Vaccine Acceptance among Adults in Jalingo

Vaccine acceptance is crucial to containing the most raging viral infections ravaging the world today. The COVID-19 vaccine is not an exception to this. COVID-19 vaccine acceptance is an issue of great concern all over the world, Nigeria inclusive; considering the manner the disease, COVID-19 ravaged the world, crumbled economies, and almost overwhelmed the healthcare delivery of every country. A cross-sectional study was adopted to determine the acceptance of the COVID-19 vaccine among adults aged 18-55 in Jalingo. The study was carried out among 420 Jalingo adult residents between June and November 2022. The pretested questionnaires were self-administered and collected on the spot. The results revealed that 61.1% of the adults in Jalingo accepted the COVID-19 vaccine. However, 61(33%) and 98(41.7%) of the male and female respondents, respectively, accepted it. While 13(68.40%),6(50%), 39(50.60%) and 101(32.40%) respondents of the age groups 46-55, 36-45, 26-35 and 18-25, respectively, accepted the vaccine, 11(78.60%) secondary school leavers, 4 (44.4%) and 68(33.20%) tertiary and primary school leavers accepted the vaccine. In the same vein, 76(39.60%) of the respondents who had no formal education (NFE) accepted the vaccine. However, factors like giving incentives, making the vaccine compulsory, providing substantial information on the vaccine, and making health professionals recommend it can influence the acceptance of the vaccine. The acceptance of the COVID-19 vaccine among adults in Jalingo was moderate. However, this acceptance rate can be improved upon if the encouraging factors are detected and efficiently utilised. APA CITATION Mbah, M. I. & Yero, S. B. (2023). Vaccine Acceptance among Adults in Jalingo East African Journal of Health and Science, 6(1), 172-186. https://doi.org/10.37284/eajhs.6.1.1269.


INTRODUCTION
COVID-19 is very much around with us. The approved and recommended vaccines against it is also available. Yet some people will not avail themselves of the opportunity. A lot of factors contribute to this. They include the level of education, fear of needles, negative beliefs based on myths, e.g., that vaccination of women leads to infertility, misinformation, mistrust in the health care professional or health care system, the role of influential leaders, costs; geographic barriers and concerns about vaccine safety. While some of these factors are barriers to vaccine acceptance, others are promoters. In some cases, a particular factor (such as level of education) can be a promoter as well as a barrier to vaccine acceptance depending on the area or setting (WHO, 2015).

Why Don't People Embrace Vaccination? Do They Know What Vaccine is and the Purpose
A vaccine is any preparation that is used to stimulate the body's immune response against diseases. Vaccines are usually administered through needle injections, but some can be administered by mouth or sprayed into the nose (CDC, 2021).
There are several types of vaccines; they are inactivated vaccines, live-attenuated vaccines, messenger RNA (mRNA) vaccines, Subunit, recombinant, polysaccharide, and conjugate vaccines, toxoid vaccines and Viral vector vaccines (US Department of Health and Human Services, 2022). Some of the methods are used in the production of COVID-19 vaccines. For instance, mRNA vaccines make proteins in order to trigger an immune response. It has the advantage of shorter manufacturing times and no risk of causing disease in the person getting vaccinated. mRNA vaccines can be used to protect against COVID-19(US Department of Health and Human Services, 2022). Viral vector vaccines use a modified version of a different virus as a vector to deliver protection. Several different viruses have been used as vectors, including influenza, vesicular stomatitis virus (VSV), measles virus, and adenovirus, which causes the common cold. Adenovirus is one of the viral vectors used in some COVID-19 vaccines being studied in clinical trials. Viral vector vaccines are used to protect against COVID-19(US Department of Health and Human Services, 2022). Viral vector-based vaccines use a harmless virus to smuggle the instructions for making antigens from the disease-causing virus into cells, triggering protective immunity against it (VIPER Group COVID-19 Vaccine Tracker Team, 2022). Viral vector has an advantage over most conventional vaccines by not containing the antigens but rather using the body's own cells to produce them. The vaccine mimics what happens during natural infection with certain pathogensespecially viruses. This has the advantage of triggering a strong cellular immune response by T cells as well as the production of antibodies by B cells. The virus itself is harmless, and by getting the cells only to produce antigens, the body can mount an immune response safely without developing disease (VaccinesWork, 2020).
Nevertheless, in recent years, vaccine development using ribonucleic acid (RNA) has become the most promising and studied approach to producing safe and effective new vaccines. During the COVID-19 pandemic, the use of mRNA as a vaccine became more relevant; two out of the four most widely applied vaccines against COVID-19 in the world are based on this platform (Machado et al., 2021).  James et al. (2022). Sixty-point two per cent (60.2%) (n = 201) of respondents showed positive attitudes with a mean of (13.96±2.97) towards the vaccine (James et al., 2022). Also, in a review study by Ackah et al. (2022), the vaccine acceptance rate ranged from 6.9 to 97.9% (Ackah et al., 2022). On the other hand, among clinical practitioners, the COVID-19 vaccine was accepted by 84.4 per cent of those polled, and 86.1 per cent said they would recommend it to others (Abay et al., 2022). Therefore, this study aimed to determine the acceptance of the COVID-19 vaccine among adults in Jalingo as well as the influencing factors.

Study Design
This community-based cross-sectional design was carried out between June and November 2022. It utilised a self-structured questionnaire designed to get information on the acceptance of the COVID-19 vaccine among adults aged 18-55 years in Jalingo and the factors that influence the acceptance. The respondents comprised only the adults who were residents of Jalingo and were willing to participate. The research instrument (questionnaire) also contained information on the demographic characteristics of the participants. The research instrument was administered by hand and collected in the same spot after it had been filled/attended to.

Collection Tool
The questionnaire was used. It contained two sections. Section "A" contained information on the demographic characteristics of the participants, while section "B" contained information that will help to determine the acceptance of the COVID-19 vaccine among adults as well as the factors that influence it. The research instrument was scaled 3-1, designated as "YES", "MAYBE' and "NO", respectively. The reliability of the questionnaire was obtained using the Cronbach Alpha method, and a pretest was done to determine its validity.

Sample and Sampling Technique
The study adopted a simple random sampling technique. The sample size was obtained using the Taro Yamane method of sample size determination.

Data Collection
A pilot study was carried out by administering the questionnaire to 20 of the participants. The questionnaire was self-administered and collected on the spot after the participants had provided the needed information. The reliability test was done, and Cronbach Alpha Reliability of 0.8 was obtained, and since no major correction was done on the questionnaire, the result of the pilot study was added to that of the main study. Just like in the pilot study, the questionnaire was administered by hand by the researchers in a one-to-one interaction with the respondents. The participants were given some time to respond to the items posed on the questionnaire, after which it was collected back by the researchers. This continued until the 420 participants' target sample size was obtained.

Data Analysis
Filled questionnaires were individually analysed and scored using the predetermined scores of '3' depicting 'YES', '2'-'MAY BE and 'NO' graded '1'. The total score of each respondent was obtained by calculating the sum of the scores of the responses as graded. High scores, such as 70% and above, was regarded as "accepted/high acceptance", while 50% to 69% were regarded as Moderate and < 50% was regarded as rejection/Low acceptance. Then, the total number of individuals with high acceptance was used to calculate the acceptance of the COVID-19 vaccine for each category of respondents, while the total number of respondents with moderate and low acceptance/rejection was used to calculate the percentage of moderate acceptance and rejection separately, respectively. However, the total response to each item on the questionnaire by each category of respondents was collated and used to determine the factors that influence vaccine acceptance. The data obtained were analysed using descriptive statistics and presented in frequencies and percentages, while inferences were drawn using Chi-square.

Ethical Clearance/Approval
The first part of the survey instrument had a clear statement to show that participation in the study was completely voluntary and that the consent for study participation was implied by duly signing/submitting the completed form. Forms were filled and submitted anonymously, and confidentiality of the participants' information was ensured during and after the study.

Figure 1: Covid-19 vaccine acceptance among adults in Jalingo
Ninety-seven (52.4%) males and 117(49.8%) females will accept the vaccine if given incentives. Meanwhile, 80(43.2%) males and 112(47.7%) females will accept the vaccine if it is made compulsory. On the other hand, 105(56.8%) males and 85(36.2%) females will accept the vaccine if given substantial information on the vaccine, while 114(61.6%) males and 90(38.3%) females will be eager to take the vaccine if recommended by healthcare professionals as presented in Table 2  The acceptance of the COVID-19 vaccine among male and female adults in Jalingo showed that 61(33%) and 98(41.7%) of the male and female respondents, respectively, accepted the vaccine. However, 11(5.9%) males and 11 (4.7%) females rejected the vaccine, as presented in Figure 2.

Figure 4: The acceptance of the COVID-19 Vaccine among Adults of various employment statuses in Jalingo
The  The acceptance of the vaccine showed that 11(78.60%) secondary school leavers accepted the COVID-19 vaccine, while 4 (44.4%) and 68(33.20%) of the tertiary and primary school leavers also did the same. In the same vein, 76(39.60%) of the respondents who had no formal education (NFE) accepted the vaccine, as presented in Figure 5.

DISCUSSIONS
The study was carried out among 420 adults aged 18-55 who were residents of Jalingo. More women (56.0%) than men (44.0%) constituted the respondents. Almost three-quarters (74.3%) of the respondents were in the age group 18-25. Meanwhile, a little below half (48.8%) of the respondents were primary school leavers, while a handful (2.1%) had tertiary education ( Table 1).
A good number (61.1%) of the adults in Jalingo accepted the vaccine. The few (2.7%) that had low acceptance/rejected the COVID-19 vaccine were probably because of the way they perceived the vaccine as well as the disease, while 36.2% had moderate acceptance ( Figure I). The 61.1% acceptance obtained in this study is higher than the 37.4% reported by El-Elimat et al. (2021) in a study carried out in Jordan. Also, El-Ghitany et al. (2022) reported that the acceptance rate of COVID-19 among healthcare workers (HCWs) was 58.2%.
The acceptance of the COVID-19 vaccine among females was 41.7%, while it was 33.0% among men ( Figure 2). The acceptance was higher among women because most men, by nature, like to be sure of most things they do before going into it. Moreover, the respondent constituted more women than men. They are represented in the ratio; 56 to 44. However, Zintel et al. (2023), in their review paper, reported that a majority (58%) of the papers they reviewed reported men to have higher intentions to get vaccinated against COVID-19. Also, El-Elimat et al. (2021) reported that males are more likely to accept COVID-19 vaccine. However, El-Ghitany et al. (2022) reported that males represented a higher percentage among the vaccine acceptance group compared to those who refused.
Nevertheless, some factors boosted the willingness of males to accept the vaccine. They include recommendations by healthcare providers and paying for the vaccine if the need arises. However, some other factors, such as giving the vaccine at no financial cost, will reduce the acceptance of the vaccine among men. Meanwhile, more women respondents indicated an interest in accepting the vaccine if the government gives incentives, while they will also be discouraged from taking the vaccine if it is given at no financial cost and when it is being recommended by healthcare workers ( Table 2).
The acceptance of the COVID-19 vaccine was highest (68.40%) among the age group 46-55, while it was the least (32.40%) among the age group 18-25 ( Figure 3). The reason was because of their perception towards the vaccine-some of them believed it was the white man's idea to reduce the population of Africans.  El-Elimat et al. (2021) reported that age is a factor that influences the acceptance COVID-19 vaccine. Regarding the factors that encourage people of various ages to accept the vaccine, giving incentives by the government as well as respondents paying for the vaccine when the need arises will increase the acceptance of the vaccine among adults aged 18-25. Meanwhile, giving the vaccine at no financial cost as well as making it compulsory, will reduce acceptance. However, the age group 26-35 years will be more willing to accept the vaccine if they pay for it when the need arises. Meanwhile, giving the vaccine at no financial cost will discourage them from accepting the vaccine. Just like the age group 26-35, adults 36-45 will be discouraged from taking the COVID-19 vaccine if offered at no financial cost. Meanwhile, if a healthcare worker recommends it or if the government gives incentives, the acceptance among them will increase. For individuals aged 46-55, giving incentives and making the vaccine compulsory will increase acceptance. However, giving it at no financial cost will discourage them from accepting the vaccine ( Table 3).
The acceptance of the COVID-19 vaccine was highest (50%) among students and least (32.30%) among the unemployed (Figure 4). This study also revealed that though half of the student respondents accepted COVID-19, a little above one-third of them rejected the vaccine (Figure 4). This was because they believed they were young and strong and that their body could resist infection. El-Elimat et al. (2021), just like in this study, stated that employed participants were less likely to accept the COVID-19 vaccines. Meanwhile, El-Ghitany et al. (2022) reported that employment status is a factor that influences the acceptance of the COVID-19 vaccine. However, if the COVID-19 vaccine is recommended by healthcare workers or if asked to pay for it when the need arises, the employed will more likely accept the vaccine. Meanwhile, giving the vaccine at no cost will discourage them from accepting the vaccine. Nevertheless, giving substantial information on the vaccine to the unemployed and the vaccine being recommended by healthcare workers will be a deterrent to their accepting the vaccine while paying for the vaccine when the need arises and giving incentives will encourage them (Table 4).
However, the study on the acceptance of COVID-19 among adults of various educational levels in Jalingo revealed that a high percentage (55.60%) of the respondents who had tertiary education rejected the vaccine. This was because they were still observing how those that took the vaccine would react /respond to it. They did not want to be used as "Experimental animals". Meanwhile, the acceptance of the vaccine was highest (78.60%) among the secondary school leavers, while the least (33.20%) was the primary school leavers ( Figure 5). Nevertheless, Wuet al. (2022), as well as El-Ghitany et al. (2022), separately reported that the level of education is also a predictor of the acceptance of the COVID-19 vaccine. However, at various levels of education, different factors encourage and deter them from accepting the vaccine. For instance, however, giving substantial information on the vaccine will increase the acceptance among secondary school leavers but decrease it among primary school leavers. Nevertheless, giving the vaccine at no financial cost will reduce the acceptance across all the groups.

CONCLUSION
The acceptance of the COVID-19 vaccine among adults in Jalingo was moderate. A higher proportion of females than males accepted the vaccine. However, a higher percentage of males than females agreed to accept the vaccine if given enough substantial information on it. However, people aged 45-55 accepted the vaccine more than any other group. They accepted the vaccine regardless of any potential adverse effects. Though half of the student respondents accepted the vaccine, more agreed to accept it if the government gives them incentives, makes it compulsory and if a healthcare provider recommends it. Nevertheless, a high percentage of adults with no formal education accepted the COVID-19 vaccine. However, almost all (8/9) of the respondents who had tertiary education agreed to take the COVID-19 vaccine if given enough substantial information on it. Nevertheless, the willingness to accept the vaccine is low among every category of adults if the vaccine is given at no financial cost and if the government makes it compulsory.

Recommendation
The COVID-19 vaccine should not be given to adults at no financial cost and the government should not make it compulsory rather, people should be made to see the need to take the vaccine.

Limitation
There is no available study to compare the factors (raised in this study) influencing the acceptance of COVID-19.