Impact of second wave of COVID-19 pandemic on the hesitancy and refusal of COVID-19 vaccination in Puducherry, India: a longitudinal study

The second wave of COVID-19 pandemic has spread rampantly throughout India between April and May 2021, leading to high mortality rates. Identifying any change in the rate of vaccine hesitancy or refusal due to such mass casualty events will provide further insights on developing appropriate risk communication strategy. Hence, this study was undertaken to identify the vaccine hesitancy and refusal before and during the second wave of COVID-19 pandemic. We conducted a longitudinal study among 900 adults to know about their vaccine hesitancy and refusal pattern before (March 2021 - round-1) and during the second wave of COVID-19 pandemic (May 2021 - round-2). Telephonic interview was conducted using the pre-tested semi-structured questionnaire. There was an increase in the vaccine hesitancy (27.8% in round-1 to 32.7% in round-2) and refusal (25.6% in round-1 to 35.6% in round-2) during the second wave of pandemic in Puducherry. In adjusted analysis, vaccine hesitancy was found to increase by 1.19 times during the round-2 survey compared to round-1 survey (aIRR = 1.19; 95%CI: 1.03-1.37). We also found that the vaccine refusal increased by 1.40 times during the round-2 survey compared to round-1 survey (aIRR = 1.40; 95%CI: 1.22-1.62) after adjusting for age, place of residence, and occupation. We found that the confidence in COVID-19 vaccine efficacy and safety has declined over time leading to increase in the vaccine hesitancy and refusal in our study cohort, with more than one-third refusing to get themselves vaccinated during the second wave of pandemic.