Page 145 - GHES-3-2

Global Health Economics and
Sustainability
Vaccine hesitancy in the US, India, and China

acceptance rates among adults were reported in Ecuador been relatively high rates of anxiety symptoms (6.3% –
(97.0%), Malaysia (94.3%), Indonesia (93.3%), and China 50.9%), depression (14.6% – 48.3%), post-traumatic stress
(91.3%). In contrast, the lowest COVID-19 vaccine disorder (7.0% – 53.8%), psychological distress (34.4% –
acceptance rates were observed in Kuwait (23.6%), Jordan 38.0%), and stress (8.1% – 81.9%) among the population
(28.4%), Italy (53.7%), Russia (54.9%), Poland (56.3%), the of China, Spain, Italy, Iran, the US, Turkey, Nepal, and
US (56.9%), and France (58.9%). Lin et al. (2020) reported Denmark (Xiong et al., 2020). Other studies also found
similar findings for China, with vaccine acceptance rates high rates of negative MH outcomes in the Italian general
ranging from 88.6 to 91.3%, and found 79.8% acceptance population within 3 weeks of lockdown (Rossi et al., 2020).
in South Korea. Other highly receptive countries included Studies have also shown a positive association between the
Brazil (85.4%), South Africa (81.6%), Denmark (80.0%), probability of contracting COVID-19 and anxiety within
and the UK (79.0%). the younger age group, while older individuals were better
Sallam et al. (2022) updated their previous vaccine in this perspective and did not show concerns regarding
acceptance rates based on the regional classification of MH (Smith et al., 2021). Experts have pointed out the need
the Joint Nations Program on HIV/AIDS (UNAIDS) for attention to COVID-19-related impacts on MH, stress,
(Tables S1 and S2; survey date varied from May 2020 anxiety, and human psychology. Providing psychological
to June 2021). Within the South Asian region, vaccine first aid is an essential care component for populations
acceptance data from lower-middle-income countries that have been victims of emergencies and disasters before,
(LMIC) were available: Bangladesh (61%), Afghanistan during, and after the event (Talevi et al., 2020).
(63%), Pakistan (72%), India (79%), and Nepal (97%). Another study conducted in China found that the high
Southeast Asian countries with LMIC were Lao People’s prevalence of MH problems was positively associated with
Democratic Republic (62%), Philippines (63%), Indonesia frequent social media exposure during the COVID-19
(65%), Timor-Leste (66%), Myanmar (86%), and Vietnam outbreak, highlighting a need for further attention from
(97%). The figures in parentheses indicate the vaccine health and government officials (Gao et al., 2020). Anxiety
acceptance rate. levels increased from 18.1% before the pandemic to 25.3%
We also examined the vaccine acceptance rates in the within 4 months after its onset, while the prevalence of
Association of Southeast Asian Nations countries. These moderate to severe depression increased from 21.5% to
countries are: (i) Brunei, (ii) Cambodia, (iii) Indonesia 31.7%. In a 2023 study by Xiao et al. in China, the cognitive
(65%), (iv) Lao PDR (62%), (v) Malaysia, (vi) Myanmar theory of stress was used to assess the effects of information
(86%), (vii) the Philippines (63%), (viii) Singapore, quality and media richness on social media fatigue amid
(ix) Thailand, and (x) Vietnam (97%). Note that Brunei the disruptions caused by the COVID-19 pandemic. The
and Singapore are high-income countries, while Malaysia authors concluded that high-quality information reduces
and Thailand are both upper-middle-income countries. the likelihood of social media fatigue, while richer media
No vaccine acceptance data were available for Cambodia content may lead to increased fatigue among recipients.
(Sallam et al., 2022). This social media fatigue could subsequently contribute to
MH issues (Xiao et al., 2023). In addition, a 2022 study by
We analyzed vaccine acceptance data from the original
five BRICS countries: Brazil (83%), Russia (30%), India Jia et al. measured information overload among individuals
in the US (n = 493) and China (n = 571). The authors
(79%), China (82%), and South Africa (76%), as well as concluded that Chinese participants had significantly
the newly added BRICS countries in 2024: Egypt (25%), lower levels of information overload compared to their US
Iran (62%), and the United Arab Emirates (60%). Based on participants (p < 0.001) (Jia et al., 2022).
World Bank data, India is the only BRICS country classified
as a LMIC. A recent study by Lazarus et al. (2023), which Based on our literature review on vaccine hesitancy,
surveyed 23,000 respondents across 23 countries from we recognized the value of comparing the three largest
June 29 to July 10, 2022, found that willingness to accept countries by population, as direct vaccine hesitancy
vaccination was 79.1%, representing an increase of 5.2% comparisons among these three nations had not been
from June 2021. However, vaccine acceptance decreased previously conducted. Our motivation also stemmed from
in eight of the surveyed countries. In addition, Yanto the desire to include a representative country from each
et al. (2022) found a vaccination acceptance rate of 71% in income category: the US as a high-income country, China
Southeast Asian countries during the 2020 – 2021 period as a middle-income country, and India as a low-income
(Table S1). country.
A recent systematic review on the impact on mental Our objective was to estimate the COVID-19 vaccine
health (MH) during COVID-19 reported that there have hesitancy rate using the US Census Bureau’s Household

Volume 3 Issue 2 (2025) 137 https://doi.org/10.36922/ghes.2958