COVID-19 Vaccine Acceptance Survey in Indonesia

"Several actions are needed to be carried out urgently, such as providing information about COVID-19 vaccine safety and efficacy to the general public using clear, tailored communication approaches and channels."

The Government of Indonesia (GOI) has made various efforts in the wake of the COVID-19 pandemic, including developing a COVID-19 vaccine deployment plan. As part of this work, the Ministry of Health (MoH) and National Immunization Technical Advisory Group (NITAG), with support from United Nations Children's Fund (UNICEF) and the World Health Organization (WHO), conducted an online survey to understand the public's views, perceptions, and concerns about COVID-19 vaccination. This report from UNICEF shares the results and makes several communication-centred recommendations.

More than 115,000 respondents from all 34 provinces and 508 of 514 districts completed the online survey, which took place from September 19 to 30 2020.

Three-quarters of the respondents said they had heard about the COVID-19 vaccine, with respondents with low income levels reporting the lowest levels of knowledge. Approximately 65% expressed their willingness to accept COVID-19 vaccination if provided by the GOI, with acceptance levels varying by province, economic status, religious beliefs, health insurance status, and educational status. About 30% of respondents reported they or their close contacts such as family members, friends or neighbours had contracted COVID-19 infection; these respondents were found to be more willing to accept a vaccine. Throughout the country, respondents who were better informed about the vaccine were more likely to accept it.

Approximately 79% of respondents wanted more information about potential COVID-19 vaccines, with the demand reported to be highest (95%) among respondents aged more than 65 years. However, reluctance and hesitancy to seek more information was highest (11%) among the younger age group of 18- to 25-year-olds. Overall, more than 27% of respondents expressed hesitation towards the GOI's intention to distribute COVID-19 vaccines; per UNICEF, this group is critical for a successful vaccination programme.

Health professionals and health workers were considered the most trustworthy (57%) in guiding hesitant respondents in deciding whether to accept a COVID-19 vaccine. Family members were the second choice for respondents who would like to consult others. However, respondents also wanted to get more information about a vaccine's safety and efficacy through academics and scientists, medical journals and articles, social media and the internet, traditional healers, and volunteers who have received a COVID-19 vaccine as part of a clinical trial.

Approximately 54% of respondents preferred social media - such as WhatsApp, Facebook, Instagram, and Twitter - to access more information about COVID-19 vaccines, followed by print and mass media such as television and newspapers. About 13% wanted to receive information through telecommunication channels such as SMS and phone calls. The preference for electronic and print media increased progressively by the age of the respondents. Social media was the most preferred channel of information (57%) among the respondents with poor economic status.

Approximately 8% said they would not take the vaccine. The most common reasons for not accepting it were concerns about vaccine safety (30%), uncertainty about its effectiveness (22%), lack of trust towards the vaccine (13%), fear of side effects such as fever and pain (12%), and religious beliefs - e.g., concerns about the haram-halal category of the vaccine (8%). Those who were afraid of needles and those who had previously experienced side effects following immunisation also expressed hesitancy. Several respondents questioned the vaccine clinical trial process.

Many respondents neither believed in the existence of COVID-19 (SARS-CoV-2) nor its transmissibility and the vulnerability of the public. Several respondents claimed the pandemic was a product of propaganda, conspiracies, hoaxes, and/or an intentional attempt to spread fear through the media for profit.

People's perceptions towards health and disease prevention also played a role, with many considering spirituality as a way to maintain health and deal with disease. Other contextual factors, such as perceptions of pharmaceutical companies and socio-cultural-economic conditions, were also crucial for vaccine acceptance. Those who reported having been diligently following the "3M" advice [("menggunakan masker" (mask-wearing), "mencuci tangan" (hand-washing), and "menjaga jarak" (social-distancing)] saw the benefits of this approach and questioned the risk-to-benefit of adding a vaccine.

Many stated they would welcome a vaccine if Indonesia produces it. Respondents also expressed their wish to see political leaders set an example, such as by being the first people to receive a vaccine before mass deployment. Relatedly, key recommendations for increasing vaccine acceptance include:

• Develop a communications strategy that considers the diverse information needs of the audience before, during, and after vaccine introduction, especially those relating to the benefits of vaccine, safety, efficacy, and equity issues.
• Continue strong messaging and policy support provision for other COVID-19 mitigation measures such as 3M, and promote them as a new social norm.
• Localise COVID-19 vaccine preparedness efforts as much as possible, including tailoring risk communication and community engagement (RCCE) approaches.
• Include frontline health workers as the primary audience in communications planning, and build their capacity.
• Conduct more in-depth research to understand concerns and perceptions toward a COVID-19 vaccine and how misinformation, disinformation, or an "infodemic" may contribute to these concerns.
• Find ways to reach the people who have the least access to information, such as economically poor and vulnerable people.
• Include behavioural interventions in RCCE planning, not just communication messages:
  • Consider including environmental "nudges" to address issues related to concerns about cost, complacency (low-risk perception), and convenience; and
  • Consider building out user profiles of early groups to be reached with the vaccine in a human-centred design approach to ensure services provided are appropriate and acceptable to mitigate risk.
• Make confidence-building part of every public action related to COVID-19 vaccine development and rollout - for example, live-stream a plenary session of a national vaccine safety meeting.
• Speak with one consistent voice: choose a leading spokesperson.
• Plan for all contingencies, and create a robust vaccine-related events response plan that considers all possible scenarios and responses.
• Involve religious leaders, professional organisations, and civil society organisations.

UNICEF concludes that further studies and discussions about costs and payment-related issues are needed. It is also suggested that vaccine acceptance rate, willingness to pay, and access to services be considered during vaccine forecasting exercises.

Click here for the 26-page report in Bahasa Indonesia.