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COVID-19 Vaccine Willingness and Related Factors Among Health Care Workers in 3 Southeast Asian Jurisdictions

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To identify the key insights or developments described in this article
1 Credit CME
Key Points

Question  What are the COVID-19 vaccine willingness rates among the health care workers (HCWs) in 3 Southeast Asian jurisdictions in the context of pandemic severity and vaccination policies?

Findings  In this survey study including responses from 3396 doctors and nurses , willingness to take the COVID-19 vaccine was highest in Nepal, followed by Vietnam, and lowest in Hong Kong, which may be associated with the pandemic severity and vaccination policy in the 3 jurisdictions. Type of HCW (doctor), older age, male gender, higher educational level, and having seasonal influenza vaccination history were found to be factors associated with vaccination willingness.

Meaning  The findings of this study may have utility in informing future public health policies and strategies to promote vaccine acceptance during pandemics.


Importance  COVID-19 vaccine hesitancy is widespread and may lead to refusal or delay of vaccination, eventually reducing the overall vaccination coverage rate and vaccine effectiveness. Willingness to receive COVID-19 vaccination among health care workers (HCWs) is diverse across different jurisdictions.

Objective  To assess the COVID-19 vaccine willingness among HCWs in 3 Southeast Asian jurisdictions in the context of pandemic severity and vaccination policy.

Design, Setting, and Participants  A cross-sectional online survey was conducted among frontline HCWs in Hong Kong, Nepal, and Vietnam from May to November 2021. Eligible participants were nurses and doctors aged 18 and older, working in public or private health care settings on a full-time or part-time basis.

Exposures  The COVID-19 pandemic and vaccination policy.

Main Outcomes and Measures  COVID-19 vaccination willingness was defined as HCW willingness toward receiving the COVID-19 vaccine in full course or the first dose of the vaccine, and willingness to take the second dose. Information on sociodemographic characteristics, the history of seasonal influenza vaccination, attitudes toward vaccination, and opinions on strategies associated with vaccination uptake from the study participants.

Results  Among the 3396 eligible doctors and nurses who participated in the survey, 2834 (83.4%) were from Hong Kong, 328 (9.7%) were from Nepal, and 234 (6.9%) were from Vietnam. Most respondents were female (76.2% [2589 ]), aged 30 to 39 years (31.2% [1058]), and nurse HCWs (77.6% [2636]); the response rates were 11% (2834 of 25 000) in Hong Kong, 36% (328 of 900) in Nepal, and 13% (234 of 1800) in Vietnam. Overall, the prevalence rate of willingness to take the COVID-19 vaccine was highest in Nepal (95.4% [313 of 328]), followed by Vietnam (90.6% [212 of 234]), and lowest in Hong Kong (54.4% [1542 of 2834]), relating to their different attitudes and opinions toward the COVID-19 vaccination, and the pandemic severity and vaccination policy in the 3 jurisdictions. Doctors were more willing to take COVID-19 vaccination than nurses (odds ratio, 5.28; 95% CI, 3.96-7.04). Older age (odds ratios, 1.39-3.70), male gender (odds ratio, 1.41; 95% CI, 1.11-1.75), higher educational level (odds ratio, 1.48; 95% CI, 1.17-1.87), and having seasonal influenza vaccination uptake history (odds ratio, 2.15; 95% CI, 1.82-2.54) were found to be associated with increased willingness. Choice of vaccination brand with adequate information, immunity passport, time off from work for vaccination and subsidy for travel to inconvenient vaccination centers were considered as strategies to enhance vaccine willingness.

Conclusions and Relevance  In this survey study, vaccination unwillingness existed among HCWs in Southeast Asian regions, especially in Hong Kong. The findings of this study may have utility in the formulation of vaccination promotion strategies such as vaccination incentives. Attitudes toward vaccination in HCWs might be examples for the general population; however, changes over time should be further investigated.

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Article Information

Accepted for Publication: July 7, 2022.

Published: August 22, 2022. doi:10.1001/jamanetworkopen.2022.28061

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2022 Wong ELY et al. JAMA Network Open.

Corresponding Author: Eliza Lai-yi Wong, PhD, Professor, Prince of Wales Hospital, School of Public Health Building, Room 418, Shatin, NT, Hong Kong (lywong@cuhk.edu.hk).

Author Contributions: Ms E. LY Wong and Dr Qiu had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: E. Wong, Chien, C. Wong, Chan, M. Wong, Yeoh.

Acquisition, analysis, or interpretation of data: E. Wong, Qiu, Chalise, Hoang, Trang Nguyen, Cheung.

Drafting of the manuscript: E. Wong, Qiu.

Critical revision of the manuscript for important intellectual content: E. Wong, Chien, C. Wong, Chalise, Hoang, Trang Nguyen, Chan, M. Wong, Cheung, Yeoh.

Statistical analysis: Qiu.

Administrative, technical, or material support: Chien, C. Wong, Cheung.

Supervision: E. Wong, Chan, M. Wong, Yeoh.

Conflict of Interest Disclosures: None reported.

Additional Contributions: We thank Ms Zoe Pui Yee Tam (BSc) and Mr Jonathan Chun Hei Ma (BSc) from the Centre for Health Systems and Policy Research, JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, HKSAR, China for their support on monitoring the survey collection platform. No compensation was received.

WHO. WHO issues its first emergency use validation for a COVID-19 vaccine and emphasizes need for equitable global access. Published December 2020. Accessed March 23, 2022. https://www.who.int/news/item/31-12-2020-who-issues-its-first-emergency-use-validation-for-a-covid-19-vaccine-and-emphasizes-need-for-equitable-global-access
Thompson  MG , Burgess  JL , Naleway  AL ,  et al.  Prevention and attenuation of COVID-19 with the BNT162b2 and mRNA-1273 vaccines.   N Engl J Med. 2021;385(4):320-329. doi:10.1056/NEJMoa2107058 PubMedGoogle ScholarCrossref
Hodgson  SH , Mansatta  K , Mallett  G , Harris  V , Emary  KRW , Pollard  AJ .  What defines an efficacious COVID-19 vaccine? a review of the challenges assessing the clinical efficacy of vaccines against SARS-CoV-2.   Lancet Infect Dis. 2021;21(2):e26-e35. doi:10.1016/S1473-3099(20)30773-8 PubMedGoogle ScholarCrossref
Anderson  RM , Vegvari  C , Truscott  J , Collyer  BS .  Challenges in creating herd immunity to SARS-CoV-2 infection by mass vaccination.   Lancet. 2020;396(10263):1614-1616. doi:10.1016/S0140-6736(20)32318-7 PubMedGoogle ScholarCrossref
Larson  HJ , Jarrett  C , Eckersberger  E , Smith  DMD , Paterson  P .  Understanding vaccine hesitancy around vaccines and vaccination from a global perspective: a systematic review of published literature, 2007-2012.   Vaccine. 2014;32(19):2150-2159. doi:10.1016/j.vaccine.2014.01.081 PubMedGoogle ScholarCrossref
Sadaf  A , Richards  JL , Glanz  J , Salmon  DA , Omer  SB .  A systematic review of interventions for reducing parental vaccine refusal and vaccine hesitancy.   Vaccine. 2013;31(40):4293-4304. doi:10.1016/j.vaccine.2013.07.013 PubMedGoogle ScholarCrossref
Jarrett  C , Wilson  R , O’Leary  M , Eckersberger  E , Larson  HJ ; SAGE Working Group on Vaccine Hesitancy.  Strategies for addressing vaccine hesitancy - a systematic review.   Vaccine. 2015;33(34):4180-4190. doi:10.1016/j.vaccine.2015.04.040 PubMedGoogle ScholarCrossref
Wang  K , Wong  ELY , Ho  KF ,  et al.  Change of willingness to accept covid-19 vaccine and reasons of vaccine hesitancy of working people at different waves of local epidemic in Hong Kong, China: repeated cross-sectional surveys.   Vaccines (Basel). 2021;9(1):1-15. doi:10.3390/vaccines9010062 PubMedGoogle ScholarCrossref
Nguyen  LH , Drew  DA , Graham  MS ,  et al; COronavirus Pandemic Epidemiology Consortium.  Risk of COVID-19 among front-line health-care workers and the general community: a prospective cohort study.   Lancet Public Health. 2020;5(9):e475-e483. doi:10.1016/S2468-2667(20)30164-X PubMedGoogle ScholarCrossref
Wang  Q , Yang  L , Jin  H , Lin  L .  Vaccination against COVID-19: a systematic review and meta-analysis of acceptability and its predictors.   Prev Med. 2021;150(January):106694. doi:10.1016/j.ypmed.2021.106694 PubMedGoogle ScholarCrossref
Biswas  N , Mustapha  T , Khubchandani  J , Price  JH .  The nature and extent of COVID-19 vaccination hesitancy in healthcare workers.   J Community Health. 2021;46(6):1244-1251. doi:10.1007/s10900-021-00984-3 PubMedGoogle ScholarCrossref
Dzieciolowska  S , Hamel  D , Gadio  S ,  et al.  COVID-19 vaccine acceptance, hesitancy, and refusal among Canadian healthcare workers: a multicenter survey.   Am J Infect Control. 2021;49(9):1152-1157. doi:10.1016/j.ajic.2021.04.079 PubMedGoogle ScholarCrossref
Verger  P , Scronias  D , Dauby  N ,  et al.  Attitudes of healthcare workers towards COVID-19 vaccination: a survey in France and French-speaking parts of Belgium and Canada, 2020.   Euro Surveill. 2021;26(3):1-8. doi:10.2807/1560-7917.ES.2021.26.3.2002047 PubMedGoogle ScholarCrossref
Chau  C . Hong Kong Free Press Guide: receiving a Covid-19 vaccine in Hong Kong. January 6, 2022. Accessed April 11, 2022. https://hongkongfp.com/2022/01/06/hkfp-guide-receiving-a-covid-19-vaccine-in-hong-kong/
The World Bank. World Bank-financed Moderna vaccines arrive in Nepal to protect children and youth from COVID-19. January 25, 2022. Accessed April 11, 2022. https://www.worldbank.org/en/news/press-release/2022/01/25/world-bank-financed-moderna-vaccines-arrive-in-nepal-to-protect-children-and-youth-from-covid-19
Nguyen  S . Vietnam begins COVID-19 vaccination drive without China-made shots. South China Morning Post. March 7, 2021. Accessed April 11, 2022. https://www.scmp.com/week-asia/health-environment/article/3124384/vietnam-begins-covid-19-vaccination-drive-without
Data on COVID-19 (coronavirus) by Our World in Data. Accessed March 31, 2022. https://github.com/owid/covid-19-data/tree/master/public/data
Wang  K , Wong  ELY , Ho  KF ,  et al.  Intention of nurses to accept coronavirus disease 2019 vaccination and change of intention to accept seasonal influenza vaccination during the coronavirus disease 2019 pandemic: a cross-sectional survey.   Vaccine. 2020;38(45):7049-7056. doi:10.1016/j.vaccine.2020.09.021 PubMedGoogle ScholarCrossref
Wong  ELY , Ho  KF , Dong  D ,  et al.  Compliance with standard precautions and its relationship with views on infection control and prevention policy among healthcare workers during COVID-19 pandemic.   Int J Environ Res Public Health. 2021;18(7):3420. doi:10.3390/ijerph18073420 PubMedGoogle ScholarCrossref
Wong  MCS , Wong  ELY , Cheung  AWL ,  et al.  COVID-19 vaccine hesitancy in a city with free choice and sufficient doses.   Vaccines (Basel). 2021;9(11):1-11. doi:10.3390/vaccines9111250 PubMedGoogle ScholarCrossref
Bland  JM , Altman  DG .  Multiple significance tests: the Bonferroni method.   BMJ. 1995;310(6973):170. doi:10.1136/bmj.310.6973.170 PubMedGoogle ScholarCrossref
Han  D , Li  D , Sun  M .  How the initial level of visibility and limited resource affect the evolution of cooperation.   Sci Rep. 2016;6(June):27191. doi:10.1038/srep27191 PubMedGoogle ScholarCrossref
Chalise  HN , Pathak  KP .  Situation of COVID-19 pandemic in South Asia.   J Heal Allied Sci. 2020;10(2):11-14. doi:10.37107/jhas.184Google ScholarCrossref
Minh  LHN , Khoi Quan  N , Le  TN , Khanh  PNQ , Huy  NT .  COVID-19 Timeline of Vietnam: important milestones through four waves of the pandemic and lesson learned.   Front Public Health. 2021;9(November):709067. doi:10.3389/fpubh.2021.709067 PubMedGoogle ScholarCrossref
Cowling  BJ , Ali  ST , Ng  TWY ,  et al.  Impact assessment of non-pharmaceutical interventions against coronavirus disease 2019 and influenza in Hong Kong: an observational study.   Lancet Public Health. 2020;5(5):e279-e288. doi:10.1016/S2468-2667(20)30090-6 PubMedGoogle ScholarCrossref
Wong  CL , Leung  AWY , Chung  OMH , Chien  WT .  Factors influencing COVID-19 vaccination uptake among community members in Hong Kong: a cross-sectional online survey.   BMJ Open. 2022;12(2):e058416. doi:10.1136/bmjopen-2021-058416 PubMedGoogle ScholarCrossref
Bish  A , Yardley  L , Nicoll  A , Michie  S .  Factors associated with uptake of vaccination against pandemic influenza: a systematic review.   Vaccine. 2011;29(38):6472-6484. doi:10.1016/j.vaccine.2011.06.107 PubMedGoogle ScholarCrossref
Luo  C , Yang  Y , Liu  Y ,  et al.  Intention to COVID-19 vaccination and associated factors among health care workers: a systematic review and meta-analysis of cross-sectional studies.   Am J Infect Control. 2021;49(10):1295-1304. doi:10.1016/j.ajic.2021.06.020 PubMedGoogle ScholarCrossref
Chor  JSY , Ngai  KLK , Goggins  WB ,  et al.  Willingness of Hong Kong healthcare workers to accept pre-pandemic influenza vaccination at different WHO alert levels: two questionnaire surveys.   BMJ. 2009;339(7721):b3391. doi:10.1136/bmj.b3391 PubMedGoogle ScholarCrossref
Paul  E , Steptoe  A , Fancourt  D .  Attitudes towards vaccines and intention to vaccinate against COVID-19: Implications for public health communications.   Lancet Reg Health Eur. 2021;1:100012. doi:10.1016/j.lanepe.2020.100012 PubMedGoogle ScholarCrossref
Gagneux-Brunon  A , Detoc  M , Bruel  S ,  et al.  Intention to get vaccinations against COVID-19 in French healthcare workers during the first pandemic wave: a cross-sectional survey.   J Hosp Infect. 2021;108:168-173. doi:10.1016/j.jhin.2020.11.020 PubMedGoogle ScholarCrossref
Gadoth  A , Halbrook  M , Martin-Blais  R ,  et al.  Cross-sectional assessment of COVID-19 vaccine acceptance among health care workers in Los Angeles.   Ann Intern Med. 2021;174(6):882-885. doi:10.7326/M20-7580 PubMedGoogle ScholarCrossref
Mills  MC , Rüttenauer  T .  The effect of mandatory COVID-19 certificates on vaccine uptake: synthetic-control modelling of six countries.   Lancet Public Health. 2022;7(1):e15-e22. doi:10.1016/S2468-2667(21)00273-5 PubMedGoogle ScholarCrossref
Daly  M , Jones  A , Robinson  E .  Public trust and willingness to vaccinate against COVID-19 in the US from October 14, 2020, to March 29, 2021.   JAMA. 2021;325(23):2397-2399. doi:10.1001/jama.2021.8246 PubMedGoogle ScholarCrossref
Sikora  D , Rzymski  P .  COVID-19 vaccination and rates of infections, hospitalizations, ICU admissions, and deaths in the European Economic Area during autumn 2021 wave of SARS-CoV-2.   Vaccines (Basel). 2022;10(3):437. doi:10.3390/vaccines10030437 PubMedGoogle ScholarCrossref
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