Page 159 - GHES-3-2

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

significant effects in India. The personality trait appears to (i) contextual, (ii) individual and group, (iii) vaccine-
play a bigger role in vaccine hesitancy in India (Jennings specific, and (iv) disease-specific. Contextual factors were
et al., 2023). A meta-analysis of 60 articles published on sex, age, ethnicity, education, and income. Individual and
the Indian population by Dey et al. (2023) identified three group factors were: (i) information sources; (ii) trust; and
major factors for vaccine hesitancy: Side effects 93.7%), (iii) personal experiences. Vaccine-specific determinants
concern regarding efficacy (30%), and safety (30%). In were: (i) vaccine safety and effectiveness; (ii) perceived
addition, low-income groups in India and China were also vaccine barriers; (iii) concern over the rapid development;
more hesitant to take the vaccine. The Northern region in and (iv) inadequate knowledge status of COVID-19
China demonstrated to be vaccine-hesitant in our sample. vaccines. Finally, disease-specific factors included
By comparing vaccine hesitancy data from the US to India knowledge and perceptions of COVID-19 vaccines.
and China, we see that there are some common factors that Other factors included planning a family or currently
contribute to vaccine hesitancy. In all three countries, low pregnant or breastfeeding, consistent anti-vaccine status,
income and a rural geographic area are associated with previous negative experiences, religious restrictions,
increased vaccine hesitancy. racial discrimination, or believing in conspiracy (Kafadar
et al., 2022). A 2024 umbrella review of 78 meta-analyses
A 2021 questionnaire by Khubchandani et al. (2021) published between 2021 and 2023 put a hesitancy rate
found that those living in rural areas, having lower incomes, of 32% (95% CI: 25 – 39%) in the general population
and having lower levels of education were more likely (Rohbeni et al., 2024). In their study, the lowest hesitancy
to be vaccine-hesitant. These results are in concordance rate of 13% was among healthcare workers to 48% among
with our findings. Khubchandani et al. (2021) reported pregnant and breast-feeding women (Rabbani et al.,
that approximately 22% of respondents were hesitant to 2024), followed by speed of vaccine development and
receive the vaccine, while our data shows that 61% of the safety concerns (19.4%), followed by trust and confidence
respondents of the HPS survey were hesitant to receive the (13.2%) (Nwachukwu et al., 2024).
vaccine. Most of the respondents to the HPS survey data
used were able-bodied, white, female, having high income, Trogen & Pirofski (2021) posit that overcoming vaccine
and living in the West or South. hesitancy will require a proactive approach. In addition
to identifying sociodemographic characteristics relating
Pourrazavi et al. (2023) conducted a systematic review to being vaccine-hesitant, as we have done in this study,
of 91 studies to investigate cognitive determinants of the reason behind vaccine hesitancy must be investigated
vaccine hesitancy across several countries. Of these 91 further and also addressed. Assessing vaccine hesitancy is
studies, 14 were of US participants, two studies from India, complex. It is possible that factors at play in larger countries
and eight studies from China. Concerns about efficacy, may be different from those in smaller countries. Out of
safety, and side effects of the COVID-19 vaccine were the 98 countries for which vaccine hesitancy data were
common across studies and across three countries. In available, 27/98 (28%) had a vaccine acceptance rate of
addition, lack of trust in government was also a common <50%. It is of interest to note that out of twenty-two South
theme across countries. Other US participants’ responses Asian and Southeast Asian countries, only Hong Kong had
can be categorized as: anti-vaccine attitude, not worried less than a 50% acceptance rate. Based on the results from
about getting the COVID-19 vaccine, make me feel our study, public health officials and policymakers can
sick, other individuals may need more than I, vaccine- target educational and policy interventions to the more
causing relapse of Multiple Sclerosis, and concern about hesitant groups to alleviate the reasons behind the vaccine
the ingredients in the vaccine. In India, it was the lack of hesitancy and encourage vaccine uptake.
enough information and the question of whether they are Several other variable selection methods, such as LASSO
eligible for vaccination, while on the other hand, in China, and Elastic-net were utilized, which did not produce any
conspiring beliefs, complacency, and psychological distress potential increase in the accuracy of the model. In the
were the responses in addition to what is indicated above. k-fold cross-validation, data are put in k bins. One bin is

An umbrella review, which is a systematic review of used as test data, and k-1 bins are used as training data. The
reviews, using the SAGE working group model, is quite process is continued repeatedly until all k-bins are used
revealing. However, one significant limitation is that many one-by-one as test data.
studies included in the umbrella review were conducted
before the launch of a COVID-19 vaccine (Kafadar 5.1. Strengths
et al., 2022). These authors identified 79 factors based The unique contribution of this study is the utilization of
on 31 studies out of a total of 3,392 studies identified. two robust datasets to study vaccine hesitancy: One cross-
Four categories of vaccine hesitancy were identified: sectional dataset from the University of Michigan, US,

Volume 3 Issue 2 (2025) 151 https://doi.org/10.36922/ghes.2958