for various reasons like efficacy, safety and credibility.⁶ There are reports from the UAE concerning the non-acceptance of vaccination by 12% of the parents.⁷ Odisha, a state in eastern India, has been reported to control the spread of the pandemic through proactive and effective measures.⁸ Parida and Das⁹ had made a prediction based on model analysis that the pandemic will end by August 2020 in Odisha. With an objective to find out the acceptance, concern of safety for the vaccine we conducted a cross-sectional survey among the adult population of the state of Odisha, India.

Materials and methods

A simple survey instrument was prepared by making modifications to the earlier reported instrument by Saratchandra et al..¹⁰ A self-administered multiple-choice questionnaire containing 23 items with three sections (demography, acceptance of vaccine, experience of vaccination) was developed and pretexted among 30 persons to check its validity, and necessary changes were made as per the comments of the respondents. The final survey instrument was prepared in Google form and deployed following snow ball sampling method through social media platforms (Facebook, Twitter), WhatsApp, and e-mail. The participants recruited were above 18 years of age residing in Odisha. The participation in the survey was completely voluntary. The survey was conducted during February 2021. The response of the participant was recorded in the MS Excel, and cleaning of the data was done by removing incomplete responses.

Sample size

There were previous reports that the acceptance to vaccine is only 85%. We considered that a sample size of 400 would be sufficient, with a confidence limit of 95%. Adding of the possibilities of incomplete survey, the sample size of 450 would be sufficient. The formula N = Zα2P (1 − P)/d2 was followed to calculate the sample size, where values of α, Zα, P, and d were 0.05, 1.96, 50%, and 0.1.

Statistical analysis

Descriptive statistics was carried out for the entire questionnaire response and the number and percentage of response were tabulated. One-way ANOVA for the response from question number 6–19, with respect to age, gender, education, marital status, and occupation, was carried out. The F value and significance was tabulated. SPSS statistical software was used for the analysis.

Results

A total number of 359 members participated in the survey (247 males and 112 females). The number and percentage of different age groups along with marital status, education, and occupation are given in Table 1. The participants were grouped into four categories basing upon their occupation like sudents of medical and related education (64%), student of humanities (7.2%), medical and related profession (17%), and other profession (11.4%).

Table 1.

Demographic details of the participants

Serial number	Question	Option	Number (N)	Percentage
1	Age (years)	18–25	260	72.4
		26–35	35	9.7
		36–45	26	7.2
		>45	38	10.6
		Total	359	100.0
2	Gender	Male	247	68.8
		Female	112	31.2
		Total	359	100.0
3	Marital status	Married	66	18.4
		Single	291	81.1
		Separated/divorced/widowed	2	.6
		Total	359	100.0
4	Education	Post graduate	124	34.5
		Graduate	167	46.5
		Diploma	41	11.4
		High school	27	7.5
		Total	359	100.0
5	Occupation	Student (medicine, pharmacy, nursing, dentistry)	231	64.3
		Student (other)	26	7.2
		Profession (medicine, pharmacy, nursing, dentistry)	61	17.0
		Profession (other)	41	11.4
		Total	359	100.0

The response of the participants to the questionnaire (1–15) related to safety concern of the public to covid-19 vaccine has been given in Table 2. The majority of the respondents (69%) strongly agree/agree that covid-19 vaccine is safe. 41.5% of the participants disagree/strongly disagree that the vaccine contains dangerous ingredients. The majority of the participants (39.3%) are neutral about the vaccine causing other diseases. 55.5% of the participants either disagree or strongly disagree that the vaccine will be effective against all strains of covid-19 virus. 44.8% of the participants agree or strongly agree that Covid-19 infection will provide better immunity than vaccines do. 74.3% of the participants agree or strongly agree that vaccines will be effective in preventing covid-19. 44.3% of the participants were neutral about safety of vaccine on children. 65.4% of the participants agree or strongly agree to the appropriateness of the vaccination timing and schedule. 73.5% of the participants agree or strongly agree that Covid-19 vaccines are a major advancement in preventing covid-19 infection. Pertaining to mandatory covid-19 vaccination by government, 68.8% participant either agree or strongly agree. 85.8% participants feel that everyone should follow government guidelines about Covid-19 vaccines to protect public health. Regarding sufficiency of human study concerning safety and efficacy of the covid-19 vaccine, 56.3% participants either agree or strongly agree. 35.9% of the participants consider that concern of safety is the major barrier to the vaccination. 48.5% do not agree that the vaccine should be available free of cost. Out of the total participants, only 8.1% have received the vaccine.

Table 2.

Responses of participants concerning safety and acceptance

	Strongly agree		Agree		Neutral		Disagree		Strongly Disagree
Question	N*	%	N*	%	N*	%	N*	%	N*	%
Covid-19 vaccines is safe.	82	22.8	166	46.2	98	27.3	12	3.3	1	0.3
Covid-19 Vaccines is containing dangerous ingredients	10	2.8	31	8.6	133	37.0	145	40.4	40	11.1
Covid-19 Vaccines cause other disease.	8	2.2	55	15.3	141	39.3	124	34.5	31	8.6
Covid-19 vaccines will be effective against all strains of covid-19 virus	33	9.2	151	42.1	113	31.5	53	14.8	9	2.5
Covid-19 infection will provide better immunity than vaccines do.	35	9.7	126	35.1	115	32.0	64	17.8	19	5.3
Covid-19 vaccines will be effective at preventing covid-19.	59	16.4	208	57.9	77	21.4	13	3.6	2	.6
Covid-19 vaccine is safe for children	22	6.1	99	27.6	159	44.3	64	17.8	15	4.2
The timing of the current vaccination schedule is appropriate	50	13.9	185	51.5	99	27.6	24	6.7	1	.3
Covid-19 Vaccines are a major advancement in preventing covid-19 infection.	74	20.6	190	52.9	85	23.7	8	2.2	2	.6
Covid-19 vaccination should be made mandatory by the government	101	28.1	146	40.7	64	17.8	38	10.6	10	2.8
To protect public health, we should follow government guidelines about Covid-19 vaccines	184	51.3	124	34.5	41	11.4	10	2.8	-	-
Enough human study concerning safety and efficacy of the covid-19 vaccine has been done.	48	13.4	154	42.9	112	31.2	35	9.7	10	2.8

Which of the following is the major barrier to Covid-19 vaccination?	Cost		Safety		Awareness		Social distancing		Religious belief			Availability
	N*	%	N*	%	N*	%	N*	%	N*		%	N*	%
	26	7.2	129	35.9	91	25.3	48	13.4	7		1.9	58	16.2
	Yes				No		Not sure				Total
	N*		%		N*	%	N*			%	N*		%
Covid-19 vaccination should be available free of cost	129		35.9		174	48.5	56			15.6	359		100
Have you taken covid-19 vaccine?	29		8.1		330	91.9	-			-	359		100

* N indicates number.

The results of vaccination experience are given in Table 3. 37.9% of the participants had fever, 13.8% experienced headache following vaccination, and none of the participants experienced the adverse effects like nausea and skin rashes. Most of the participants were happy about the organization and preparedness to handle the adverse reaction of the vaccination center.

Table 3.

Experience of vaccination

Question	Response
Did you experience any side effects after vaccination?	Fever		Headache		Nausea		Skin rash		Others		Nothing
	N*	%	N*	%	N*	%	N*	%	N*	%	N*	%
	11	37.9	4	13.8	0	0	0	0	0	0	14	48.3
	Strongly agree		Agree		Neutral		Disagree		Strongly disagree
	N*	%	N*	%	N*	%	N*	%	N*	%
The organization of vaccination center was appropriate	12	41.4	12	41.4	4	13.8	0	0	1	3.4
The vaccination center was prepared to handle any adverse reaction	13	44.8	9	31	6	20.7	0	0	1	3.4

*N indicates number.

Statistical analysis

Statistical comparison of responses following one-way ANOVA is given in Table 4, p ≤ 0.05 considered as significant. Regarding the safety of the vaccine, there was no significant variation in the opinion among the groups like age, gender, and occupation but there was significant variation in the opinion by different groups in education and occupation. However, regarding the content of vaccine there was significant variation in the opinion among all groups except occupation, and about the side effects of vaccine there was no significant variation in the opinion among different group except gender. Regarding spectrum of vaccine efficacy, major barrier to Covid-19 vaccination, and free availability of vaccine, there was significant variation in the opinion among all groups. Significant variation among all the groups was found regarding acquisition of higher immunity following infection rather by vaccination, effectiveness in infection prevention, safety in children, provision of mandatory vaccination by government, and public health protection following government guidelines. Regarding appropriateness of vaccination schedule, there was no significant variation in the opinion among all groups. Regarding the role of vaccine toward advancement in preventing covid-19 infection, human study concerning safety and efficacy of the covid-19 vaccine, there was significant variation in the opinion among all groups except age. Regarding human study concerning safety and efficacy of the covid-19 vaccine, there was significant variation in the opinion among all groups except gender.

Table 4.

Statistical analysis (ANOVA) of the results

Variable	Age		Gender		Marital status		Education		Occupation
Questionnaire	F*	Sig.*	F*	Sig.*	F*	Sig.*	F*	Sig.*	F*	Sig.*
6. Covid-19 vaccines are safe	3.259	0.022	5.582	0.019	2.976	0.052	2.976	0.052	2.023	0.110
7. Covid-19 vaccines are containing dangerous ingredients	2.220	0.086	1.093	0.296	0.927	0.397	.927	0.397	5.300	0.001
8. Covid-19 vaccines cause other disease	5.710	0.001	0.967	0.326	4.105	0.017	4.105	0.017	3.601	0.014
9. Covid-19 vaccines will be effective against all strains of covid-19 virus	0.216	0.885	1.356	0.245	0.190	0.827	0.190	0.827	0.909	0.437
10. Covid-19 infection will provide better immunity than vaccines do	0.109	0.955	1.060	0.304	1.004	0.367	1.004	0.367	0.776	0.508
11. Covid-19 vaccines will be effective at preventing covid-19	0.577	0.630	2.536	0.112	0.305	0.737	0.305	0.737	1.125	0.339
12. Covid-19 vaccine is safe for children	0.433	0.729	2.313	0.129	0.032	0.969	.032	0.969	2.346	0.073
13. The timing of the current vaccination schedule is appropriate	4.715	0.003	5.879	0.016	3.124	0.045	3.124	0.045	2.361	0.071
14. Covid-19 vaccines are a major advancement in preventing covid-19 infection	3.488	0.016	2.131	0.145	1.306	0.272	1.306	0.272	2.210	0.087
15. Covid-19 vaccination should be made mandatory by the government	0.103	0.958	0.241	0.624	0.706	0.494	0.706	0.494	0.786	0.502
16. To protect public health, we should follow government guidelines about Covid-19 vaccines	1.627	0.183	0.008	0.928	1.204	0.301	1.204	0.301	0.158	0.924
17. Enough human study concerning safety and efficacy of the covid-19 vaccine has been done	2.131	0.096	8.554	0.004	0.434	0.648	0.434	0.648	0.590	0.622
18. Which of the following is the major barrier to Covid-19 vaccination?	0.861	0.462	0.473	0.492	0.349	0.706	0.349	0.706	0.926	0.428
19. Covid-19 vaccination should be available free of cost	0.231	0.875	0.001	0.970	1.479	0.229	1.479	0.229	0.311	0.817

*F indicates F value, Sig indicates *significance.

Discussion

Vaccine has been proved to be the most promising invention in control and spread of infectious diseases. However, always an inhibition has been seen among the public in accepting vaccine due to several reasons.^11–15 No such study concerning the vaccine acceptance has been reported from the state of Odisha, India.

In this study, most of the respondents feel that covid-19 vaccine is safe (questions 1, 2, and 3), which agrees to the earlier reports of the study from China and the USA.^16,17 The majority of the participants in our study feel that the vaccine will not be effective against all strains of Covid virus, which has not been reported in any earlier study. 44.8% participants are of the opinion that better immunity will be developed due to Covid-19 infection rather vaccination as vaccines developing immunity may not be same as it is developed after natural infection.¹⁸ The people involved in the study have the opinion that vaccine will be effective in preventing covid-19 infection. The majority of the participants believe that the vaccine is safe on children, which is in agreement with the earlier report about parental safety concern in the USA.¹⁹

Most of the participants involved in the study feel that the timing of the current vaccination is appropriate and also believe that the vaccine will be a major advancement in preventing covid-19 infection.²⁰ Respondents at large realize that vaccination should be made mandatory to all by the government, which is in congruence with the earlier report.^21,22 The majority of the participants supported following government guidelines to get protected from covid-19 infection, which agrees with the earlier study report from India.^8,23

The majority of the participants agreed that enough human studies concerning the safety and efficacy of the covid-19 vaccine have been done and there are no such earlier reports. This study reveals that awareness and safety is the major barrier for Covid-19 vaccination.^24–26 Cost is not a constrain for vaccination as revealed in this study, similar to the earlier report of Dodd et al.²⁷

Only 8% of total participants have taken the vaccine, and none of them has experienced any serious side-effects, only a few of them have experienced fever and headache, which is similar to the report of moderna covid-19 vaccine.²⁸

This study has the limitation of being conducted on a very small population. The use of Web-based survey produced higher response rates when administered to an educated population with access to computers.²⁹ Limited access to the internet, poor computer literacy, and limited English-language proficiency might have been the reasons for the poor participation in the study. It would have not been a good idea to conduct the survey physically among the participants in lieu to the current pandemic situation. Although the sample was small, the participants were recruited from all parts of the state with different professional and educational backgrounds to justify the representation of a large population.

Conclusion

This is the first community-based cross-sectional survey in the state of Odisha, India. From the survey, it is concluded that there are some concerns of safety (in adults and children), contents, side effects, and effectiveness, spectrum of activity, cost irrespective of age, gender, marital status, and occupation. Most of the participants are of the opinion that the timing of the vaccination is appropriate; the vaccine will not be effective against all strains of covid-19 virus, and vaccination will be effective in preventing the spread of infection. No serious side effects were seen among the vaccinated population. Participants were satisfied regarding the organization of vaccination center. The major barrier to the covid-19 vaccination was found to be safety and awareness. But there is well acceptance to covid-19 vaccine among the community of Odisha, India, and further efforts to create awareness concerning the safety of vaccines will be instrumental in the eradication of this infection.

Funding Statement

This work was supported by the Taif University [TURSP-2020/62].

Disclosure of potential conflicts of interest

No potential conflict of interest was reported by the author(s).