Factors influencing COVID-19 vaccine acceptance and hesitancy among pharmacy students in Bangladesh: a cross-sectional study

Introduction

The coronavirus disease (COVID-19) has emerged as a recent health and humanitarian crisis and persisted with resurgent waves. COVID-19 has resulted in devastating consequences in human lives and has impacted the health care services provided in hospitals and community pharmacies. Since pharmacists and pharmacy students in training directly interact with patient-centered services in the health care industry and are, therefore, a group at high risk for COVID-19 exposure and transmitting the infection.¹ To prevent rapid transmission and to protect a particular subset of the healthcare student from COVID-19 , vaccination is the most promising and effective therapeutic tool because the vaccine is delivered to curb the transmission of a contagious virus that saves millions of human lives every year.² A growing number of vaccines to curb the COVID-19 pandemic have now been developed and distributed globally to fight against the novel coronavirus. Despite undeniable immunization success in the 21st century, a growing segment of people still distrusts vaccine safety and efficacy. In contrast, the doubtful attitude of the public towards accepting vaccines endangers massive public health threats and has been denoted as “hesitancy.”³ The World Health Organization (WHO) reported vaccine hesitancy as one of the ten top public health emergencies around the world.⁴

The complex nature of motives behind the COVID-9 vaccine hesitancy among the people varies widely depending on the context, way of measurement, and the pandemic stages.⁵ Recently, the magnitude of COVID-9 vaccine hesitancy has been found to differ significantly across the countries among different population sub-groups worldwide.⁶ Importantly, the prevalence of COVID-19 vaccines was also found to be predominant among students identified as 32% in Asian countries, 28.11% in the USA, 15.59% in Europe, and 55.93% in African regions, while the global pooled hesitancy rate in students was 29.8%.⁷ Students of representative health education sectors were potentially influenced by COVID-19; vaccine hesitancy reported 46% in Egypt⁸_, 45% and 23% in the USA⁹, 30.5% in Malta¹⁰, 10.6% in India¹¹, 17.8%inIsrael¹², 62.7% in Uganda¹³, and 75.5% in Zambia.¹⁴ The most prevailing factors associated with distrust of corona vaccine receptivity that led to vaccine hesitancy among students follow the same pattern as they marked in frequencies around the world. A recent systematic review deduced that the most common concerns of COVID-19 vaccination decisions among students were side effects, safety, efficacy, trust, effectiveness, vaccine mandate, social influence, information sufficiency, conspiracy beliefs, and religiosity.⁷

Due to the long-term existence of COVID-19 in Bangladesh, education is prey to collateral damage adding to the woes of the already hard-hit sector and its students. Although the government has sought to open educational institutions, but sudden unexpected worsening of the pandemic caused them to retract. The policymakers have started to work on a plan to include university students in the COVID-19 vaccine inoculation program on a priority basis to resume their regular physical activities in the classrooms and thereby comply with government decisions.¹⁵ To date, however, most of the studies conducted so far in Bangladesh focused on COVID-19 vaccination acceptability among the general people^16,17 and rural community.¹⁸ However, to the best of our knowledge, there is a lack of exploratory study⁷ investigating COVID-19 vaccine acceptance among healthcare students, particularly pharmacy students in Bangladesh. This study thus aimed to assess COVID-19 vaccine acceptance among pharmacy students in Bangladesh and to explore the key factors associated with their vaccine acceptance and hesitance.

Methods

We deposited step-by-step descriptions of the study protocols on protocols.io and the doi: dx.doi.org/10.17504/protocols.io.n2bvj88wngk5/v1.

Results

Willingness to accept a COVID-19 vaccine and WTP

Figure 1 shows the proportion of responses of COVID-19 vaccine behaviors among pharmacy students. Overall, 908 (87.8%; 95% CI 85.8─87.8) participants responded to the intent for vaccination, while 126 (12.2%; 95% CI 10.2─14.1) had the reservation to uptake it. By more specific breakdown, majority of the students responded “definitely yes” 701 (67.8%; 95% CI 64.9─70.7) followed by “yes, probably” 207 (20%; 95% CI 17.6─22.4). However, 64 (6.2%; 95% CI 4.7─7.7) admitted “probably not” response; 35 (3.4%; 95% CI 2.7─4.5) were“unsure” and 27 (2.6%; 95% CI 2.5─3.6) responded “definitely not”. However, 454 (87%; 95% CI 85.0─89.0) female and 454 (88.7%; 95% CI 61.3─91.4) male students had vaccine acceptance willingness and 29.6% (95% CI25.4─33.9) pharmacy students admitted WTP for COVID-19 vaccine. Since the online survey bars showed acceptance of any incomplete survey instrument, our postulated variable of interest produced no missing data.

Figure 1. Overall COVID-19 vaccine intent among pharmacy students (N=1034).

Discussion

Massive vaccination is the only hopeful savior to curb the current pandemic. This study investigated COVID-19 vaccine acceptability among university pharmacy students in Bangladesh and identified the key factors associated with their vaccination decision. According to the study result, the pooled COVID-19 vaccine acceptance was 87.8%, while 12.2% students had the reservation to accept it. Although young pharmacy students are more inclined to get COVID-19 vaccinated; disagreements in enlisting the predictors potentially influenced their intention to accept vaccine or hesitance to receive. We observed that several societal, psychological, and vaccine related factors were associated with COVID-19 vaccine acceptance among student pharmacist. According to our analysis safety, efficacy, and trust had highly significant while communication and information sufficiency had significant association with vaccine acceptance and were identified as the most potential concerns.

This is the first study focused on COVID-19 vaccination and applied a new analytical approach to explore the key determinants of vaccine acceptance and hesitancy. Since misinformation and false news led to vaccine hesitancy, the significant impact of scientific reading in improving vaccine uptake has been identified. The preference for scientific resources other than traditional and social media was recognized, which would provide an important message to health academicians. The study addressed some limitations. Firstly, sampling method, scarcity of sample size and online data collection mode has been noted. Although we collected 1034 data a sample, the sample size was inadequate compared to the total number of pharmacy students in Bangladesh. Thus, a non-response bias may occur for individuals who did not participate and might have been more willing or refusal intention to take the COVID-19 vaccine. Secondly, the transformative behavioral nature of the respondents may be altered with the frequent changes in perceived health risk, newly promoted vaccines, and vaccine deployment. More specifically, the pattern of COVID-19 vaccine reluctance can alter over time in young adults, hence estimation of in-spot vaccine acceptance and hesitancy among the youth was challenging. Finally, sequential alteration and modification in associated factors of COVID-19 vaccinations would occur. This study did not explicitly define additional confounding factors that may also lead to vaccine hesitancy.

Empirical studies reported 76.4% COVID-19 vaccine acceptance intention among general Bangladeshi people¹⁷ and 84.3% among rural community¹⁸ included student participants in both surveys. In the Asian context, 89.4% of medical students had the willingness to uptake the COVID-19 vaccine reported in India.¹¹ All these results are supportive of the current study findings. Even though there have been few studies^16,17,20 that reported relatively high vaccine hesitancy rate among Bangladeshi people; however, this study found relatively low (12.2%) vaccine hesitancy among pharmacy students. These studies^16,17,20 were conducted since COVID-19 vaccination was inaugurated to administer in priority groups of a few selective areas in Bangladesh. However, we collected data when the country-wide mass vaccination program was started among various population sub-groups. At the same time, people became more conscious about COVID-19 vaccinations and information communicated through different channels. We observed that safety and efficacy had a highly significant and positive correlation with corona vaccine acceptance. Results obtained from similar studies revealed that safety was one of the primary concerns among 10.6% of undergraduate medical students in India¹¹, 17.8% of medical and nursing students in Israel¹², 71.1% of pharmacy students in Zambia¹⁴, and 28.9% dental students in low and lower-middle countries (LMICs).²¹

It has been reported that the perceived efficacy varied between 50% and 95% for COVID-19 vaccines either approved by the Food and Drug Administration (FDA) or permitted for conditional approval in phase three trials.²² Efficacy has been identified as an essential determinant of COVID-19 vaccination decisions among 10.6% of medical students in India¹¹ and 62.7% of medical students in Uganda.¹³ Public trust in vaccine safety and efficacy data to uptake it was one of the strongest forecasters of COVID-19 vaccine intention.²³ Worldwide, side effects, safety, efficacy, trust, and information sufficiency were the most important predictors of COVID-19 vaccination decisions among students⁷ as well as in general population.⁶ Pharmacy students are well equipped to access scientific information and awakened to anti-vaccination rumors, thereby rejecting rumor-mongers associated with vaccine data. As a result, trust, communication, and information sufficiency were identified as critical predictors of vaccine acceptance among young pharmacists. Embracing the digital era and exposure to multimedia systems enabled university students to avoid misinformation, which positively built trust. It is thus necessary to provide adequate scientific resources for counteracting the anti-vaccination sentiment related to COVID-19 vaccinations.²⁴ In our study, an insignificant association between side effects and vaccine acceptance was observed because mild symptoms were observed within 48 hours following administering the vaccine's first dose in Bangladeshi people, and no severity was reported to date.²⁵ It has been evident that anti-vaccination sentiments such as conspiracy beliefs and religious beliefs were found to be critical determinants of COVID-19 vaccine acceptability among students⁷;follow-up consequences could build long term hesitancy. A roadmap to convey accuracy; however, these predictors were insignificant in our study. Information sufficiency and trust were impacted positively by COVID-19 vaccine acceptance, so the anti-vaccination belief was found insignificant. Association of conspiracy beliefs with vaccine origin, vaccine data, and post-administration information and strategic communications with community people would build public trust²⁶ which in turn boosts vaccine confidence and reduces anti-vaccination beliefs.²⁷ consequently; communication and trust were previously identified as a paramount concern of COVID-19 vaccination among general Bangladeshi people¹⁶, which are supportive of our findings. Although the COVID-19 vaccine is provided free of cost in Bangladesh, 29.6% of pharmacy students admitted WTP for COVID-19 vaccines if the government fixes the price value. It has been reported that several indicators that influenced the higher marginal WTP for vaccines, including socio-economic condition, affordability status, receiver occupations, and higher income level.^28,29 This study has practical implications for policy support, practices, and future research. This study primarily benefits health policymakers and stakeholders in designing perfect vaccine promotion plans for mass vaccinations. The findings support overcoming the perceived vaccination barriers and facilitate pharmacists’ health engagement with the COVID-19 vaccination drive in near real-time, thus helping the governments to implement actionable strategies accordingly. The current study would act as a valuable scientific report for continuing further observational studies reflecting COVID-19 vaccine acceptance by re-examining additional confounding variables that impacted COVID-19 vaccine hesitancy, adding new value for scientific evaluation.

We collected a large data sample (1034) to ensure the external validity of our study outcomes. Respondent’s socio-demographic characteristics varied significantly. A large sample size ensured much strength to predict the generalizability of the study findings, reinforcing health engagement and boosting vaccine confidence among the general people. Since the pattern of COVID-19 vaccine reluctance can alter among young adults³⁰, So the author suggests adopting a long-term surveillance study to evaluate more precisely the vaccination consequences among young pharmacists globally. Educational interventions highlighted vaccine readiness and pandemic preparedness materials would be imperative to improve people’s health engagement in the COVID-19 vaccination drive.³¹ Worldwide, pharmacists played a key role by offering advice and counseling to the public regarding ways to reduce COVID-19 contamination and suggesting potential treatments and preventive measures.^32,33 Pharmacists were involved in vaccination programs to increase vaccine acceptance rate in a pandemic crisis.^34,35 It is thus necessary to ascertain the potential drivers of COVID-19 vaccine acceptance and hesitancy among pharmacy students because they are the future pharmacists and custodians of medicine and vaccine development.

Conclusions

Pharmacy professional’s immunization act of COVID-19 was evaluated when the health policymakers launched a new vaccine vaccination throughout the country. The optimization of a large vaccine drive has already been proven to be effective in reducing coronavirus spread; however, at the same time, achieving a high uptake rate is a critical indicator of successful COVID-19 vaccination effort. This study explicitly defined the significance of positive behaviors regarding vaccine safety, efficacy, and trust in receiving a vaccine under any circumstances. The preference for academic knowledge and scientific reading had unique importance to counter rumors has been detected in this study. COVID-19 vaccine acceptance will improve if vaccine related data become more publicly available. Current study finding would be useful in planning adequate response and designing multi-disciplinary educational strategies for future pharmacist to encounter the future pandemic. Evidence-based and tailored health communication would reduce anti-vaccination sentiments, thus ensuring young pharmacist adherence in COVID-19 vaccination consequences.

Consent

The authors confirm that, informed consent form was sent to participants with online questionnaire. The individuals were free to reject participation at any time.

Ethical statement

The Ethical Review Committee approved as exempt.

Acknowledgements

All authors greatly acknowledge all student pharmacists who participated in this study.