Early Publication – Behavioral Responses and Likelihood of Receiving COVID-19 Vaccines During Pandemic, Hong Kong – Volume 27, Issue 7 – July 2021 – Journal of Emerging Infectious Diseases

Our 5-cycle online longitudinal survey analyzed temporal changes in community responses during the first 2 outbreaks of COVID-19 in Hong Kong. Overall, perceived sensitivity (assuming no precautionary action was taken) remained high: self-sensitivity (87.2% -92.8%) was significantly higher than that observed for the 2003 SARS outbreak (23.0%) (21) and the 2009 influenza pandemic (58.1%) (22) in the same population. However, in terms of perceived severity, the proportions fell dramatically over time, but were still higher than those seen in other heavily affected regions (UK, 20.7% [12]; State of Kerala, India, 55.7% [23]). The proportions of people with abnormal levels of anxiety also fell over the study period, from 34.3% to 22.0%. We observed consistently high levels of precautionary measures, such as mask wear, hand hygiene, and home disinfection throughout the study period. Greater anxiety was associated with a higher tendency to social distancing. The adoption rate of the projected COVID-19 vaccine increased from 48.7% (R4) to 37.6% (R5). Greater anxiety, greater confidence in the vaccine, collective responsibility and less self-satisfaction contributed to a greater likelihood of a planned vaccination.

Implications of the results

Our results have 5 immediate implications for public health. First, with the uncertain progression of the disease (for example, the emergence of new variants of the coronavirus) and the evolution of institutionalized interventions, there should be continued monitoring of the perceived risk of COVID-19 in the community. . The perception of risk is an essential determinant of behavior change (24) and depends on the prevalence of the health risk concerned (25). Our results show a perception of risk that varies over time during a pandemic, illustrating a perceived severity of COVID-19 that has decreased significantly over time. Deducing from the large difference between naive (assuming no precautionary measures) and current (based on the current situation) scenarios, perceived sensitivity is sensitive to disease progression and interventions in place. Although such a temporal trend in risk perception has also been observed in past pandemics (26), the absolute level of risk perception was not.

Second, surveillance and encouragement of social distancing should be sustained over the medium to long term, given the low expected adoption rate of the COVID-19 vaccine. In Hong Kong, breeding numbers peaked at 2.39 in wave 1 and 3.04 in wave 220), which (based on early data) roughly matched the immunity requirement of 56.1% to 66.9% of the population to confer collective immunity (27). Since the projected vaccination rates (R4, 48.7%; R5, 37.6%) have not reached the required level, future epidemics on a relatively small scale compared to previous waves are expected. With more people vaccinated, there could be more social interactions. Efforts should be made to maintain social distancing (such as avoiding unnecessary gatherings). At the same time, further research is expected to focus on disease transmission during a mix of established social distancing and vaccine reluctance among the population.

Third, risk communication in Hong Kong should target complacency, vaccine confidence and collective responsibility to drive uptake of the COVID-19 vaccine. Temporal changes in the psychological history of vaccine reluctance should be closely monitored to inform the design of immunization campaigns. We reported low uptake of potential vaccines, which has declined over time in Hong Kong. A similar situation was observed in the United States, where the projected vaccination rate fell from 74.1% in April 2020 to 56.2% in December 2020 (28). This low intention of absorption in the elderly in our study (R4, 29.4%; R5, 31.4%) is particularly worrying because advanced age is a risk factor for death from COVID-19 (29).

The extent to which our results on predictors of adoption intention can be generalized to other countries or regions requires further investigation. The low rate of COVID-19 infection and the low level of confidence in government action was unique to Hong Kong. The low intention of absorption reported in this study was rare compared to other countries (71.5% overall for 19 countries) (30). The low infection rate, along with the decreased perceived severity of COVID-19, could weaken the urgency for vaccination, which can also apply to places such as Taiwan, Japan and Australia. However, social unrest in Hong Kong at the end of 2019 could have led to mistrust of the government (31), which could subsequently reduce the vaccination intention (32) and trigger the continuation of personal precautionary measures. One possible explanation is that, when moderated by mistrust of the government, people tend to rely on individual protective measures (such as wearing face masks and maintaining social distancing) but become skeptical of institutional protective measures (such as vaccines). Mistrust of governments during the pandemic may also influence vaccine reluctance in other regions, such as Brazil and Poland (33). Nevertheless, given the low vaccination rate predicted in this study, it may be insufficient to achieve herd immunity in the near future, if ever, in Hong Kong. Therefore, whether or not you take the vaccine may have little impact on easing government interventions in the medium term. Moreover, according to results from other regions, trust in the government itself (34) and information provided by the government (30) increased preventive practices, in particular vaccine acceptance, during pandemics (30). Therefore, effective health communication is particularly crucial for the Hong Kong government. To restore trust, public health authorities must demonstrate competence, objectivity, fairness, consistency, transparency, sincerity and faith (35). In addition, organizations other than government and health care providers, such as professional bodies and religious groups, can help disseminate pro-vaccine messages (36).

Fourth, our results help prioritize the content of promotional messages. It is worth investing resources in promotional messages, especially when few respondents in R4 (overall, 16.7%; 18-24, 24.7%; 25-34, 14, 5%; 35 to 44, 15.5%; 45 to 54, 11.5%; >55 years, 17.6%) and R5 (overall, 10.5%; 18–24 years, 12.8%; 25–34 years, 7.4%; 35–44 years, 12.1%; 45– 54 years old, 6.1%; >55 years old, 20.0%) indicated an absolute ‘yes’ to receiving the COVID-19 vaccines (measured on an 11-point Likert scale) and when there was a decline in antibodies after receiving the vaccine. The decreasing confidence measure from R4 to R5 underscored the need to build public confidence in the logistics of vaccine development, licensing, guideline generation and distribution (37). Before the government authorizes the use of a COVID-19 vaccine, establishing an advisory committee will help determine factors the government should consider, such as performance (safety, efficacy and efficacy) and characteristics (number of doses, formulation and presentation). and packaging) of available vaccine (38). Additionally, to increase collective accountability and the perceived need for the vaccine, the government should promote understanding of the vaccine among the public through transparent communication, including increased engagement with various community stakeholders and affected populations. disproportionately by the pandemic to listen to their concerns. Leveraging the knowledge, skills and expertise of these communications will provide a solid assessment to underpin the immunization campaign. Although the calculations and constraints of the 5C model have not been associated with the likelihood of taking the vaccine at this point, continued review of these 2 constructs will help to refine future vaccination campaigns to involve citizens in the process. cost-benefit calculations and to increase the availability, accessibility and affordability of vaccines.

Fifth, the psychological distress resulting from burnout must be balanced against well-established anxiety. This pandemic is ongoing and has lasted much longer than the SARS outbreak, so more and more people are developing emotional exhaustion syndromes. The interaction between 2 psychological distress, burnout and anxiety, deserves to be studied during the current pandemic. Our study showed that nearly half of respondents had symptoms of burnout within a short 4-month window from June to September 2020. This symptom did not contribute to the likelihood of COVID-19 vaccination in the latest survey. in 2 points. However, the current general measure of burnout has failed to identify the sources of burnout, such as financial stress, social isolation, illness itself or their combinations, for analysis. detailed. Nevertheless, the phenomenon of professional burnout among people facing a long-lasting pandemic (39) suggests the need to re-examine the temporal association between the adoption of social distancing, vaccination and burnout.

The first limitation of our study is that the survey may have been subject to recall and social compliance bias, but its longitudinal design allowed us to follow the same respondents over time, thereby reducing the self-control bias. . Second, caution should be exercised in generalizing our results to other regions, as Hong Kong has recently been exposed to other disease outbreaks, such as the 1997 avian flu. (40), 2003 SARS (41) and pandemic influenza 2009 (42). Nonetheless, our experience with COVID-19 after these past outbreaks may be a precedent for other countries, after the current COVID-19 pandemic. Third, our investigation was conducted prior to the release of data on the safety and effectiveness of COVID-19 vaccines. Actual utilization rates could be affected by possible side effects of the vaccination, such as deaths recently reported after taking the vaccines in Hong Kong (4345).

In conclusion, our results underscore the importance of a continuous longitudinal assessment of community psycho-behavioral responses during the COVID-19 pandemic. Tracking these responses can help public health authorities tailor health communication strategies to achieve desired behavioral outcomes (vaccination and adoption of precautionary measures) to control future epidemic waves.

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