CHAPTER ONE
INTRODUCTION
1.1 Background of Study
COVID-19 is a respiratory disease that was first identified in December 2019 in Wuhan, the capital of Hubei province in the people’s republic of China.1 It is caused by SARS-CoV-2 and was said to have emerged from a livestock market in the city of Wuhan in December 2019. The first case of COVID-19 in Nigeria was discovered on the 27th February 2020, when an Italian in Lagos tested positive for the virus. Since then, the number of cases has steadily increased in Nigeria. The WHO declared COVID-19 a global pandemic on the 11th March 2020 (Shigemura, Ursano and Benedek, 2020). The case fatality rate in Nigeria is presently 1.2% of the total confirmed cases with 82% recovery rate, while the prevalence is 12.2%. (Coronatracker, 2020; Amzat, Aminu, Kolo, Akinyele, Ogundairo and Danjibo, 2020).There is presently no widely accepted or recommended treatment modality for COVID-19. The recommendations of various disease control institutions are geared towards disease prevention in order to control the spread and reduce the burden on healthcare system. Many drugs have been tried for the treatment of COVID-19. These drugs include hydroxychloroquine, chloroquine, azithromycin, ivermectin, doxycycline, cotrimoxazole, remdesivir, ulinastatin and colchicine, but none has been unanimously recommended for the treatment of COVID19. An inhaler was recently tried in Israel and said to have an efficacy of 96% (WorldTopNews, 2020). The device is based on exosomes enriched in CD24 that is inhaled directly into the lungs and capable of clearing the virus within 5 days of use. Clinical trials are still ongoing (WorldTopNews, 2020).Since there is presently no widely recommended effective treatment for COVID-19, vaccination is the biggest hope for the control of the COVID-19 pandemic. Vaccination has been effective in the prevention of infectious diseases thereby reducing associated morbidity and mortality. It is the mainstay of prevention and control of infectious diseases. However, the success of vaccination against COVID-19 will be largely dependent on the willingness of the general populace to accept and receive the vaccine and the subsequent development of herd immunity (SSRN, 2020).The second wave of the COVID-19 pandemic is presently ongoing. As at 31st December 2020, three new variants of the SARS-CoV-2 have been detected and has spread to about 13 countries worldwide (Aljazeera, 2020). In the face of mutations of the SARS-CoV-2, there is increasing concern about the effectiveness of the available vaccines against the present variants of the SARS-CoV-2, as a new variant of the virus first discovered in Nigeria has been found in the United Kingdom (Mirror, 2020). This variant (B1525) contains the E484K mutation that helps the virus evade antibodies against it, which may render the presently available COVID-19 vaccines ineffective (Mirror, 2020).The COVID-19 vaccine works by delivering the genetic sequence of the SARS-CoV-2 spike protein to the body’s cells (GAVI, 2020). The body’s cells read this genetic code and produce copies of the spike protein, the immune system in turn mounts a response against these proteins and remembers them. If SARS-CoV-2 later enters the body, its spike proteins will immediately flag it to the immune system for destruction.The WHO has recommended the Oxford/AstraZeneca COVID-19 vaccine for use in all adults.10 It has recommended two doses of the vaccine to be given 8 to 12 weeks apart.10 The efficacy of the vaccine is higher when the second dose is administered.10 The national agency for food and drug administration and control (NAFDAC) has also recommended the Oxford/AstraZeneca COVID-19 vaccine for use in Nigeria.11 A recent study on COVID-19 vaccine efficacy in Israel revealed that Pfizer/BioNTech’s vaccine is about 85% effective after the first dose.12 When the immune system is not optimal, there may be poor vaccine response especially in the elderly. Therefore, optimising the immune system with nutrition, vitamins and minerals to improve the effectiveness of COVID-19 vaccine has been suggested (The Conversation, 2020).
1.2 Statement of Problem
Low uptake of vaccines is a widely recognised rate limiting factor to achieving successful global vaccination against infectious diseases (Piltch-Loeb and DiClemente, 2020). Vaccine uptake may be influenced by a number of factors which include understanding, level of education, ethnicity, sociocultural factors, religious factors, personal risk perception, access to social media, fear of side effects, accessibility to healthcare facility, sources of information and level of trust in the healthcare system. Therefore, introducing a new vaccine to the general populace may be met with a lot of resistance due to the factors mentioned above.
1.3 Research Objectives
The objective of this research is to determine the predictors and willingness of patients at the FMC, Owo to accept the COVID-19 vaccine.
1.4 Specific Objective
The specific objectives of the study are to:i. determine the factors that influence acceptance of vaccine;ii. determine the willingness to receive COVID-19 vaccine;iii. evaluate reasons for unwillingness to receive COVID-19 vaccine; andiv. determine the preferred route of administration of COVID-19 vaccine
1.5 Research Questions
To critically fulfil the research objectives, the following questions were asked:
i. What are the factors determining the acceptance of COVID-19 vaccine?
ii. What is the willingness to receive COVID-19 vaccine?
iii. What are the reasons for unwillingness to receive COVID-19 vaccine?
iv. What is the preferred route of administration of COVID-19 vaccine?
1.6 Significance of Study
The following are the significance of this study:i. Findings from this study would be helpful for adequate planning for the introduction of the COVID-19 vaccine. This formative study would thus be important in quickening prompt interventions which would be targeted at stimulating the right kind of support at community levels.ii. The study will also be of great benefit to the government and health ministry as the findings will help them educate the people on the COVID-19 vaccine and its importance.iii. The study will also be of importance to researcher who intends to carry out study in similar topic as the study will serve as a reference point. Finally, the study will be of significance to academia, student, teachers, lecturers and the general public as the findings will also contribute to the pool of knowledge.
1.7 Scope of Study
Although the study focused on patients in tertiary hospital in South-West Nigeria, the emphasis was on patients in Federal Medical Centre, Owo. The study area consisted patients who were easily accessible. The hospital was selected for investigation because of the period of time it had existed, the sizeable number of patients who are in the facility, the level of documentation and follow up program.1.8 Definition of TermsVaccine: A substance used to stimulate the production of antibodies and provide immunity against one or several diseases, prepared from the causative agent of a disease, its products, or a synthetic substitute, treated to act as an antigen without inducing the disease.Factors: A determinant which decisively affects the nature or outcome of something.COVID-19: COVID-19 is a disease caused by a new strain of coronavirus. ‘CO’ stands for corona, ‘VI’ for virus, and ‘D’ for disease. Formerly, this disease was referred to as ‘2019 novel coronavirus’ or ‘2019-nCoV.’Acceptance:The action of consenting to receive or undertake something offered.