|
 
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| ORIGINAL ARTICLE |
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| Year : 2022 | Volume
: 5
| Issue : 3 | Page : 108-114 |
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“I believe in science and in all vaccines:” Older adult and the intention for a vaccine against COVID-19
Marcelo de Maio Nascimento1, Allysson Nathan Galvão Nunes2, Luciano Juchem1
1 School of Physical Education, Federal University Vale do São Francisco, Petrolina, PE-, Brazil
2 Department of Nursing, Federal University Vale do São Francisco, Petrolina, PE-, Brazil
| Date of Submission | 26-Jan-2022 |
| Date of Decision | 25-May-2022 |
| Date of Acceptance | 25-Jun-2022 |
| Date of Web Publication | 9-Aug-2022 |
Correspondence Address:
Marcelo de Maio Nascimento
Universidade Federal do Vale do São Francisco, Colegiado de Educação Física, Av. José de Sá Maniçoba S/N, 56304-917 Centro, Petrolina, PE
Brazil
 Source of Support: None, Conflict of Interest: None  | 3 |
DOI: 10.4103/shb.shb_17_22
Introduction: To investigate the intention of older Brazilian adults to receive the COVID-19 vaccine, to find out their perception of the older adults' fragility to the virus, and to know their opinion on the progress of the national immunization plan against COVID-19. Methods: An exploratory qualitative study was carried out through semi-structured telephone calls with 32 participants (aged 60–89), between February and March 2021. Data were analyzed thematically, emerging three major themes. Results: Most participants expressed concern about the vulnerability of their immune system to the coronavirus, and dissatisfaction with the organization of the national immunization plan. Strong criticism was leveled at the leadership of the President of the Republic due to his resistance to vaccination and encouraging the use of hydroxychloroquine. Conclusion: The vast majority of respondents reported an intention to receive the vaccine. The short time for the production of vaccines generated distrust with its effectiveness. All expressed dissatisfaction with the organization of the national immunization plan, and agreed that after the pandemic, their lives and the world will no longer be as before.
Keywords: Aging, coronavirus, COVID-19, health policy, vaccine
How to cite this article:
Nascimento Md, Nunes AN, Juchem L. “I believe in science and in all vaccines:” Older adult and the intention for a vaccine against COVID-19. Asian J Soc Health Behav 2022;5:108-14 |
How to cite this URL:
Nascimento Md, Nunes AN, Juchem L. “I believe in science and in all vaccines:” Older adult and the intention for a vaccine against COVID-19. Asian J Soc Health Behav [serial online] 2022 [cited 2023 Dec 2];5:108-14. Available from: http://www.healthandbehavior.com/text.asp?2022/5/3/108/353634 |
| Introduction | |  |
The new severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has infected millions of people worldwide, and caused hundreds of thousands of deaths.[1] In Brazil, the focus of this study, the first COVID-19 case report took place in São Paulo on February 26, 2020.[2] For this reason, the development of safe and effective vaccines capable of controlling the spread of the virus is a priority for the global society.
Having a vaccine available for the disease does not mean that it is accepted by the entire population.[3],[4] Therefore, governments must know the perception of citizens about vaccination because this can qualify the creation of public health policies.[5],[6] Several factors can influence the acceptance of vaccination by the population;[4] however, there is a difference of opinion between the groups.[7] It is known that women accept vaccination better than men, and older adults are more aware than younger ones.[7] Another factor to consider is that governmental recommendations are also decisive to achieve widespread acceptance by the population.[8]
For decades, vaccines have been a successful disease prevention measure.[9] Vaccines are an important public health strategy, especially today, to protect the population from COVID-19.[10] In Brazil, the vaccine began to be distributed on February 19, 2021: The “CoronaVac” is produced by the Butantan Institute of São Paulo in partnership with Sinovac (Beijing). However, during this period, the country experienced a troubled political context, which made it difficult to implement the national immunization plan.[11],[12],[13] Among them, there was a mistaken planning by the Ministry of Health (MS), an inaccurate dissemination of data on the disease and failures in communication between the federal government and the 26 states, and between these and the 5570 municipalities.[14]
Another issue that raises doubts among Brazilians regarding the vaccine is the attitude of the President of the republic, who has often publicly minimized the lethality of the virus, trivializing the importance of social isolation and the use of masks.[15],[16] Moreover, for a long time, the Brazilian Ministry of Health recommended the use of early treatment, which includes medications such as chloroquine, hydroxychloroquine, azithromycin, and ivermectin. All without scientific evidence against COVID-19.[17],[18]
Current studies have analyzed the hesitation or acceptance of the population for the COVID-19 vaccine.[8],[19],[20],[21] However, few studies have used the qualitative methodology to solve the problem,[22],[23],[24] besides that a small number focused on the older population.[25] To fill this gap, we carried out a qualitative study that aimed to (1) investigate the intention of older Brazilian adults to receive the COVID-19 vaccine, (2) to find out their perception of the older adults' fragility to the virus, as well as (3) to know their opinion on the progress of the national immunization plan against COVID-19.
| Methods | | |
Study design
Qualitative exploratory study conducted by semi-structured telephone interviews conducted with older adults (aged 60–89), living in Brazil, between February and March 2021. We opted for the qualitative methodology because this technique allows us to explore in more detail the phenomena of the real world, offering a more in-depth summary of the behavior of the subjects that the research intends to describe, particularly in situations of interest to research.[26] In times of pandemics, the telephone interview offers advantages over the face-to-face method because it respects safety norms, avoiding direct contact between the researcher and the interviewees. Moreover, this investigative technique makes it possible to contact a considerable number of people in a short period, at a low cost.
Data collection
Respondents were recruited from older adult groups in the city of Petrolina, in the Northeast region of Brazil. Initially, the coordinators of the groups were contacted, after the presentation of the intentions of this study, the coordinator himself announced the invitation to the older adults through the WhatsApp group. Those who expressed interest in participating in the study were contacted by the researchers. In the first contact, interested parties were informed about the research objectives, methodological procedures, and ethical issues. In case of acceptance, candidates indicated the best day and time for the interview. Afterward, the candidate receives a free and informed consent form through WhatsApp, which should be read, signed, and sent to the researchers before the interview. At the time, the candidates were informed that the talk could take between 40 and 60 min and that they should take the call in a reserved place, to avoid possible interruptions.
In the present study, a nonprobabilistic convenience sampling was adopted. The use of this technique is justified by the ease of access for people to community-dwelling during the period of social isolation required by the COVID-19 pandemic. Thus, we considered the availability of a group of people to integrate the study at the time. Initially, 50 people were contacted. Of these, 18 refused to participate in the study. Thus, 32 older adults (28 women and 4 men) were included. Participants in this study did not receive any financial payments. Inclusion criteria were as follows: (i) be Brazilian, (ii) age ≥60 years old, and (iii) eligible to answer the questions. As an exclusion criterion, it was considered when the participant did not answer all the questions. The questions were open and structured, as follows: (a) “Could you tell me what your intention is to be vaccinated?;” (b)”Do you fully trust the vaccine or do you believe it may have side effects?;” (c) “How do you feel knowing that older people are more vulnerable to the virus than younger people?;” and (d) “How do you perceive the progress of the Brazilian national immunization plan against COVID-19?.” Telephone interviews vary from 44 to 60 min. A summary of the practical considerations applied before, during, and after the interviews is detailed in [Supplementary Appendix 1]. In addition, basic demographic information was collected, including sex, age, education, monthly income, and coronavirus infection.
[Table 1] presents the main characteristics of the participants. Out of the 32 included, 28 were women (69.2 ± 6.7 years old), and 4 were men (67.0 ± 9.0 years old). All participants have had almost the same level of education: In terms of education, 1 participant attended elementary school, another 16 attended high school, and 15 completed higher education. When asked about the economic situation, 7 responded that they received 1 monthly minimum wage (SM), 16 between 2 and 3 SM, 4 between 4 and 6 SM, and 4 more than 6 SM.
At the time of the interviews, none of the participants had received the COVID-19 vaccine.
Ethical considerations
This study is part of a broad project that aims at longitudinally assessing intergenerational issues and the perception of the quality of life of older citizens. The procedures were approved by the Research Ethics Committee of the Federal University of Vale do São Francisco, Brazil (protocol No. 1,149,117). Before the interview, each participant was informed of the study procedures. After the participation agreement, a written consent form was obtained.
Qualitative data analysis
The testimonies were evaluated by three researchers. We developed a reflective thematic analysis, this method allows us to obtain meaning patterns that cannot be readily mapped from the interview questions.[27] This method is useful to identify key themes capable of describing a significant amount of qualitative data, showing analogies and differences between respondents' experiences.[28] To ensure the accuracy and reliability of the data, the methodology followed clear procedures [Supplementary Appendix 2].
Rigor and data reliability
Reliability and agreement between coders is an important factor in the development of qualitative data coding schemes.[29] To preserve data quality: (1) two reviewers systematically analyzed the content (MN, AN), discrepancies and doubts between codes were resolved between these two reviewers; (2) data coding was performed on two subsets of transcripts, after which the codes were compared and corrected until the two coders reached a minimum agreement of 80%; (3) cases of disagreement between the two raters were determined by a third reviewer (LJ);[30] (4) to achieve acceptable levels of reliability, the coding process followed the steps [Supplementary Appendix 2], including text segmentation, thematic map creation, coding, theme creation, reliability assessment, theme modification map, and the final coding [Table 2]. The last two steps were performed several times by two team members (MN, AN).[29]
| Results | | |
Three main themes emerged: “Intention to receive the vaccine,” “Coronavirus, aging, vulnerability,” and “COVID's national immunization plan.” From this, seven subthemes (first order) and three subthemes (second order) were derived [Table 2]. The interviewees' testimonies will be presented according themes generated by the thematic analysis [Table 1].
During the presentation of the results, the 32 participants will be identified in parentheses according to the code system created for each individual [Table 1], including their age.
Theme 1: Intention to receive the vaccine
Subtheme 1: Vaccination acceptance
The analysis of the speeches showed that 87.5% (28/32) of the interviewees expressed an interest in receiving the vaccine. According to the speeches, the main justifications were to believe in efficacy, increased chances of cure, and the possibility of a quick return to life/normal world as before: “Yes, I can't wait to get the vaccine and put an end to all the stress the virus is causing in our lives.” (F2, aged 80). During the period in which the interviews were conducted, none of the participants had received the vaccine. Until then, there was a great deal about its effectiveness, including rumors of being more lethal than the coronavirus.
In Brazil, during many months of the pandemic a series of false information was released on social networks, causing misunderstanding and fear of receiving the vaccine, especially among older adults:
“I confess that I get confused because there is a lot of information on WhatsApp that makes us afraid. However, I do not believe that the vaccine can kill so many people and as fast as the virus is killing (F5, aged 63).
Subtheme 2: Vaccination hesitation
Not getting vaccinated is a decision associated with distrust of the vaccine's efficacy, reinforced by false information transmitted mainly on social networks: “I receive information daily in the WhatsApp groups, so I compare the information and realize that the vaccine is unreliable.” (F26, aged 67). The fear of receiving the Brazilian CoronaVac vaccine was not new. Years ago, many Brazilians reacted against the H1N1 flu vaccine: “I had the Influenza vaccine (H1N1) and also others. But I did it because they were produced calmly and safely.” (F8, aged 79).
Subtheme 1.2.1: Early treatment
Since 2020, the Ministry of Health of Brazil has supported the use of prophylactic medication to prevent infections caused by COVID-19: A strategy to prevent and/or reduce intensive care unit admissions and deaths. Among those interviewed, 9.0% (3/32) said they used chloroquine or hydroxychloroquine, which are originally drugs used in the prophylaxis of malaria and diseases such as lupus and rheumatoid arthritis. Another drug advised was azithromycin (antibiotic to treat bacterial infections), and ivermectin (therapeutic drug for parasite infestations):
“Ivermectin was recommended by President Bolsonaro. So, I don't plan to get vaccinated until the labs take responsibility for possible damage. Ivermectin works for me as a vaccine.” (F4, aged 61)
Theme 2: Coronavirus, aging, vulnerability
Subtheme 2.1: Being older adult is not simple
In addition to forcing everyone to comply with isolation restrictions, the pandemic generated high levels of concern and anxiety in the older population for belonging to the risk group: “I live with intense uncertainty about how to behave indoors and outdoors because of this virus, because it is a danger to us older adults.” (F24, aged 72). According to depointes, a vulnerable point strongly perceived during the pandemic was health itself:
“I look forward to receiving the vaccine with extreme anxiety. Being an older adult, right now, is not simple! I know the situation is bad for everyone, but for us it's even worse.” (F21, aged 75).
Subtheme 2.2: My vulnerability to coronavirus
Respondents reported feeling profound changes in their physical and mental health, attributing the deficits not only to the time of confinement but also to a new way of aging:
“Right now, being an older adult is life-threatening. In my case, the coronavirus can be lethal, two years ago I had a stroke, and after that, I had serious health complications. If I get infected, I have a high chance of death. That scares me!” (F8, aged 79)
Theme 3: COVID's national immunization plan
Subtheme 3.1: Immunization plan
“Brazil is at a standstill, our President does not believe in the effectiveness of the vaccine. He speaks ill of the vaccine produced in São Paulo: He is a denialist!”.(F16, aged 71)
The term denial was widely used to characterize people's refusal to face the facts, even if there is scientific evidence.[31] The fact occurred why the government refused to recognize the lethality of the virus, as well as the funeral collapse that took place in the city of Manaus, in April 2020:[31] “The government's negative stance on the pandemic has existed since 2020. There has never been a serious plan to fight COVID-19.” (M29, aged 66).
Subtheme 3.2: Vaccine and the end of COVID-19
When asked if the vaccine would be able to eradicate COVID-19, respondents were unanimous in saying no: “Based on human history, the virus will not disappear. The vaccine will control the situation. We will have to learn to live with the virus.” (M30, aged 60). Some reports associate COVID-19 with other diseases known to Brazilians: “COVID-19 will be like Dengue and Chikungunya. Here on my street, there is always someone with Dengue. (F13, aged 78).
Subtheme 3.3: What will happen after the vaccine
This sub-theme presents two important reflections of the study participants, which are their future visions for their own lives and the progress of the world after the arrival of the vaccine, and an eventual reduction in cases of COVID-19.
Subtheme 3.3.1: My life postvaccine
Although everyone receives the vaccine, respondents were unanimous that some habits will remain: “I know that even vaccinated I will have to continue wearing a mask. But I have no problem with that.” (F1, aged 72). One participant showed her strong desire for life to return to normality: “I'm going to get vaccinated as soon as possible because I need my routine, I want to go on a trip, visit my son and meet my grandson.” (F3, aged 64).
Subtheme 3.3.2: The world postvaccine
Although the vast majority of respondents indicated acceptance of the vaccine, all, including those who did not express interest in receiving the vaccine, reported a pessimistic position on the future of the world: “The world will continue as it has always been and maybe it will get worse because we have already had several pandemics: People's behavior has never changed.” (F28, aged 72).
| Discussion | | |
This qualitative study investigated the intention of 32 older adult Brazilians to receive the vaccine against COVID-19, sought to know their perception of fragility in the face of the virus, as well as to investigate their opinion on the progress of the national immunization plan. Our findings showed that 87.5% of respondents expressed an intention to receive the COVID-19 vaccine. Of those, only 6% expressed concern about the vaccine's effectiveness, although they wished to receive the doses. A total hesitation to be immunized was indicated by four people. The reasons were the distrust in the effectiveness of the vaccine due to the short period of its production, which generated distrust about its reliability.
According to respondents, the speed of production of the vaccine could lead to side effects. This result corroborates current studies conducted with older adults in different countries.[19],[20],[23],[32],[33] Evidence has shown that vaccine refusal is independent of age group, a study carried out in England with emigrants of different ethnicities (aged 25–54) also revealed the rapid production time of the drug as a reason for refusal for COVID-19 vaccination.[23] Thus, the success of a vaccination campaign does not depend exclusively on the safety related to the vaccine's efficacy,[34] the process also requires strategies that consider cultural and social aspects of each population.[35]
Another essential measure for vaccine acceptance is adequate and up-to-date information dissemination to avoid suspicion and consequently, hesitation.[36] In February 2020, the World Health Organization[9] reported that the COVID-19 outbreak was accompanied by a large amount of false information: An infodemic outbreak. During the study period, Brazil had 251,498 deaths from COVID-19, and none of the respondents had received the vaccine. Thus, most interviewees showed extreme concern about their body's fragility to resist a coronavirus infection, recognizing the vaccine as the only solution. Regarding the end of the epidemic, after everyone received the vaccine, the general opinion was that this would not happen. Therefore, the world will have to learn to live with the coronavirus.[37] The fact comes from the genetic transformations that SARS-CoV2 presents.[38] Older adult Brazilians revealed to be used to endemic diseases in their neighborhoods (Dengue and Chikungunya). However, COVID-19 was something never seen before.
Our findings showed that, if, on the one hand, there was great interest among respondents in accepting the vaccine, on the other hand, the Brazilian government did not offer enough doses to immunize. All respondents were unanimous that the process was taking place slowly, in many cities, there were no vaccines. The fact was attributed to the Brazilian government, which hesitated to buy vaccines from laboratories at the end of 2020.[16] Thus, the contradictory institutional context that Brazil lived delayed the fight against the coronavirus.[39] Although the scientific community and WHO reported on the lethality of COVID-19, for a long time, the Brazilian government took a lethargic and negative stance towards the vaccine and the use of a mask.[16] For this reason, COVID-19's risk management was inefficient.
In Brazil, denial of the pandemic influenced the behavior of a large part of the population, who felt safe, and thus ignored the virus prevention guidelines.[11] An example of the Brazilian government's denial of COVID-19 was the wide dissemination of early treatment and incentives for the production and consumption of hydroxychloroquine, which started to be distributed free of charge at public health posts. However, physicians were free to indicate or not early treatment.[17] An interesting finding was that even older adults who used ivermectin were confused about the real effect of this drug, which at the time had no scientific evidence for the treatment of coronavirus.[40],[41] Thus, an explanation for the adoption of early treatment among the interviewees was not the effectiveness of this drug, but the dissemination of false news about the vaccine, and the uncertainty about when they would be vaccinated.
Thus, an explanation for the adoption of early treatment among respondents was not the effectiveness of this drug, but the spread of false news about the vaccine and the uncertainty about when they would be vaccinated. In fact, this had negative implications for the acceptance of the vaccine against COVID-19, both misinformation and the circulation of false information presented themselves as barriers to health promotion and preservation of lives. Therefore, it is important that decision-makers understand the dangers of disinformation and the need to combat them. This strategy is capable of saving lives.
Limitations
This study has certain limitations. First, the sample size of 32 participants was relatively small; therefore, it is not representative for the older population, both in the place where this study was carried out, and for the older population in Brazil. Furthermore, the number of men and women was not proportional. Indeed, it was not possible to offer a rich description of the older men's perspectives. Second, determinants of vaccine hesitation vary across regions, age groups, gender, and cultural and social aspects.[6],[35] Third, our results do not serve as a predictor of immunization uptake rates for COVID-19 because they detail perceptions from a strictly time-frame. On the other hand, the findings may contribute to the understanding of the behavior of older Brazilians in relation to the coronavirus, highlighting their concerns and life perspectives in the most critical period of the pandemic.
| Conclusion | | |
The results attested that the vast majority of respondents indicated an intention to receive the vaccine, although some have expressed doubts about its effectiveness. Among the concerns about the vaccine, there were issues related to production time. Regarding the challenges created by COVID-19 to the older population, the interviewees were unanimous that the situation imposed by the virus on their lives was a challenge never experienced. The general opinion about the national immunization plan was dissatisfaction with the attitudes of those responsible for the process. Finally, older Brazilian adults agreed that after the coronavirus their lives and the world will no longer be as they were before.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2]
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