Factors influencing COVID-19 vaccine acceptance and hesitancy among pharmacy students in Bangladesh: a cross-sectional study

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Mohabbot Hossen" }, { "@type": "Person", "name": "Mohitosh Biswas" }, { "@type": "Person", "name": "Ekramul Islam" }, { "@type": "Person", "name": "Md. Shah Azam" } ], "publisher": { "@type": "Organization", "name": "F1000Research", "logo": { "@type": "ImageObject", "url": "https://f1000research.com/img/AMP/F1000Research_image.png", "height": 480, "width": 60 } }, "image": { "@type": "ImageObject", "url": "https://f1000research.com/img/AMP/F1000Research_image.png", "height": 1200, "width": 150 }, "description": "Background: In the wake of COVID-19 prevention, a growing attention has been devoted to administering vaccines among various sub-group populations including community health care providers. As a community health worker pharmacists and pharmacy students played a crucial role in patient-centered services for managing COVID-19. Examining pharmacy students’ vaccine acceptance intent has great potential in understanding how pharmacists’ perception impacts community people. This study investigated COVID-19 vaccine acceptance among pharmacy students in Bangladesh and identified the potential factors associated with their vaccine acceptance and hesitancy. Methods: An anonymous questionnaire was deployed online using Google forms in English and conveniently sent to 1190 pharmacy students at different universities between 15th October 2021 and 15th December 2021. The convenience sampling consisted of 1034 student pharmacists (response rate 86.9%) who participated in this study. Binary logistic regressions and Chi-squared test were used for rationalizing the study objectives. Results: The pooled COVID-19 vaccine acceptance rate was 908 (87.8%; 95% CI 85.8─87.8) among student pharmacists while 29.6% (95% CI 25.4─33.9) admitted the willingness to pay (WTP) for a COVID-19 vaccine. Out of 12 vital predictive factors, “safety,” “efficacy,” and “trust” had the strongest significant and positive association with vaccine acceptance (p=0.000). The logistic analysis also revealed that “communication” and “information sufficiency” had a significant positive association with vaccine acceptance (p=0.035 and 0.038, respectively) among student pharmacists. Although the odds of accepting the COVID-19 vaccine were found to be 1.1; an insignificant association between gender and vaccine acceptance was observed in the Chi-squared test. Conclusions: The prevalence of COVID-19 vaccine apprehension will reduce if vaccine-related information becomes more publicly available. Ensuring easy access to scientific information with evidence-based and tailored communication would enhance vaccine acceptance among pharmacy students. Implementation of multidisciplinary educational intervention would support the health care students to achieve adequate knowledge on vaccination consequences." } { "@context": "http://schema.org", "@type": "BreadcrumbList", "itemListElement": [ { "@type": "ListItem", "position": "1", "item": { "@id": "https://f1000research.com/", "name": "Home" } }, { "@type": "ListItem", "position": "2", "item": { "@id": "https://f1000research.com/browse/articles", "name": "Browse" } }, { "@type": "ListItem", "position": "3", "item": { "@id": "https://f1000research.com/articles/11-1379", "name": "Factors influencing COVID-19 vaccine acceptance and hesitancy among..." } } ] } Home Browse Factors influencing COVID-19 vaccine acceptance and hesitancy among... ALL Metrics - Views Downloads Get PDF Get XML Cite How to cite this article Roy DN, Hossen MM, Biswas M et al. Factors influencing COVID-19 vaccine acceptance and hesitancy among pharmacy students in Bangladesh: a cross-sectional study [version 1; peer review: 1 approved with reservations] . F1000Research 2022, 11 :1379 ( https://doi.org/10.12688/f1000research.126560.1 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. Close Copy Citation Details Export Export Citation Sciwheel EndNote Ref. Manager Bibtex ProCite Sente EXPORT Select a format first Track Share ▬ ✚ Research Article Factors influencing COVID-19 vaccine acceptance and hesitancy among pharmacy students in Bangladesh: a cross-sectional study [version 1; peer review: 1 approved with reservations] Debendra Nath Roy https://orcid.org/0000-0001-8622-0108 1 , Md. Mohabbot Hossen https://orcid.org/0000-0002-3792-507X 2 , Mohitosh Biswas 3 , Ekramul Islam 3 , Md. Shah Azam 4 Debendra Nath Roy https://orcid.org/0000-0001-8622-0108 1 , Md. Mohabbot Hossen https://orcid.org/0000-0002-3792-507X 2 , [...] Mohitosh Biswas 3 , Ekramul Islam 3 , Md. Shah Azam 4 PUBLISHED 24 Nov 2022 Author details Author details 1 Pharmacy, Jashore University of Science and Technology, Jashore, Bangladesh 2 Pharmacy, Khulna University, Khulna, Bangladesh 3 Pharmacy, University of Rajshahi, Rajshahi, Bangladesh 4 Marketing, University of Rajshahi, Rajshahi, Bangladesh Debendra Nath Roy Roles: Conceptualization, Data Curation, Formal Analysis, Funding Acquisition, Methodology, Resources, Software, Writing – Original Draft Preparation, Writing – Review & Editing Md. Mohabbot Hossen Roles: Conceptualization, Data Curation, Formal Analysis, Resources, Software, Writing – Original Draft Preparation Mohitosh Biswas Roles: Data Curation, Investigation, Methodology, Project Administration, Supervision, Validation, Visualization, Writing – Review & Editing Ekramul Islam Roles: Data Curation, Investigation, Project Administration, Supervision, Validation, Visualization, Writing – Review & Editing Md. Shah Azam Roles: Conceptualization, Formal Analysis, Investigation, Methodology, Project Administration, Supervision, Validation, Visualization, Writing – Review & Editing OPEN PEER REVIEW DETAILS REVIEWER STATUS This article is included in the Emerging Diseases and Outbreaks gateway. Abstract Background: In the wake of COVID-19 prevention, a growing attention has been devoted to administering vaccines among various sub-group populations including community health care providers. As a community health worker pharmacists and pharmacy students played a crucial role in patient-centered services for managing COVID-19. Examining pharmacy students’ vaccine acceptance intent has great potential in understanding how pharmacists’ perception impacts community people. This study investigated COVID-19 vaccine acceptance among pharmacy students in Bangladesh and identified the potential factors associated with their vaccine acceptance and hesitancy. Methods: An anonymous questionnaire was deployed online using Google forms in English and conveniently sent to 1190 pharmacy students at different universities between 15th October 2021 and 15th December 2021. The convenience sampling consisted of 1034 student pharmacists (response rate 86.9%) who participated in this study. Binary logistic regressions and Chi-squared test were used for rationalizing the study objectives. Results: The pooled COVID-19 vaccine acceptance rate was 908 (87.8%; 95% CI 85.8─87.8) among student pharmacists while 29.6% (95% CI 25.4─33.9) admitted the willingness to pay (WTP) for a COVID-19 vaccine. Out of 12 vital predictive factors, “safety,” “efficacy,” and “trust” had the strongest significant and positive association with vaccine acceptance (p=0.000). The logistic analysis also revealed that “communication” and “information sufficiency” had a significant positive association with vaccine acceptance (p=0.035 and 0.038, respectively) among student pharmacists. Although the odds of accepting the COVID-19 vaccine were found to be 1.1; an insignificant association between gender and vaccine acceptance was observed in the Chi-squared test. Conclusions: The prevalence of COVID-19 vaccine apprehension will reduce if vaccine-related information becomes more publicly available. Ensuring easy access to scientific information with evidence-based and tailored communication would enhance vaccine acceptance among pharmacy students. Implementation of multidisciplinary educational intervention would support the health care students to achieve adequate knowledge on vaccination consequences. READ ALL READ LESS Keywords COVID-19; vaccine acceptance; hesitancy; pharmacy students; Bangladesh Corresponding Author(s) Debendra Nath Roy ( [email protected] ) Md. Shah Azam ( [email protected] ) Close Corresponding authors: Debendra Nath Roy, Md. Shah Azam Competing interests: No competing interests were disclosed. Grant information: The author(s) declared that no grants were involved in supporting this work. Copyright: © 2022 Roy DN et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. How to cite: Roy DN, Hossen MM, Biswas M et al. Factors influencing COVID-19 vaccine acceptance and hesitancy among pharmacy students in Bangladesh: a cross-sectional study [version 1; peer review: 1 approved with reservations] . F1000Research 2022, 11 :1379 ( https://doi.org/10.12688/f1000research.126560.1 ) First published: 24 Nov 2022, 11 :1379 ( https://doi.org/10.12688/f1000research.126560.1 ) Latest published: 24 Nov 2022, 11 :1379 ( https://doi.org/10.12688/f1000research.126560.1 ) Introduction The coronavirus disease (COVID-19) has emerged as a recent health and humanitarian crisis and persisted with resurgent waves. COVID-19 has resulted in devastating consequences in human lives and has impacted the health care services provided in hospitals and community pharmacies. Since pharmacists and pharmacy students in training directly interact with patient-centered services in the health care industry and are, therefore, a group at high risk for COVID-19 exposure and transmitting the infection. 1 To prevent rapid transmission and to protect a particular subset of the healthcare student from COVID-19 , vaccination is the most promising and effective therapeutic tool because the vaccine is delivered to curb the transmission of a contagious virus that saves millions of human lives every year. 2 A growing number of vaccines to curb the COVID-19 pandemic have now been developed and distributed globally to fight against the novel coronavirus. Despite undeniable immunization success in the 21st century, a growing segment of people still distrusts vaccine safety and efficacy. In contrast, the doubtful attitude of the public towards accepting vaccines endangers massive public health threats and has been denoted as “hesitancy.” 3 The World Health Organization (WHO) reported vaccine hesitancy as one of the ten top public health emergencies around the world. 4 The complex nature of motives behind the COVID-9 vaccine hesitancy among the people varies widely depending on the context, way of measurement, and the pandemic stages. 5 Recently, the magnitude of COVID-9 vaccine hesitancy has been found to differ significantly across the countries among different population sub-groups worldwide. 6 Importantly, the prevalence of COVID-19 vaccines was also found to be predominant among students identified as 32% in Asian countries, 28.11% in the USA, 15.59% in Europe, and 55.93% in African regions, while the global pooled hesitancy rate in students was 29.8%. 7 Students of representative health education sectors were potentially influenced by COVID-19; vaccine hesitancy reported 46% in Egypt 8 , 45% and 23% in the USA 9 , 30.5% in Malta 10 , 10.6% in India 11 , 17.8%inIsrael 12 , 62.7% in Uganda 13 , and 75.5% in Zambia. 14 The most prevailing factors associated with distrust of corona vaccine receptivity that led to vaccine hesitancy among students follow the same pattern as they marked in frequencies around the world. A recent systematic review deduced that the most common concerns of COVID-19 vaccination decisions among students were side effects, safety, efficacy, trust, effectiveness, vaccine mandate, social influence, information sufficiency, conspiracy beliefs, and religiosity. 7 Due to the long-term existence of COVID-19 in Bangladesh, education is prey to collateral damage adding to the woes of the already hard-hit sector and its students. Although the government has sought to open educational institutions, but sudden unexpected worsening of the pandemic caused them to retract. The policymakers have started to work on a plan to include university students in the COVID-19 vaccine inoculation program on a priority basis to resume their regular physical activities in the classrooms and thereby comply with government decisions. 15 To date, however, most of the studies conducted so far in Bangladesh focused on COVID-19 vaccination acceptability among the general people 16 , 17 and rural community. 18 However, to the best of our knowledge, there is a lack of exploratory study 7 investigating COVID-19 vaccine acceptance among healthcare students, particularly pharmacy students in Bangladesh. This study thus aimed to assess COVID-19 vaccine acceptance among pharmacy students in Bangladesh and to explore the key factors associated with their vaccine acceptance and hesitance. Methods We deposited step-by-step descriptions of the study protocols on protocols.io and the doi: dx.doi.org/10.17504/protocols.io.n2bvj88wngk5/v1 . Study design An anonymous self-administered questionnaire was deployed online using Google form and conveniently sent to 1090 Bangladeshi university pharmacy students between 15th October 2021 and 15th December 2021, either via social media networks or personal emails. The investigators incorporated at the beginning of the questionnaire a separate paragraph describing the study and terms of consent. The permission to conduct this cross-sectional comparative study has been obtained from the “Ethical Review Committee” (IRC) of the author’s university. The detailed research protocol was reviewed and evaluated by the IRC before the study began. Data were collected via online mode and analyzed anonymously. No clinical intervention was applied on the subjects and the IRC approved this study as exempt. There was no external funding for the study. Settings and participants Currently pharmacy students are studying at public or private university in Bangladesh. According to the latest census, out of 51 public and 108 privately funded universities in Bangladesh, 13 and 28 are providing Bachelor of Pharmacy (B.Pharm) education for students, respectively. These universities are approved by the University Grants Commission (UGC), and the B. Pharm education was approved by the Pharmacy Council of Bangladesh (PCB). This study did not harm the participants because and the individual was free to reject participation anytime Participant’s inclusion criteria The study fixed some inclusion criteria to confirm the participant’s eligibility: (i) participants clearly understand and consent with the research objectives, (ii) willing to provide anonymous data on COVID-19 vaccine and vaccinations, (ii) pharmacy students of public or private universities in Bangladesh, and (iii) studying in junior (1 st year) to masters, and research degree level. The study didn’t offer financial or in-kind reward for participating and submitting online survey. Measures and survey instruments development The theoretical foundation of the potential factors associated with COVID-19 vaccine acceptance and hesitancy has been conceptualized from recent reviews. 6 , 7 Accordingly, items of a multi-item’s questionnaire was adopted from theory analysis of the recent studies reflected COVID-19 vaccinations among the various students’ sub-groups globally. 8 – 14 The questionnaire addressed multifaceted socio-psychological aspects and common concerns of COVID-19 vaccinations. The individual predictive items relating to vaccine receptivity were measured as a binary variable. Primarily we employed 5-point Likert scale: “definitely yes”, “yes probably”, “unsure”, “probably not” and “definitely not” to assess in-depth intention. The questionnaire was developed bilingually and the content of each item was validated for ensuring the relevance and clarity of the questionnaire. 16 , 18 Furthermore, final version of the questionnaire was subsequently pre-tested on 20 student pharmacist, which were later excluded from final statistical analysis. The survey instrument assessed (1) participants socio-demographic profile; (2) COVID-19 vaccine acceptance intention, (3) potential drivers of COVID-19 vaccine acceptance and hesitancy, and (4) WTP for vaccines. Survey administration The convenience sampling technique was used for systematic data gathering from online survey tools. This process created a survey to collect maximum insights from students’ sample of entities to develop quantitative variables of the attributes. The investigators distributed the online questionnaire among pharmacy students in almost all universities and encouraged them to participate in this study; thus, a potential source of non-response bias was avoided. Study variables For analyzing responses in binary regression model, the categories “definitely yes” and “yes probably” responses were merged into binary variable (Yes=1) and the remaining three responses were combined into (No=0) response. Thus, vaccine acceptance was the response variable evaluated in binary response (1=Yes, 0=No). Respondent’s socio-demographic characteristics were also figured outby using suitable measurement scale. Predictive variables were dichotomized into (1=Yes and 0=No) response and thereby assessed the effects of these predictive factors on outcome variable. We used one item question to understand WTP and responses were measure by 1=Yes and 0=No scale. Sample size calculation For observational studies, a data of minimum of 500 considered the sample size compulsory to conduct binary logistic regression that characterizes the variable parameters. Another established thumbs rule explained an event per variable of 50 and the equation is expressed as; sample size (N) =100+50n, where n= number of predictor variables in the model. 19 The average duration for survey completion and the clarity of instrument’s items were examined via pilot test (n=20). The possibility for generating missing data was minimized because the survey bars showed receiving any partial data, which ensured collection of complete response. Statistical process The descriptive statistics utilized weighted frequencies and percentage for expressing values of demographic profiles of the student participants. A non-parametric data analytical tool (binary logistic regression) was employed to explore the association mode between explanatory variables and response variable. The key assumptions were performed to adjust the suitability of binary regression analysis. Accordingly, the postulated model summary was evaluated and goodness of model fit was also examined. Raw data were inserted into the Microsoft excel (version 10) and imported to Statistical Package of Social Science (SPSS) software IBM SPSS Statistics, RRID: SCR_016479 for statistical analysis. We considered p<0.05 as statistically significant cut-point value. Results Participant’s demographic profiles The following table 1 represents the respondent’s demographic characteristics. We re-examined the participant’s inclusion criteria and in total, 1034 potentially eligible pharmacy students were included in this study. Participants not having digital devices had the possibility to skip participation in this study. According to the gender demographic profile, 50.5% (n=522) female and 49.5% (n=512) male students participated among which 87.1% (n=901) was the highest count of 20─24 years aged youth. However, the highest proportion 39.3% (n=406) pharmacy students studied in 4th year and 36.0% (n=372) of total participants are currently residing across Dhaka division. Most participants 87.9% (n=909) were Muslim by religion and 86.8% (n=898) of total respondents reported not being infected by COVID-19. Table 1. Overview of the demographic profiles (N=1034). Variables N % Age distribution 15–19 Years 25 2.4 20—24 Years 901 87.1 25—29 Years 100 9.7 30 Years & above 8 0.8 Year of study 1 st Year 60 5.8 2 nd Year 146 14.1 3 rd Year 290 28.0 4 th Year 406 39.3 5 th Year 32 3.1 Masters and Research 100 9.7 Living place (division) Dhaka 372 36.0 Rajshahi 262 25.3 Khulna 152 14.7 Chattogram 84 8.1 Mymensingh 42 4.1 Rangpur 86 8.3 Sylhet 18 1.7 Barishal 18 1.7 University location Metropolitan city 482 46.6 District city 416 40.2 Other 136 13.2 Gender Male 512 49.5 Female 522 50.5 Religion Muslim 909 87.9 Hindu 125 12.1 Experience of COVID positive Not Infected 898 86.8 Having experience of Corona Infection 136 13.2 Intention to receive vaccine Reservation to accept vaccination 126 12.2 Willing to accept vaccination 908 87.8 Willingness to accept a COVID-19 vaccine and WTP Figure 1 shows the proportion of responses of COVID-19 vaccine behaviors among pharmacy students. Overall, 908 (87.8%; 95% CI 85.8─87.8) participants responded to the intent for vaccination, while 126 (12.2%; 95% CI 10.2─14.1) had the reservation to uptake it. By more specific breakdown, majority of the students responded “definitely yes” 701 (67.8%; 95% CI 64.9─70.7) followed by “yes, probably” 207 (20%; 95% CI 17.6─22.4). However, 64 (6.2%; 95% CI 4.7─7.7) admitted “probably not” response; 35 (3.4%; 95% CI 2.7─4.5) were“unsure” and 27 (2.6%; 95% CI 2.5─3.6) responded “definitely not”. However, 454 (87%; 95% CI 85.0─89.0) female and 454 (88.7%; 95% CI 61.3─91.4) male students had vaccine acceptance willingness and 29.6% (95% CI25.4─33.9) pharmacy students admitted WTP for COVID-19 vaccine. Since the online survey bars showed acceptance of any incomplete survey instrument, our postulated variable of interest produced no missing data. Figure 1. Overall COVID-19 vaccine intent among pharmacy students (N=1034). Findings of descriptive statistics The following table 2 displays the descriptive statistics of independent variables utilized in this study and the dependent variable (vaccine acceptance intention) as well. Table 2. Variable’s descriptive statistics. Variables n (%) Mean SD I intend to accept vaccination anytime (Yes=1, otherwise=0) 908 (87.8) 0.88 0.372 I confirm that the vaccination is safe (Yes=1, otherwise=0) 830 (80.3) 0.80 0.398 I think the vaccination has no significant side effects (Yes=1, otherwise=0) 576 (55.7) 0.56 0.497 I believe the vaccination has efficacy to protect (Yes=1, otherwise=0) 908 (87.8) 0.88 0.327 I believe that the effectiveness of vaccination is satisfactory 858 (83.0) 0.83 0.376 I am well-communicated about the vaccination (Yes=1, otherwise=0) 802 (77.6) 0.78 0.417 I have religious constraints to accept vaccination (Yes=1, otherwise=0) 580 (56.1) 0.56 0.497 I believe there remains a conspiracy against the vaccination (Yes=1, otherwise=0) 626 (60.5) 0.61 0.489 I felt strong pressure from a political party not to accept vaccination (Yes=1, otherwise=0) 206 (19.9) 0.20 0.400 I have trust on the vaccination process (Yes=1, otherwise=0) 912 (88.2) 0.88 0.323 I do prefer access to scientific information for COVID-19 vaccine information (Yes=1, otherwise=0) 988 (95.6) 0.96 0.206 I received many rumors about COVID-19 vaccination but I refused these to consider (Yes=1, otherwise=0) 657 (63.5) 0.64 0.482 Receiving a vaccine is very usual to me (Yes=1, otherwise=0) 396 (38.3) 0.38 0.486 COVID-19 vaccine should be mandated for health care students (Yes=1, otherwise=0) 956 (92.5) 0.92 0.264 GENDER (Female=1, otherwise=0) 522 (50.4) 0.50 0.500 Assumptions test for binary regression (1) Model summery The value of Nagelkerke R Square and the Cox & Snell R square test were the best approaches employed to explain the model summery because these values together expressed the joint impact of predictive variables on the outcome variable shown in table 3 . However, the Cox & Snell R square test result in our binary model showed that all predictive variables jointly 20%─38% explained the outcome variable in our binary model. The obtained result was satisfactory and confirmed to be at a good level. Table 3. Model summery. -2 Log likelihood Cox & Snell R Square Nagelkerke R Square 537.715 0.198 0.379 (2) Goodness of model fit Goodness of model fit is evaluated by Omnibus tests of model coefficients and Hosmer and Lemeshow test as displayed in table 4 . The significance level for Omnibus tests of model coefficients was found significant ( p0.05) for Hosmer and Lemeshow test. The results indicated a very good model fit for the binary logistic regression analysis. Table 4. Omnibus tests of model coefficients and Hosmer and Lemeshow test. Omnibus Tests of Model Coefficients Chi-square df Sig. Step 228.703 14 0.000 Block 228.703 14 0.000 Model 228.703 14 0.000 Hosmer and Lemeshow Test 9.506 8 0.301 Binary regression analysis The association pattern between independent variables and outcome variable (vaccine acceptance) is represented in the following table 5 . Out of 12 key predictive factors listed out in table 5 , “safety”, “efficacy” and “trust” had the strongest significant and positive association with vaccine acceptance (p=0.000). The binary logistic analysis also revealed that “communication” and “information sufficiency” had significant and positive association with vaccine acceptance (p=0.035 and p=0.038 respectively) among pharmacy students. Table 5. Results of binary regression analysis. Variables B S.E. Wald Sig. Exp(B) 95% C.I.for EXP(B) Lower Upper Safety 1.275 ** 0.271 22.199 .000 3.578 2.105 6.080 Side effect 0.403 0.254 2.518 0.113 1.496 0.910 2.459 Efficacy 1.252 ** 0.305 16.838 0.000 3.496 1.923 6.357 Communication 0.065 * 0.270 0.811 0.035 1.067 0.628 1.811 Religious beliefs 0.401 0.253 2.511 0.113 1.494 0.909 2.453 Conspiracy beliefs 0.032 0.243 0.017 0.895 1.032 0.641 1.663 Political influences 0.439 0.339 1.680 0.195 1.551 0.799 3.014 Trust 0. 312 ** 0.316 0.978 0.000 1.366 0.736 2.536 Rumor 0.527 0.243 4.684 0.060 1.694 1.051 2.730 Culture 0.147 0.255 0.331 0.075 1.158 0.702 1.909 Vaccine mandated 0.367 0.364 1.015 0.314 1.444 0.707 2.949 Information sufficiency 0.898 * 0.432 4.317 0.038 2.456 1.052 5.731 Gender 0.416 0.238 3.039 0.081 1.515 0.950 2.418 CONSTANT -3.023 0.561 29.011 0.000 0.049 ** = significant at <0.01, * = significant at <0.05, level of significance Vaccine risky group identification Table 6 represented that Chi-squared test and Odds Ratio demonstrated no significant association between gender group-difference in response to accept COVID-19 vaccines. Although female group had a slight trend towards the willingness to accept vaccine (Odds Ratio=1.1), however, it was insignificant ( p>0.05 ) according to Chi-Squared test. Hence, statistically no vaccine hesitancy risky group was found among young pharmacists in Bangladesh. Table 6. Pearson’s Chi-squared test results. Pharmacy students (N=1034) Chi-Squared Tests Value Asymptotic Significance (2-sided) Exact Sig. (2-sided) Exact Sig. (1-sided) Pearson Chi-square 0.697 a 0.404 Continuity correction b 0.547 0.459 Likelihood ratio 0.698 0.404 Fisher's exact test 0.447 0.230 Linear-by-linear association 0.696 0.404 No. of valid cases 1034 Value 95% Confidence Interval Lower Upper Risk estimate Odds ratio for gender: (Female/Male) 1.172 0.807 1.704 For cohort I intend to accept vaccination anytime = No 1.150 0.828 1.597 For cohort I intend to accept vaccination anytime = Yes 0.981 0.937 1.026 No. of valid cases 1034 Discussion Massive vaccination is the only hopeful savior to curb the current pandemic. This study investigated COVID-19 vaccine acceptability among university pharmacy students in Bangladesh and identified the key factors associated with their vaccination decision. According to the study result, the pooled COVID-19 vaccine acceptance was 87.8%, while 12.2% students had the reservation to accept it. Although young pharmacy students are more inclined to get COVID-19 vaccinated; disagreements in enlisting the predictors potentially influenced their intention to accept vaccine or hesitance to receive. We observed that several societal, psychological, and vaccine related factors were associated with COVID-19 vaccine acceptance among student pharmacist. According to our analysis safety, efficacy, and trust had highly significant while communication and information sufficiency had significant association with vaccine acceptance and were identified as the most potential concerns. This is the first study focused on COVID-19 vaccination and applied a new analytical approach to explore the key determinants of vaccine acceptance and hesitancy. Since misinformation and false news led to vaccine hesitancy, the significant impact of scientific reading in improving vaccine uptake has been identified. The preference for scientific resources other than traditional and social media was recognized, which would provide an important message to health academicians. The study addressed some limitations. Firstly, sampling method, scarcity of sample size and online data collection mode has been noted. Although we collected 1034 data a sample, the sample size was inadequate compared to the total number of pharmacy students in Bangladesh. Thus, a non-response bias may occur for individuals who did not participate and might have been more willing or refusal intention to take the COVID-19 vaccine. Secondly, the transformative behavioral nature of the respondents may be altered with the frequent changes in perceived health risk, newly promoted vaccines, and vaccine deployment. More specifically, the pattern of COVID-19 vaccine reluctance can alter over time in young adults, hence estimation of in-spot vaccine acceptance and hesitancy among the youth was challenging. Finally, sequential alteration and modification in associated factors of COVID-19 vaccinations would occur. This study did not explicitly define additional confounding factors that may also lead to vaccine hesitancy. Empirical studies reported 76.4% COVID-19 vaccine acceptance intention among general Bangladeshi people 17 and 84.3% among rural community 18 included student participants in both surveys. In the Asian context, 89.4% of medical students had the willingness to uptake the COVID-19 vaccine reported in India. 11 All these results are supportive of the current study findings. Even though there have been few studies 16 , 17 , 20 that reported relatively high vaccine hesitancy rate among Bangladeshi people; however, this study found relatively low (12.2%) vaccine hesitancy among pharmacy students. These studies 16 , 17 , 20 were conducted since COVID-19 vaccination was inaugurated to administer in priority groups of a few selective areas in Bangladesh. However, we collected data when the country-wide mass vaccination program was started among various population sub-groups. At the same time, people became more conscious about COVID-19 vaccinations and information communicated through different channels. We observed that safety and efficacy had a highly significant and positive correlation with corona vaccine acceptance. Results obtained from similar studies revealed that safety was one of the primary concerns among 10.6% of undergraduate medical students in India 11 , 17.8% of medical and nursing students in Israel 12 , 71.1% of pharmacy students in Zambia 14 , and 28.9% dental students in low and lower-middle countries (LMICs). 21 It has been reported that the perceived efficacy varied between 50% and 95% for COVID-19 vaccines either approved by the Food and Drug Administration (FDA) or permitted for conditional approval in phase three trials. 22 Efficacy has been identified as an essential determinant of COVID-19 vaccination decisions among 10.6% of medical students in India 11 and 62.7% of medical students in Uganda. 13 Public trust in vaccine safety and efficacy data to uptake it was one of the strongest forecasters of COVID-19 vaccine intention. 23 Worldwide, side effects, safety, efficacy, trust, and information sufficiency were the most important predictors of COVID-19 vaccination decisions among students 7 as well as in general population. 6 Pharmacy students are well equipped to access scientific information and awakened to anti-vaccination rumors, thereby rejecting rumor-mongers associated with vaccine data. As a result, trust, communication, and information sufficiency were identified as critical predictors of vaccine acceptance among young pharmacists. Embracing the digital era and exposure to multimedia systems enabled university students to avoid misinformation, which positively built trust. It is thus necessary to provide adequate scientific resources for counteracting the anti-vaccination sentiment related to COVID-19 vaccinations. 24 In our study, an insignificant association between side effects and vaccine acceptance was observed because mild symptoms were observed within 48 hours following administering the vaccine's first dose in Bangladeshi people, and no severity was reported to date. 25 It has been evident that anti-vaccination sentiments such as conspiracy beliefs and religious beliefs were found to be critical determinants of COVID-19 vaccine acceptability among students 7 ;follow-up consequences could build long term hesitancy. A roadmap to convey accuracy; however, these predictors were insignificant in our study. Information sufficiency and trust were impacted positively by COVID-19 vaccine acceptance, so the anti-vaccination belief was found insignificant. Association of conspiracy beliefs with vaccine origin, vaccine data, and post-administration information and strategic communications with community people would build public trust 26 which in turn boosts vaccine confidence and reduces anti-vaccination beliefs. 27 consequently; communication and trust were previously identified as a paramount concern of COVID-19 vaccination among general Bangladeshi people 16 , which are supportive of our findings. Although the COVID-19 vaccine is provided free of cost in Bangladesh, 29.6% of pharmacy students admitted WTP for COVID-19 vaccines if the government fixes the price value. It has been reported that several indicators that influenced the higher marginal WTP for vaccines, including socio-economic condition, affordability status, receiver occupations, and higher income level. 28 , 29 This study has practical implications for policy support, practices, and future research. This study primarily benefits health policymakers and stakeholders in designing perfect vaccine promotion plans for mass vaccinations. The findings support overcoming the perceived vaccination barriers and facilitate pharmacists’ health engagement with the COVID-19 vaccination drive in near real-time, thus helping the governments to implement actionable strategies accordingly. The current study would act as a valuable scientific report for continuing further observational studies reflecting COVID-19 vaccine acceptance by re-examining additional confounding variables that impacted COVID-19 vaccine hesitancy, adding new value for scientific evaluation. We collected a large data sample (1034) to ensure the external validity of our study outcomes. Respondent’s socio-demographic characteristics varied significantly. A large sample size ensured much strength to predict the generalizability of the study findings, reinforcing health engagement and boosting vaccine confidence among the general people. Since the pattern of COVID-19 vaccine reluctance can alter among young adults 30 , So the author suggests adopting a long-term surveillance study to evaluate more precisely the vaccination consequences among young pharmacists globally. Educational interventions highlighted vaccine readiness and pandemic preparedness materials would be imperative to improve people’s health engagement in the COVID-19 vaccination drive. 31 Worldwide, pharmacists played a key role by offering advice and counseling to the public regarding ways to reduce COVID-19 contamination and suggesting potential treatments and preventive measures. 32 , 33 Pharmacists were involved in vaccination programs to increase vaccine acceptance rate in a pandemic crisis. 34 , 35 It is thus necessary to ascertain the potential drivers of COVID-19 vaccine acceptance and hesitancy among pharmacy students because they are the future pharmacists and custodians of medicine and vaccine development. Conclusions Pharmacy professional’s immunization act of COVID-19 was evaluated when the health policymakers launched a new vaccine vaccination throughout the country. The optimization of a large vaccine drive has already been proven to be effective in reducing coronavirus spread; however, at the same time, achieving a high uptake rate is a critical indicator of successful COVID-19 vaccination effort. This study explicitly defined the significance of positive behaviors regarding vaccine safety, efficacy, and trust in receiving a vaccine under any circumstances. The preference for academic knowledge and scientific reading had unique importance to counter rumors has been detected in this study. COVID-19 vaccine acceptance will improve if vaccine related data become more publicly available. Current study finding would be useful in planning adequate response and designing multi-disciplinary educational strategies for future pharmacist to encounter the future pandemic. Evidence-based and tailored health communication would reduce anti-vaccination sentiments, thus ensuring young pharmacist adherence in COVID-19 vaccination consequences. Consent The authors confirm that, informed consent form was sent to participants with online questionnaire. The individuals were free to reject participation at any time. Ethical statement The Ethical Review Committee approved as exempt. Acknowledgements All authors greatly acknowledge all student pharmacists who participated in this study. Data availability Underlying data Figshare: “Factors influencing COVID-19 vaccine acceptance and hesitancy among pharmacy students in Bangladesh: a cross-sectional study” doi: 10.6084/m9.figshare.21368394. Reporting guidelines Figshare: STORBE Checklist for “Factors influencing COVID-19 vaccine acceptance and hesitancy among pharmacy students in Bangladesh: a cross-sectional study” doi: 10.6084/m9.figshare.21368556. Figshare: Questionnaire for “Factors influencing COVID-19 vaccine acceptance and hesitancy among pharmacy students in Bangladesh: a cross-sectional study” doi: 10.6084/m9.figshare.21533598 Data are available under the terms of the Creative Commons Attribution 4.0 International license (CC-BY 4.0). References 1. Basheti IA, Nassar R, Barakat M, et al. : Pharmacists’ readiness to deal with the coronavirus pandemic: assessing awareness and perception of roles. Res. Soc. Adm. Pharm. 2021 Mar 1; 17 (3): 514–522. PubMed Abstract | Publisher Full Text 2. Centers for Disease Control and Prevention (CDC): Ten great public health achievements--United States, 2001-2010. MMWR Morb. Mortal. Wkly Rep. 2011 May 20; 60 (19): 619–623. 3. Marotta C, Raia DD, Ventura G, et al. : Improvement in vaccination knowledge among health students following an integrated extracurricular intervention, an explorative study in the University of Palermo. J. Prev. Med. Hyg. 2017 Jun; 58 (2): E93–E98. PubMed Abstract 4. 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PubMed Abstract | Publisher Full Text Comments on this article Comments (0) Version 1 VERSION 1 PUBLISHED 24 Nov 2022 ADD YOUR COMMENT Comment Author details Author details 1 Pharmacy, Jashore University of Science and Technology, Jashore, Bangladesh 2 Pharmacy, Khulna University, Khulna, Bangladesh 3 Pharmacy, University of Rajshahi, Rajshahi, Bangladesh 4 Marketing, University of Rajshahi, Rajshahi, Bangladesh Debendra Nath Roy Roles: Conceptualization, Data Curation, Formal Analysis, Funding Acquisition, Methodology, Resources, Software, Writing – Original Draft Preparation, Writing – Review & Editing Md. Mohabbot Hossen Roles: Conceptualization, Data Curation, Formal Analysis, Resources, Software, Writing – Original Draft Preparation Mohitosh Biswas Roles: Data Curation, Investigation, Methodology, Project Administration, Supervision, Validation, Visualization, Writing – Review & Editing Ekramul Islam Roles: Data Curation, Investigation, Project Administration, Supervision, Validation, Visualization, Writing – Review & Editing Md. Shah Azam Roles: Conceptualization, Formal Analysis, Investigation, Methodology, Project Administration, Supervision, Validation, Visualization, Writing – Review & Editing Competing interests No competing interests were disclosed. Grant information The author(s) declared that no grants were involved in supporting this work. Article Versions (1) version 1 Published: 24 Nov 2022, 11:1379 https://doi.org/10.12688/f1000research.126560.1 Copyright © 2022 Roy DN et al . 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COPY CITATION DETAILS track receive updates on this article Track an article to receive email alerts on any updates to this article. TRACK THIS ARTICLE Share Open Peer Review Current Reviewer Status: ? Key to Reviewer Statuses VIEW HIDE Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Version 1 VERSION 1 PUBLISHED 24 Nov 2022 Views 0 Cite How to cite this report: Kabir R. Reviewer Report For: Factors influencing COVID-19 vaccine acceptance and hesitancy among pharmacy students in Bangladesh: a cross-sectional study [version 1; peer review: 1 approved with reservations] . F1000Research 2022, 11 :1379 ( https://doi.org/10.5256/f1000research.138984.r164150 ) The direct URL for this report is: https://f1000research.com/articles/11-1379/v1#referee-response-164150 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 16 Mar 2023 Russell Kabir , School of Allied Health, Anglia Ruskin University, Essex, UK Approved with Reservations VIEWS 0 https://doi.org/10.5256/f1000research.138984.r164150 Thanks for submitting your manuscript. A published literature on the same issue is already from the same region. I was surprised that it was not even mentioned in the discussion part of the manuscript. I think you should consider using ... Continue reading READ ALL Thanks for submitting your manuscript. A published literature on the same issue is already from the same region. I was surprised that it was not even mentioned in the discussion part of the manuscript. I think you should consider using the following article in the discussion - http://dx.doi.org/10.3390/vaccines9050416 Is there any particular reason for selecting pharmacy students? Inclusion criteria numbering is wrong. IC (ii) is completely vague. What is the difference between IC (iii) and (IV), they can be merged. The methods section does not clearly entail how many universities participated in this study. What does it mean 'RRID: SCR_016479'? This is not required. Any citation for this statement - 'For observational studies, a data of minimum of 500 considered the sample size compulsory to conduct binary logistic regression that characterizes the variable parameters'? "Furthermore, final version of the questionnaire was subsequently pre-tested on 20 student pharmacist, which were later excluded from final statistical analysis." For the above statement, how did you select them and how did you ensure that they are not part of the main research? "This study did not harm the participants because and the individual was free to reject participation anytime." The above statement is vague. An anonymous self-administered questionnaire was deployed online using Google form and conveniently sent to 1090 Bangladeshi university pharmacy students between 15th October 2021 and 15th December 2021, either via social media networks or personal emails. For the above, how did you ensure the quality of the data? Why social media was used? How did you receive the email addresses of all the students? How did you make sure that the participants recruited through social media are Pharmacy students? Is the work clearly and accurately presented and does it cite the current literature? Partly Is the study design appropriate and is the work technically sound? Partly Are sufficient details of methods and analysis provided to allow replication by others? Partly If applicable, is the statistical analysis and its interpretation appropriate? Partly Are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions drawn adequately supported by the results? Yes References 1. Kabir R, Mahmud I, Chowdhury MTH, Vinnakota D, et al.: COVID-19 Vaccination Intent and Willingness to Pay in Bangladesh: A Cross-Sectional Study. Vaccines (Basel) . 2021; 9 (5). PubMed Abstract | Publisher Full Text Competing Interests: No competing interests were disclosed. Reviewer Expertise: Suicide and Mental Health, Oral Health, Ageing and Healthcare, Violence against women I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Kabir R. Reviewer Report For: Factors influencing COVID-19 vaccine acceptance and hesitancy among pharmacy students in Bangladesh: a cross-sectional study [version 1; peer review: 1 approved with reservations] . F1000Research 2022, 11 :1379 ( https://doi.org/10.5256/f1000research.138984.r164150 ) The direct URL for this report is: https://f1000research.com/articles/11-1379/v1#referee-response-164150 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Comments on this article Comments (0) Version 1 VERSION 1 PUBLISHED 24 Nov 2022 ADD YOUR COMMENT Comment keyboard_arrow_left keyboard_arrow_right Open Peer Review Reviewer Status info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Reviewer Reports Invited Reviewers 1 Version 1 24 Nov 22 read Russell Kabir , Anglia Ruskin University, Essex, UK Comments on this article All Comments (0) Add a comment Sign up for content alerts Sign Up You are now signed up to receive this alert Browse by related subjects keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2023 Kabir R. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 16 Mar 2023 | for Version 1 Russell Kabir , School of Allied Health, Anglia Ruskin University, Essex, UK 0 Views copyright © 2023 Kabir R. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Thanks for submitting your manuscript. A published literature on the same issue is already from the same region. I was surprised that it was not even mentioned in the discussion part of the manuscript. I think you should consider using the following article in the discussion - http://dx.doi.org/10.3390/vaccines9050416 Is there any particular reason for selecting pharmacy students? Inclusion criteria numbering is wrong. IC (ii) is completely vague. What is the difference between IC (iii) and (IV), they can be merged. The methods section does not clearly entail how many universities participated in this study. What does it mean 'RRID: SCR_016479'? This is not required. Any citation for this statement - 'For observational studies, a data of minimum of 500 considered the sample size compulsory to conduct binary logistic regression that characterizes the variable parameters'? "Furthermore, final version of the questionnaire was subsequently pre-tested on 20 student pharmacist, which were later excluded from final statistical analysis." For the above statement, how did you select them and how did you ensure that they are not part of the main research? "This study did not harm the participants because and the individual was free to reject participation anytime." The above statement is vague. An anonymous self-administered questionnaire was deployed online using Google form and conveniently sent to 1090 Bangladeshi university pharmacy students between 15th October 2021 and 15th December 2021, either via social media networks or personal emails. For the above, how did you ensure the quality of the data? Why social media was used? How did you receive the email addresses of all the students? How did you make sure that the participants recruited through social media are Pharmacy students? Is the work clearly and accurately presented and does it cite the current literature? Partly Is the study design appropriate and is the work technically sound? Partly Are sufficient details of methods and analysis provided to allow replication by others? Partly If applicable, is the statistical analysis and its interpretation appropriate? Partly Are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions drawn adequately supported by the results? Yes References 1. Kabir R, Mahmud I, Chowdhury MTH, Vinnakota D, et al.: COVID-19 Vaccination Intent and Willingness to Pay in Bangladesh: A Cross-Sectional Study. Vaccines (Basel) . 2021; 9 (5). PubMed Abstract | Publisher Full Text Competing Interests No competing interests were disclosed. Reviewer Expertise Suicide and Mental Health, Oral Health, Ageing and Healthcare, Violence against women I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. reply Respond to this report Responses (0) Kabir R. Peer Review Report For: Factors influencing COVID-19 vaccine acceptance and hesitancy among pharmacy students in Bangladesh: a cross-sectional study [version 1; peer review: 1 approved with reservations] . F1000Research 2022, 11 :1379 ( https://doi.org/10.5256/f1000research.138984.r164150) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/11-1379/v1#referee-response-164150 Alongside their report, reviewers assign a status to the article: Approved - the paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations - A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. 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