4.1. Key Findings
The COVID-19 pandemic has lasted longer than three years, rendering its prevention and control a complex global problem. VH is a major barrier for mass vaccination strategies [17]. It increases the difficulty of achieving herd immunity and negatively impacts the prevention and control of infectious diseases [18]. Therefore, reducing VH can build an immune barrier against SARA-COV-2 infections [3]. Many studies have reported an overall low level of VH in mainland China [2, 3, 16, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29]. However, our findings suggest that more than half (64.3%) of the Taiwanese adults are hesitant to use the COVID-19 vaccine. This percentage is higher than the results of a survey study on VH among Taiwanese adults from March-May 2021 (46.14%) [12].
Our study yielded several main findings. Gendergender differences emerged as an important factor in VH, whereby women were more hesitant to get vaccinated than men. This has been confirmed by several previous studies [30, 31, 32]. Additionally, adults who believe that vaccines are safer are more likely to receive them, a finding reflected in previous studies in Taiwan [11, 12]. This suggests that reducing women's hesitation and raising awareness of vaccine safety are important factors for increasing overall vaccination rates.
We also observed a large variation in the percentage of VH, ranging from 2.1–85.5% (Table 3). In a summary of VH surveys conducted among Chinese adults from 2020 to the present, we found that most adults living on the mainland had lower VH than those living in Hong Kong and Taiwan. This is a novel finding, and factors contributing to these regional differences between mainland China, Taiwan, and Hong Kong may be related to educational attainment, media coverage, and place of residence. Additional potential factors need to be further investigated [33, 34]. We were also concerned to find that, in several surveys conducted at different times, the proportion of VH among adults living in Hong Kong was high (up to 85.5%) [9, 35, 36, 37, 38]. their confidence in vaccines and trust in the government appeared to be the main factors influencing the high rate of VH.
However, a recent longitudinal study in Hong Kong reported that VH decreased from 62.8–30.7%. Factors contributing to the decline in hesitation were changes at the individual level in terms of trust in the authorities, information consumption, and risk perception of both COVID-19 and the vaccine[9]. China reportedly has higher VH than Taiwan and Hong Kong. There are many similarities between the latter two regions, such as management style, political parties, and level of education. Thus, we could learn from Hong Kong's experience of reducing vaccine hesitation.
Our study provides profound insight into VH among adults in Taiwan; it could be reduced by addressing women's fears of vaccination and disseminating reliable vaccine-related information. In turn, understanding those who are willing to be vaccinated and the factors that determine their willingness can also contribute to reducing VH. Other studies have found that it is important to leverage the role of social media in mitigating VH [39, 40] Therefore, public health authorities should use these findings to inform outbreak prevention and control measures. For example, it is recommended that appropriate incentives be developed to encourage professional organizations or personnel to publish frequent scientific information about COVID-19 vaccines. This move could raise awareness regarding vaccines.
This study has several limitations. First, it was a cross-sectional study, which can only reflect people’s attitudes at a specific point in time. Conversely, many studies have indicated that the public’s hesitancy towards receiving vaccinations changes at different stages of a pandemic [35, 41, 42]. The factors that influence VH can change and thus studying the dynamic changes in the public’s VH is important. Second, the sample for our study may not be representative; there is a selection bias since our sample consisted mostly of urban residents, and households with high education levels and stable economic resources. This will be addressed through follow-up studies with more representative sample sizes in the future. Finally, the attitudes of the participants were fluid and they may have changed their intentions quickly.