COVID-19 vaccine perception poor among SG drivers

A substantial proportion of transport drivers in Singapore had poor vaccine perception, were hesitant to receive the COVID-19 vaccine, and were unwilling to receive the third dose (booster shot) despite the high vaccination coverage in the city-state, a cross-sectional pilot study reports.

“[Our findings] suggest that vaccination rate may thus not be an accurate reflection of true vaccine acceptance,” said the researchers.

A total of 104 transport drivers (mean age 46.9 years, 93 percent male, 76 percent Chinese) completed the online questionnaire. Two-thirds of the cohort were private drivers, 75 percent were working full-time, and 88 percent were exposed to the public daily. Vaccine perception (primary outcome) was determined by asking the question, “How important do you think getting COVID-19 vaccine is for your health?” Vaccine hesitancy was determined by failure to receive the first vaccine dose by June 30, 2021*. [Am J Trop Med Hyg 2023;108:588-591]

About a third of participants perceived the vaccine as either moderately important, a little important, or not at all, with education having the strongest influence on vaccine perception (adjusted odds ratio [adjOR], 17.29; p=0.024).

Another misconception that was positively associated with poor vaccine perception is that pain, redness, and swelling were rare vaccine side effects (adjOR, 0.15; p=0.027). “These could have negatively affected their perception if a mismatch of expectations arose due to misinformation and deterred them from taking future booster doses,” they said.

Negative perceptions may lead to vaccine hesitancy and thus hamper global efforts in achieving herd immunity. Indeed, 20 percent of the responders were vaccine hesitant. “[As such,] greater effort may be needed to shift drivers’ vaccine perception because they may have lower health literacy and could be more susceptible to misinformation and misconception,” they added.

About a third of the cohort were unwilling to take the booster. This was primarily driven by the notion that vaccines were ineffective (10 percent). Other reasons that could have influenced this result are side effects (5 percent) and complacency with the initial doses (4 percent). One participant shared that his reluctance was driven by the belief that the booster was not WHO-approved. Another respondent preferred evidence to substantiate the necessity of a booster.

Filing the knowledge gaps

The findings however may not be extrapolated to other subgroups given the specific group of respondents. The small sample size could also be a limiting factor, as well as the online nature of the survey.

Nonetheless, the results underpin the importance of enhancing the knowledge about vaccines to consequently improve vaccine perception. “[By] improving the knowledge of drivers, their perceived benefits of vaccination … could also be improved. This sets the foundation for building confidence in COVID-19 vaccines,” said the researchers.

As Singapore adopts a vaccine-driven strategy to eventually transition into an endemic state, it is imperative to address poor vaccine perception if vaccination is to remain a long-term strategy in the battle against COVID-19, they said. “It is thus pertinent for health authorities to address such knowledge gaps.”

“These could be achieved through open communication … Communication strategies [and outreach programmes] need to focus on correcting knowledge gaps, instilling collectivist attitudes, and highlighting the importance of vaccination over social distancing to enhance booster uptake rate,” they continued.

Drivers with good vaccine perception felt that it was part of their social responsibility to be vaccinated to continue to help propel the nation towards a space of normalcy. “Messages that emphasize social responsibility and protection of loved ones may thus improve vaccine perception,” they added.