Acceptance, perception and awareness regarding COVID-19 vaccination among general population in Karachi, Pakistan
Authors: Zaidi Tafazzul Hyder , Zaidi Nadira Hyder , Ansari Aamer Humayun , Memon Sobia , Ahmed Faheem , Waheed Aleena , Mateen Javeria Abdul , Bari Amtul , Zehra Fatima Tuz 
Published: July 2022

Introduction: Even though the coronavirus disease 2019 (COVID-19) outbreak was first reported in late 2019 in Wuhan, China, it is still prevalent across the globe and continues to create mayhem. According to WHO, on March 26, 2021, SARS- CoV-2 virus has infected a total of 125 million people worldwide and caused 3 million casualties. There have been 14.5 million confirmed cases in Southeast Asia, out of which 6.5 lac confirmed cases of COVID-19 are from Pakistan alone, with 14,028 deaths. In Sindh, Pakistan, there have been 2.6 lac confirmed cases of COVID-19 out of which 2 lac 56 thousand have recovered while 4,487 died. Since the outbreak, countless research has been undertaken pertaining to the virus transmission cycle and different countries have strived to come up with a vaccine to protect the masses. The continued dissemination of this coronavirus vaccine emphasizes the role of international collaboration in the development of vaccines and therapeutics. Factors contributing towards vaccine hesitancy include unknown adverse effects of the vaccine, perceived threats, lack of awareness, religious beliefs, myths surrounding the pandemic and vaccine, lack of confidence in the health system and lack of community awareness about vaccine-preventable diseases. Moreover, since the vaccine is new and there is a lack of research pertaining to its efficacy and detrimental effects, people are reluctant to get vaccinated. The findings of this study might help the government figure out the best way to introduce mass vaccination programs in Pakistan and other South Asian countries. Moreover, lockdowns and social distancing may be eased if a COVID-19 vaccination offers immune defense, which will be beneficial for the country’s economy. Objective: To gauge the percentage of citizens who are willing to become vaccinated, their overall attitude towards the vaccination programs and the factors contributing towards vaccine hesitancy at the COVID Vaccination Center, Jinnah Post Graduate Medical Center, Karachi, Pakistan. Methodology: A cross sectional study from May 2021 to August 2021 was conducted at the COVID Vaccination Center, Jinnah Post Graduate Medical Center in Karachi. The study was conducted on 400 persons who were either the vaccination staff of the COVID Vacination Center or the persons coming for COVID vaccination. The sampling technique was non probability purposive sampling. The data was collected by rotating a structured questionnaire. The questionnaire was given to the data collectors who distributed them to the vaccination staff and the visitors .Written consent was taken from the participants and all ethical considerations and research protocols were observed. Data was collected in the form of pre-tested self-administered questionnaires. In order to standardize the questionnaires, a pilot study was conducted among research participants for the purpose of examining content validity. Data collected was analyzed using SPSS software version 20. The statistical analysis was conducted with 95% confidence interval and a p-value of <0.05 was taken as threshold of statistical significance. Results: 400 subjects were approached to fill in the questionnaires. The age group of participants was less than 25 years were 48.2%( n=204), 25 to 50 years were 38.8% (n=164) and more than 50 years were 7.6%(n=32) Males were 40.%(n=169) while females were 54.5%(n=231). Among the participants 40.4% ( n=171) were married and 54.1%(n=229) were unmarried. Coming to the educational background, the majority had a bachelor’s degree or beyond. Not Formally educated were 1.7%(n=7), those who studied till fifth grade or below were 1.2%(n=5), those educated up until matriculation were 3.3%(n=14), those who were intermediate educated were 14.3%(n=63), Diploma holders were 31%(n=131) and those who were university educated were 42.5%(n=180. When the participants were asked about their opinion regarding their health status, 21.5%(n=91) said it was excellent, 47.8%(n=202) said it was good, 21.3%(n=90) said it was fair, while 4%(n=17) said it was poor. When the participants were asked whether they were they suffering from any illness ( e.g: asthma, high BP, diabetes mellitus), 16.3%(n=69) said yes while 78.3%(n=331) said no. When the participants were asked whether COVID-19 existed, 86.5% (n=366) said yes while 8%(n=34) said no. When asked if COVID-19 was dangerous, 82.7%(n=350) said yes while 11.8% (n=50) said no. Replying to the question had the participants ever been infected by COVID in past, 13.9%(n=59) said yes while 54.8%(n=274) said no. When asked whether any members of their family, friends or neighbours had been affected by COVID-19, 61.9%(n=262) said yes and 32.6%(n=138) said no. When asked had they ever heard about COVID-19 vaccination, 39%(n=165) said yes and 55%(n=235) said no. 92.7%(n=392) said yes while 1.9%(n=8) said when asked whether had they received COVID-19 vaccination, 39%(n=165) said yes while 61 %(n=235) said no. When those who had not taken the vaccine were asked the reasons for not doing so, 6.5%(n=28) said that the COVID-19vaccine was not effective, 9.5%(n=40) said that it had side effects, 4.7%(n=20) believed that they had alternate protection against COVID-19 while 36.9%(n=156) gave other reasons. When the participants were asked whether they considered themselves at risk of getting COVID-19,43.7%(n=185) said yes ,27.2%(n=115) said no and 23.6%(n=100) said that they were not sure. Replying to the question would they prefer a vaccine with lower efficacy for the time being, 50.6%(n=214) said yes and 44%(n=186) said no. When asked which vaccine would they prefer, 35.5%(n=150) said Sinopharm/Sinovac (China), 5.2%(n=22) said Sputnik-V (Russia), 3.1%(n=13) said AstraZeneca( United Kingdom), 17.5%(n=74) said Pfizer( USA), 18.9%(n=80) said any vaccine and 14.4(n=61) were not in favour of any vaccine. When asked in detail regarding the participants ‘ major concerns and reservations regarding COVID 19 vaccine, about 29.6%(n=125) participants did not trust a vaccine made in such a short period of time, 35.7%(n=151) trusted the vaccine and 29.3%(n=124) were not sure. When asked whether the Vaccine’s contents were not permissible in their religion, 7.1%(n=30) agreed, 60.3%(n=255) disagreed and 27.2%(n=115) were not sure. When asked whether they did not need a vaccine as they had already contracted COVID-19, 8%(n=34) agreed, 70.7%(n=299) disagreed and 15.8%(n=57) were not sure, Replying to the question whether the Vaccine could cause infertility, 7.8%(n=33) agreed, 49.9%(n=211) disagreed and 36.9%(n=156) were not sure. When the participants were asked whether COVID-19 vaccine was a conspiracy of the West, 17%(n=72) agreed, 52.2%(n=221) disagreed while 25.3%(n=107) were not sure. Responding to the question whether the participants would wait and see vaccine outcomes on other recipients, 38.8%(n=154) agreed, 45.4%(n=132) disagreed while 10.4%(n=44) were not sure. Responding to the question that vaccination would not be effective for different mutated forms, 34.3%(n=145) agreed, 23.9%(n=121) disagreed and 36.4%(n=154) were not sure. When asked whether they suspected that Vaccine inserts a chip inside the body, 6.9%(n=19) agreed, 59.8%(n=253) disagreed while 27.9%(n=118) were not sure. When the participants were asked whether they would get a booster dose if required, 49.4%(n=209) said yes and 22.7%(n=96) said no. When asked what were their reason/s for getting vaccinated, 51.1%(n=216) said that they wanted to protect their family and friends, 21.7%(n=92) said that they were at high risk of contracting COVID 19, 1.9%(n=8) said that they were suffering from co-morbidities while 15.4%(n=65) gave other reasons and 4.5%(n=19) said that they did not want to get vaccinated. Conclusion: The population’s acceptance rate for COVID-19 vaccine is only thirty nine percent according to this study. In this research, key characteristics are emphasized that have significant consequences for formulating vaccine policy that maximizes vaccine uptake. Religious leaders should be involved in developing successful communication strategies, particularly for low-income families. Public messaging shoulddispel any worries about the vaccine’s safety and efficacy, as well as emphasize the vaccine’s potential for containing the pandemic. Keywords: COVID Vaccination+ Acceptance+ Healthcare workers+ general population