Assessment of Attitude and Perception of COVID 19 Vaccine Hesitancy in Rural and Urban Areas of Maharashtra, India

Background: COVID 19 pandemic has afflicted the whole world. Older age group and people with comorbidities are on major risk to COVID 19. Around 200 vaccines are being developed around the world in hope to return the life to normal. On January 3, 2021, India’s drug regulator approved two COVID 19 vaccines in IndiaCovaxin and Covisheild. COVID 19 vaccines are a great boon for the public health but they have posed new challenges amongst the healthcare workers as well as general population. Hesitancy towards these vaccines is one such significant botheration to public health. Objectives: To evaluate the attitude and perception of COVID 19 vaccine hesitancy amongst the different age groups i.e., 18-45 years, >45 years (without co-morbidities and >45 years (with comorbidities). Methodology: A special questionnaire would be designed for evaluation of the hesitancy for COVID 19 vaccine amongst the 400 participants from various rural and urban areas in Maharashtra according to different age groups i.e., 18-45 years, >45 years (without co-morbidities and >45 years (with co-morbidities). Study Protocol Gadge et al.; JPRI, 33(63A): 71-76, 2021; Article no.JPRI.80063 72 Expected Results: As the world is fighting with the deadly pandemic, COVID 19 vaccines have come to the relief of the people. The emanation and distribution of these vaccines have put forth many challenges in front of the government and the health care workers. COVID 19 vaccine hesitancy is one such challenge amongst the Indian population. Thus, this study is formulated to assess the attitude and perception of people towards COVID 19 vaccine hesitancy and to determine the cause of it. Conclusion: This study will evaluate the attitude and perception for COVID 19 vaccine among the participants. Senior citizens perceive that they will have some side effects due to vaccine whereas 18+ citizens perceive that their immunity can resist COVID-19.


INTRODUCTION
COVID 19 is a fatal pandemic endangering the entire population with the toxic virus. It mainly affects the respiratory system resulting in deficiency to draw breath. Along with this, patients also reported symptoms like pyrexia with chills, dry expectorations, tiredness and headache. The virus spreads mainly through person-to-person contact. Older age group and people with comorbidities are on major risk to COVID 19. The disease sprang from Wuhan, China in December 2019 with a large number of cases appearing globally. As a result of the prodigious spread of the virus, the entire country went in a state of complete lockdown on 24th March 2020 [1]. Thereafter several measures were implemented by the ministries and other authorities to contain the spread of virus: maintaining social distancing among the people, use of N95 or surgical or fabric masks, recurrent handwashing, etc. As there is no availability of specific drugs for the disease, People prefer home remedies. Around  As the COVID-19 vaccines emerge successful from clinical trials, the focus must shift from the advanced and sophisticated technologies to the behaviour and communications that will build trust among clinicians and the general public. COVID 19 vaccines are a great boon for the public health. Not only the vaccines provide first hand security to the vaccinated individuals but also it helps in concomitant safety of the general public through the generation of herd immunity. While significant resources have been invested in the evolution of shielded and efficacious vaccines, it is important to note that vaccination prevents harm and saves lives. Recently, India has started the vaccination drive on 16th March 2021 encompassing with it a lot many challenges and opportunities.
COVID 19 Vaccine hesitancy is one such challenge to public health recognised by WHO [3]. It is characterised as a spectrum of vaccine beliefs and behaviours that ranges from complete vaccine refusal to complete vaccine acceptance. Within this spectrum, vaccineaverse people make up a diverse group. They may reject some vaccines but accept others; they may hold up or welcome vaccines depending upon the advocated programmes but are unassertive whether their decision is "right." [4]. Vaccine hesitancy is described by the World Health Organization as a "detaination in accepting or refusing vaccinations in spite of accessibility and feasibility of vaccination facilities." Health knowledge gathered from a number of outlets, comprising of digital media such as the Internet and social media networks, can fuel COVID 19 vaccine hesitancy [5]. Since vaccines for COVID 19 are distinctive, unique and recently developed; misinformation or lack of knowledge, mistrust and fear for the vaccines can also trigger vaccine hesitancy. Thus, this study aims to assess the "COVID 19 vaccine hesitancy" amongst the general population in various rural and urban areas of Maharashtra.

Background/rationale
COVID 19 pandemic has afflicted the whole world. Older age group and people with comorbidities are on major risk to COVID 19. Around 200 vaccines are being developed around the world in hope to return the life to normal. On January 3, 2021, India's drug regulator approved two COVID 19 vaccines in India-Covaxin and Covisheild. COVID 19 vaccines are a great boon for the public health but they have posed new challenges amongst the healthcare workers as well as general population. Hesitancy towards these vaccines is one such significant botheration to public health.

Objectives
To assess the attitude and perception of COVID 19 vaccine hesitancy amongst the different age groups i.e., 18-45 years, >45 years (without comorbidities and >45 years (with co-morbidities).

MATERIALS AND METHODOLOGY
Sample selection-Sample size is determined using the following formula Where, σ = previous expected values=24 E =desired Margin of error = 5 z α/2 , confidence interval of 90%, z = 1.65 n = sample size estimated 400 A special questionnaire would be designed for evaluation of the hesitancy for COVID 19 vaccine amongst the 400 participants from various rural and urban areas in Maharashtra.

Measurement
A questionnaire is designed to evaluate the hesitancy for COVID 19 vaccine amongst the participants. The questionnaire is divided in 3 parts: the first part consists of the demographic information of participants, and their educational status. The second part include assessing the attitude and the third assessing the perception using a 5-point Likert scale. Participants will be asked to complete a questionnaire in a particular period and demographic information was included at the start of the survey.
Bias: All the potential sources of bias has been removed.
Quantitative variables: All the demographic details and the questions in relation to the questionnaire will be recorded with the help of electronic forms and record in the excel sheet.

Statistical methods: Statistical software of SPSS version 22 has been used for the analysis.
Descriptive statistics and frequency distribution will be done for recording the demographic details and responses of the questionnaire. Person's correlation and chisquare analysis is done to evaluate the association between age, gender and socioeconomic scale with the perception of the patients towards the selection of dentist. Do you think that the medical establishment is not trustworthy regarding COVID 19 vaccine? 8) Do you feel that the foreign vaccines are more effective than indigenous vaccines? 9) Do you think that the herd immunity will protect you even if you don't take the vaccine?

RESULTS
As the world is fighting with the deadly pandemic, COVID 19 vaccines have come to the relief of the people. The emanation and distribution of these vaccines have put forth many challenges in front of the government and the health care workers. COVID 19 vaccine hesitancy is one such challenge amongst the Indian population. Thus, this survey is formulated to analyse the attitude and perception of people towards COVID 19 vaccine hesitancy and to deduce the cause of it.

CONCLUSION
This study will evaluate the attitude and perception for COVID 19 vaccine among the participants. Senior citizens perceive that they will have some side effects due to vaccine whereas 18+ citizens perceive that their immunity can resist COVID-19.

DISCLAIMER
The products used for this research are commonly and predominantly use products in our area of research and country. There is absolutely no conflict of interest between the authors and producers of the products because we do not intend to use these products as an avenue for any litigation but for the advancement of knowledge. Also, the research was not funded by the producing company rather it was funded by personal efforts of the authors.

CONSENT
As per international standard or university standard, participants' written consent will be collected and preserved by the author(s).

ETHICAL APPROVAL
As per international standard or university standard written ethical approval will be collected and preserved by the author(s).