key: cord-0334215-gcbd8y2a authors: KUMAR S, L.; NAIK, Z.; PANWAR, A.; M, S.; KELUSKAR, V.; K, R. S. K. title: Knowledge, Attitude, and Practice among the Healthcare Professionals regarding the myths on COVID-19 vaccination - Demystified. date: 2021-08-01 journal: nan DOI: 10.1101/2021.07.30.21261378 sha: 10ed727134686cc48630a55ddf6f5f766f9bcedd doc_id: 334215 cord_uid: gcbd8y2a Background: COVID-19 vaccine is the mighty weapon opted by all the countries across the globe in an attempt to eradicate the fatal COVID-19 pandemic. The myths on the COVID-19 vaccine are spreading widely, causing a hindrance to this noble preventive measure. The prevalence of such myths among the healthcare professionals may be toxic and deadly. Aim & Objectives: To assess the knowledge, attitude, and practice of the healthcare professionals regarding the myths on COVID-19 vaccination and to demystify them. Materials and Methods: An 18-item questionnaire evaluating knowledge, attitude, and practice based on the existing myths on COVID-19 vaccination was circulated through Google Forms among the 412 healthcare professionals of six disciplines belonging to a private University. The responses obtained were subjected to statistical analysis using SPSS 20 software package. Results: A total of 385 health professionals participated in this study. The majority of them had medium knowledge (165) and positive attitude (273) with the mean knowledge and attitude scores of 3.82 (SD-1.55) out of 6 and 4.3 (SD-1.58) out of 7 respectively. Even though 312 participants got vaccinated, 72 of them failed to receive it. The knowledge scores showed a high statistically significant difference among the participants of different designations (p=0.001), but not with gender, field, and staff with different years of experience (p>0.05). The attitude scores were statistically different among participants of fields and designation (p<0.05) but not among genders (p=0.31) and staff with different years of experience (p=0.87). Knowledge and attitude scores showed a positive linear correlation and a high statistically significant difference (p<0.001). Conclusion: This study recommends more enhanced education programs on COVID-19 vaccination for the health professionals and demands an improved knowledge, attitude, and practice among them to achieve the goal of 100% vaccination so as to completely eradicate the COVID-19 pandemic. Authority of China way back on 31st December 2019 about the outbreak of 27 pneumonia cases of unknown etiology in its Wuhan city of Central China. [1] Since then, the viral disease had spread to the whole world involving almost all countries at an exponential rate, making it a global health emergency. WHO first termed the causative agent as 2019-novel-Corona Virus(2019-n-COV), which was later renamed by the Corona Virus Study Group to be Severe Acute Respiratory Syndrome Corona Virus-2 (SARS-CoV-2) that causes the disease called Corona Virus Disease 2019 . [2] After thorough surveillance of the etiology, mode of spread, symptoms, severity, and fatality on a global scale, WHO declared the SARS-CoV-2/ corona virus disease (COVID-19) outbreak as a Public Health Emergency of International Concern (PHEIC) or a pandemic on 30th January, 2020. [3] Human life has been affected in all dimensions, such as in terms of physical, mental, social and behavioral well-being by putting the world to halt. [4] [5] [6] [7] WHO Global COVID-19 statistics reported a total of 195,266,156 confirmed cases of COVID-19, including 4,180,161 deaths as of 28th July, 2021. [8] The Governments of all the countries are taking mammoth efforts and facing a gargantuan struggle to bring the situation under control by adopting measures like lockdown, restrictions, other important political decisions, and especially mass-scale vaccination drives which seem to be a promising resort. [9] Various researchers around the world jumped into the research on vaccine development since the outbreak and few reaped successes despite the isolation of 30 different strains across the globe in just 6 months. [10] As of 29th July 2021, a total of 22 COVID-19 vaccines across the globe have been added within the WHO Emergency Usage Listing (EUL)/ Prequalification (PQ) process, with a few finalized among them. [11] The focus of the global Target Product Profile (TPP) for COVID-19 vaccine is on vaccination for people under a high-risk category like healthcare workers, to provide longterm protection and rapid inception of immunity in outbreak settings. [12] A total of 3,829,935,772 vaccine doses have been administered globally as of 27 th July 2021. [8] India launched its vaccination drive on 16 th January 2021, starting with healthcare and frontline workers [13] , and achieved 441,912,395 vaccine doses as of 26 th July 2021 including the general population. [14] Covishield TM from Serum Institute of India Pvt Ltd and Covaxin TM from Bharat Biotech, India were the two vaccines administered in India's vaccination drive, where healthcare workers being vaccinated with the former, mostly. Despite the massive efforts taken by the Government to develop a safe and efficacious vaccine, hesitance to accept the vaccine among the people is still persistent. [15] Myth is a folklore genre, that consists of stories/ narratives, playing an important role in people's daily life. [16] Despite the awareness campaigns among the public to get vaccinated through various platforms like social media, television, radio, newspapers, health talks by politicians, pamphlet distributions, and signboards, several myths and misconceptions are prevailing among the public regarding COVID-19 vaccines. These myths are spread by word of mouth and social media that may convince the public the other way, reducing the needed health practices resulting in dangerous health hazards. Such beliefs can be harmful to society since they cause clamor and disarray among the population. They also hamper the Government's goals and efforts to eradicate and control the COVID-19 pandemic. Healthcare professionals play a pivotal role in creating awareness and promoting vaccination drive among the general public that demands superior knowledge about the facts on the COVID-19 vaccine. To the best of our knowledge, there are no studies in the literature that assess the prevalence of myths/misconceptions or knowledge about COVID-19 vaccination among healthcare professionals. Hence, the current study aims to assess the knowledge, attitude, and practice among healthcare professionals regarding myths/misconceptions on COVID-19 vaccination and to demystify them with facts. Before the execution of this questionnaire study, protocols/ strategies to be followed regarding the literature search on myths/ misconceptions on COVID-19 vaccine, questionnaire design, validation, pilot study, and enrolment of study participants were clearly established by discussion among the researchers. The sample size was estimated to be 376 using the formula n= (Z 1-α/2 + Z 1-β ) 2 knowledge-based questions, where the correct response was coded as "1" and the incorrect responses were coded as "0". Hence, the maximum knowledge score was set at 6 and was graded as follows: 0-2= low, 3-4= medium, and 5-6= high. Similarly, the correct response in regards to 7 attitude-related questions were coded as "1" and the incorrect responses were coded as "0". Thus, the maximum attitude score was set at 7 and was graded as follows: 0-3= negative and 4-7= positive. The responses from the pilot study were excluded from the main analysis. Fifty-three of the 385 health professionals answered that they had been tested positive for COVID-19 infection before, out of which, 45 participants still took the vaccine and 8 of them did not take it. The majority of the health professionals (306) considered the COVID-19 All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted August 1, 2021. ; vaccine to be safe, whereas 23 considered it to be unsafe and 56 did not know regarding the safety of the vaccine. Interestingly, 43 of the 306 participants who considered the vaccine to be safe did not get vaccinated and 14 of the 23 participants who considered the vaccine to be unsafe got vaccinated. On the other hand, 35 of the 56 participants who did not know whether the COVID-19 vaccine is safe got vaccinated. The responses of the health professionals for the questions on COVID-19 vaccination and its myths/ misconceptions are presented in Table 1 . The majority of the health professionals (165) had a medium knowledge score whereas, 139 and 81 participants had high and low knowledge scores respectively (Chart 1). Kruskal-Wallis test depicted that there was no significant difference (p>0.05) in the knowledge scores between the health professionals of different fields, the staffs with different years of experience (0-4 years, 4-8 years, and >8years), however, showed a high statistically significant difference between the different designations (p=0.001). Mann-Whitney U test showed that there was no significant difference in the knowledge scores between the health professionals of different gender (p=0.84). (Table 3 ). The mean knowledge score among the health professionals was 3.82 ± 1.55 out of 6 with the highest in teaching staff cum consultant (4.64 ± 2) among designations and in staffs with the experience of 4-8 years (4.7 ± 1.34). The knowledge scores of post graduates, teaching staff, staff with experience of 0-4 years and above 8 years were 3.72 ± 1.53, 3.39 ± 1.61, 4.05 ± 1.85, and 3.95 ± 1.50 respectively. The majority of the health professionals (273) had a positive attitude towards the COVID-19 vaccination and on the other hand, 112 participants had a negative attitude (Chart 2). There was a statistically significant difference in the attitude scores (p<0.05) between the health All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted August 1, 2021. ; https://doi.org/10.1101/2021.07.30.21261378 doi: medRxiv preprint professionals of different fields and different designations but was not significant between the staff with different years of experience (p=0.87) when tested by the Kruskal-Wallis test. Mann-Whitney U test for the attitude scores between the male and female health professionals depicted that they were not statistically significant with a p-value of 0.31. (Table 4 ) The mean attitude score among the participants was 4.3 ± 1.58 out of 7 with the highest in teaching staff cum consultant among designations and in staff with experience of 4-8 years (4.80 ± 1.28). The attitude scores of post graduates, teaching staff, staff with experience of 0-4 years and above 8 years were 4.21 ± 1.61, 4.09 ± 1.47, 4.52 ± 1.40, and 4.6 ± 1.5 respectively. A greater number (312, 81.04%) of the health professionals got themselves vaccinated for COVID-19 infection, but 73 (18.96%) participants did not receive the vaccine that showed a high statistically significant difference among the different fields (p<0.001) using Chi-square test. The majority of the participants (309) answered that we should still need to wear a mask and follow the social distancing guidelines after COVID-19 vaccination, on the other hand, 64 of them answered that we need not follow and 12 health professionals did not know what to be done. This was statistically significant, with a p-value of 0.019 among the health professionals of different fields. Simple linear regression analysis depicted a significant relationship between knowledge with designation (p=0.003, R=0.150) and years of experience among staff (p=0.026, R=0.113) but not with gender (p=0.981, R=0.001) and field (p=0.801, R=0.013). It also showed a significant relationship between attitude with designation (p=0.009, R=0.132) but not with All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted August 1, 2021. ; gender (p=0.550, R=0.031), field (p=0.149, R=0.074), and years of experience among staff (p=0.067, R=0.094). Multiple linear regression analysis revealed that the better knowledge scores were significantly associated with designation (p=0.003) but not with gender (p=0.76) and fields (p=0.68) having a positive correlation (R=0.152), whereas better attitude scores were significantly associated with designation (p=0.01, R=0.132) but not with gender (p=0.21) and field (p=0.07) having a positive correlation (R=0.166). (Table 5 ) A positive linear correlation (r= +0.431) and a high statistically significant difference (p<0.001) between the knowledge and attitude scores among the health professionals were found by the Spearman's rank correlation coefficient test. The field-wise correlation data are presented in table 6. COVID-19 vaccine is considered an efficient measure to achieve herd immunity against this fatal pandemic by various countries across the globe that have launched their vaccination drives. Despite the efforts made by the governments to get all their citizens vaccinated for COVID-19 infection, certain hurdles influence the people's acceptance of the COVID-19 vaccine, the most important being the myths/ misconceptions that are prevalent and shared through the various social media platforms which were also faced by the previous vaccination drives of rubella, mumps, measles, and polio. [17, 18] In a survey conducted in 2020, almost one-third or more of the population globally answered that they might not receive the first COVID-19 vaccines questioning their efficacy, side effects, and rushing through the regulatory approval procedures. [19] This study involved a questionnaire with questions, that All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. were framed based on a few important myths/ misconceptions that are known to be widespread among the public. It was conducted among the health professional population, as they are very crucial for creating awareness and promoting the COVID-19 vaccine owing to their direct interactions with the public. The prevalence of these myths/ misconceptions on the COVID-19 vaccine among healthcare professionals may prove toxic as they are responsible for being the advocates and ambassadors for the vaccination drive. The majority of the participants (58%) felt that the vaccine trials are being rushed (171) or they did not know regarding it (56). But the fact states that, like any other vaccine, the COVID-19 vaccine went through all the rigorous processes of safety reviews and clinical trials as prescribed by the Food and Drug Administration (FDA) agency, without skipping any of the steps although it had been developed in a short record timeframe and given a nod under EUA as biologics license approval (BLA) mandates a long time. The phase III trials were conducted on a large number of human volunteers same as any large vaccine trials in the United States and internationally. [20] Vaccines generally entail a timeline of 10.7 years on an average [20] , and hence the COVID-19 vaccine research was built on the previous decade's research on the corona virus than mere start after the outbreak. [21] This was made possible because of the unprecedented collaboration and investment of the researchers, government, and organizations worldwide. In this current study, 267 health professionals (69.35%) answered correctly that the COVID-19 vaccine will not alter the host's DNA. The pioneer vaccines which were granted EUA contained messenger RNA (mRNA) that instructs the cells to produce the "spike protein" that is responsible for creating the antibodies. The mRNA gets translated into polypeptides in the cytoplasm and never enters the cellular nucleus where the DNA is present. Moreover, the body disposes the mRNA after the generation of immunity and cellular DNA similar to COVID-19 virus sequences on in-vitro overexpression of LINE-1 or HIV-1 reverse transcriptase in HEK cell lines [22] but, lacks evidence relevant to human All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted August 1, 2021. ; https://doi.org/10.1101/2021.07.30.21261378 doi: medRxiv preprint clinical medicine [21] . About 215 (55%) health professionals answered that the COVID-19 vaccine causes severe allergic reactions such as anaphylactic reactions in the majority which is not true as it can only cause mild side effects such as fever, chills, and malaise that are known to be present with all vaccinations. The anaphylactic reactions are extremely rare, and experts recommend not to receive the vaccine if there is known history of severe allergic reactions to the ingredients of the vaccine. Around 62.07% of the participants (239) answered correctly that the COVID-19 vaccine does not cause infertility. A myth/ false information on social media stated that the vaccine makes the immune system fight against syncytin-1, a mammalian placental protein present in women which causes infertility in women. [23] But, despite the spike protein and placental protein sharing a homologous amino acid sequence, it cannot produce infertility as it is short to cause such an effect. Also, there is a rumor that COVID-19 vaccines contain actual aborted fetal tissues but, such vaccines like AstraZeneca Oxford, CanSinoBio, and Johnson & Johnson have been propagated for many years, no longer contain the actual fetal tissue remnants. Even the Vatican has recommended that the health benefits of these vaccines overshadow the moral opposition of vaccines developed from these cell lines. [24] Even the people who had been diagnosed with COVID-19 infection before, still need to receive the vaccine as the natural immunity may vary from person to person and it is still unknown that how long the same may last. [25] The researchers are yet to understand the confounding factors completely like the longevity of the antibodies targeting the SARS-CoV-2 spike protein, which is shorter than expected actually. [26] It is noteworthy that the people who had been infected and still received the vaccine had a 140-fold boost in antibodies against the spike protein from peak pre-vaccine levels. [27] This was answered right by a larger number of health professionals (276/ 71.68%), and it is a fact that we can still be benefited from the vaccine despite the previous infection history. It's a myth that one can get All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted August 1, 2021. It is a misconception that the people who are not at risk for severe complications of COVID-19 infection need not get themselves vaccinated, as all need to get vaccinated regardless of the risk due to the chance of spreading to others on acquiring the disease, and this was answered right by 268 (69.6%) participants. It is thought wrong that one will be at greater risk for other illnesses after receiving the vaccine due to reduced immunity. Instead, the vaccine boosts immunity against COVID-19 infections and does not increase the risk for other diseases. None of the authorized vaccines have the live form of the virus. [29] Only 147 (38.18%) of the 385 health professionals answered right that the vaccine trials being halted doesn't mean that there are problems with the drug candidates. In a vaccine trial, all the effects including the adverse effects and even other effects that are not caused due to or related to the study to be noted and analyzed. Halting a trial and resuming it are the safety mechanisms to protect the volunteers of the trial until the effect is thoroughly investigated and studied. [30] Around 80% of the participants (309) believed rightly that the practices of handwashing, masking, and following the social distancing guidelines to be followed even after the vaccination as all these measures are mandated necessary by The Ministry of Health and Family Welfare (MoHFW) until a sufficient number of populations gets vaccinated and All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted August 1, 2021. ; https://doi.org/10.1101/2021.07.30.21261378 doi: medRxiv preprint the duration of protection of the vaccine is unknown. This highlights the importance of following the appropriate COVID-19 protocols and guidelines until further recommendations from the healthcare agencies and public health experts. Almost 23.63% of the healthcare professionals (91) answered that the COVID-19 vaccine would be an answer to the end of the corona virus which is not true. Although vaccines in the past have played a pivotal role to eradicate the small pox and reduce the incidence rate of polio, it took many years to achieve such a success. Vaccination to almost all citizens is a tedious and time-consuming process, especially with new vaccines and the virus is known to mutate. These question the long-term efficacy of the vaccine and also, the method of natural immunity cannot be resorted, as the fatality rate of COVID-19 infection is very high. Hence, believing that a vaccine would be an answer to the end of this pandemic is highly audacious at this point. One another myth/ misconception about COVID-19 vaccination is that the vaccine has a tracking or surveillance device which was false information that was circulated in a video form on social media. A syringe maker in America, ApiJect Systems Corp ® has an optional variant of its product with an embedded microchip that enables the administrator to find the origin of the vaccine and however, the microchip is not injected into the body. Additionally, there is a spreading fear that vaccine trials might cause inadvertent consequences like the 1950-60s tragedy of using thalidomide for the treatment of early pregnancy nausea. [21] In the current study, though 79% of the health professionals had medium to high knowledge scores, 21% of the health professionals still projected a low knowledge score level which requires additional enhancement of knowledge and awareness among the health professionals. Although 70% had a positive attitude score, 29.1% had a negative attitude score demanding a change in attitude towards the COVID-19 vaccination as they have the responsibility to eliminate the vaccine hesitancy among general public. It is also depicted All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted August 1, 2021. ; https://doi.org/10.1101/2021.07.30.21261378 doi: medRxiv preprint that the better knowledge levels led to a better attitude towards the COVID-19 vaccination among the health professionals. It is a good sign that 81% of the health professionals had got vaccinated, in turn trusted and supported the vaccination drive. This study was conducted in a smaller sample size of the health professionals of a single University. Future studies could be done, involving a larger population of health professionals from multiple centers, with a uniform sample size among the fields. Even though the participants had a high standard of knowledge, attitude and practice, there were a considerable percentage of participants with low knowledge and negative attitude. Hence, the findings of the study demand a more enhanced, stronger, and accessible health education programs on COVID-19 vaccination for the health professionals to improve their knowledge, attitude and practices regarding COVID-19 vaccination drive to reduce the vaccination hesitancy among the general public and to motivate all the citizens to get vaccinated against this deadly pandemic, thereby achieving a complete eradication in the near future. All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted August 1, 2021. All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted August 1, 2021. ; https://www.who.int/docs/default-source/coronaviruse/risk-commsupdates/update52_vaccines.pdf?sfvrsn=b11be994_4 Accessed on July 29, 2021. Vaccines. https://www.cdc.gov/coronavirus/2019-ncov/vaccines/facts.html Accessed on July 29, 2021. All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted August 1, 2021. All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted August 1, 2021. ; https://doi.org/10.1101/2021.07.30.21261378 doi: medRxiv preprint *p-value≤0.05, **Kruskal-Wallis Test, ***Mann-Whitney U Test. All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted August 1, 2021. ; https://doi.org/10.1101/2021.07.30.21261378 doi: medRxiv preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted August 1, 2021. ; https://doi.org/10.1101/2021.07.30.21261378 doi: medRxiv preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. 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