1. Introduction
The year 2019 was marked by the emergence of the severe acute
respiratory syndrome coronavirus 2 (SARS-CoV-2) which has gained
worldwide exposure since the beginning of 2020. 1 The
coronavirus disease 2019 (COVID-19) has spread around the world in an
extremely short period and, despite the passing of the months, the
number of infected people is still increasing rapidly on a global scale.
While the rapid escalation of the COVID-19 continues, the world has
taken several measures to contain the disease spread, especially
vaccines. 2 Vaccines are one of the most important
contributions to public health in the 20th century and are responsible
for the sharp decline in vaccine-preventable diseases worldwide.
However, achieving herd immunity to SARS-CoV-2 through vaccines will
require a joint effort to understand and address people’s attitudes and
beliefs regarding vaccination.
Recently, the Wellcome Global Monitor 2018 study showed that 97% of
Brazilians agree or strongly agree that it is important to vaccinate
children. 3 However, despite being higher than the
global average (92%), the need to address the relationship between
vaccine hesitancy and an ineffective communication remains explicit as
there is a drop to 80% among those who expressed themselves positively
when asked if vaccines are effective and safe. Nevertheless, there are a
number of factors that can influence behaviour towards vaccination such
as, but not limited to: (i) confidence in the efficacy and safety of
vaccines; (ii) trust in the system that provides them, and (iii) trust
in the motivations of policy makers who decide on the vaccines offered.4 Yet, the COVID-19 pandemic have repeatedly put to
the test these and a number of other factors that can influence the
decision to accept vaccination and similar results on COVID-19 vaccine
acceptance have been reported around the globe, including
England5, Australia6,
Poland7, Malaysia8,
Jordan9, Hong Kong10 and
Nepal11 among others. However, until now we are
unaware of the Brazil population’s perceptions towards vaccination for
COVID-19. This is especially important, as the Brazilian Unified Health
System (also known as SUS, for its initials in Portuguese) is one of the
largest public health systems in the world, with an excellent track
record on vaccination coverage. Through the SUS, the National
Immunization Program makes available, free of charge, a series of
vaccines that guarantee the immunization of children, adolescents,
adults, older adults and pregnant women. Currently, four vaccines for
COVID-19 are available at SUS: Astrazeneca/Oxford and Pfizer/BioNTech
have definitive registration by the Brazilian National Health
Surveillance Agency (Anvisa), while Janssen and Coronavac are only
approved for emergency use.
Therefore, the aim of this study was to assess the perceptions and
attitudes of the Brazilian adult population about COVID-19 vaccines,
seeking to identify which factors are associated with vaccine hesitancy,
in order to support individual or collective strategies for welcoming
and guidance.