In current study, 64.1% of all participants were self-reported having COVID-19 vaccine hesitancy. While 35.9% were non-hesitant for get vaccination against COVID-19, this rate was lower than the findings in most of the previous other studies, 77.6% in France, 91.3% in China, 74.5% in India, 70.8% in Italy and 62.6% in Ethiopia (21–24). Among the study participants, the public health professionals (73.7%) had the highest rate of hesitancy, followed by medical workers (64.9%), general population (61.0%) and students (58.4%). Compared to the hesitancy rate of 47.5% among college students in United states, it was noteworthy that the Chinese college students had a higher rate of hesitancy toward COVID-19 vaccine (9, 25, 26). Apart from the change of people’s attitude with the increasingly severe COVID-19 pandemic over the world and different study time, different socio-demographic factors, levels of health literacy, particularly with respect to immunization schedules, as well as changes in local health policies over time and advances in the development of the COVID-19 vaccines are possible reasons of the differences on COVID-19 vaccine hesitancy. At present, the COVID-19 vaccine is available in China, however, not everyone in the cities or areas with accessible vaccination has been vaccinated. This level of hesitancy is very likely to be a barrier to or delay the establishment of herd immunity.
Among different population groups, this study indicated that public health professionals were more likely to have COVID-19 vaccine hesitancy than the general population. Most of the public health professionals in our study were healthcare workers from local CDCs who had more specialized knowledge. Previous studies had reported that healthcare workers or providers were instead more likely to have a low willingness to be vaccinated (27, 28). Public health professionals did not want to receive the shot might probably due to their low perception of risk on contracting the disease, or they would pay more attention to individual protection. On the other hands, they might consider the COVID-19 as common flu and not a much dangerous disease, or thought that they would be infected even though they get vaccination, due to the doubts of the efficacy of the vaccine. Additionally, we assumed public health professionals had more sources or approaches to receive information about the vaccine, including some negative news or information, which in turn affected their willingness to get a shot to some extent(29). Public health professionals always serve as the most trusted advisors and influencers of vaccination decisions and their recommendations are important facilitators for vaccine acceptance (28). If the attitudes or behaviors of them towards getting COVID-19 vaccine are hesitant, the public would have doubts or concerns about the vaccine. Therefore, interventions focusing on increasing the health care workers’ willingness to be vaccinated is an urgent need. Another study showed that knowledge about particular vaccines, their efficacy and safety, would help healthcare workers to build their own confidence in vaccines and willingness to recommend vaccines to others (30). To develop education campaigns based on accurate and authoritative knowledge or information might be working for reducing their hesitancy.
Besides, participants who have ever hesitated to get vaccination were more likely to be hesitant for the vaccination against COVID-19. Similarly, another survey found that a prominent determinant of COVID-19 vaccine avoidance is whether a person had the flu shot in the last two years (31). In our research, a lower score of the General Vaccine Hesitancy Scale was correlated to a higher possibility to be hesitant towards COVID-19 vaccines. It is surprising those who were not hesitant against other vaccines during pre-COVID era were more likely to be hesitant towards the COVID-19 vaccine. This might because the COVID-19 epidemic has posed unprecedented health threats to the public’s health and the COVID-19 vaccines were not undergone long-term clinical trials as others for emergency use as a strategy of controlling the pandemic. All individuals may have preoccupation and anxiety on safety and efficacy issues of COVID-19 vaccination, even if they were not previously hesitant to uptake the general vaccines. Therefore, the concerns about vaccine’s safety and efficacy is one of the most important sources of vaccine hesitancy, as demonstrated in as other studies (32).
In the past several months, the negative news about the safety and efficacy of COVID-19 vaccines have been widely spread on the Internet, both before and during vaccination. During the COVID-19 pandemic, governments and the public were unavoidably exposed to huge amount of rapid and far-reaching spread of questionable information, namely infodemic. Fake news and misinformation have become prevalent in various social media and have been skyrocketed since the beginning of the COVID-19 pandemic(33). Some media or websites would exaggerate or make unreliable news, because negative tweets expressing misinformation on vaccine confidence and even rumors, had more followers and attracted more public engagement online (34). Our study highlighted the needs of transparent information about COVID-19 vaccine development, efficacy and safety and the negative roles of misinformation on COVID-19 vaccine in vaccine hesitancy. The COVID-19 vaccine was developed at an alarming rate, unlike other vaccines in the past, so people may have more concerns about it, which has frequently been reported as the major obstacle to vaccination decision-making, especially for newly introduced vaccines which have not been fully tested in the real world (21, 35, 36). Meanwhile, risk information in the news had direct effects on people’s health behavior during the pandemic (37). Indeed, some other studies reported perceived effectiveness of the vaccine increased vaccination intention(32, 38). Therefore, providing reliable information on the disease and the relevant vaccines by the authorities and establishing suitable communication strategies between the government and the public would be helpful to create a trustworthy environment and hence improve public’s confidence in vaccination. Also, a warning system on infodemic is needed, apart from the monitoring of the disease itself in the similar circumstances.
In the information age, people can be easily influenced by false information and negative news, and thus may led to fear or panic and make arbitrary decisions (39). In the meantime, social medias play an increasingly important role in spreading both accurate information and misinformation, hence we can also use medias or websites to inform people in a positive way. To increase vaccination rates, information and education campaigns on the safety and efficacy of the COVID-19 vaccine will enhance public confidence in the COVID-19 vaccine (40, 41). People who have received vaccines, such as respected celebrities, those with influencing popularity and health care professionals with high click rate can be used as vaccination advocates to promote the benefits of vaccines to increase public’s willingness of vaccination (42).
In general, our study suggested a high prevalence of vaccine hesitancy against the COVID-19 vaccine among Chinese, especially among public health professionals. In addition, the spread of inaccurate information can cause, even increase vaccine hesitancy. Nowadays, especially after the outbreak, people are more likely to get information about vaccines on the Internet, which always containing incorrect, false and negative information. As a result, people may have further doubts about the safety or efficacy of the vaccine and refusal or delay vaccination. Consequently, proactive work against possible misinformation is needed during the development and vaccination phases of the COVID-19 vaccine, and more focused and nuanced public health information from trusted members of the population, including physicians, journalists, and experts is necessary and useful. More importantly, educating social media users on how to distinguish reliable information and to encourage them not to circulate false information are helpful for tackling COVID-19-related misinformation (39). For healthcare workers, to improve their knowledge, confidence of COVID-19 vaccine and communication skills is essential both for their own health and for the guiding effects on the general public. However, vaccine hesitancy is a complex phenomenon that does not depend only on a sufficient knowledge of vaccinations or perceived correct information, further study is necessary to explore other factors and effective prevention or intervention to reduce vaccine hesitancy.
Our survey was conducted before the COVID-19 vaccine became widely available in China. Therefore, there might have differences between the prevalence of hesitancy in our study and the actual vaccination rate later on. However, our study still provided meaningful results in terms of the prevalence and related factors of the vaccine hesitancy among various populations. Although four different population groups were surveyed in our study, the generalizability of our results will still be limited in certain aspects due to the nonprobability sampling we used. Also, the questionnaires were self-reported online, thus the information bias probably existed in this study.