The determinants of SARS-CoV-2 vaccine hesitancy in a rural area of an Indonesia–Philippines border island: A mixed-method study

BACKGROUND: The SARS-CoV-2 vaccination program campaign has been underway in Indonesia for people aged ≥18 years. The program’s success can be hampered by vaccine hesitancy in communities. This study aims to elucidate the determinants of SARS-CoV-2 vaccine hesitancy in a rural area of the Indonesia–Philippines border island Sangihe. METHODS: A mixed-methods study was conducted; a quantitative part involving a cross-sectional survey was carried out among participantes aged ≥18 years to determine the prevalence and determinants of SARS-CoV-2 vaccine hesitancy. The qualitative part involved in-depth interviews to explore the perceptions towards the SARS-CoV-2 vaccine. RESULT: Among 557 participantes, the prevalence of vaccine hesitancy was 63.9% (95% CI: 59.8–67.9). In the adjusted analysis, three factors affected vaccine hesitancy: education (aOR: 0.40; 95% CI: 0.22−0.70), knowledge of the SARS-CoV-2 vaccine (aOR: 2.17; 95% CI: 1.41–3.34) and willingness to pay (aOR: 0.12; 95% CI: 0.07–0.20). The majority of reasons for refusing the vaccine included doubt regarding its safety and effectiveness, the fear of side effects, lack of information regarding the vaccine and local Christians’ religious beliefs. CONCLUSION: This study found that most adults in the area were hesitant about the SARS-CoV-2 vaccine. Lack of knowledge, a low level of education and misinformation were factors that greatly affected vaccination hesitancy. The government, by involving religious leaders, is expected to pay serious attention to the dissemination of accurate and convincing information to the public regarding the safety and importance of the SARS-CoV-2 vaccine.