Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
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Dr Mohan Z Mani,
Professor & Head,
Department of Dermatolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Original article / research
Year : 2022 | Month : November | Volume : 16 | Issue : 11 | Page : LC18 - LC22 Full Version

COVID-19 Vaccine Hesitancy among the Non Medical Adult Population Attending a Tertiary Care Hospital of Kolkata, India: A Cross-sectional Study


Published: November 1, 2022 | DOI: https://doi.org/10.7860/JCDR/2022/57569.17142
Atanu Roy, Oyimang Paloh, Saikat Bhattacharya, Soumitra Mondal

1. Undergraduate Student, Department of Community Medicine, Medical College, Kolkata, West Bengal, India. 2. Undergraduate Student, Department of Community Medicine, Medical College, Kolkata, West Bengal, India. 3. Associate Professor, Department of Community Medicine, Nil Ratan Sircar Medical College and Hospital, Kolkata, West Bengal, India. 4. Tutor, Department of Community Medicine, Medical College, Kolkata, West Bengal, India.

Correspondence Address :
Dr. Soumitra Mondal,
S4/5, Srabonia Bason, FC-Block, Sector-III Saltlake,
Kolkata-700106, West Bengal, India.
E-mail: commedrhub@gmail.com

Abstract

Introduction: Vaccines play an important role in the fight against diseases whose cure is unavailable. In the battle against pandemics such as Coronavirus Disease 2019 (COVID-19), the vaccine is the only available course of prevention. The hesitancy has been found all over the world, while some find it against their religious values, others are concerned about safety, or have doubts about its efficacy. Some are hesitant due to fear of needles while some show brass negligence. Being the second most populated country globally and a developing nation, India had faced its fair share of struggles with her citizens vaccinated. Even a minute percentage of people accounts for millions; hence, it is of utmost importance to get to the root of the causes of delay in vaccination.

Aim: To find the causes of delay or hesitancy among the people attending COVID-19 vaccination centre of a tertiary care hospital of Kolkata, (a year after vaccines were introduced to the general population).

Materials and Methods: A cross-sectional study was performed in the COVID-19 vaccination centre of Medical College Kolkata, West Bengal, India, from 14th January 2022 to 14th April 2022. Total 74 non medical (not related to healthcare work) people who had come for 1st or 2nd dose of COVID-19 vaccination were included in the study. A prestructured, pretested, prevalidated questionnaire was used to collect data from the participants of the study. The Likert scale comprising of nine questions were used to assess hesitancy. Data were analysed using Chi-square test. Binary logistic regression was done to confirm any predictability of occupation, literacy rate, age and gender on vaccine hesitancy.

Results: The participants comprised of 45 (60.8%) females and 29 (39.2%) males, aged between 18 to 60 years with the mean age of 33.75±11.06 years. The participants included 22 (29.7%) people, who had just taken their first dose. Twenty six (35.1%) participants were hesitant. The most common causes of hesitancy were individuals’ fear of the vaccine and its impact on general health, unavailability of slots for vaccination and reluctance. Out of total, 58 (78.4%) people had faith in vaccines made in India and 48 (64.9%) persons believed that the vaccine would provide complete protection against COVID-19.

Conclusion: People were mainly concerned about safety issues as adequate and reliable information was not available to them. Some of them ignored the importance of vaccination, while some could not get vaccinated due to the unavailability of slots.

Keywords

Coronavirus disease-2019, Disease prevention, Severe acute respiratory sydrome coronavirus 2, Vaccine acceptance

The novel coronavirus disease, Coronavirus Disease-2019 (COVID-19) has become the fifth documented pandemic since the 1918 flu pandemic (1). The COVID-19 disease originated from the Huanan Seafood Wholesale Market, Wuhan, Hubei province, China and the subsequent outbreak of pneumonia cases occurred in Wuhan City from late December 2019 (1). Since its emergence, it has spread to almost every country around the globe within a few months. World Health Organisation (WHO) declared the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection a pandemic on 11th March 2020 (2). Due to it’s contagiously and longer incubation period, a worldwide lockdown was initiated. The virus was targeting the lungs and likely bound with the angiotensin-converting enzyme 2 receptor, which is highly expressed in the nasal epithelial cell [3,4] and undergoes local replication and propagation, along with the infection of ciliated cells in the conducting airways. After that, it involves upper respiratory tract resulting in symptoms like fever, dry cough. But, COVID-19 has a wide range of clinical presentations, varying from asymptomatic carrier state to viral pneumonia in addition to various extrapulmonary manifestations including cardiac, nervous, renal, gastrointestinal and coagulation systems (5),(6),(7),(8),(9).

Amidst all the adversity, a race for a cure or a vaccine for the disease had already begun in different countries (10),(11),(12),(13),(14). This soon brought a couple of vaccines into the light that was clinically working. Although vaccination has been proved to be effective against several diseases in the past, ‘taking a jab’ was still voluntary. Amongst the rising tides of COVID-19 patients, the vaccination seemed to be the only protection one can have until a cure was discovered. However, vaccination was not accepted by different sections of society, while some saw it as unacceptable in terms of religious grounds, others were not sure if it was safe (10). A wide range of rumours and unscientific remedies have surfaced which caused more harm than any good. There had been promotions by anti-vaxxers on the different social platforms, who promoted against taking the vaccination (8). There has been a fair share of studies done regarding hesitancy in various countries (12),(13),(14) but instead of general population Indian studies involved specific groups like medical students (12). So, present study focused on personnel, who were not involved in medical profession any way.

Vaccination in India had begun on 16th January 2021. In the first phase, the vaccination programme for health workers and frontline workers; the second phase of vaccination started on 1st March and vaccines were made available for people of 60 years or above age and people having comorbidities of age 45 years and above. From 1st April, all people of age 45 and above were eligible for vaccination. In the third phase, vaccines were available for all adults (18+) from 1st May (15). The Government of India had increased the duration between the two doses of the available vaccines on the advice of the National Expert Group on Vaccine Administration for COVID-19 (NEGVAC) (16). On a much more recent note, the vaccination for 15-18 years old has begun on 3rd January 2022. In spite of prompt introduction of mass vaccination India with the world’s second-largest population (1.38 billion in 2020) is still struggling to reach a satisfactory level of vaccination (17).

The hesitancy among the general population of one of the most diverse and largest populations of the world needs to be known, understood and resolved at the earliest to prevent another global lockdown. Given the diversity of the peoples in India, the nature and causes of delay are expected to be versatile too. Thus, the present study embarks to find the causes of hesitancy to avail of vaccine in the eligible age group, a year after vaccines were introduced to the general population.

Material and Methods

A cross-sectional study was conducted in the COVID-19 vaccination centre of Medical College Kolkata, West Bengal, India, from 14th January, 2022 to 14th April, 2022 for a duration of three months. The study was approved by the Institutional Ethics Committee (MC/KOL/IEC/NON-SPON/1257/01/2022 dated 13.01.2022). Written consent was taken from each participant after thoroughly explaining the study and its utility and complete confidentiality of their responses. No personal identification details were asked or taken from them. Those who could not read were explained orally in their mother tongue and then consent was taken in presence of a witness.

Inclusion criteria: Non medical (not related to healthcare work) people aged ≥18 years and who had come for 1st or 2nd dose of COVID-19 vaccination were included in the study.

Exclusion criteria: The people receiving the booster/precautionary dose, aged <18 years and people who refused to participate in the study were excluded from the study.

Sample size calculation: The sample size for the cross-sectional study was calculated using formula:

n= (Z×Z)pq/L×L

The prevalence of hesitancy was taken as 22.5% from previous study (14). The precision (L) was taken to be 10%. The results so obtained were 67. We calculated the final sample size by taking a 10% non response rate to get the sample size as 74.

Data were collected from the participants in a self-administered interview guide prepared by the investigators. Questions for hesitancy scale were framed and face and content validity was achieved with the help of experts from public health.

Questionnaire

Internal consistency of the questionnaire as determined by Chronbach’s alpha was satisfactory (0.71). The questionnaire was translated in local languages (Hindi and Bengali) by linguist. Those who were illiterate and yet decided to participate in the study were asked to listen to the questions dictated by the investigators in their mother tongue as written in different sets of questionnaires of different languages. Care has been taken to explain the participants the exact meaning of the questions and reassuring that their opinion is completely confidential without influencing their answer in the slightest.

The ‘Hesitancy’ was determined from a set of nine questions using the Likert scale. The questions assessed individuals’ opinions but more specifically look into their trust level about each parameter of the COVID-19 vaccine, the parameters considered were efficacy, community benefit, time of arrival, safety, side-effects in the long-term or short-term, hindrances to day to day activity. These parameters were chosen by studying previous articles and the most prevailing causes of hesitancy were selected (12),(14),(18). The answers were scored from 1-to 5, ranging from ‘Strongly Disagree’ to ‘Strongly Agree’. The summation of the scores of all the nine questions was used as the final value to determine hesitancy. A minimum value of 36 was required to be obtained for the participant to be ‘non hesitant’. The minimum value was achievable only, if all the 9 questions were answered to “Agree” or atleast five questions “strongly agree” and rest “undecided”. All values below 36, were assumed to be hesitant in taking COVID-19 vaccines for the purpose of the present study only.

Demographic variables like age, gender, religion and educational status were included for comparison purpose. Which dose (1st or 2nd) the recipient is having is also considered as an independent variable. Apart from hesitancy questionnaire, one open ended question was also asked to understand the reason of delay in receiving vaccination. A person can state more than one reason for delay and similar responses were clubbed and listed finally.

Statistical Analysis

The data were analysed using Statistical Package for Social Sciences version 20.0. Central dispersion measures were calculated for continuous variables. Demographic data were represented in frequency and percentage. The Chi-square test and risk estimation were done to find any significant association between demographic variables and hesitancy. Alpha error was taken at 5% level to consider one association significant. Binary logistic regression was done to confirm any predictability of occupation, literacy rate, age and gender on vaccine hesitancy.

Results

The study participants comprised of 45 (60.8%) women and 29 (39.2%) men, aged between 18 to 60 years with the mean age being 33.75±11.06 years. Among the study population 27 (36.48%) of people had not completed secondary education. Only 14 (18.9%) of the people were graduates and above. Out of total, 22 (29.7%) of the participants had just taken their first dose of the COVID-19 vaccine and 26 (35.1%) of the recipients who had come for the vaccination were still hesitant (Table/Fig 1).

As per the nine item Likert scale for hesitancy, it was seen that mean score obtained was more then four (regarded as non hesitant) for five out of those nine items. It was lowest (3.66±0.96) for the agreement on the efficacy of foreign made vaccines. The study revealed that 35 (47.3%) of the participants had faith in vaccines of foreign origin while 58 (78.4%) believed vaccines made in India were more effective. (Table/Fig 2). The overall idea of the vaccine among the participants reveals that 48 (64.9%) of them believe that, it would provide complete protection against COVID-19.

No significant association were found between hesitancy and age (p-value=0.26), gender (p-value=0.55), educational qualification (p-value=0.34), religion (p-value=0.07) and dose taken (p-value=0.22) (Table/Fig 3).

Some of the most common causes of delay in vaccination were: the individual’s fear of the vaccine in 11 (14.9%) and its impact on general health in 22 (29.7%), unavailability of slots for vaccination in 14 (18.9%) and reluctance in 13 (17.7%). Whereas, 10 (13.5%) of the participants were concerned about the long-term side effects and 9 (12.2%) are completely unaware of any changes that the vaccine may or may not produce (Table/Fig 4).

Discussion

The questionnaire containing nine questions, was considered to study the participants’ opinion regarding vaccine efficacy, community benefit, time of arrival, safety, side-effects in the long-term or short-term, hindrances to day to day activity. It is our understanding that if a subject lacks confidence in either of the above said parameters he is hesitant about the vaccine even if he takes the jab. The participant’s trust in the newly developed vaccine is stressed in this study and even a single doubt compromises their faith in the overall vaccine. India has the world’s second-largest population. Hence, the vaccine requirement for India is proportionately higher than any developed nation. The vaccines for SARS-CoV-2 were developed rapidly and were available in the market faster than any other vaccine in the past. However, while these vaccines were still in different phases of trials the developing nations could not risk buying them as the worldwide lockdown had struck them hard. In the meantime, the developed nation bought the lion’s share of the vaccines available in their testing phases itself. Thus 60-80% of developed nations’ citizens were vaccinated while countries like India, and Africa are still struggling to acquire and vaccinate their people (18),(19). One of the major reasons for delayed vaccination found in this study was the unavailability of slots for vaccination. A massive demand, and limited resources accompanied by poor distribution cause wastage of vaccines leading to an immense crisis of vaccines at centres (18),(19). This explains one of the reasons for the delay.

Vaccine safety has been a serious concern among people of all countries. The vaccines were being acquired even before they had completed all phases of the clinical trial. The virus was new and highly contagious with very little known about its pathophysiology. The entire disease and its treatment were vague to the general masses. The mass hysteria created more doubts than preventions. Side-effects of vaccines were one major reason for delayed vaccination and hesitancy as evident from the results. The doubt about the effectiveness of the vaccines was reflected across the world and is evident in several studies (20),(21),(22),(23),(24),(25). The present study showed that 12.2% of the participants are completely unaware or do not believe in the effectiveness of the vaccine and 13.5% were concerned about the long-term effects that the vaccine may produce. In the massive population of India, even small percentages account for millions of people, which in turn, reflects a significant number of concerned people all over the earth.

The present study participants comprise 60.8% females which was contrary to previous hesitancy studies done in India (24),(25). However, it is as par with recent studies done on dental students globally (26) and university students in Italy (25). In the present study, no significant association with any of the demographical factors such as age, sex, religion and education level was found. This is quite rare as other studies have shown significant association with economic status, gender or literacy rate (25),(27).

Vaccine safety and efficacy were the most common reasons for delay even though significant time had passed after the introduction of COVID-19 vaccines. Among the various reasons, reluctance occupied a significant portion. The participants claimed to have no reason for the delay, they just did not want to take a vaccine. Whether this hesitancy has a deeper cause like fear of needles is unexplored, however, a significant number of people are included in reluctance. Such reluctance is quite likely to make future battles against pandemics tougher. Unless there are some deep-lying roots to this reluctance, one may assume that it is sheer irresponsibility on their side. They are not only compromising themselves, but also their family and their community. A summarised comparison of findings of the present study and previous similar studies (19),(22),(23),(25),(27),(28),(29) are given in (Table/Fig 5).

Limitation(s)

Present study was a monocentric study, so comparison of the views of people from other regions could not be done. The present study reflected the hesitancy of only those people who arrived at the tertiary healthcare facility in Kolkata. It is important to compare, how similar or dissimilar the views of people attending tertiary care facilities in other regions (like North Bengal) to discover any new causes of hesitancy or any other issues like geographical barriers that may cause delays in vaccination. The hesitancy scale in present study works in an ‘all or none’ policy. Authors were unable to grade the levels of hesitancy, as it would require more elaborate questioning of the participants followed by addressing other scales of determining stress and trust levels. The people who came to the vaccination centre were mostly under a time crunch or were not the most co-operative people either.

Conclusion

The results of present study revealed that 29.7% of study subjects were receiving first dose of vaccine after more than eight months of initiation of vaccination program. This is alarming and points towards their hesitancy for receiving vaccine. As per the hesitancy score also, it was found about one-third of the subjects hesitant about this vaccine. Fear of the adverse events following vaccination, unavailability of slots due to mandatory online registration was stated to be main reasons of this delay. This study was hospital based and conducted on people attending the vaccination centre. Hence, large community based studies are recommended to discover any new causes of hesitancy or any other issues like geographical barriers that may cause delays in vaccination, including those who were more hesitant and not even attending the vaccination centre.

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DOI and Others

DOI: 10.7860/JCDR/2022/57569.17142

Date of Submission: May 05, 2022
Date of Peer Review: Jun 20, 2022
Date of Acceptance: Sep 16, 2022
Date of Publishing: Nov 01, 2022

AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. NA

PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: May 06, 2022
• Manual Googling: Aug 20, 2022
• iThenticate Software: Aug 29, 2022 (13%)

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