Study Shows How To Win Over Vaccine-Hesitant Malaysians

According to a vaccine attitude study on young adults in the Klang Valley, respondents want localised data on Covid-19 vaccine efficacy and official reports of vaccine side effects.

KUALA LUMPUR, August 5 — Young adults undecided about getting themselves and family members vaccinated against Covid-19 say they want more local information about vaccine effectiveness, safety, and side effects, a new Malaysian study showed.

Local researchers found that 25.5 per cent of 350 young adult respondents in the Klang Valley — aged between 18 and 30 — who are unwilling to be vaccinated, say they want hard facts showing clear results on the effects of vaccines before deciding to get inoculated.

Some worry about the potential side effects of the vaccine, especially against new and more infectious Covid-19 variants, and would rather wait to see a proven track record. Others, albeit a few, are broadly wary of all vaccines, citing concerns over acceptability in their religion. 

Wan Puspa Melati Wan Halim, a sociologist and senior lecturer from the School of Liberal Arts and Sciences at Taylor’s University, who co-authored a working paper on vaccine willingness among young adults, said many vaccine-hesitant respondents want plain evidence of vaccine success and would prefer not to take risks and serve as “test subjects”.

This is particularly prevalent among those with elderly parents, who said they were worried about health complications that may arise for those with a weaker immune system. One respondent even said: “I am not going to let my parents be a ‘tikus makmal’ (lab rat).”

“They want hard facts. The only way to persuade this group of people is to show more data on the effects of the vaccine,” Wan Puspa Melati told CodeBlue in a recent interview.

“If a person has a health complication, what does it mean? What type of health complications could put someone at a higher risk? By giving people details to help them understand why the vaccine is affecting certain groups over others, that would help them make informed decisions.”

Vaccine hesitancy in Malaysia is not an uncommon phenomenon and has been widely reported since the Covid-19 pandemic began — mostly stemming from personal testimonies, due to the lack of official data and verified accounts of those who had missed their appointments.

Malay-language daily Utusan Malaysia on May 27 reported that 52,771 people in seven states had missed their Covid-19 vaccine appointments, though experts have warned against using such figures as definitive indicators for vaccine hesitancy.

According to Wan Puspa Melati, the study’s open-ended questions revealed that those who are vaccine-hesitant simply do not register for Covid-19 vaccine appointments 

“They feel that, at this point, they are not going to take it. They are not registering for it and they feel it is their right to have a decision over their body. 

“What they would do instead is to adopt a wait-and-see approach by getting more data and seeing what happens to people who have taken the vaccine,” she said.

“Since they are opting not to get vaccinated at the moment, those who are vaccine-hesitant are engaging in self-monitoring and keeping themselves away from the public by staying at home.”

Trusted Sources And Influences

Tracking a total of 350 respondents, the study found that the majority, or 80 per cent, said their most trusted source of information on vaccines is the World Health Organization (WHO). 

This is followed by Malaysian health professionals at 70 per cent, news reports at 40 per cent, and social media at 17 per cent. Wan Puspa Melati said the findings suggest that the young adults surveyed are more swayed towards “hard facts” and “credible sources”.

“Generally speaking, most of them say they believe in science — if it’s not proven in the lab, it is not valid. This also suggests that conspiracy theories, rumours and uncited sources do not play that much of a role among vaccine-hesitant young adults,” she said.

Based on the responses, Wan Puspa Melati said health authorities should make data, such as localised vaccine efficacy rates against new Covid-19 variants and reports of side effects and relapse post-vaccination, more readily available to the public.

“Yes, we have vaccinated people. But out of this, how many people of them had headaches or other symptoms? They (authorities) may feel that the release of this kind of information may create nervousness among those who want to take it, but for the vaccine-hesitant group, they want to know what is going on, so they can go in prepared.

“If I know that, for example, 80 per cent of people (who get vaccinated) get headaches, I know when I take it, I can expect to get a headache, and I won’t be scared because this is common.

“If they (authorities) feel that releasing this information will cause fear, I think by withholding this kind of data, it will make people more hesitant,” Wan Puspa Melati said.

The government does not release public reports of adverse effects following immunisation (AEFI) with Covid-19 vaccines. Local real-world data on the efficacy rates of different shots used in Malaysia — Pfizer-BioNTech, AstraZeneca-Oxford, and Sinovac — have also not been published. 

Discussing the role of social media further, Wan Puspa Melati said vaccine-hesitant respondents scored higher when measuring the influence of online posts about loss of family members, side effects from Covid-19 vaccinations and deaths, as well as new Covid-19 variants.

“Those who are hesitant about vaccines are more susceptible to stories of Covid-19 vaccine side effects and deaths — and this goes back to the issue of trust. Those who are hesitant say the government has not convinced them enough that the vaccines are indeed safe,” she said.

Many studies have pointed to considerable evidence that trust and confidence in government authorities play a critical role in vaccine decision-making.

A 2021 peer-reviewed study published by Elsevier stipulated that lack of trust and confidence in government authorities increases the likelihood of vaccine hesitancy and refusal.

The study, which compared surveys across cities in the US, UK and Australia, found there is greater likelihood of willingness to receive the vaccine in Sydney and Melbourne in Australia where trust and confidence in government are higher than in New York or Phoenix in the US.

The authors of the study said this is unsurprising as public health measures such as wearing masks and getting vaccinated have been politicised in the US. “Willingness to receive the vaccine in the US appears to be related to one’s political affiliations,” they said.

Lives And Livelihoods

The survey conducted by Wan Puspa Melati’s team also found that more than 50 per cent of respondents who are unwilling to get vaccinated come from low-income households. 

In view of their duties as providers for their families, she said the risk of potential complications upon receiving Covid-19 vaccination means that the stakes are higher for those in lower-income households than those in higher-income groups.

“They may be influenced by family members (not to take the shot) to ensure they are healthy and well to support their families. Should there be any complication, the worry of financial burden or lack of assistance may be a further concern,” Wan Puspa Melati said.

The latest “Families on the Edge” report by the United Nations Children’s Fund (UNICEF) and United Nations Population Fund (UNFPA), in partnership with Malaysia-based public policy research outfit DM Analytics, found that over a third of Projek Perumahan Rakyat (PPR) folks living in public housing remain unwilling to be inoculated, despite being offered free vaccines.

The majority who do not want to take or are unsure of Covid-19 jabs said they were worried about the safety of the vaccines and their side effects.

“Failure to address vaccine hesitancy among low-income communities offers the concerning prospect of persistent pockets of vaccine transmission coinciding with pockets of poverty, with the two phenomena potentially reinforcing one another,” the UN agencies said.

Will Vaccine Hesitancy Impede The National Target?

As of August 2, a total of 20,946,912 people, or 83.3 per cent, of Malaysia’s adult population have registered for vaccination. A total of 14.47 million people, or 61.8 per cent of the country’s adult population, have received at least one dose as of August 2, including 7,197,861 people or 30.7 per cent fully inoculated with double doses.

The government has set a target of fully vaccinating 40 per cent of the adult population in all states by Merdeka on August 31, as part of efforts to minimise the time difference taken for each state to transition between phases under the National Recovery Plan (NRP).

While data from the study suggests that more than 25 per cent of respondents may not be willing to receive a Covid-19 vaccine, Wan Puspa Melati said they were not explicitly anti-vaccination and may become more willing to get vaccinated over time.

“I personally feel that these vaccine-hesitant individuals will not impede the rollout process. Based on the sample that we have, it is only 25 per cent of the young adult population in the Klang Valley, so it is not a big population that is hesitant at this point. 

“I feel that there are a lot more people who are willing to take the vaccine and have not received their vaccination appointments. There are still a lot of people who will try hard to ensure they get their shots in the next couple of months.

“That means people who are hesitant will have additional time to see what happens to those who have been vaccinated. By then, we will also have more data from researchers and experts in the field to reveal how effective the vaccines are,” she said.

“Over time, I am confident with more data and information made available, these individuals will be persuaded to get their vaccines.”

Note: The study paper’s other co-authors are Affezah Ali from the Faculty of Education and Social Sciences, University Selangor (UNISEL); and Ng Miew Luan from the Faculty of Social Sciences, School of Communication at Quest International University.

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