Indonesia: Planning for Future Vaccine Hesitancy
"The healthcare setting is one important source of transmission; there is approximately one healthcare worker infection for every 100 confirmed monkeypox cases. Therefore, healthcare workers are at risk of occupationally-acquired infection with monkeypox virus even in non-endemic countries." (Harapan et al., 2020, p. 1260)
Monkeypox, an orthopoxvirus like smallpox, emerged in the middle of the last century and is endemic principally in the Democratic Republic of the Congo, although cases of the disease have worryingly appeared in more countries in West and Central Africa in recent years. Additionally, there have been cases of monkeypox reported in countries beyond the African continent, with Asia experiencing its first case in Singapore in 2019. In response to these developments, health officials have considered strategies for combatting an outbreak of monkeypox in their country. There is no vaccine for monkeypox, but because the disease is so genetically similar to smallpox, "vaccination against smallpox has been proven to be 85% effective in preventing monkeypox" (Harapan et al., 2020, p. 1260). Thus, the reintroduction of smallpox vaccination is seen as pivotal to any initiative to counteract monkeypox, but one big question looms over these deliberations: Would enough physicians be comfortable accepting the vaccine?
Researchers at Maulana Malik Ibrahim State Islamic University of Malang, Indonesia-- nervous about the aforementioned first outbreak of monkeypox in Asia-- surveyed general practitioners in Indonesia about their willingness to get vaccinated to protect against smallpox and whether their willingness changed depending on whether the government footed the bill for the vaccine (the monkeypox vaccine would cost 250,000 rupiahs, or about $17.90). Survey respondents were also surveyed on a variety of background and demographic factors (e.g., age, income, and alma mater), as well as their knowledge of monkeypox.
Indonesian nurses in training
Photo of Indonesian nurses practicing CPR under the instruction a Hospital Corpsman with the U.S. Navy, taken in 2005 by Rebecca J. Moat
Results found that in the scenario the government paid for the smallpox vaccine, 93.6% of respondents would accept vaccination. If physicians had to pay for vaccination themselves, only 71.9% of respondents would get the vaccine. Women, physicians without an advanced degree, physicians working in private clinics, and physicians with a lower income were particularly likely to accept vaccination, although an adjusted statistical analysis of the results suggests that of the surveyed factors, only gender had a significant association with willingness to accept vaccination. The reason for this gender difference is debated. Some point out that prior research has found that women are more willing to participate in health-related research and are generally more accepting of vaccines. Others stress that monkeypox is a skin disease, and studies have found that women are more anxious about skin diseases than men; therefore, gender differences in smallpox vaccine acceptance could be specific to monkeypox and may not be generalizable to other conditions.
Also of note was what factors did not influence vaccine acceptance. Researchers were surprised that physicians who knew more about monkeypox were not more likely to seek the vaccine. This finding contrasts with other research that has found that people more knowledgeable about a disease are more interested in receiving a vaccine for it, yet other studies have been more inconclusive. This had led some health researchers to propose that an individual's overall attitude towards a disease is more significant than their knowledge, but further research is needed.