Awareness, Views, and Expectations about COVID-19 Vaccinations: A Cross-Sectional Study of Dental Clinic Patients in India.

INTRODUCTION: Several vaccines against coronavirus disease 2019 (COVID-19) have been licensed and are being administered worldwide in various countries. However, the awareness, behaviors, and expectations of COVID-19 vaccines among dental clinic patients are poorly understood.
METHODS: An e-survey was carried out among 1800 patients who visited dental clinics in India. The survey was carried out using a questionnaire of four parts and informed consent (i.e. sociodemographics, knowledge, attitudes, and perceptions). The investigators used Internet methods for data collection during the pandemic.
RESULTS: The mean awareness score was significantly higher among participants who reported having a university/higher level of schooling, being in the upper socioeconomic status community, living in cities, and having previously received all required vaccines. The mean attitude score was slightly higher for participants who reported being female and had a history of getting all required vaccinations. Just over half (52%) of participants felt everyone should be vaccinated. This interpretation was slightly higher among females than males (56.9% vs. 47.9%, P = 0.004).
CONCLUSIONS: The results indicate that patients attending dental clinics in India have insufficient awareness but more optimistic attitudes about the COVID-19 vaccine. Immediate health promotion campaigns must be implemented before vaccine schedules in order to increase awareness. Copyright:

INTRODUCTION

The highly communicable coronavirus disease 2019 (COVID-19) is fostered by severe acute respiratory syndrome coronavirus 2. This disease started in Wuhan, China, in December 2019. The disease has spread globally across countries, making it a pandemic.[1]

The changeable symptoms of COVID-19 includes fever, cough, fatigue, breathing difficulties, and anosmia and ageusia. Symptoms usually start between 1 and 14 days after exposure to the virus. Among those with detectable symptoms, majority (81%) develop mild-to-moderate symptoms (mild pneumonia), while 14% develop severe symptoms such as dyspnea, hypoxia, or >50% lung involvement on imaging, and 5% suffer critical symptoms such as respiratory failure, shock, or multiorgan dysfunction.[2] At least a 3rd of the people remain asymptomatic and do not develop any visible symptoms, but they still can act as carriers of the disease.[34] After months of healing, a few cases appear to undergo a series of outcomes known as long COVID, and organ damage has been observed.[5]

When a human breathes, coughs, or sneezes, small aerosols containing the virus can spread from their mouth and nose. While the virus will transmit across infected areas, this is not the most common method of transmission.[6] Infected people will spread the virus to another person for up to 2 days before becoming symptomatic. People can be contagious for up to 10 days after the onset of symptoms in mild cases and up to 20 days in extreme cases.[7]

Various vaccines have been produced in different countries. However, though testing is being done to produce medications that suppress the infection, the main therapy is symptom based. Treatment of complications, compassionate care, isolation, and novel approaches are all part of management.[8]

Vaccines are the most reliable way to defend the population against COVID-19 disease, since SARS-CoV-2 is a highly contagious virus that threatens communities worldwide.[9] As vaccines are distributed, it is critical to assess community approval of COVID-19 vaccinations. COVID-19 vaccines are controversial among India's general population. According to a global survey of COVID-19 vaccine adoption, 48% of the sample population are uncertain about the COVID-19 vaccines, and the rest are unclear if they will get the shot.[10] Since the most reliable way of controlling the transmission of the virus is to prevent us from being exposed to COVID-19, it is therefore important to vaccinate the vulnerable group of people as soon as possible. In such a case, people's awareness, views, and expectations of COVID-19 are critical for the government and policymakers to address all obstacles to vaccine delivery. Until now, no prior research has been conducted among India's general population to investigate their understanding, views, and expectations of the COVID-19 vaccine.[11]

METHODS

Participants and procedure

In India, an e-survey was conducted among patients visiting dental clinics. The survey was carried out from January 2021 to February 2021, along with the launch of COVID-19 vaccination programs in India. A questionnaire was designed and inserted into the Google survey tool (Google Forms), and a shareable connection was created and distributed widely on different social media sites (e.g. Facebook, WhatsApp, and Instagram), as well as directly to the investigators' and research assistants' contact lists. The investigators used internet methods for data collection during the pandemic. Initially, 1907 people completed an e-survey and gave informed consent. The poll was conducted by 1800 people (56.7% males and 43.3% females). Participants were required to meet the following criteria: (i) be Indian, (ii) attend dental clinics, (iii) be adults (over the age of 18), (iv) having good internet access, and (v) having voluntary participation.

RESULTS

Knowledge about the coronavirus disease 2019 vaccine

Table 1 shows the distribution of each information object regarding the COVID-19 vaccine. The mean awareness score was significantly higher among participants who reported having a university/higher level of schooling, being in the upper socioeconomic status (SES) community, living in cities, and having previously received all required vaccines.

Table 1

Distribution of each knowledge item and sex difference

Variables	Total, n (%)	Male, n (%)	Female, n (%)
Have you learned something about the COVID-19 vaccine?
Yes	1620 (90.1)	919 (89.9)	701 (90.1)
No	100 (5.5)	62 (6.3)	38 (4.8)
Don’t know	80 (4.4)	39 (3.8)	41 (5.1)
Do you know how effective the COVID-19 vaccine is?
Yes	972 (54.2)	562 (54.9)	410 (52.6)
No	352 (19.4)	201 (19.7)	151 (19.3)
Don’t know	476 (26.4)	259 (24.6)	217 (28.1)
Is vaccine associated with allergic reactions?
Yes	713 (39.6)	425 (41.6)	288 (37)
No	84 (4.7)	53 (5.2)	31 (4)
Don’t know	1003 (55.7)	544 (53.1)	459 (59)
Is vaccine associated with allergic reactions?
Yes	639 (35.5)	401 (39.2)	238 (30.8)
No	102 (5.7)	63 (6.1)	39 (5.3)
Don’t know	1059 (58.8)	558 (54.8)	50 (63.9)
Is it dangerous to overdose vaccine?
Yes	1138 (63.2)	631 (61.8)	507 (64.9)
No	49 (2.7)	35 (3.4)	14 (1.9)
Don’t know	613 (34.1)	356 (34.8)	257 (33.2)

Attitudes toward the coronavirus disease 2019 vaccine

The distribution of each of the attitudes items toward the COVID-19 vaccine is presented in Table 2. The mean attitude score was substantially higher for participants who reported being female and having received all appropriate vaccines in the past. It is worth noting that only about a quarter of participants (25.5%) believe the new COVID-19 vaccine in India is safe; however, about 58.6% would have the vaccine without reservation, and two-thirds would recommend it to family or friends to have the vaccination. As a result, public health efforts are required to favorably influence attitudes about the COVID-19 vaccine.

Table 2

Distribution of each attitudes items and sex difference

Variables	Total, n (%)	Male, n (%)	Female, n (%)
The recently discovered COVID-19 vaccine is risk-free
Disagree	84 (4.7)	55 (5.4)	29 (3.8)
Undecided	1256 (69.8)	673 (65.9)	583 (74.6)
Agree	460 (25.5)	294 (28.6)	166 (21.6)
The COVID-19 vaccine is critical to our survival
Disagree	76 (4.2)	24 (5.1)	24 (3.1)
Undecided	395 (21.9)	178 (21.3)	178 (22.7)
Agree	1329 (73.9)	576 (73.6)	576 (74.2)
Without vaccine, there is no way to limit the incidence of COVID-19
Disagree	245 (13.6)	170 (16.7)	75 (9.6)
Undecided	414 (23)	233 (22.8)	181 (23.2)
Agree	1141 (63.4)	619 (60.5)	522 (67.1)
I’ll even urge my family, friends, and relatives to get vaccinated
Disagree	122 (6.8)	69 (8.7)	53 (4.3)
Undecided	499 (27.7)	282 (27.4)	217 (28.1)
Agree	1179 (65.5)	671 (63.9)	508 (67.5)
If the COVID-19 vaccine is available, I would take it without hesitation
Disagree	189 (10.1)	126 (12.3)	55 (7.5)
Undecided	564 (31.3)	302 (29.5)	262 (33.6)
Agree	1055 (58.6)	594 (58.2)	461 (58.9)
The COVID-19 vaccine should be administered equally to all of us
Disagree	34 (1.9)	24 (2.3)	10 (1.4)
Undecided	162 (9.0)	94 (9.2)	68 (8.8)
Agree	1604 (89.1)	904 (88.5)	700 (89.8)

COVID-19: Coronavirus disease-2019

Perceptions toward the coronavirus disease 2019 vaccine

The distribution of each perceptions item about COVID-19 vaccine is presented in Table 3. In response to the question, “Who should have been vaccinated?”, slightly more than half (52%) of participants believed that everybody should have been vaccinated. This interpretation was slightly higher among females than males (56.9% vs. 47.9%, P = 0.004). Almost 95% of participants agreed that the vaccine should be given free of charge in India, with females slightly outnumbering males (96%). Furthermore, the majority of participants assumed that the recently discovered COVID-19 vaccine may have side effects (89%). More than half of participants (56%) believe that if everyone in society maintains prevention initiatives, the COVID-19 pandemic will be eradicated without vaccines, and almost a third (35%) say they will not buy the vaccine on their own expense if it was not given free of charge by the government.

Table 3

Distribution of each perceptions items and sex difference

Variables	Total, n (%)	Male, n (%)	Female, n (%)
Who do you believe should have been vaccinated?
Those who have not yet been infected	432 (24)	267 (26.1)	165 (21.3)
People infected with COVID-19	397 (22.6)	248 (24.3)	144 (20.4)
Newly recovered from COVID-19	27 (1.5)	16 (1.6)	11 (1.4)
Everyone	944 (51.9)	491 (47.9)	453 (56.9)
Can you believe that if everyone in society continues to take precautions, the COVID-19 pandemic will be eradicated without vaccination?
Yes	1009 (56.1)	585 (57.2)	424 (54.8)
No	791 (43.9)	437 (42.8)	354 (45.2)
Do you believe the recently developed COVID-19 vaccine would have any side effects?
Yes	1603 (89.1)	911 (89.2)	692 (89)
No	197 (10.9)	111 (10.8)	86 (11)
Do you believe the vaccine should be given free of charge?
Yes	1711 (95.1)	960 (94.1)	751 (96.3)
No	89 (4.9)	62 (5.9)	27 (3.7)
Will you pay for the vaccine if it wasn’t funded for free by the government?
Yes	1177 (65.4)	657 (64.3)	520 (66.7)
No	623 (34.6)	365 (35.7)	258 (33.3)

COVID-19: Coronavirus disease-2019

DISCUSSION

A large number of vaccine candidates are being developed, and many clinical trials with promising outcomes have recently been published, leading to a number of countries accepting new vaccinations for use in vaccination programs.[12] The government of India has already begun the COVID-19 vaccine, giving optimism as a part of a pandemic response.[13] Despite the fact that there are various vaccination programs in India, the complete newness of the COVID-19 vaccination roll-out raises concerns about vaccine delivery and acceptance in this country.[1415] More than half of the population has no experience of COVID-19 vaccines. Awareness was found to be strongly related to schooling, family gender, monthly family income, and prior vaccine uptake experience in this sample. However, views were mainly related to previous vaccine administration experience and sex. Notably, the majority of participants (78%) displayed positive attitude toward COVID-19 vaccine. The sex of participants has little impact on their knowledge of COVID-19 vaccines. This result is consistent with other research in India that found no major gender gaps in COVID-19 awareness. This result is comparable to studies conducted in India on knowledge of COVID-19 (not vaccinations), which found that males had slightly higher knowledge scores regarding COVID-19 than females.[161718] However, this finding is inconsistent to studies concerning knowledge toward COVID-19 (not vaccinations) conducted in India which reported that males had marginally higher scores in knowledge regarding COVID-19 than females. These disparities in awareness discovered in the COVID-19 vaccine sample may be attributed to insufficient government exposure to facts or advertising. Furthermore, possible under-reporting or misunderstanding of data on the severity of COVID-19 occurrence and mortality could reduce concerns about vaccine safety or make Indian residents hesitant to pursue information on either COVID-19 or related vaccinations.[1920] It is critical to assist community residents by making vaccination knowledge easily accessible. Participants with a higher degree of education were shown to have more information about COVID-19 vaccines in our sample, which is confirmed by previous research.[21] Similar scenarios were discovered in previous studies in India, demonstrating that individuals with a higher educational history possessed more knowledge about COVID-19. Since they have access to more intelligence sources, more informed people are more aware and caring about their health and well-being.[22] People with a higher SES knew all about COVID-19 vaccines, which is close to a survey undertaken in Indonesia to test Dengue vaccine approval.[23] A new Chinese research testing COVID-19 vaccine approval discovered that people who had recently been immunized against influenza were more likely to support the COVID-19 vaccine, which was also shown in a Hong Kong study.[24] An earlier research conducted in India found a strong association between COVID-19 awareness and urban area. In the current analysis, 78% of participants had more favorable views about the COVID-19 vaccine, which was strongly related to gender. This finding is consistent with the findings of a previous report on attitudes toward dengue vaccination conducted in Indonesia. Perceptions on COVID-19 vaccines in an another survey discovered that females were more hesitant to receive COVID-19 vaccines than males.[2425] However, a study in China showed that males were more willing to adopt the COVID-19 vaccine.[26] There is a widely held gendered belief that women have more favorable views toward preventive initiatives than men. Furthermore, participants who had administered both of the vaccines early in life had more favorable views about COVID-19 vaccinations. Our findings are close to those of a Hong Kong study, which found that prior vaccine uptake experience was one of the most important variables affecting readiness to obtain the A/H7N9 influenza vaccine, which is also confirmed by an earlier Chinese study.[27] In our research, we discovered that more than half (52%) of participants believed that everyone in India should receive the COVID-19 vaccine.[27] Furthermore, more than half of the participants (61%) believed that health professionals should be the first to receive the vaccine. This assumption may be due to the fact that health-care staff are on the front lines in diagnosing COVID-19 and they meet with patients on a daily basis. In our survey, 89% of participants believed that the newly discovered COVID-19 vaccine (the vaccine actually being used in India) may have some side effects, which is close to a study conducted in the United States.[28]

CONCLUSIONS

The COVID-19 pandemic threatens to wreak havoc on people's health and livelihoods around the world, and the COVID-19 vaccine offers a potential ray of hope for the future. The results recommend that urgent health outreach services are implemented, as well as more reliable knowledge be disseminated and advertised.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.