Vaccine hesitancy rises as 69% Indians now say they won’t rush to take it

December 18, 2020, New Delhi: Since the onset of coronavirus, several vaccines that are in development are all designed for a single purpose, which is to develop an immune response in our body called antibodies – fighters that can attack the particular ‘spike protein’ of coronavirus when it recognises one so that we will have a much lower chance of getting infected by COVID-19. Vaccine regulators have been constantly looking at information about the performance of vaccines and are picking up any issue around safety that might arise in the future before the vaccine is authorised for public use. Countries such as the UK, US, Canada, Singapore have already authorised Pfizer-BioNtech vaccine dose for citizens, especially to healthcare and frontline workers and elderly citizens. In addition, another COVID-19 vaccine from Moderna is expected to get FDA approval this week. Meanwhile, Oxford-AstraZeneca's COVID-19 vaccine via Serum Institute of India, one which may be available in India sooner than others in large quantities, is likely to have 100 million doses available by February 2021. But the big question is, how many Indians are ready to take the vaccine?

To throw light on the issue of citizens’ reluctance or hesitancy to get the vaccine, LocalCircles since October 2020 has been collecting citizens’ response to the question: “The COVID-19 vaccine is likely to be available from February 2021 via private and Government channels. If that happens, what will be your approach to taking this vaccine?”. In the survey conducted between October 15 and 20, 61% of those who participated expressed hesitancy in getting the vaccine. In the passing weeks, vaccine makers – Pfizer, Moderna and Oxford-AstraZeneca – gave hope to the world with their success on efficacy results. With the news, the aggregate percentage of citizens in India hesitant about the vaccine reduced by 2% to 59% in the survey conducted from November 23-28. Citizens' reluctance to get the COVID-19 vaccine was compared with previously conducted surveys on the subject to understand the change over time. In the aftermath of several developments in place and the possibility of an affordable vaccine by February 2021, LocalCircles decided to conduct another survey on the subject to understand if citizen’s hesitancy levels have reduced, increased or been maintained. The survey received more than 18,000 responses from citizens across 242 districts of India. 66% respondents were men and 34% were women. 55% respondents were from tier 1, 26% from tier 2, and 19% were from tier 3, 4 and rural districts. Also, the attitude of the healthcare professionals in India towards the Covid vaccination was measured in a separate independent survey conducted by Dr Abdul Ghafur, Consultant for Infectious Diseases.

The first question on willingness to take the vaccine received 9,458 responses from citizens. Of whom, 4% said, “I am a health of frontline worker and will get it on priority through Government”, 27% said “Will wait 3-6 months after it comes to get it”, 15% said “Will wait 6-12 months after it comes to get it”, 8% said “Will only get it in 2022”, 6% said “Will not get it at all”, 5% said “Will get it as quickly as it becomes available via private healthcare channels”, 22% said “Will get it as quickly as it becomes available via any healthcare channels”, and 13% voted “Can’t Say”. The aggregate percentage of responses indicated that 69% Indians still won’t rush to take the COVID-19 vaccine even if it becomes available in the near future. The percentage of citizens hesitant was at 61% in October, dropped to 59% in November, and rose to 69% in December 2020. From the discussion, it appears some of the key reasons for citizens to become hesitant are limited information about side-effects, efficacy levels and a growing belief in parts of the population that COVID-19 cannot infect them because of their high immunity levels.

Though COVID-19 vaccine will soon become available, 69% Indians still won’t rush to take it

While India awaits COVID-19 vaccine and finalises distribution plans, hesitancy amongst citizens rises

While India’s official case load is almost 1 crore, the daily caseload reported has reduced by over 60% since September, and India-based experts believe that we are now declining from the peak and the same is expected to continue with less than 20,000 daily cases by February 2021. The declining case load also has some bearing on people’s interests in the vaccine. To understand citizen perceptions, LocalCircles asked them about their understanding of what was the primary reason the daily caseload was reducing? The question received 9,081 responses from citizens. Of them, 17% said “Because we are moving towards herd immunity”, 14% said “Because Indians in general have high immunity”, 8% said “Because COVID virus is going away or weakening”. 15% said “Cases are reducing because we are following norms for masks and social distancing”, 8% said “They thought something else was the reason”. 33% said “Official daily case count is significantly understated as most people are not getting tested and self-treating”, 5% did not have an opinion.

One takeaway is that 39% of the citizens believe India’s daily caseload is reducing because of people’s high immunity or because the virus has had its run and is now going away. While the public is no expert on the virus, the findings throw light on why vaccine hesitancy is rising. The average daily caseload from just mid-November around Diwali to mid-December has declined from 50,000 a day to 25,000 a day. This when combined with concerns around side-effects and vaccine efficacy that best explains why the hesitancy towards vaccines is rising in India.

39% citizens feel India’s daily case load is reducing because of people’s high immunity or because the virus is going away

According to a report, the Central Government of India has outlined 4 categories for vaccination, which includes around 1 crore healthcare professionals including doctors, MBBS students, nurses, ASHA workers, etc. Another category includes to cover around 92% of government hospitals and 55% of private hospitals across all States and UTs. Further, around 2 crore frontline workers including municipal corporation workers, personnel of the police, armed forces; about 26 crore people aged above 50 years; and a special category of those below 50 with co-morbidities would be vaccinated. The Centre has directed the States to cooperate with the initiative, with proper planning and mapping of human resources across departments that could be deployed for vaccination sessions for verification of beneficiaries, crowd management and overall coordination, the report said.

A separate independent survey of healthcare professionals coordinated by Dr. Abdul Ghafur took responses from healthcare professionals across India to understand their attitude towards Covid vaccination and received 1424 responses. According to Dr. Ghafur “The findings reveal significant concerns and suggest potential solutions.” In one of the questions in the survey, healthcare professionals were asked if they were willing to take the Covid vaccine when it is made available. To the question that received 1,420 responses, 44.58% said "Yes, I will take the dose as soon as it is made available", 15.28% said "Yes, I will take after 3-6 months", 3.24% said "Yes, I will take after 12 months", while 29.15% were "Undecided", and 7.75% said "Will not take the vaccine". Dr. Ghafur said, “The aggregate percentage of responses from the healthcare professional survey indicated that although 45% of healthcare workers are willing to receive the vaccine as soon as a vaccine is made available, 55% will either defer the vaccination or haven’t yet decided what to do. Less than one-tenth of the respondents i.e., 7.7% stated they would never take the Covid vaccine.”

The independent healthcare professional survey according to Dr. Ghafur also asked respondents about their reason to delay the vaccination shot. Of 1,406 responses, 15.01% said "Worried about the side effects", 7.75% said "Not sure about the efficacy", 38.26% said "Both reasons stated above", while 38.98% said "Not applicable, as I will accept the vaccine as soon as made available". Commenting on this finding Dr. Ghafur illustrated, “The survey result indicated that even majority of the healthcare professionals i.e., 55% are hesitant about COVID-19 vaccination. The healthcare professionals included general physicians, medicine specialists, surgeons, dentists, paramedics and nurses as well as medical students. 57% of the healthcare professionals who participated were women, while 43% were men and 73% of the respondents were between ages 25 and 54. 61% of the healthcare professionals who participated were working with a Covid designated hospital or center.”

The vaccine hesitancy concerns among the professionals are likely to percolate down to the general public as many citizens would consult their doctors before taking the vaccine. Any hesitation in accepting the vaccine by healthcare professionals and in turn citizens will have a negative consequence on India’s effort to control the spread of COVID-19. The key action needed here by both the pharmaceutical industry and the Central and State Governments is to keep citizens updated at every step about the vaccine trial results, including adverse events and successes. Also, as the vaccination begins, it is critical that central, state and local information sharing channels be created so any adverse events and issues are identified quickly and shared by the authorities in a transparent manner. With high penetration of social media, the risk of fake information and its becoming viral is high. Authentic and timely information coming from the authorities can play a big role in minimising such risk and converting some of the hesitant healthcare professionals and citizens into vaccine champions.

Survey Demographics

18,000 responses from citizens across 242 districts of India. 66% respondents were men and 34% were women. 55% respondents were from tier 1, 26% from tier 2, and 19% were from tier 3, 4 and rural districts. The survey was conducted via LocalCircles platform and all participants are validated citizens who had to be registered with LocalCircles to participate in this survey.