What fuels flu, pneumococcal vaccine hesitancy in SG?

In Singapore, influenza and pneumococcal vaccination coverage remains stubbornly low. Results of two separate analysis of a cross-sectional survey shed light on this concerning trend, highlighting the roles of vaccine knowledge and attitude, healthcare professionals, and social support in influencing vaccination decisions.

A total of 153 high-risk individuals, including those 65 years of age or older and those with chronic conditions, were recruited for the cross-sectional survey. Most were of Chinese ethnicity and of older age, and 79 percent had at least a secondary education. All of them were invited to complete two locally validated questionnaires that assessed knowledge, attitudes, and hesitancy toward flu and pneumococcal vaccination. The response rate was high at 88.9 percent. [Goh LJ, et al, WONCA 2024]

Misconceptions about influenza, pneumonia

In the first analysis, vaccine hesitancy in high-risk groups appeared to be influenced by a combination of factors, including misconceptions about flu and pneumonia, limited knowledge about vaccination benefits, and fear of injections.

More than half of the respondents incorrectly believed that flu was the same as the common cold. Only 32.7 percent perceived themselves at risk of flu and pneumonia, while a mere 7.2 percent understood that vaccines worked as a preventive measure. A vast majority (77.8 percent) of respondents perceived themselves to be in good health and saw no need to be vaccinated. Meanwhile, 73 percent expressed a fear of injections.

Greater vaccine knowledge had a strong positive correlation with more favourable attitudes towards vaccination (p<0.001), both of which were, in turn, associated with lower vaccine hesitancy (p<0.001 for both).

“Improving knowledge about vaccines and fostering positive attitudes can contribute to a decrease in vaccine hesitancy,” and subsequently increase flu and pneumococcal vaccination rates in high-risk groups in Singapore, according to first author Ling Jia Goh from the National Healthcare Group Polyclinics, Singapore.

“Further research should explore optimal strategies to enhance vaccination knowledge and promote positive attitudes,” Goh said.

Healthcare workers as key influencers

In a separate analysis, healthcare workers were shown to be instrumental in encouraging vaccination and providing information.

Responses from the same cross-sectional survey showed that coverage for flu and pneumococcal vaccines was low (below 50 percent) despite the high levels of vaccine awareness (70 percent for flu and 50 percent for pneumococcal vaccines).

A substantial number of respondents cited that healthcare workers played a crucial role in their decision to be vaccinated. More specifically, 43.1 percent and 50 percent of respondents said that they received encouragement from healthcare workers to get flu and pneumococcal vaccinations, while 54.2 percent and 50 percent said that they received education about flu and pneumococcal vaccines, respectively.

The respondents mentioned that individual initiative and support from family and friends also factored into their decision to be vaccinated. Conversely, traditional media and the internet had minimal impact.

These findings suggest that healthcare workers play an important role in both vaccination uptake and information dissemination, according to Goh, suggesting that healthcare workers should underscore the importance of opportunistic vaccinations when educating patients.

Also, since media and the internet had limited impact, Goh called for alternative communication strategies to reach vaccine-hesitant populations.

The authors believe that the data from their cross-sectional survey could aid in developing effective interventions to increase flu and pneumococcal vaccine uptake in Singapore, which stood at 32.4 percent and 22.4 percent in 2021, according to data from the Ministry of Health. [https://www.moh.gov.sg/news-highlights/details/national-population-health-survey-2021-highlights-need-to-focus-on-preventive-health]