Mandatory Vaccination against COVID-19: Qualitative Analysis of Responses to Open-Ended Questions
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design, Population, and Data Collection
2.2. Qualitative Data Analysis
2.3. Validity and Reliability
2.4. Statistical Analysis
2.5. Ethical Approval
3. Results
3.1. Sociodemographic Characteristics and COVID-19 Vaccination Status
3.2. Findings of the Qualitative Data Analysis
3.3. Vaccination Perceptions and Challenges
3.3.1. Universal Mandatory Vaccination
“Vaccination should be made mandatory for everyone.”—Male, age 46
“Forced vaccination.”—Woman, age 25
“Mandatory vaccination for everyone.”—Woman, age 23
3.3.2. Targeted Mandatory Vaccination
“Mandatory vaccination should apply to specific population groups, not to the general population (e.g., above a certain age).”—Woman, age 26
“I disagree with the way you forced the third dose on people who don’t need it at this stage—forced vaccination! Older people have not been vaccinated with even one dose! Let’s make it mandatory for the over 60s, like other countries have done.”—Woman, age 42
“Mandatory vaccination should be implemented at least in working groups: health professionals, those who work in hospitals, closed structures, schools, police, fire department, shops, and public services.”—Woman, age 47
3.3.3. Insufficient Research
“But the much-discussed ‘vaccine’ against ‘SARS-CoV-2′, as we all know, is an early vaccine that has not undergone long-term testing stages (6+ years) …”—Male, age 29
“The older vaccines have shown improvement over time, and the occurrence of side effects has been extremely rare… The main concern is the rushed administration of the vaccine”—Woman, age 42
“…for a vaccine to be considered safe, it usually takes 5–6 years… Therefore, personally, I don’t feel confident in the safety of these vaccines…”—Woman, age 42
“For people with autoimmune diseases, there have been reports of disease flare-ups after completing their vaccination regimen.”—Female, age 44
3.3.4. Inadequate Communication and Information Discrepancies
“Mandatory vaccination may not be the safest approach to tackle COVID-19… Better information is needed.”—Male, age 52
“Providing proper information, rather than enforcement, will yield better results.”—Male, age 48
“The communication strategy throughout the pandemic, in my opinion, was fundamentally flawed! The attitudes displayed by prominent scientists, who were not necessarily the most specialized or experienced in the field, were often contradictory and lacked proper substantiation. This not only failed to inspire trust but also ran counter to the accumulating evidence.”—Male, age 58
“I believe that if the mass media in Cyprus, particularly television, didn’t repeatedly emphasize the importance of vaccination, more people might have chosen to get vaccinated.”—Woman, age 42
3.3.5. Protective Measures
“Implement a lockdown for the unvaccinated.”—Woman, age 58
“Implement measures to address the pandemic by restricting the activities of the unvaccinated and considering compulsory vaccination.”—Male, age 66
“Find a legal mechanism for compulsory vaccination and restrict the travel of unvaccinated individuals, similar to what Israel has done.”—Female, age 56
“…unvaccinated individuals should not be entitled to ICU care without paying.”—Male, age 39
“…by using other methods to fight the virus, such as vitamin supplementation.”—Woman, age 23
“…given that vaccinated individuals can still get infected and transmit the virus, it would be beneficial for them to undergo antigen testing as well.”—Woman, age 23
“There should be weekly free testing available in businesses, especially in hospitals and clinics where nurses come into close contact with patients.”—Female, age 23
“It should be mandatory for everyone, regardless of vaccination status, to undergo rapid testing if we genuinely prioritize the well-being of all.”—Male, age 27
3.3.6. Interdisciplinary Collaboration
“It is important to seek the opinion of lawyers as well.”—Woman, age 50
“They should consult experts outside of the government team.”—Man, age 40
“It is crucial to follow the instructions and actions taken by other countries such as France, Germany, and Italy, which have more advanced medical, university, research networks and knowledge.”—Male, age 56
3.3.7. Lack of State Responsibility
“Even worse is the fact that you do not take responsibility for any side effects.”—Male, age 45
3.3.8. Natural Immunity
“I firmly believe that natural immunity against viruses is significantly superior to any vaccine. However, I acknowledge that vaccines may have their usefulness in dealing with other diseases.”—Male, age 38
“In my opinion, the ultimate solution lies in natural immunity, especially for high-risk individuals.”—Male, age 37
3.3.9. COVID-19 Denial and Perceived Risk
“If you don’t know, you should learn that there is no such thing as COVID-19…. You are committing the greatest crime in the history of mankind.”—Male, age 43
3.4. Mandatory Vaccination Policies and Societal Impact
3.4.1. Two-Tiered Society
“… not in the division of people.”—Male, 45 age years
“Privileges are provided by the government, such as overnight stays for vaccinated people, while other measures are punitive towards the unvaccinated. Personally, this differential treatment instils fear in me.”—Female, age 39
3.4.2. Human Rights
“…the infringement of human rights”—Woman, age 44
“Everyone should have the right to decide what goes into their own body…”—Woman, age 33
“…mandatory vaccination across the entire population could potentially infringe upon individual personal liberties to some extent”—Male, age 56
“Human rights should never be questioned under any circumstances.”—Man, age 48
3.4.3. Reactive Response to Obligation
“…as well as the oppressive way that it is imposed, only create a negative mood in the world…”—Woman, age 40
“…when something becomes mandatory, it is automatically considered suspicious…”—Male, age 31
3.4.4. Political and Economical Expediencies
“I have faith in science, but I no longer trust the financial backers of scientific research and their pursuit of enormous profits. I am certain that they are not concerned about my well-being…”—Female, age 46
“…the government has failed to persuade me that it is providing the vaccine for my personal protection”—Woman, age 39
3.4.5. Social Impact Outweighed
“Vaccines are considered the sole solution for the greater good, and anyone who refuses to comply should be compelled to do so.”—Female, age 52
“While mandatory vaccination may encroach upon individual rights, the infringement is deemed less significant compared to the violation of the collective’s right to health and freedom from the restrictions imposed by the pandemic.”—Male, age 60
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
- Tsiotas, D.; Tselios, V. Understanding the uneven spread of COVID-19 in the context of the global interconnected economy. Sci. Rep. 2022, 12, 666. [Google Scholar] [CrossRef] [PubMed]
- Pullano, G.; Pinotti, F.; Valdano, E.; Boëlle, P.-Y.; Poletto, C.; Colizza, V. Novel coronavirus (2019-nCoV) early-stage importation risk to Europe, January 2020. Eurosurveillance 2020, 25, 2000057. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- World Health Organization. Naming the coronavirus disease (COVID-19) and the virus that causes it. Braz. J. Implantol. Health Sci. 2020, 2, 1–4. [Google Scholar]
- Mills, M.C.; Rüttenauer, T. The effect of mandatory COVID-19 certificates on vaccine uptake: Synthetic-control modelling of six countries. Lancet Public Health 2022, 7, e15–e22. [Google Scholar] [CrossRef]
- Scott, N.; Saul, A.; Spelman, T.; Stoove, M.; Pedrana, A.; Saeri, A.; Grundy, E.; Smith, L.; Toole, M.; McIntyre, C.R. The introduction of a mandatory mask policy was associated with significantly reduced COVID-19 cases in a major metropolitan city. PLoS ONE 2021, 16, e0253510. [Google Scholar] [CrossRef]
- Greenwood, B. The contribution of vaccination to global health: Past, present and future. Philos. Trans. R. Soc. B Biol. Sci. 2014, 369, 20130433. [Google Scholar] [CrossRef] [Green Version]
- Kauffmann, F.; Bechini, A.; Bonanni, P.; Casabona, G.; Wutzler, P. Varicella vaccination in Italy and Germany–different routes to success: A systematic review. Expert Rev. Vaccines 2020, 19, 843–869. [Google Scholar] [CrossRef]
- Clark-Wright, J.; Hudson, P.; McCloskey, C.; Carroll, S. Burden of selected infectious diseases covered by UK childhood vaccinations: Systematic literature review. Future Microbiol. 2020, 15, 1679–1688. [Google Scholar] [CrossRef]
- Chuenkitmongkol, S.; Solante, R.; Burhan, E.; Chariyalertsak, S.; Chiu, N.-C.; Do-Van, D.; Husin, M.; Hwang, K.-P.; Kiertiburanakul, S.; Kulkarni, P.S. Expert review on global real-world vaccine effectiveness against SARS-CoV-2. Expert Rev. Vaccines 2022, 21, 1255–1268. [Google Scholar] [CrossRef]
- Utami, A.M.; Rendrayani, F.; Khoiry, Q.A.; Alfiani, F.; Kusuma, A.S.; Suwantika, A.A. Cost-Effectiveness Analysis of COVID-19 Vaccination in Low-and Middle-Income Countries. J. Multidiscip. Healthc. 2022, 15, 2067–2076. [Google Scholar] [CrossRef]
- Shrotri, M.; Navaratnam, A.M.; Nguyen, V.; Byrne, T.; Geismar, C.; Fragaszy, E.; Beale, S.; Fong, W.L.E.; Patel, P.; Kovar, J. Spike-antibody waning after second dose of BNT162b2 or ChAdOx1. Lancet 2021, 398, 385–387. [Google Scholar] [CrossRef]
- Pormohammad, A.; Zarei, M.; Ghorbani, S.; Mohammadi, M.; Razizadeh, M.H.; Turner, D.L.; Turner, R.J. Efficacy and safety of COVID-19 vaccines: A systematic review and meta-analysis of randomized clinical trials. Vaccines 2021, 9, 467. [Google Scholar] [CrossRef]
- Dror, A.A.; Eisenbach, N.; Taiber, S.; Morozov, N.G.; Mizrachi, M.; Zigron, A.; Srouji, S.; Sela, E. Vaccine hesitancy: The next challenge in the fight against COVID-19. Eur. J. Epidemiol. 2020, 35, 775–779. [Google Scholar] [CrossRef] [PubMed]
- Dyer, O. COVID-19: Turkmenistan becomes first country to make vaccination mandatory for all adults. Br. Med. J. 2021, 374, n1766. [Google Scholar]
- Dyer, O. COVID-19: US imposes mandatory vaccination on two thirds of workforce. BMJ 2021, 374, n2238. [Google Scholar] [CrossRef]
- Gravagna, K.; Becker, A.; Valeris-Chacin, R.; Mohammed, I.; Tambe, S.; Awan, F.A.; Toomey, T.L.; Basta, N.E. Global assessment of national mandatory vaccination policies and consequences of non-compliance. Vaccine 2020, 38, 7865–7873. [Google Scholar] [CrossRef] [PubMed]
- Wise, J. COVID-19: France and Greece make vaccination mandatory for healthcare workers. Br. Med. J. 2021, 374, n1797. [Google Scholar]
- Graeber, D.; Schmidt-Petri, C.; Schröder, C. Attitudes on voluntary and mandatory vaccination against COVID-19: Evidence from Germany. PLoS ONE 2021, 16, e0248372. [Google Scholar] [CrossRef] [PubMed]
- Smith, D.T.; Attwell, K.; Evers, U. Support for a COVID-19 vaccine mandate in the face of safety concerns and political affiliations: An Australian study. Politics 2022, 42, 480–491. [Google Scholar] [CrossRef]
- Largent, E.A.; Persad, G.; Sangenito, S.; Glickman, A.; Boyle, C.; Emanuel, E.J. US public attitudes toward COVID-19 vaccine mandates. JAMA Netw. Open 2020, 3, e2033324. [Google Scholar] [CrossRef]
- Gagneux-Brunon, A.; Botelho-Nevers, E.; Bonneton, M.; Peretti-Watel, P.; Verger, P.; Launay, O.; Ward, J.K. Public opinion on a mandatory COVID-19 vaccination policy in France: A cross-sectional survey. Clin. Microbiol. Infect. 2022, 28, 433–439. [Google Scholar] [CrossRef] [PubMed]
- Giannouchos, T.V.; Steletou, E.; Saridi, M.; Souliotis, K. Mandatory vaccination support and intentions to get vaccinated for COVID-19: Results from a nationally representative general population survey in October 2020 in Greece. J. Eval. Clin. Pract. 2021, 27, 996–1003. [Google Scholar] [CrossRef]
- Stead, M.; Ford, A.; Eadie, D.; Biggs, H.; Elliott, C.; Ussher, M.; Bedford, H.; Angus, K.; Hunt, K.; MacKintosh, A.M. A “step too far” or “perfect sense”? A qualitative study of British adults’ views on mandating COVID-19 vaccination and vaccine passports. Vaccine 2022, 40, 7389–7396. [Google Scholar] [CrossRef]
- Giannakou, K.; Kyprianidou, M.; Heraclides, A. Attitudes and determinants of mandatory vaccination against COVID-19 among the general population of Cyprus: A nationwide cross-sectional study. Vaccines 2022, 10, 438. [Google Scholar] [CrossRef]
- Tong, A.; Sainsbury, P.; Craig, J. Consolidated criteria for reporting qualitative research (COREQ): A 32-item checklist for interviews and focus groups. Int. J. Qual. Health Care 2007, 19, 349–357. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Braun, V.; Clarke, V. Using thematic analysis in psychology. Qual. Res. Psychol. 2006, 3, 77–101. [Google Scholar] [CrossRef] [Green Version]
- Ritchie, J.; Lewis, J.; Nicholls, C.M.; Ormston, R. Qualitative Research Practice: A Guide for Social Science Students and Researchers; Sage: Newcastle upon Tyne, UK, 2013. [Google Scholar]
- Bradley, E.H.; Curry, L.A.; Devers, K.J. Qualitative data analysis for health services research: Developing taxonomy, themes, and theory. Health Serv. Res. 2007, 42, 1758–1772. [Google Scholar] [CrossRef] [Green Version]
- Hickey, G.; Kipping, C. A multi-stage approach to the coding of data from open-ended questions. Nurse Res. 1996, 4, 81–91. [Google Scholar] [CrossRef]
- Guba, E.G.; Lincoln, Y.S. Competing paradigms in qualitative research. Handb. Qual. Res. 1994, 2, 105. [Google Scholar]
- Jennings, W.; Stoker, G.; Bunting, H.; Valgarðsson, V.O.; Gaskell, J.; Devine, D.; McKay, L.; Mills, M.C. Lack of trust, conspiracy beliefs, and social media use predict COVID-19 vaccine hesitancy. Vaccines 2021, 9, 593. [Google Scholar] [CrossRef]
- Watermeyer, J.; Scott, M.; Kapueja, L.; Ware, L.J. To trust or not to trust: An exploratory qualitative study of personal and community perceptions of vaccines amongst a group of young community healthcare workers in Soweto, South Africa. Health Policy Plan. 2022, 37, 1167–1176. [Google Scholar] [CrossRef] [PubMed]
- Woodhead, C.; Onwumere, J.; Rhead, R.; Bora-White, M.; Chui, Z.; Clifford, N.; Connor, L.; Gunasinghe, C.; Harwood, H.; Meriez, P. Race, ethnicity and COVID-19 vaccination: A qualitative study of UK healthcare staff. Ethn. Health 2022, 27, 1555–1574. [Google Scholar] [CrossRef] [PubMed]
- Paul, E.; Steptoe, A.; Fancourt, D. Attitudes towards vaccines and intention to vaccinate against COVID-19: Implications for public health communications. Lancet Reg. Health-Eur. 2021, 1, 100012. [Google Scholar] [CrossRef] [PubMed]
- Neumann-Böhme, S.; Varghese, N.E.; Sabat, I.; Barros, P.P.; Brouwer, W.; van Exel, J.; Schreyögg, J.; Stargardt, T. Once We Have It, Will We Use It? A European Survey on Willingness to Be Vaccinated against COVID-19; Springer: Berlin/Heidelberg, Germany, 2020; Volume 21, pp. 977–982. [Google Scholar]
- Rhodes, A.; Hoq, M.; Measey, M.-A.; Danchin, M. Intention to vaccinate against COVID-19 in Australia. Lancet Infect. Dis. 2021, 21, e110. [Google Scholar] [CrossRef] [PubMed]
- Benham, J.L.; Lang, R.; Kovacs Burns, K.; MacKean, G.; Léveillé, T.; McCormack, B.; Sheikh, H.; Fullerton, M.M.; Tang, T.; Boucher, J.-C. Attitudes, current behaviours and barriers to public health measures that reduce COVID-19 transmission: A qualitative study to inform public health messaging. PLoS ONE 2021, 16, e0246941. [Google Scholar] [CrossRef]
- Dillard, J.P.; Tian, X.; Cruz, S.M.; Smith, R.A.; Shen, L. Persuasive messages, social norms, and reactance: A study of masking behavior during a COVID-19 campus health campaign. Health Commun. 2021, 38, 1338–1348. [Google Scholar] [CrossRef]
- Allington, D.; McAndrew, S.; Moxham-Hall, V.; Duffy, B. Coronavirus conspiracy suspicions, general vaccine attitudes, trust and coronavirus information source as predictors of vaccine hesitancy among UK residents during the COVID-19 pandemic. Psychol. Med. 2023, 53, 236–247. [Google Scholar] [CrossRef]
- Sallam, M.; Dababseh, D.; Eid, H.; Al-Mahzoum, K.; Al-Haidar, A.; Taim, D.; Yaseen, A.; Ababneh, N.A.; Bakri, F.G.; Mahafzah, A. High rates of COVID-19 vaccine hesitancy and its association with conspiracy beliefs: A study in Jordan and Kuwait among other Arab countries. Vaccines 2021, 9, 42. [Google Scholar] [CrossRef]
- Mousoulidou, M.; Christodoulou, A.; Siakalli, M.; Argyrides, M. The Role of Conspiracy Theories, Perceived Risk, and Trust in Science on COVID-19 Vaccination Decisiveness: Evidence from Cyprus. Int. J. Environ. Res. Public Health 2023, 20, 2898. [Google Scholar] [CrossRef]
Sociodemographic Characteristics | Overall (N = 311) |
---|---|
Mean Age (SD) | 39.3 (10.5) |
Gender (N a (%)) | |
Female | 183 (59.4) |
Male | 125 (40.6) |
Geographical area (N b (%)) | |
Nicosia | 146 (48.3) |
Limassol | 66 (21.9) |
Larnaca | 48 (15.9) |
Paphos | 22 (7.3) |
Ammochostos | 20 (6.6) |
Occupation (N c (%)) | |
Private employee | 129 (42.2) |
State employee | 82 (26.8) |
Freelance | 51 (16.7) |
Student | 10 (3.3) |
Unemployed | 20 (6.4) |
Housewife | 7 (2.3) |
Retired | 7 (2.3) |
Marital status (N d (%)) | |
Married/In cohabitation | 224 (73.0) |
Unmarried | 60 (19.5) |
Divorced/separated/widowed | 23 (7.5) |
Underage children living in the household (N e (%)) | |
No | 99 (36.7) |
Yes | 170 (63.3) |
Healthcare professional (N a (%)) | |
No | 274 (89.0) |
Yes | 34 (11.0) |
Education level (N d (%)) | |
Up to secondary education | 46 (15.0) |
Undergraduate education | 152 (49.5) |
Postgraduate education | 109 (35.5) |
Annual income (N f (%)) | |
Low (≤EUR 6500) | 38 (12.6) |
Moderate (EUR 6500–19,500) | 107 (35.6) |
High (>EUR 19,500) | 156 (51.8) |
COVID-19 Vaccination | Overall (N = 311) |
---|---|
Vaccination status (N a (%)) | |
No | 198 (64.9) |
Yes | 107 (35.1) |
Number of doses (N b (%)) | |
1 | 9 (8.3) |
2 | 67 (61.5) |
3 | 33 (30.2) |
Type of COVID-19 vaccine (N b (%)) | |
Pfizer | 76 (69.7) |
Moderna | 12 (11.0) |
Astra Zeneca | 13 (11.9) |
Johnson & Johnson | 5 (4.7) |
Combination | 3 (2.7) |
Intention to receive another dose if requested (N c (%)) | |
Not at all | 38 (28.6) |
Little | 8 (6.0) |
Moderate | 11 (8.2) |
A lot | 38 (28.6) |
Very much | 38 (28.6) |
Believe that the vaccine helped to prevent COVID-19 disease? (N d (%)) | |
Not at all | 39 (25.8) |
Little | 16 (10.6) |
Moderate | 33 (21.9) |
A lot | 28 (18.5) |
Very much | 35 (23.2) |
If you have not received the COVID-19 vaccine to date, do you plan to receive it? (N e (%)) | |
I do not know | 24 (12.0) |
No | 173 (86.5) |
Yes | 3 (1.5) |
They belong to a vulnerable group (diabetic, immunosuppressed, etc.) for whom vaccination is recommended (N f (%)) | |
I do not know | 14 (4.6) |
No | 257 (84.8) |
Yes | 32 (10.6) |
Thematic Area | Category |
---|---|
Vaccination Perceptions and Challenges | Universal Mandatory Vaccination |
Targeted Mandatory Vaccination | |
Insufficient Research | |
Inadequate Communication and Information Discrepancies | |
Protective Measures | |
Interdisciplinary Collaboration | |
Vaccine Side Effects and Lack of State Responsibility | |
Natural Immunity | |
COVID-19 Denial and Perceived Risk | |
Mandatory Vaccination Policies and Societal Impact | Two-tiered Society |
Human Rights | |
Reactive Response to Obligation | |
Political and Economical Expediencies | |
Social Impact Outweighed |
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content. |
© 2023 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Giannakou, K.; Soulioti, E.; Kyprianidou, M. Mandatory Vaccination against COVID-19: Qualitative Analysis of Responses to Open-Ended Questions. Hygiene 2023, 3, 291-305. https://doi.org/10.3390/hygiene3030021
Giannakou K, Soulioti E, Kyprianidou M. Mandatory Vaccination against COVID-19: Qualitative Analysis of Responses to Open-Ended Questions. Hygiene. 2023; 3(3):291-305. https://doi.org/10.3390/hygiene3030021
Chicago/Turabian StyleGiannakou, Konstantinos, Eftychia Soulioti, and Maria Kyprianidou. 2023. "Mandatory Vaccination against COVID-19: Qualitative Analysis of Responses to Open-Ended Questions" Hygiene 3, no. 3: 291-305. https://doi.org/10.3390/hygiene3030021
APA StyleGiannakou, K., Soulioti, E., & Kyprianidou, M. (2023). Mandatory Vaccination against COVID-19: Qualitative Analysis of Responses to Open-Ended Questions. Hygiene, 3(3), 291-305. https://doi.org/10.3390/hygiene3030021