Population Preferences and Attitudes Towards COVID-19 Vaccination: A Cross-Sectional Study from Pakistan

"The population's positive attitude should be improved by increasing awareness and eradicating false myths about vaccines through large-scale campaigns.""

Challenges with immunisation uptake in Pakistan are linked to a variety of reasons, including the role of religious and political figures in promoting misleading narratives and conspiracy theories (as seen in polio vaccination campaigns). Conspiracies pertaining to the COVID-19 vaccine are widespread in Pakistan, channeled through social media platforms, with influential and authoritative personalities in the country making dubious remarks against vaccination. With this context and history in mind, this study assesses the Pakistani population's attitude and preferences regarding the COVID-19 vaccine.

A cross-sectional study was carried out through an online self-administered questionnaire completed by 883 people from September 27 2020 to October 11 2020. Most (88.7%) of the participants in the study were under 30 years of age.

Though only 42.1% (n=372) of respondents had been vaccinated against influenza, 70.8% (n=625) were willing to get the COVID-19 vaccine when available. Of these willing respondents, 70.7% (n=442) would pay for the COVID-19 vaccine, with 33.9% (n=212) willing to pay up to Pkr 1000 (US$7). Due to uncertainty associted with the vaccine, as it was still under development at the time of the study, 84.9% (n=750) believed that more public awareness of the vaccine would be needed.

Overall, 66.8% (n=590) of the respondents showed a positive attitude towards COVID-19 vaccination, which was a prominent determinant of vaccine acceptability: Participants with a positive attitude had 4.78 times higher acceptability score than participants with a negative attitude.

Monthly family income, education level, and diagnosis of COVID-19 of oneself or a friend, family member, or colleague are other significant factors influencing acceptance of COVID-19 vaccination. With regard to the latter factor, the researchers suggest that witnessing a close person infected with COVID-19 might aid in removing the blindfold that conspiracy theories can create, thus encouraging people to adhere to experts' recommendations. The respondents who were willing to take the vaccine were asked to state the reasons for vaccination: 81.6% (n=510) wanted to protect themselves, and 72.6% (n=454) wanted to protect the people around them from COVID-19.

In this study, 258 (29.2%) respondents reported they do not wish to be vaccinated against COVID-19. Their primary reasons include natural immunity against COVID-19 (48.4%), use of protective measures (39.9%), and concerns about side effects of the vaccine (32.2%). Less than half (48%) of those who refuse will vaccinate themselves if government officials make it compulsory, while 38% said they would get the vaccine if their doctor recommended it. On the latter finding, the researchers note that, in collaboration with government, religious, and media personalities, healthcare providers have the potential to foster vaccine confidence, for the public tends to trust them and seek their advice. "With a profound knowledge of the vaccine's efficacy and safety profile, healthcare professionals can confidently convince them to get vaccinated."

Immunisation campaigns in Pakistan are regulated by the Expanded Program on Immunization (EPI) in collaboration with the World Health Organization (WHO). The researchers suggest that, owing to its close interaction with the general population, EPI staff can help correct the myths floating around regarding COVID-19.

The Pakistani media also has a role to play in encouraging people to accept vaccination against COVID-19, the researchers suggest. Namely, the responsibility falls upon the Pakistani media not to broadcast content that fuels COVID-19 conspiracy theories. The Pakistan Electronic Media Regulatory Authority (PEMRA), in association with the Ministry of Information, is responsible for controlling media content; therefore, it should ensure that false news and suspicious remarks related to COVID-19 are not aired and that channels promoting misinformation are held accountable.

Along these lines, a teleportal could be set up where the public can direct their queries and fears, and experts can respond and comment on vaccine safety. As has been shown, public awareness campaigns have help boost vaccine confidence. Mass awareness campaigns in the country should be channeled through social media platforms, television, radio, newspapers, and billboards. To emphasise the need for vaccination, campaigns could highlight the past successes achieved through vaccines.

The researchers point to the need to address religious concerns and conspiracy theories associated with COVID-19 vaccination. In the case of polio vaccines, false beliefs regarding the vaccine containing pig or monkey derivatives were articulated. Involving religious scholars and having them address the public regarding the importance of vaccination according to Islamic Sharia law could curb doubts among the public.

Finally, the researchers stress that, to reduce the spread of false information, effective investigation of the source of spread, mode of spread, and its impact on the public is required. To do so, researchers and public health educators should develop a system to contain the spread of incorrect information and conspiracies.