Only 4% Indian adults surveyed likely to take COVID nasal booster; 50% hesitant to take any booster in any form

January 17, 2023, New Delhi: The Chinese government's decision to drop its zero COVID-19 policy in December after almost three years, leading to a mammoth rise in cases in China in last 4 week has led to a considerable global concern. COVID surge is once again being observed in several countries including USA, UK, Ireland and Japan. Estimates suggest that nearly 60,000 people are losing their life in China to COVID each week.

While COVID continues its surge across many countries in the world, India continues to report a few hundred cases a day. While many in India are not getting tested despite having flu or viral like symptoms, hospitalisations haven’t risen either giving respite to experts that even if it is COVID, it is not a severe form of it. However, the country has taken several steps in the last four weeks to prepare for a COVID spike and in late December, the Government approved Bharat Biotech's intranasal COVID vaccine iNCOVAAC as a booster dose.

Over the last month, people have been discussing on LocalCircles, the vaccines, their side effects, the booster dose, COVID and whether the booster dose would be helpful to them. Given the conversations, LocalCircles conducted a national survey which received 15,958 responses from citizens located in 304 districts of India. 63% respondents were men while 37%respondents were women. 45% respondents were from tier 1, 36% from tier 2 and 19% respondents were from tier 3, 4 and rural districts.

50% citizens surveyed hesitant to take the COVID booster dose while 10% likely to take it (6% say injectible while 4% say will take the nasal booster)

The survey sought to find out the current status of people in regard to COVID booster dose. Informing people that a new nasal COVID booster would soon be available for all above 18, what are their plans to take the same? In response, 39% revealed that they have already taken the booster dose. Among the remaining, 40% maintained that they have already taken two doses of vaccination and have no plans to take the booster dose in any form; 6% stated that having already taken two doses of vaccination, they will take the injectable booster soon; 4% stated that they have taken two doses of vaccination and will take the new nasal booster soon; and 2% indicated that they have taken no decision so far. The survey data also revealed that 9% of the respondents haven’t even taken the first two vaccination doses so there is no question of a booster dose for them. Overall, the survey indicates that only 10% adult citizens in India are likely to take the COVID booster dose. 6% are likely to take it in injectible form while 4% are likely to take it in nasal form. Feedback in community discussions continues to indicate that the key reasons why people are reluctant to take the COVID booster is the belief that COVID won’t come back to India in severe form and a spate of unexplained cases of sudden cardiac arrest or heart attacks across the country which some are attributing to the COVID vaccine. The current booster uptake is less than 25,000 doses per day which is partly due to poor availability of doses at many centers but largely because of high booster hesitancy levels in many districts and areas.

Globally, health experts are getting increasingly divided on whether a 4th or 5th booster is useful given the rapidly mutating Omicron variant of COVID. In addition, late last week the US CDC stated that it is investigating if there is any linkage between cases of strokes and the Pfizer mRNA vaccine given an increasing number of sudden deaths that have been reported.

In India, a task force of medical experts from Indian Public Health Association (IPHA), Indian Association of Preventive and Social Medicine (IAPSM) and Indian Association of Epidemiologists (IAE), have meanwhile urged the government to declare an end to the pandemic, reassure the population and, at the same time, institute a mechanism for preventing the pharmaceuticals and vaccine industry from "misuse of Covid or any other similar disease in cahoots with self-styled public health experts and scientists”. “Vaccination should be recommended for those having comorbidities or those who never had Covid-19," the experts, many of whom have been part of the Government's Covid action group have stated in their latest joint statement. The experts have stressed that resources, both financial and human, saved from avoiding unnecessary vaccination and other unnecessary interventions can be better used for strengthening public healthcare facilities.

In summary, though the COVID nasal booster will soon be available to adults, the LocalCircles survey finds that only 4% adults are likely to take the same. Approximately 6% of those surveyed are likely to take the injectible booster dose. With 39% in the survey indicating that they have already taken the booster dose, a whopping 50% of those surveyed are not likely to take any booster dose in the current situation. This high booster hesitancy is largely driven by two factors i.e. a strong belief that a severe form of COVID is unlikely at this point and a spate of deaths due to sudden cardiac arrests and heart attacks that are being reported from across the country and some in people’s own social networks. With little or no research available so far on the root causes of such sudden deaths and low severity of COVID, many seem to be choosing the option of staying away from boosters, given the risk -benefit analysis.

LocalCircles will share the findings of this survey with Ministry of Health and Family Welfare, Government of India so that they are aware of the current public pulse on COVID boosters and plan any research, awareness and policy interventions accordingly.