4. Discussion
This is the first study to assess the perceptions and attitudes of the Brazilian adult population about COVID-19 vaccines. Although the vast majority of our sample expressed favourable opinions regarding COVID-19 vaccination, there was also a small fraction (2.2%) of respondents who were hesitant. Among these, most were males within age range of 30 to 59 years and reported that their reasons for vaccine hesitation are mainly due to uncertainty about safety (57.9%) and efficacy (36.8%) of vaccines, followed by concern with how they were developed, that is, the issue of timing and the adoption of a new development technology (28.9%).
Several studies have identified similar results on COVID-19 vaccine acceptance around the globe, including England5, Australia6, Poland7, Malaysia8, Jordan9, Hong Kong10 and Nepal11 among others. In all of these studies, those likely to delay or refuse vaccines share common reasons with our results: uncertainties about safety and efficacy of vaccines, the issue of timing and the adoption of a new development technology. But how do these reasons articulate with perceptions and attitudes that can influence their decision to accept or not be vaccinated?
Most respondents to our study reported that before administering a vaccine, they did not always receive sufficient information about the vaccines and their safety and the side effects that may occur. Such notes reflect an ineffective communication about the risks and benefits of vaccines. Therefore, it is essential to think about how the population is receiving information about COVID-19 vaccines. A survey conducted in the United States with a nationally representative sample (n = 1600) of parents with children <6 years of age showed that there are three main resources parents use when seeking information about immunizations: their healthcare providers, the media, and the Internet. 13,14 Our results also identified health professionals as the most reliable source for obtaining information, but the vast majority also pointed a lack of confidence in the content propagated in social media, by government and pharmaceutical companies. Thus, many of the barriers mentioned can be overcome or mitigated by timely and effective communication between the healthcare workers and the population. Our results point to the need to strengthen this bond. While social media platforms have become a common source of health information around the world, they have also been recognized as an unreliable source. But confidence that vaccination can reduce the chance of contracting the disease and that the vaccine is safe are not the only aspects to be addressed.
Rosenstock et al. performed one of the first studies on vaccine hesitancy. Although more than half a century has passed, our results show that little has changed. According to Rosenstock et al. , four psychosocial domains influence parents’ decisions to vaccinate their children for polio: (1) parents’ assessment of their child’s risk of contracting the disease; (2) parental assessment of whether the disease was a sufficient health concern to warrant vaccination; (3) parental assessment of whether their child’s vaccination may reduce their child’s chance of contracting the disease and whether the vaccine is safe; and (4) the concerns and influences that facilitated or discouraged parents’ decision to vaccinate their children.15 Therefore, personal perception about the disease and the vaccine or influences from the social environment are fundamental aspects to be considered.
Traditionally, groups and peers play an important role in shaping an individual’s thinking and decision making. However, although most of those hesitant affirmed that leaders (religious, political, teachers, healthcare workers) in their community support COVID-19 vaccines, they position themselves neutral when asked if agree or disagree with some groups or leaders who do not agree to vaccination for different reasons such as religious or cultural. Likewise, they do not perceive it as a risk to their health or the community health if these groups or leaders do not take the COVID-19 vaccine. Therefore, while the impact of groups and peers on those who hesitate to vaccinate is still unclear, the perception of a low risk of contracting the disease is evident.
Our research has some limitations. Our results are not fully generalizable to the Brazilian adult population, due to the high level of education and self-reported QoL of the participants and the high rate of people already vaccinated. Therefore, there is little information available about the population belonging to the most vulnerable social groups, which are often the ones who have difficulty in accessing information about vaccines and who are at greater risk of contracting the disease for various reasons. However, our sample provided a significant picture of the relevant perceptions and attitudes of this population, which can inform the development of individual or collective support strategies for embracement and guidance. In addition, the decision to keep the survey open until December, 2021 will be important to capture temporal trends, object of further analysis.