What were the explanations for COVID-19 vaccine refusal in Hong Kong?

In a recent study published in JAMA Network Open, researchers examined the willingness to simply accept the coronavirus disease 2019 (COVID-19) vaccine and reasons for hesitancy in Hong Kong.

Study: COVID-19 Vaccination Willingness and Reasons for Vaccine Refusal. Image Credit: Anishka Rozhkova/Shutterstock.com

Background

Hong Kong has been exemplary in its response to the COVID-19 pandemic until the very best every day mortality was recorded in the town. COVID-19 deaths per capita in Hong Kong are also far higher than in other high-income Asia-Pacific economies.

Hong Kong’s poor vaccination coverage in older populations might account for the observed COVID-19 mortality.

Specifically, over 82% of older adults ≥ 80 were non-vaccinated or had only received one vaccine dose, in comparison with 6.7% in England, 9% in Singapore, and a pair of.9% in Recent Zealand. A possible explanation for vaccine refusal could possibly be the sustained periods of zero-COVID, i.e., no local cases, in Hong Kong.

Furthermore, Hong Kong witnessed a significant social upheaval before COVID-19, as a proposed bill on extradition triggered extensive social unrest for over 50 years.

As such, people in Hong Kong were polarized and mistrustful of authorities. Thus, this scenario presents a singular opportunity to analyze how political opinions and mistrust influence vaccination.

In regards to the study

The current study explored COVID-19 vaccination willingness and refusal in Hong Kong. Around 18,045 individuals aged 15 or older and 1,488 children aged 10-14 were enrolled in 2009-11 and followed up until 2014.

A few of these were randomly followed up for over a decade. During COVID-19, participants were interviewed between February 2020 and May 2022. Cooperation and response rates were estimated in accordance with standards.

Vaccine refusal in Hong Kong was compared with Singapore. The Singaporean sample was drawn from a 2016 study on mental health. The study’s primary outcomes were vaccination prevalence and vaccine refusal. Refusal was described as a scarcity of intention to receive the vaccine.

Willingness to simply accept the COVID-19 vaccine was defined as having received no less than one dose, scheduled an appointment for vaccination, or intent to be vaccinated.

Political beliefs were analyzed throughout the 2019-20 social unrest based on whether subjects were for (pro-establishment), against (non-establishment), or neutral. Trust in vaccine information sources (media platforms, the World Health Organization [WHO], health authorities, academics, and physicians) was assessed.

COVID-19 vaccine confidence was analyzed using statements on perceived efficacy, importance, and safety of vaccines.

Vaccine misconceptions about chronic diseases, older adults, and safety were also evaluated. The team calculated the weighted prevalence of COVID-19 vaccine willingness throughout the pandemic.

Poisson regression was used to analyze the associations between political opinions and trust in vaccine information sources, vaccine misconceptions, vaccine refusal, and vaccine confidence.

Findings

In total, over 28,000 interviews were conducted. The median cooperation and response rates were 63.4% and 75.7%, respectively. In 2020, nearly two-thirds of Hong Kong adults were willing to vaccinate when available.

Willingness increased to over 73%, coinciding with positive vaccine trial results. Nevertheless, willingness dropped to 55% after the Hong Kong government announced that folks couldn’t select which vaccine to receive.

Furthermore, willingness reached the bottom level (43.6%) by the beginning of the vaccination program and media reports of hostile vaccine effects. Individuals with non-establishment political opinions were more prone to refuse vaccination than those with pro-establishment views. Political participation throughout the 2014 Occupy Central protests was related to COVID-19 vaccine refusal.

In Hong Kong, physicians and academics were essentially the most trusted sources of vaccine information, followed by the WHO, government authorities, and social media.

In Singapore, academics and government authorities were essentially the most trusted sources of vaccine information, followed by traditional media, WHO, and social media. Vaccine confidence was the very best before the rollout of COVID-19 vaccines and declined to the bottom levels at first of vaccination programs.

There was an association between low vaccine confidence and vaccine refusal. Nearly 59% of Hong Kong adults had no less than one misconception about vaccines, in comparison with 16.6% of Singaporean adults.

Further, over 56% of participants opposed vaccination of older adults (above 80 years). Social media, family/friends, and physicians were the highest sources of misconceptions regarding priority groups.

Mistrust in health authorities, low vaccine confidence, and misconceptions mediated 72.5% of the association between political opinions and vaccine refusal. As such, the direct association between political opinions and vaccine refusal was not significant.

Political beliefs, mistrust in health authorities, vaccine misconceptions, and low vaccine confidence jointly accounted for about 82% of vaccine refusal in adults aged 18-59 and 69.3% in older populations (≥ 60 years).

Conclusions

The study showed that political opinions could have short- and long-term associations with refusal to vaccinate against COVID-19.

This association was primarily mediated by modifiable aspects, corresponding to vaccine misconceptions, low vaccine confidence, and mistrust of health authorities.

Constructing trust in health authorities is significant to offset vaccine refusal. Furthermore, governments should prioritize the credibility of health agencies, which might help them improve vaccination coverage.