Acceptance and Hesitancy Toward the Covid-19 Vaccine Among Medical Students in Kabul, Afghanistan

Introduction

The availability of vaccination services”¹ the vaccine campaign’s success highly depends on vaccine confidence.¹

Acceptance of vaccines is essential for controlling the pandemic of covid-19 but the low acceptance rate reported in many countries may contribute to the formation of challenges in efforts toward putting an end to the pandemic.^2,3 As the World Health Organization has stated earlier, hesitancy toward the COVID-19 vaccine is a global health threat (Organization).

In a systematic review of acceptance of the COVID-19 vaccine across 33 countries (as of 25th December 2020), it was reported that Kuwait (23.6%), Jordan (28.4%), and Italy (53.7%) had the lowest acceptance rate.⁴

The hesitancy rate toward Covid-19 vaccine found to be 84.6% in Cameroonians adults.⁵

Specifically, medical students should be the focus of attention because they have close contact with patients and they may visit the infected patients during their clinical rotations and they are a model for non-medical students. The same recommendations for health-care workers should be applied to medical students.⁶ Therefore, the rate of acceptance of vaccines among medical students is very important. Many studies have revealed significant hesitancy of medical students to COVID-19 vaccination.^7,8 In this study, we aim to find the acceptance and hesitancy rates toward covid-19 vaccine among medical students in Kabul, so as to offer suggestions for increasing vaccine uptake. This study is the first to demonstrate the acceptance and hesitancy toward covid-19 vaccine among medical students in Afghanistan.

Objective

In this study, we aim to find‎ the acceptance and hesitancy rates toward Covid-19 vaccine along with its reasons among medical students in Kabul.

Methodology

A cross-sectional study was conducted among the medical students of five randomly selected medical universities in Kabul, between 20 March 2022 and 2 June 2022. Currently enrolled medical students in the clinical years (4th, 5th, 6th, and 7th year) and being able to understand the questionnaire, were the inclusion criteria of the study. Clinical rotations of medical students in Kabul universities start from the 4th year and students have close contact with patients.

A brief explanation about the study was provided for the students who entered the survey and the consent forms were signed by participants. A total of 459 students received and completed the questionnaire voluntarily, and anonymously and they did not receive any compensation.

The validated Questionnaires with close-ended questions were adapted from former studies by.^8–10 Then the related questions were selected and modified to suit the study participants. The data were then transferred to Microsoft Excel for coding and the data were analysed by Statistical Package for Social Sciences program (SPSS) Version 23. The results were presented with tables and graphs as appropriate.

Results

The total participants were 459 medical students, 70.3% were female and the rest were male, with a mean age of 21 years. The total awareness about the availability of the COVID-19 vaccine in Kabul was 90%. The acceptance rate for COVID-19 vaccine was found to be 57.7%, while 42.3% showed hesitancy as is shown in Figure 1. A greater hesitancy rate toward the COVID-19 vaccine was found to be in males (64%), while in females hesitancy rate was 52.2%. Almost half of the participants (51.5%) were already been vaccinated. More than half of the participants (55.2%) said they would encourage others for getting the covid-19 vaccine. 26.4% of participants were sure about contracting the COVID-19 infection in the past, while 40% said that they may contract the virus in the past and 33.5% reported not being infected with covid-19.

Figure 1 The acceptance and hesitancy rate toward the COVID-19 vaccine.

The main reason for taking the vaccine in the vaccinated group was protection against covid-19 (60.2%) alongside other causes as is shown in Table 1. While the main reason for the rejection in the non-vaccinated group was hesitancy due to concerns about the safety and adverse effect of the vaccine (62.3%) and in 38.49% the negative news about the vaccine was the reason for not taking the vaccination. Other causes of hesitancy are shown in Table 2. In 64.3% of cases, social media was the source of negative information about covid-19, while 31.2% of participants received misinformation about the vaccine from their friends. Also, medical experts, family and lecturers were the source of negative information in 10.5%, 7.9%, and 4.5%, respectively.

Table 1 Reasons for Taking the Vaccine

Table 2 Reasons for Hesitancy

Discussion

The hesitancy rate for covid-19 vaccine among medical students was found to be 42.3%, hesitancy rate in male and female students was 64% and 52.2%, respectively. The essential reason for refusing of the vaccine was concerns about safety and adverse effects of the vaccine (62.3%). More than half of the participants (51.5%) have already been vaccinated. In 60.2% of participants, protection against the COVID-19 virus was the main reason for accepting the vaccine. This study indicates that social media was the leading source (64.3%) of false information about the vaccine. In this study, the hesitancy rate toward the COVID-19 vaccine was found to be 42.3%. This indicates a much lower hesitancy rate among medical students than in Sudan, United States, and Iraq where hesitancy rates were 44.2%, 47%, and 65.22%, respectively.^4,8,11 Although compared to our findings, a lower vaccine hesitancy rate was demonstrated among medical students in India and Japan, 16.57% and 10.9%, respectively.^8,12

In this study, the main reasons for accepting the vaccine were protecting self (60.2%) and others from covid-19 infection (36.86%). These findings are in line with the results of research in Sudan, Uganda, Egypt, and Poland.^8,10,13,14

The less prevalent cause of accepting the vaccine in this study was being at risk of severe form of the infection (3.8%) which is slightly different from the Sudan research that the percentage was 4.1%.⁸

Being concerned about the safety and adverse effects of the vaccine was the main reason for hesitancy which is similar to the finding of researches in Uganda, United States, Egypt, Poland, Sudan, and India.^4,8,10–14 Although another study indicated muscle pain, local pain at the site of injection, fever and fatigue with the mild to moderate severity as the most prevalent side effects with the AstraZeneca vaccine among lecturers and staff of Kabul University of Medical Sciences.¹⁵

In the general population, there is a concern about the existence of microchips in the covid-19 vaccines, as in research in Arabic countries 27.7% had this idea.³ To some extent, this idea exists among medical students too, in this study 0.89% of the medical students have chosen the presence of microchips in the vaccine as the hesitancy reason, this finding is less than the Polish research in which 1.75% of medical students were concerned about the microchips.¹⁴

Nowadays with the progress of technology and social media, the world seems to be like a village and the news and information spread very rapidly, not only the truth but also false news and information.¹⁶ The majority of medical students (64.3%) received negative information about the vaccine from social media. The results of Sudan research also indicate similar results that 56.1% of students used social media as source of information about the COVID-19 vaccine.⁸ The role of media and its potential role in hesitancy toward the COVID-19 vaccine has well understood.⁸

This study is the first to demonstrate the acceptance and hesitancy toward covid-19 vaccine among medical students in Afghanistan. In this study, medical students from different universities in Kabul were included to improve generalizability. This study has revealed a high level of COVID-19 vaccine hesitancy among medical students. Efforts to provide accurate information on COVID-19 vaccine safety and effectiveness are highly recommended.