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.