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American Journal of Public Health Research
DOI: 10.12691/ajphr-1-1-3

The Implementation of a Tele-Homecare System with Service Oriented Architecture and HL7 Message Transmission Standard
Ching-Sung Wang

American Journal of Medical and Biological Research
DOI: 10.12691/ajmbr-1-1-2

The Influence of Ethanol on Pyruvate Kinases Activity in Vivo, in Vitro, in Silico
Lelevich Sergey Vladimirovich, Khrustalev Vladislav Victorovich, Barkovsky Eugene Victorovich, Shedogubova Tatyana Aleksandrovna

American Journal of Medical Sciences and Medicine
DOI: 10.12691/ajmsm-1-1-1

Clinical and Histological Features in Wegener Granulomatosis
Li Cavoli Gioacchino, Passantino Rita, Bono Luisa, Tortorici Calogera, Ferrantelli Angelo, Giammarresi Carlo, Rotolo Ugo

American Journal of Infectious Diseases and Microbiology
DOI: 10.12691/ajidm-1-1-2

The Curse of Lymphatic Filariasis: Would the Continual Use of Diethylcarbamazine Eliminate this Scourge in Papua New Guinea?
Anne Lanham, Lillian Mwanri

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Willingness to Accept a Potential COVID-19 Vaccine in Nigeria

Amakiri Paschal Chiedozie*, Ogbodo Jude Chukwuebuka, Chude Florence Chidimma, Offor Vivian Onyinyechi, Anoka Kennedy Chijioke, Olisakwe Sandra Chibuzor, Obi Chidera Gabriel, Ukazu Bethel Chioma

Chester Medical School University of Chester United Kingdom

Abstract: Background: Vaccine hesitancy is a potential threat to global public health including Nigeria. Since there is an unprecedented global effort to develop a vaccine against the COVID-19 virus, there are questions regarding the probability in acceptance of the vaccine in Nigeria. Understanding key determinants that influence the preferences and demands of a future vaccine in Nigeria may help to develop a vaccination program. The purpose of this survey study is to access the level of willingness of Nigerians to accept a potential COVID- 19 vaccine. Method: Using a multi-choice and open-ended questions with predefined answers, this survey was conducted among 499 respondents and analyzed to access their level of willingness to accept a potential COVID-19 vaccine when available and statistical differences in willingness to accept a potential COVID-19 vaccine based on age and gender were also determined. Result: And the result revealed that a very high percentage of respondents (98%) have prior knowledge of what a vaccine is. 51.1% were willing to take a COVID-19 vaccine, 30.5% were not willing as 18.4% were indecisive. Concerning the acceptance of vaccines for other vaccine-preventable illnesses in the country apart from COVID-19; 79.56% of respondents were willing, 7.82% were unwilling while 12.62% were indecisive. However, 52% of the respondents at different degrees rejected a mandatory vaccination of the population using a potential COVID-19 vaccine in Nigeria. Conclusion: This survey sheds light on the willingness to take a potential COVID-19 vaccine in Nigeria. Upon realizing the percentages of individuals willing to take a potential COVID-19 vaccine and individuals unwilling to accept the vaccine, the survey identified rumoured conspiracy theory, lack of confidence in a novel vaccine and safety doubts as the major underlying factors for unwillingness to accept a potential COVID-19 vaccine in Nigeria.

Keywords:

Received December 31, 2020; Revised January 13, 2021; Accepted January 22, 2021

Citation: Amakiri Paschal Chiedozie, Ogbodo Jude Chukwuebuka, Chude Florence Chidimma, Offor Vivian Onyinyechi, Anoka Kennedy Chijioke, Olisakwe Sandra Chibuzor, Obi Chidera Gabriel, Ukazu Bethel Chioma, Willingness to Accept a Potential COVID-19 Vaccine in Nigeria. American Journal of Medical Sciences and Medicine, 9 (1). 1-5. January 2021. doi:10.12691/ajmsm-9-1-1

1. Introduction

COVID-19 is a viral disease that was first discovered in pneumonia cases in the Wuhan province of China [1,2]. This virus is highly infectious and has spread to over 100 countries globally [3]. There are over 18 million COVID-19 cases globally with the death rate of about 650000 [4]. Nigeria as a west African country has about 62,964 COVID-19 cases with about 1,146 deaths due to the Pandemic [5]. Currently, there is no cure for COVID-19 however, Remdesivir and Dexamethasone have shown promising efficacy in clinical trials thus suggesting the need for more research [6,7]. Vaccines have been used as a viable tool to curb some outbreaks and pandemics [8]. There is no approved vaccine for COVID-19 however, there are over 100 vaccines in clinical trials with about 25 in the late stage of the clinical trial [9]. There is hope that a vaccine might be ready by 2021. Approving a vaccine without people’s willingness to accept it detriments the aim of vaccine development. This research aims to determine the willingness of Nigerians to accept a potential COVID-19 vaccine.

2. Methodology

The survey contained sixteen [16] general questions and was designed to elicit the response on the willingness of people to accept a potential COVID-19 vaccine in Nigeria. The questionnaire combined multiple-choice and open-ended questions with predefined answers offering respondents to choose and rank among several options or the possibility to grade on a “strongly agree” to “strongly disagree” scale.

The questionnaire was prepared and evaluated to ensure that the respondents understanding of the question and the questions itself was in line with our goal and targeted the objectives of the research. The data preparation was collected online. The evaluation of the data was based on content validity. The Analysis was done using R studio statistical package and Excel. The gender and the average age of the respondent were analysed. A bar chat was used to show the age distribution of the participants. The willingness of people to accept a potential COVID-19 vaccine in Nigeria was analysed based on the respondent’s response and rated in percentage. The Fishers exact test was used to identify if there is a statistical difference in willingness to take COVID-19 vaccine based on gender and age.

3. Results

3.1. Sample Characteristics

The survey presented a sample of 499 valid responses. Regarding gender, there were 242 males and 257 females who participated in the study. Majority of the respondents were between the ages of 19-35. The age distribution is shown in the graph below

3.2. Educational Level

A total number of 345 participants had a bachelor’s degree remaining participants which accounted for more than half of the total participants with 88, 58 and 8 participants having A level, Masters and PhD qualifications respectively.

Figure 1. Age distribution of participants

Figure 2. Educational Level of participants

Table 1. Display of Frequency distribution based on the percentage

Table 2. Frequency percentage distribution of Likert scale questions

3.3. Frequency Analysis

98% of respondents expressed knowledge of a vaccine while 2% did not. 95% have been vaccinated in the past, 2% have never been while 3% were indecisive. 51% were willing to take a COVID-19 vaccine with 30% were not willing and 18% were indecisive. 79% were willing to take a vaccine for other illnesses aside the COVID-19 vaccine, 7% were unwilling to take the vaccine for other illnesses and 12% were indecisive. Below is a summary of all responses.

3.4. Hypothesis Testing

We used the Fisher exact test to study if there is a statistical difference in willingness to take the COVID-19 vaccine based on Gender and Age. The significance level is p < 0.05. Below is the table showing the information.

Table 3. Display of p-value results using the Fisher exact test

From the results above, both p values are below a significant level. Therefore, there is no significant difference based on Gender and Age group in the willingness to take the COVID- 19 vaccine in Nigeria.

4. Discussion

COVID-19 pandemic will remain a serious public health problem until a valid vaccine is produced and distributed throughout the world. The development of a COVID-19 vaccine has been identified as a key factor in ending the pandemic and returning to normal activities [10]. The availability of a vaccine without the adequate willingness of the populace to use it is tantamount to zero effort [11].

The willingness of Nigerians to accept a potential COVID-19 vaccine was determined using Google document online questionnaire in which about 533 responses were received. 517 participants gave their consent but only 499 participants gave valid responses to the questions relevant to the survey comprising of 242 males and 257 females, this suggests that females have higher internet presence than males, although recent studies revealed that in recent times, there is no significant difference of importance between males and females in terms of internet usage; gender differences based on internet usage have been narrowed greatly [12].

Most respondents were between the age brackets of 19-35 as seen in sample characteristics (Figure 1). The reason for this high percentage of young people of this age bracket could be due to their frequent use of the internet as the questionnaire was distributed online using social media platforms of which youths of this age bracket are heavily present. This finding aligns with the report of Clement (2020) that people between the ages of 24 and 35 were the highest internet users in the world. In the study, participants between the ages of (46-65) account for a very low percentage of participants in the survey (less than 4%) which may be due to their low online presence and are the group most vulnerable to COVID-19 disease [13].

On the educational level of the respondents as seen in Figure 2, 345 participants had a bachelor's degree which accounts for 69% of the total participants in the survey, the reason for this may be attributed to the fact that majority of bachelor's degree holders (81.2%) are constantly present on the internet desperately seeking for white-collar jobs after their tertiary education [14]. As the unemployment rate in the country hits 27.1% [15] while 17.6% of the respondents are A-level certified and PhD degree holders were the least, accounting for only 1.6%. This may be attributed to their busy schedule in their places of work and other activities of concern such as attention to Family which may result in their low internet presence to attend to an online questionnaire.

Table 1 shows that 51.1% of the respondents were willing to take a potential COVID-19 vaccine, their basic reason was that they are aware of the preventive effect of other vaccines in curbing infectious disease spread and burden. This corresponds with the findings of [16] showing significant signs of positive responses towards accepting a COVID-19 vaccine in Australia, and the findings of [17] where over two-third of the participants were willing to take a COVID-19 vaccine when one becomes available in Canada provided it's safe for use. It also corresponds with the results found in Europe with 73.9% of the participants willing to take a potential COVID-19 vaccine [18].

Although, the willingness to take a potential COVID-19 vaccine in Australia (85.8%), in Europe (73.9%) and Canada (57.5%) are much higher than the results from this survey in Nigeria (51.1%). This may be due to a higher literacy level in these countries, 99% in Canada, Australia and Italy [19,20,21] as compared to 62% in Nigeria [22].

As displayed in Table 1, 98% of the respondents affirmed that they have prior knowledge of vaccine, this shows that many Nigerians are aware of vaccine and Vaccination programs and 95% of the respondents have been previously vaccinated for other vaccine-preventable ailments in the past. This could have buttressed their willingness to accept a potential COVID-19 vaccine having experienced the preventive effects of vaccines for other ailments.

Table 1 also revealed that 30.5% of the respondents in Nigeria were unwilling to accept the potential COVID-19 vaccine. The two top reasons were anchored on rumoured conspiracy theory, that through a potential COVID-19 vaccination, humans could be chipped which may fulfil a mythical end-time prophecy. It's similar to what is obtainable in a survey in America which suggests that 28% of Americans believe that Bill Gates wants to use vaccines to implant microchips in people - with the figure rising to 44% among Republicans [23].

The unwillingness to take up vaccines against vaccine-preventable ailments is the common situation around the world and has led to the measles crisis in the Philippines with over 4000 cases and 70 new deaths, this unwillingness in Philippians was fed by conspiracy theories associated with measles vaccine program in the area [24]. Some unwilling respondents, lack confidence in the safety of a potential novel vaccine. These findings correspond with the studies carried out in Canada which showed that 9% were very unlikely to take the vaccine for COVID-19; half of these group's reason was their lack of confidence in the safety of a novel vaccine while the other half were concerned about the side effects that may be associated with a novel vaccine. This result suggest that fewer Nigerians (51.1%) are likely going to accept a potential COVID-19 vaccine than Australians (85.0%). This may also be due to the low health literacy reported in Nigeria [25]. While others who are unwilling term it "unnecessary and irrelevant”, as this corresponds to the findings of [26] were it was reported that People, often do not receive vaccinations because they think them unnecessary, or rather, they do not know how to obtain free vaccination.

As observed in Table 2: The result also showed 71.4% of the respondents were positive about implementing a potential COVID-19 Vaccine in Nigeria when available, if the vaccine would be effective against the virus and safe for human use. 18% of the participants disagree with Implementation of a potential novel COVID-19 vaccine, this may be due to their doubt on the burden of COVID-19 disease in Nigeria as worldwide opinions which suggest exaggeration of Corona virus outbreak [27] while 10.6% of the participants were indifferent on the vaccine implementation.

A Strong Belief in the effectiveness of a vaccine is the strongest predictor of people's willingness to take a vaccine [28]. From a psychological point of view, an important aspect of people's behaviour towards vaccination is their confidence in the vaccine, the vaccine benefits, safety of vaccines, vaccine providers, such as trust on healthcare workers, health authorities, and policymakers [29]. Table 1 also showed that 79.56% of the respondents were willing to take existing vaccines for another vaccine-preventable ailment aside a potential COVID-19 vaccine, this level of willingness was still tied to their confidence on those existing vaccines having experienced their effectiveness and safety. 7.82% were unwilling to take other vaccines as 12.62% were indecisive about being vaccinated for other vaccine- preventable ailments.

Table 2 revealed that 65% agree that a potential COVID-19 vaccine would be effective against the disease. This level of confidence could be attributed to the high percentage of young people (19 - 35 years) on the survey which made up a high percentage (69%) of participants with at least a Bachelor's degree from a university showing a considerably high rate of adult literacy, which is 62% in Nigeria [22].

Another group of participants (18.4%) were indifferent about accepting a potential COVID-19 vaccine, they believed that their future decision would be based on the outcome i.e. the effectiveness of the COVID-19 vaccine when implemented. Basically, these group of people believe they will take the potential vaccine only if it's safe for use and effective as other vaccines in the past. This finding is similar to what was obtained in Europe, where 18.9% were not sure of taking the vaccine [18] and in Canada 5.1% [30] basically due to lack of confidence in a novel vaccine.

However, 52% of the respondents at different degrees rejected a mandatory vaccination of the populace using a potential COVID-19 vaccine in Nigeria. This may be due to the following reasons: the aforementioned belief in a conspiracy theory, their doubt on the public health importance of COVID-19 disease in Nigeria and the general lack of vaccine confidence. This group believe that the vaccine should be administered with the consent of the people.

Anti-vaccine movements have been boosted in America because of the idea of mandatory vaccination against infectious diseases including COVID-19 [31]. This result also revealed that if a potential COVID-19 vaccine is made mandatory in Nigeria as a bill on that is been passed [32], it would further confirm the people's belief in a conspiracy theory and more resistance would be met thus truncating the goal of eradicating COVID-19 using vaccines. If this vaccine resistance is allowed to linger without a solution, it may even affect the people's confidence in other existing vaccines programs. Table 2 also revealed that 94% of the respondents agree at different degrees that vaccines generally are necessary for the prevention and control of infectious diseases.

As displayed in Table 3: The result showed that there was no significant difference in the willingness of Nigerians to take a potential COVID-19 vaccine based on age group and gender.

In conclusion, vaccines are an effective tool available for prevention of infectious diseases with their associated morbidities and mortalities [33] on the average, Nigerians are willing to accept a potential COVID-19 vaccine if the vaccine is shown to be effective with less side effect and would be administered with the consent of the people.

5. Recommendations

There is a dare need to intensify vaccine education among the people with lower education level as well those with little health literacy. An awareness campaign emphasizing on the social benefits of COVID-19 vaccination could increase the willingness to be vaccinated not just for COVID-19 but for other vaccine-preventable ailments.

6. Shortcoming

During this survey, one of the shortcomings encountered was the unwillingness of people to click on external URL links to the online questionnaire, this is because of their fear of being scammed or hacked by internet fraudsters, and this shortcoming reduced the total number of willing participants.

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