DRIXINE GUNAO.

PANELO, GAS 12 RESPECT

INQUIRIES INVESTIGATION AND IMMERSION

"Vaccine Hesitancy in Danao, Bulan, Sorsogon"

1. BACKGROUND OF THE PROBLEM

In 2019, a new coronavirus has been identified and many efforts have been directed
toward the development of effective vaccines. In the COVID-19 pandemic, nearly 2
million deaths and more than 88 million confirmed coronavirus cases (COVID-19) had
been reported in a year. This ever-growing global problem not only caused health
effects but also caused many negative economic and social consequences. The
frequency of vaccine refusal and hesitation, which is associated with many factors, is
increasing worldwide. The purpose of this study is to estimate the frequency of vaccine
refusal against COVID-19 vaccines and to identify the underlying factors for refusal or
hesitation in Danao, Bulan, Sorsogon. According to WHO, vaccination hesitations are
one of the ten biggest global health threats. It is emphasized that a well-planned COVID-
19 vaccine program is necessary to control the spread of the disease in the pandemic
and to ensure social immunity. It is an important fact that the success of the vaccination
program largely depends on the public acceptance of vaccines.

Vaccine hesitancy is an emerging term in the socio-medical literature which describes

an approach to vaccine decision making. It recognizes that there is a continuum
between full acceptance and outright refusal of some or all vaccines and challenges the
previous understanding of individuals or groups, as being either anti-vaccine or pro-
vaccine. The behaviours responsible for vaccine hesitancy can be related to confidence,
convenience and complacency. The causes of vaccine hesitancy can be described by the
epidemiological triad i.e. the complex interaction of environmental- (i.e. external),
agent- (i.e. vaccine) and host (or parent)- specific factors. Vaccine hesitancy is a complex
and dynamic issue; future vaccination programs need to reflect and address these
context-specific factors in both their design and evaluation. Many experts are of the
view that it is best to counter vaccine hesitancy at the population level. They believe
that it can be done by introducing more transparency into policy decision-making before
immunization programs, providing up-to-date information to the public and health
providers about the rigorous procedures undertaken before introduction of new
vaccines, and through diversified post-marketing surveillance of vaccine-related events.
Vaccine hesitancy is a complex public health issue referring to concerns about the
safety, efficacy or need for vaccination. Vaccines are ranked among the greatest public
health achievements. Extensive evidence documents the efficacy, minimal side effects
and cost-effectiveness of vaccines recommended by numerous national immunisation
programmes. Despite public health successes of vaccines, a large number of people
express concerns about vaccine safety, efficacy or need, a behaviour now referred to as
vaccine hesitancy. Vaccine hesitancy has gained increasing attention from the global
public health community. In August 2015, the WHO referred to vaccine hesitancy as a
‘growing challenge for immunization programs. Effective and safe COVID 19 vaccines
have been approved for emergency use since the end of 2020 and countries are actively
vaccinating their people. Nevertheless, hesitancy towards the vaccines exist globally. We
conducted this study to understand the attitudes towards COVID 19 vaccines and
hesitancy to accept it in Danao, Bulan, Sorsogon. The COVID19 has disrupted the life of
people globally. Amidst this grim situation, one of the positive signs of human resilience
is the development of effective and safe vaccines, within a year of onset of the
pandemic. Vaccines are effective public health tools, which when given to sufficient
numbers of people, can halt outbreaks of serious infections. The world currently faces a
gross inequity in access to COVID 19 vaccines. While high income countries are making
great strides in giving vaccines to all its people, low and middle income countries are still
languishing with poor vaccine access. Vaccine hesitancy is the reluctance of people to
accept a vaccine that has been proven safe and effective and made available to them for
protection against an infectious disease.

Getting a COVID-19 vaccine is a personal choice. But COVID 19-vaccines are effective
and can reduce the risk of getting and spreading the virus that causes COVID-19. Getting
children ages 5 years and older vaccinated can help protect them from serious short-
and long-term complications. Getting everyone ages 5 years and older vaccinated can
protect families and communities, including friends and family who are not eligible for
vaccination and people at increased risk for severe illness from COVID-19. Vaccine
hesitancy according to Strategic Advisory Group of Experts (SAGE) Vaccine Hesitancy
working group of World Health Organization (WHO) refers to delay in acceptance or
refusal of vaccines despite availability of vaccine services. Vaccine hesitancy is complex
and context specific, varying across geographies and vaccine types. It is influenced by
factors such as complacency, convenience and confidence. Vaccine complacency is
known to be present where the risk of vaccine preventable diseases is perceived to be
low and where vaccination is not considered essential. It has been observed that vaccine
hesitancy is heavily impacted by lack of confidence in the vaccine’s safety and efficacy as
well as fears regarding the reliability and competence of health system. Additionally, the
quality of vaccination services and their convenience (e.g. physical availability,
geographical accessibility and affordability) as well as the patient’s willingness to pay,
are all factors that impact the decision of whether or not to be vaccinated. Research has
shown that vaccination decision-making should be studied and understood in a broader
socio-cultural context as vaccination is part of a “wider social world” and its decision
making is highly influenced by various social factors [past experiences with health
services, family histories, feelings of control, conversations with friends, etc]. Streefland
and collaborators stated that “local vaccination cultures” develop from “shared beliefs
about disease etiology, potency, efficacy and safety of modern medicine as well as
vaccines and views related to preventive measures” alongwith “local health services
experiences and vaccination settings” influence the individual decision about
vaccination. It is also observed that concerns regarding child health and nutrition other
than vaccination may take priority at times or has a role to play in the willingness to
vaccinate.

The relevance of immunization in today's context sometimes becomes questionable

considering the legitimacy of science, expertise and medical authority. The stress on
health promotion about lifestyle and the growth of “consumerism” in health-care
leading to individuals’ involvement in their own health decisions may have also
contributed to some extent to vaccine hesitancy. Traditionally the doctors were the sole
directors of patient care but with the rise of informed patients, the decision-making
concerning their health process is now shared with patients who want to be active
participants and with health professionals.

2. CONCEPTUAL FRAMEWORK

The researcher used INPUT PROCESS OUTPUT (IPO) as shown in figure 1 it presents the
conceptual framework that shows the concept structure of the study. COVID-19 vaccine
is regarded as the most promising means of limiting the spread of or eliminating the
pandemic. The success of this strategy will rely on the rate of vaccine acceptance
globally. The study aims to examine the factors that influence COVID-19 vaccine
acceptance, intention, and hesitancy in Danao, Bulan, Sorsogon.

Figure 1. IPO MODEL CONCEPTUAL FRAMEWORK OF THE FACTORS THAT INFLUENCE

VACCINE HESITANCY
3. RESEARCH HYPOTHESIS

The researcher predicted that It may be possible to increase the vaccination rate by
reducing vaccine hesitancy and perceived barriers to vaccination and by encouraging
volunteers to advocate for vaccination to their friends and family members. It is also
important to reduce vaccine hesitancy by enhancing self-efficacy for vaccination, due to
its crucial mediating function.

4. STATEMENT OF THE PROBLEM

The study conducts to understand the attitudes towards COVID 19 vaccines and
hesitancy to accept it in Danao, Bulan, Sorsogon. The main problem of this research is to
look into the factors that influence vaccine hesitancy. This study will be carried out from
25 to 30 January 2022. A total of 100 people are enrolled. We will conduct the study
among adult men and women above the age of 18 years who had not received even a
single dose of the COVID 19 vaccine. We excluded persons with specific
contraindications for COVID 19 vaccine, mental disabilities or persons with
communication disabilities whom we could not interview. Researcher will administered
the questionnaire face to face to all the participants and will enter their responses into a
data collection software application (Google Forms) in our respective mobile phones.
We will count the responses to all the items in the questionnaire and tabulates them to
gain a comprehensive understanding of the data. The questionnaire consists of
questions about the sociodemographic characteristics of participants, their
thoughts/beliefs about possible effects of COVID-19 vaccines. The main dimensions of
the attitudes towards the COVID 19 vaccines were trust in effectiveness of the vaccines,
mistrust in the health system and the vaccines, concern regarding adverse reactions of
the vaccines and preference for natural immunity compared to the vaccines. The
understanding that this study provides regarding the subgroups of the population which
have high levels of hesitancy and those that have high levels of vaccine denial will guide
development of specific targeted interventions to reduce the hesitancy. The findings of
this study are directly actionable and can help develop effective behaviour change
communication campaigns.

5. DEFINITION OF TERMS

Vaccination has always been the subject of many controversies which have affected
vaccine acceptance of various vaccines to varying degrees in the past as well as in the
present. The importance of vaccination in maintaining health is an important factor for
accepting vaccines. Vaccination hesitations are one of the ten biggest global health
threats. It is emphasized that a well-planned COVID-19 vaccine program is necessary to
control the spread of the disease in the pandemic and to ensure social immunity. It is an
important fact that the success of the vaccination program largely depends on the
public acceptance of vaccines. For the purpose of clarification, the important terms used
in this study have been defined:

 Complacency

- A feeling of smug or uncritical satisfaction with oneself or one's achievements.

  Convenience

- The state of being able to proceed with something with little effort or difficulty.

 Confidence

- A feeling of self-assurance arising from one's appreciation of one's own abilities or

qualities.

 Complications

- A circumstance that complicates something.

 Disease etiology

- Etiology in medicine is defined as the determination of a cause of disease or pathology.

 Disruptive

- Disrupting or tending to disrupt some process, activity, condition, etc.

 Diversified

- To make diverse or composed of unlike elements.

 Efficacy

- The ability to produce a desired or intended result.

 Epidemiological Triad

- A number of models of disease causation have been proposed. Among the simplest of
these is the epidemiologic triad or triangle, the traditional model for infectious disease.
The triad consists of an external agent, a susceptible host, and an environment that
brings the host and agent together.

 Eligible

- Having the right to do or obtain something.

 Grim situation

- A situation or piece of information that is grim is unpleasant, depressing, and difficult

to accept.

 Gross inequality

- An income and wealth has two sides: a small number of people are very rich, and a
large number of people are either poor or one bad break away from becoming poor. This
economic inequality is both a cause and consequence of a similar inequality in political
power.

 Immunization Programs
- Immunization programs provide a set of services that ensure immunity to vaccine-
preventable diseases, including documenting evidence of immunity, administering
immunizations and re-immunizations, and record-keeping and reporting to state or local
immunization information systems (IIS), also known as vaccine registries.

 Languishing

- Failing to make progress or be successful.

 Legitimacy

- Legitimacy is the right and acceptance of an authority.

 Outbreaks

- In epidemiology, an outbreak is a sudden increase in occurrences of a disease when

cases are in excess of normal expectancy for the location or season. It may affect a small
and localized group or impact upon thousands of people across an entire continent.

 Potency

- The power of something to influence or make an impression.

 Strides

- A step forward.

 SAGE (Strategic Advisory Group of Experts)

- The Strategic Advisory Group of Experts is the principal advisory group to World Health
Organization for vaccines and immunization.

 Transparency

- The condition of being transparent.

 Vaccine Hesitancy

- Vaccine hesitancy refers to delay in acceptance or refusal of vaccination despite

availability of vaccination services. Vaccine hesitancy is complex and context specific,
varying across time, place and vaccines. It is influenced by factors such as complacency,
convenience and confidence.

 WHO (World Health Organization)

- A part of the United Nations that deals with major health issues around the world. The
World Health Organization sets standards for disease control, health care, and
medicines; conducts education and research programs; and publishes scientific papers
and reports.

6. SIGNIFICANCE/ IMPORTANCE OF THE STUDY

Vaccinations are among the most important public health tools for reducing the spread
and harm caused by dangerous diseases. The World Health Organization estimates that
vaccines prevented at least 10 million deaths between 2020–2021 worldwide. Despite
considerable evidence showing vaccines are safe, there is increasing skepticism toward
vaccination. Vaccine hesitancy has led to a decline in vaccine uptake and to an increase
in the prevalence of vaccine-preventable diseases (VPDs). Ironically, the objection to
vaccines is commonly a consequence of their effectiveness—because individuals have
lower exposure to VPDs, they are less concerned about contracting them, which
consequently leads to greater vaccine hesitancy. The COVID-19 pandemic has created a
new reality where individuals are faced with a previously unknown disease and its
effects, providing a unique opportunity to investigate vaccine attitudes during a period
of heightened disease salience. As a result of epidemiological characteristics such as the
prevalence, fatality, and infectivity of the disease, the pandemic has caused great
sociological, economic, and psychological destructions in society. In the ongoing
process, the hope of getting rid of the disease was attributed to the vaccine. With many
COVID-19 vaccines being developed, the hesitation and acceptance of the COVID-19
vaccine in the community should be well understood to reach the vaccination levels that
will provide herd immunity. Vaccination hesitations—unwillingness or refusal to get
vaccinated—are among the ten most significant global health threats. It is essential to
manage the social risk perception well in order to ensure success in the pandemic. The
vaccine, which is highly anticipated for society in all these negativities, has formed the
world agenda as an important strategy to stop the escalation in the COVID-19 epidemic.
Evidence is emerging that people get better protection by being fully vaccinated
compared with previously having a COVID-19 infection. One study showed that
unvaccinated people who already had COVID-19 are more than two times as likely than
fully vaccinated people to get COVID-19 again. COVID-19 is still a threat to people who
are unvaccinated. Some people – including children – who get COVID-19 can become
severely ill, which could result in hospitalization, and some have ongoing health
problems several weeks or even longer after getting infected. Even people who did not
have symptoms when they were infected can have these ongoing health problems.
COVID 19-vaccines are effective and can reduce the risk of getting and spreading the
virus that causes COVID-19. COVID-19 vaccines also help children and adults from
getting seriously ill even if they do get COVID-19. Efforts to convince skeptics to get a
COVID-19 vaccination should focus on thoughts and feelings about vaccines. Public
health officials could use advertising theory to achieve herd immunity to COVID-19,
marketing experts believe. Efforts to encourage vaccinations to date have focussed on
distribution but addressing how people think and feel about getting the vaccine could
convince skeptics to vaccinate. Community leaders and local health workers can play a
key role in tackling vaccine-related fear and misinformation. In this study the
beneficiaries are those experts concerned about the problem, the administrators or
policy makers who implement programs, the subjects themselves, the future
researchers and those who are directly and indirectly affected by the problem.

7. SCOPE AND LIMITATION OF THE STUDY

 This study focus on the factors that influence COVID-19 vaccine acceptance, intention
and hesitancy using findings of the various COVID-19 vaccine surveys conducted in
barangay Danao and to explore and assess the rate of COVID-19 vaccine acceptance,
intention, and hesitancy globally. We conducted the study in Danao a barangay in the
municipality of Bulan, in the province of Sorsogon. Its population as determined by the
2020 Census was 1,019. We conducted the study among adult men and women above
the age of 18 years who had not received even a single dose of the COVID 19 vaccine.
We excluded persons with specific contraindications for COVID 19 vaccine, mental
disabilities or persons with communication disabilities whom we could not interview.
The Vaccine Attitudes Examination (VAX) Scale is a validated instrument to measure
vaccine hesitancy. Researcher adapt this scale to the local context and collect
information about attitudes towards COVID 19 vaccination. We will translate this
instrument to bikol language. In addition, we also included socio-demographic details of
the participants in the questionnaire. We administered the questionnaire face to face to
all the participants and entered their responses into a data collection software
application (Google Forms) in our respective mobile phones. The understanding that this
study provides regarding the subgroups of the population which have high levels of
hesitancy and those that have high levels of vaccine denial will guide development of
specific targeted interventions to reduce the hesitancy. The findings of this study are
directly actionable and can help develop effective behaviour change communication
campaigns. COVID 19 precautions including face mask, hand sanitation, physical
distancing will be practice during the data collection to safeguard the researchers as
well as the respondents. Respondents will be provided adequate privacy during the
interview and confidentiality of their information was protected.

There are some limitations of this study. Firstly, the study is limited to a particular
geographic location. The researchers limited the study to 100 person. Another limitation
of the study was the sole dependence on only one search term to find relevant
literature which may have led to missing a few relevant studies. However, this approach
was utilized to find a broad range of studies focusing on COVID-19 vaccine surveys. The
whole purpose of the review was to illustrate a succinct summarization of the
prevalence and predictors of the COVID-19 vaccine acceptance and hesitancy
worldwide. Further, the latest evidence on the topic used to formulate the discussion
section of the review increased the breadth of the literature covered in the scoping
review, thus increasing its strength. Despite these limitations, the findings of this study
are useful because we have demonstrated the effectiveness of the tool and the methods
in conducting such a survey to strategically segment the population for public health
intervention.

Sources of information:

https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-021-07037-4

https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0250123

https://onlinelibrary.wiley.com/doi/10.1111/ijcp.14336

https://www.frontiersin.org/articles/10.3389/fpubh.2021.698111/full

https://www.jmir.org/2021/6/e27632