COVID-19 vaccine acceptance and rejection in an adult population in Bosnia and Herzegovina

  1. Adnan Fojnica
  2. Ahmed Osmanovic
  3. Nermin Đuzic
  4. Armin Fejzic
  5. Ensar Mekic
  6. Zehra Gromilic
  7. Imer Muhovic
  8. Amina Kurtovic-Kozaric

Reviewed by

Read the full article See related articles

Listed in

Log in to save this article

Abstract

Bosnia and Herzegovina is among ten countries in the world with the highest mortality rate due to COVID-19. Lack of lockdown, open borders, high mortality rate, no vaccination plan, and strong domestic anti-vaccination movement present serious COVID-19 concerns in Bosnia and Herzegovina. In such circumstances, we set out to study 1) the willingness of general public to receive the vaccine, 2) factors that affect vaccine rejection, and 3) motivation for vaccine acceptance.

Methods

A cross-sectional study was conducted among 10471 adults in Bosnia and Herzegovina to assess the acceptance or rejection of participants toward COVID-19 vaccination. Using a logistic regression model, we examined the associations of sociodemographic characteristics with vaccine rejection, reasons for vaccine hesitancy, preferred vaccine manufacturer, and information sources.

Results

Surprisingly, only 25.7% of respondents indicated they would like to get a COVID-19 vaccine, while 74.3% of respondents were either hesitant or completely rejected vaccination. The vaccine acceptance increased with increasing age, education, and income level. Major motivation of pro-vaccination behavior was intention to achieve collective immunity (30.1%), while the leading incentive for vaccine refusal was deficiency of clinical data (30.2%). The Pfizer-BioNTech vaccine is shown to be eightfold more preferred vaccine compared to the other manufacturers. For the first time in Bosnia, vaccine acceptance among health care professionals has been reported, where only 39.4% of healthcare professionals expressed willingness to get vaccinated.

Conclusion

With the high share of the population unwilling to vaccinate, governmental impotence in securing the vaccines supplies, combined with the lack of any lockdown measures suggests that Bosnia and Herzegovina is unlikely to put COVID-19 pandemic under control in near future.

Article activity feed

  1. Version published to 10.1371/journal.pone.0264754
  2. ScreenIT

    SciScore for 10.1101/2021.03.01.21252700: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementIRB: The study was approved by the Ethics Committee of the Faculty of Engineering and Natural Sciences, International Burch University
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variableGender was categorized as male, female or other.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Another limitation represents absence of information in case participants were infected with SARS-CoV-2 virus and whether they consider acquired immunity to be sufficient protection and adequate replacement for the vaccination. 23.2 % participants indicated hesitance to the vaccination due to insufficient clinical trials conducted, therefore safe and effective mass immunization around the globe could increase acceptance rate as time passes. Finally, rejection was assessed using a hypothetical vaccine, which may differ from the respondents’ preferences encountering real life situations once COVID 19 vaccines become widely available. According to current studies, herd immunity benefits are achievable if 65%–70% of the population is vaccinated20. With the high share of the population unwilling to vaccinate, governmental impotence in securing the vaccines’ supplies, combined with the number of people unable to receive the COVID-19 vaccine (e.g., allergies), herd immunity is out of reach for the B&H population in the near future. In order to increase awareness regarding health benefits of vaccination and the historical role immunization had in eradication of many deadly diseases, people must be reached through main informing sources - educational programs and media. Additional efforts must be made to organize scientific panels and conferences for healthcare workers and physicians, as only 39,4% of them are willing to accept vaccination. Ideally, frontline medical professionals sho...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  3. Version published to 10.1101/2021.03.01.21252700v1 on medRxiv