Survey shows low acceptance of COVID-19 vaccine in Hong Kong

A population-based survey in 1,200 individuals in Hong Kong shows a low level of acceptance of coronavirus disease 2019 (COVID-19) vaccine, with higher acceptance rates among those aged 18–24 years and ≥65 years. Government recommendation is shown to be the strongest driver for COVID-19 vaccine acceptance.

The telephone survey of 1,200 Hong Kong Chinese residents (female, 71.4 percent; ≥55 years old, 68.6 percent; education below or at secondary level; 76.4 percent), conducted during the peak of the third wave of the COVID-19 outbreak (27 July 2020–27 August 2020), showed an overall vaccine acceptance rate of 37.2 percent after adjustment for population distribution. The projected COVID-19 vaccination acceptance rates exhibited a “J-shaped” pattern of distribution across age groups, with an acceptance rate of 40.4 percent, 24.4 percent and 47.6 percent in adults aged 18–24 years, 25–34 years and ≥65 years, respectively. [Vaccine 2021;S0264-410X(20)31695-9]

More than half (52.2 percent) and 43.3 percent of the respondents showed lack of trust towards COVID-19 vaccines produced by manufacturers without experience in vaccine mass production and those developed using new platforms, respectively. Moreover, 67.2 percent of respondents expressed hesitancy towards COVID-19 vaccines tested in <50,000 individuals. The country of production (COP) was a factor influencing vaccine acceptance in 62.5 percent of respondents.

“Hong Kong should set a goal of informed, voluntary COVID-19 vaccination coverage of ≥70 percent. To achieve this, we recommend four priority areas that the government could proactively communicate and clarify on potential misunderstanding and concern regarding the use of newer mRNA and DNA vaccines, the manufacturers’ track record, COP, and the number of people who have received the selected COVID-19 vaccines,” said Professor Paul Chan of Department of Microbiology, the Chinese University of Hong Kong (CUHK).

In the survey, COVID-19 vaccine acceptance was associated with cues for action (adjusted odds ratio [aOR], 2.61; 95 percent confidence interval [CI], 2.32 to 2.94; p<0.001), perceived COVID-19 vaccine benefit (aOR, 1.22; 95 percent CI, 1.01 to 1.48; p=0.037), and perceived COVID-19 disease severity (aOR, 1.16; 95 percent [Cl], 1.01 to 1.32; p=0.037).

Perceived barriers to access of COVID-19 vaccine (aOR, 0.80; 95 percent CI, 0.68 to 0.94; p=0.007) and perceived harm (aOR, 0.77; 95 percent CI, 0.64 to 0.94; p=0.008), on the other hand, were negative factors associated with acceptance.

Subgroup analysis of cues for action showed that recommendation from the government, family members and physicians was associated with a 10.2-fold (p<0.001), 2.07-fold (p=0.001) and 2.06-fold (p<0.001) significant increase in COVID-19 vaccine acceptance, respectively.

“The perception of COVID-19 as a mild disease by those who may not be at high risk implies that COVID-19 vaccination promotion and education need to be tailor-made. The health belief model [HBM] should be adopted and appropriate incentives should be considered to achieve the goal of vaccination coverage of ≥70 percent,” said Professor Martin Wong of the Jockey Club School of Public Health and Primary Care, CUHK. 

The questionnaire used in the survey was based on the HBM model and developed by epidemiologists, psychologists and clinicians. Acceptance was defined as the action of consenting to receive or undertake the COVID-19 vaccine and factors associated with acceptance.