Peer-reviewed article

COVID-19 Vaccine Acceptance and Hesitancy: Perceptions in Kerala, the Indian State With the Highest Literacy.

Dhanya Muralidharan, Arun Paul, Suhaila Panangadanakath, Sreelakshmi T Nandakumar, Shana S Poothotill et al. · 13 Jun 2025

Abstract

OBJECTIVES: Public acceptance of a vaccine determines whether pandemic control is successful. Most studies assessing coronavirus disease 2019 (COVID-19) vaccine acceptance were conducted before the vaccine became publicly available, whereas the actual intent to be vaccinated often differs once the vaccine is accessible. Therefore, this study investigated COVID-19 vaccine acceptance, hesitancy, and associated determinants among the general population of Kerala, India, after the vaccine became available. METHODS: A cross-sectional descriptive online survey was conducted using a structured and validated questionnaire in both English and Malayalam. It collected information on contextual influences, individual perceptions, group influences, COVID-19 vaccine-specific factors, and attitudes toward COVID-19 vaccination. RESULTS: Of the 1078 participants, 85.0% (n=916) accepted the COVID-19 vaccine, while 15.0% (n=162) were hesitant. Factors predicting vaccine hesitancy included male sex, younger age, lower educational attainment (school level), lower income, being unmarried, and not having children. Key determinants of vaccine hesitancy identified were concerns regarding vaccine safety and effectiveness, lack of trust in the government, insufficient information provided through the vaccination program, disbelief in vaccination's protective role against COVID-19, and perception of the vaccination process as complicated and inconvenient. CONCLUSIONS: Vaccine-hesitant individuals do not perceive COVID-19 vaccination as a social responsibility to their community. Digitization of the vaccination process may not be suitable for all segments of society, indicating that additional support for persons from lower socioeconomic statuses may be necessary to enhance acceptance. The newly identified areas of concern can guide government and healthcare workers, both nationally and globally, in effectively addressing and mitigating vaccine hesitancy.