Page 160 - GHES-3-2

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

and the other from the US Census Bureau. Our analysis The cross-sectional survey through the ICPSR database
identified some new vaccine hesitancy subgroups across provided insights into vaccine hesitancy on a global scale,
different regions of the world for low-, middle-, and high- comparing acceptance rates across different cultures
income countries (Table S1). For the US, India, and China, and examining how regional demographics may affect
we have tabulated the reasons for vaccine hesitancy in detail hesitancy. Each country-related data can be analyzed
(Table S2) for future investigators. Our results indicate to determine the hesitancy rates and determine the
that rural participants are approximately three and a half lowest range of acceptance rates, thereby gaining a better
times more hesitant compared to urban participants. This understanding of the reasons behind the low acceptance.
subgroup should be analyzed in future studies to replicate However, it is important to note that selection bias may
the effect. occur in cross-sectional surveys, as study participants
could be different from eligible participants who are not
5.2. Limitations included. The HPS data provides a large US national
We acknowledge the limitations of our research. First, we sample, incorporating multiple variables that enhance
used raw survey data from the HPS survey without applying insight. By utilizing these two datasets, researchers can
population weights, which may have led to potential biases conduct in-depth analyses of major factors, such as
and may not be the true representation of the population. demographics, region, and MH status, all of which are
Therefore, the results should be interpreted with caution associated with vaccination hesitancy. These findings can
when guiding policies and making further inferences. inform more effective management strategies to tackle
Second, we could have further explored penalized future pandemics across the globe.
methods such as LASSO, elastic-net, and shrinkage prior Based on the results of this study, vaccine campaign
methods to gain a better understanding of the prediction health planners should closely consider the availability
and estimation algorithms. This will be investigated in
future studies. Third, k-fold cross validations could have of MH services in the community, as well as the stress
been used in the prediction process to further assess and factors influencing vaccine acceptance, including
individuals’ anxiety levels, concerns about vaccination,
improve the results. Finally, our data were collected in and interest in receiving the vaccine (Figures 4B and 8B).
2021, a period during which techniques were continually
evolving. COVID-19 was associated with approximately In addition, visual, mobility, and memory impairments
460,000 deaths in the US during January – December 2021, are also significant contributors to vaccine acceptance.
as per the CDC website (https://www.cdc.gov/mmwr/ Our findings suggest that factors such as education,
volumes/71/wr/mm7117e1.htm). COVID-19, listed as the marital status, income, and race must also be addressed
underlying cause of 415,399 deaths in 2021, ranked as the in vaccination campaign planning. We recommend a
third leading underlying cause of death after heart disease survey questionnaire to be administered at the beginning
(693,021 deaths) and cancer (604,553 deaths) (Figure 9) of a vaccine campaign, including all these critical factors,
(Ahmad et al., 2022). In addition, based on the Advisory which have been shown to significantly impact vaccine
Committee on Immunization Practice recommendation acceptance. In addition, questions relevant to the
from February 28, 2024, all individuals aged 65 or greater community and at the time of the campaign should also
should receive one additional dose of any updated be incorporated to have a successful vaccine campaign.
COVID-19 vaccine (Nwachukwu et al., 2024). It is also We also suggest that planners should develop a country-
important to note that our data lacks information on rural specific questionnaire. Vaccine hesitancy is an ongoing
populations. Future studies should focus on individuals issue and should be addressed at the World Health
with mental disorders, anxiety disorders, substance- Organization level. The World Health Organization should
related disorders, schizophrenia, and other comorbidities form a central committee and regional committees based
(Kafadar et al., 2022). on the regions mentioned in the paper. These committees
should only focus on the factors related to the acceptance
6. Conclusion of vaccines, especially COVID-19 since the mandate of
SAGE is much broader.
The ICPSR data analysis provides an overview of vaccine
hesitancy on an international level and offers guidance Acknowledgment
for health policymakers and governments regarding
the number of unvaccinated individuals in the world. None.
This information is crucial for informing the necessary Funding
preparations to address the significant challenge of
COVID-19. None.

Volume 3 Issue 2 (2025) 152 https://doi.org/10.36922/ghes.2958