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.