Study of Differences in COVID-19 Vaccine Responses in Developed and Developing Countries

SARS-CoV-2 can spread rapidly and has been shown to cause a wide spectrum of severity. Vaccines exist as a preventive effort to control the transmission of COVID-19 by forming herd immunity. The presence of the COVID-19 vaccine has caused many responses in the community, both positive and negative responses. The article aim to compare risk factors affecting people’s intentions as respond to the COVID-19 vaccine in developed and developing countries. The research was carried out in January 2021 and used the literature review method by collecting and concluding data from previous research. The search for previous research articles was carried out on the Scopus, Science Direct, Clinical Key, and SpringerLink portals with keywords in the form of COVID-19, Vaccine, Acceptance, Intention, and Hesitancy. This narrative review uses 29 articles that meet the inclusion and exclusion criteria. The intention was the lowest positive response (49.64%), and a fairly high form of doubt (71.20%) was found to be a negative response. Respondents who have high confidence in the country’s health system are at 3.05 times greater risk of having the intention to use the COVID-19 vaccine in developed countries (OR = 3.05; 1.13-4.92). Respondents over 65 years of age were at 3.65 times greater risk of having the intention to receive the COVID-19 vaccine in developing countries (OR = 3.65; 2.57-5.17). The COVID-19 vaccine creates positive and negative responses in the community. The intention is the lowest positive response influenced by trust in the country’s health system (developing countries) and age (developed countries).


Introduction
SARS-CoV-2 is a new coronavirus first reported in Wuhan, China in December 2019.The virus causes Coronavirus disease 2019 (COVID-19) with symptoms of severe pneumonia (Guan et al., 2020).The SARS-CoV-2 genome includes 29,903 nucleotides with 12 Open Reading Frames (ORF) (Shahhosseini et al., 2021).The virus spreads rapidly and has been shown to cause a broad spectrum of severity (Agustin et al., 2021).Some COVID-19 patients do not experience symptoms such as fever or radiological abnormalities, so they require preventive measures to control COVID-19 transmission (Guan et al., 2020).Therefore, social distancing is one of the measures to prevent the spread of COVID-19, but its implementation in the community has acceptance of the COVID-19 vaccine.Various other factors that are considered to have the same influence include distrust of health care for minorities, problems related to costs, and low levels of awareness (Khubchandani et al., 2021).Based on these facts, this study was conducted to compare the risk factors affecting people's intentions as a positive response to the COVID-19 vaccine in developed and developing countries.

Method
This research is a narrative review using the literature review method by collecting and concluding data from previous research.It took time in January 2021.The search for previous research articles was carried out on the Scopus, Science Direct, Clinical Key, and SpringerLink portals with keywords such as COVID-19, Vaccine, Acceptance, Intention, and Hesitancy.and to ensure that the community continues to implement the health protocols recommended by WHO (Abila et al., 2020).
There are many public responses to the COVID-19 vaccine, such as disagreements, doubts or refusal to vaccinate can threaten progress in tackling vaccine-preventable diseases.According to WHO, ten threats to global health, one of which is the acceptance of the COVID-19 vaccine in the community.The world is now facing this threat, and the doubt refers to people's thinking to accept or reject vaccines even though vaccination services are available (Gagneux-Brunon et al., 2021).

Result and Discussion
Gender influences people's perceptions of receiving vaccines.Research in Saudi Arabia proves a relationship between gender and intention to take the COVID-19 vaccine.As many as 64.7% of respondents have the intention of receiving the COVID-19 vaccine, and 62.33% are women (Al-Mohaithef and Padhi, 2020).The same pattern occurs in Greece 55.1% of respondents who have a positive response to receiving the COVID-19 vaccine are women (Kourlaba et al., 2021).Female respondents have a 1.12 times greater risk of having the intention to receive the COVID-19 vaccine compared to those who are male (OR=1.12;0.97 -1.30) (Lin et al., 2020).Women were more likely to avoid risky behavior and practice preventive behaviors such as influenza vaccination and wearing masks to prevent COVID-19 infection (Khubchandani et al., 2021).
Marital status is a person's status to find whether someone is married or not.Marital status was an important factor influencing the acceptance of the COVID-19 vaccine.Research in the United States shows that most married respondents (77%) prefer to receive the COVID-19 vaccine than those who are not (Khubchandani et al., 2021).Its result was in line with (Al-Mohaithef and Padhi, 2020) research in Saudi Arabia.Married respondents (69.34%) intend to receive the COVID-19 vaccine if the vaccine is available.Married respondents had a 1.36 times greater risk of having the intention to receive the COVID-19 vaccine compared to those who were not married (OR=1.36;1.02 -2.67) (Kourlaba et al., 2021).Marital status was an important factor that affects the acceptance or rejection of the COVID-19 vaccine, especially if the household already has children (Khubchandani et al., 2021).
An interesting finding in the United States is that most respondents (25%) were hesitant to receive the COVID-19 vaccine (Khubchandani et al., 2021).That result was in line with a study in Greece, which stated that respondents who had children (60.6%) chose not to receive the COVID-19 vaccine compared to those who had children (51.6%).Respondents who have children have a 0.69 times greater risk of having the intention to receive the COVID-19 vaccine compared to those who do not have children (OR=0.69;0.53-0.91)(Kourlaba et al., 2021).
Ownership of children was important in receiving the COVID-19 vaccination, where there was research stating that having children was a negative predictor for respondents to receive the COVID-19 vaccine (Dror et al., 2020).The community's response to the CO-VID-19 vaccine was related to employment status.The majority of respondents who have the intention to accept were those who worked, both as medical personnel, hospital employees, and nurses (Gagneux-Brunon et al., 2021;Kuter et al., 2021;Kwok et al., 2021).Another finding stated that respondents who did not work or were students have hesitancy (59.90%) to receive the vaccine (Caserotti et al., 2021).Respondents who worked had a 0.51 times greater risk of having the intention to accept the COVID-19 vaccine compared to those who did not work (OR=0.51;0.39 -0.65) (Kourlaba et al., 2021).The difference in receiving the COVID-19 vaccine can be seen in the type of work.Vaccine acceptance among doctors (78%) was significantly higher than among nurses (61%).The same thing in the medical team in the COVID-19 department showing a higher acceptance rate (94%) than the non-COVID-19 department (77%).It can be interpreted that employment status was a factor considered by respondents in accepting or refusing the COVID-19 vaccine (Dror et al., 2020).
High trust in the health system was a vital factor considered to have a relationship with the health services usage for disease prevention, including access to vaccinations (Fu et al., 2020).Previous research has proven a relationship between trust in health care providers and acceptance of flu vaccines that existed before the COVID-19 vaccine, such as the H1N1 vaccine (Larson et al., 2018).The majority (64.7%) of respondents said having an intention to use the COVID-19 vaccine in Saudi Arabia when the vaccine becomes available.The intention rate in Saudi Arabia (a developing country) was lower than the intention of the people in the United States (67%) as a developed country (Malik et al., 2020).Respondents who have high trust in the health system have a 3.05 times greater risk of having the intention to use the COVID-19 vaccine (OR=3.05;1.13-4.92)(Al-Mohaithef and Padhi, 2020).Trust was critical to achieving, sustaining, and increasing vaccine demand among people in developing countries (Ozawa et al., 2016).
People with low socioeconomic status have a higher risk of dying from COVID-19, mainly because of their comorbid disease (Lee et al., 2021).The highest proportion with a definite intention to vaccinate (34.8%) were respondents who considered their overall health to be very good.Respondents had the perception that they have low susceptibility, so they disagree with the possibility of contracting COVID-19, contracting COVID-19 in the next few months or for now.Respondents also had high perceptions of the severity of COVID-19 and the benefits of vaccination.Many respondents (92.1%) would receive the COVID-19 vaccine if provided with adequate information.While 82% would accept it if consumed by many people (Lin et al., 2020).
Emotional threats to oneself and distress in the face of widespread media coverage of the increasing number of COVID-19 cases, including the toll, overburdened health systems, and inadequate government response to COVID-19, can foster anxiety or a person's fear of COVID-19 (Dror et al., 2020).Research in France found that 76.9% of respondents would receive the COVID-19 vaccine.As many as 48.1% of respondents have a fear of COVID-19.Respondents who have a fear of COVID-19 have a 1.58 times greater risk of having the intention to receive the COVID-19 vaccine (OR=1.58;1.21 -1.07).It can be said that anxiety or fear was a factor affecting the acceptance of the COVID-19 vaccine (Gagneux-Brunon et al., 2021).
The risk of exposure to SARS-CoV-2 can occur through inanimate surfaces or objects (Goldman et al., 2020).Patients infected with COVID-19 can experience symptoms such as fever, cough, headache, diarrhea, and acute respiratory distress, have a high probability of receiving intensive care and have a high risk of dying (Huang et al., 2020).Research in Saudi Arabia stated that respondents who had a higher perceived risk of being infected with COVID-19 were 2.13 times more likely to be vaccinated compared to those who had a lower risk of contracting COVID-19 (Al-Mohaithef and Padhi, 2020).
People in vulnerable groups have a higher intention to receive the COVID-19 vaccine.Age was one of the factors in classifying vulnerable groups.Research in Greece shows that respondents aged over 65 years (79.3%) were the dominant group who answered "yes" and would receive the COVID-19 vaccine if it was available.Respondents over 65 years had a 3.65 times greater risk of having the intention to accept the COVID-19 vaccine compared to those aged under 65 years (OR=3.65;2.57 -5.17) (Kourlaba et al., 2021).Different conditions were found in China.Most respondents (75.5%) aged 18-25 years had a higher intention to receive the COVID-19 vaccine compared to other age groups (Lin et al., 2020).It can be concluded that each country has different characteristics of society and the age factor plays a vital role in receiving the COVID-19 vaccination in a country.
Developed countries were considered to have higher readiness for the success of the COVID-19 vaccination program associated with the country's economic status (Kourlaba et al., 2021).People in developed countries had an intention to receive a COVID-19 vaccine ranging from 37.2 to 80.0% (Malik et al., 2020;Seale et al., 2020;Wong et al., 2021).This condition is affected by many factors such as age >65 years, vulnerable groups, marital status, child ownership, and employment status.Respondents over 65 years had a 3.65 times greater risk of having the intention to receive the COVID-19 vaccine compared to those aged under 65 years (OR = 3.65; 2.57-5.17).Married respondents had a 1.36 times greater risk of having the intention to receive the COVID-19 vaccine compared to those who were not married (OR = 1.36; 1.02-2.67).Respondents who have children have a 0.69 times greater risk of having the intention to receive the COVID-19 vaccine compared to those who do not have children (OR = 0.69; 0.53-0.91).Respondents who worked had a 0.51 times greater risk of having the intention to receive the COVID-19 vaccine compared to those who did not work (OR = 0.51; 0.39-0.65)(Kourlaba et al., 2021).
The COVID-19 vaccine faces the same challenges as other vaccine programs to combat the disease before the COVID-19 pandemic.There were variations in public responses to the COVID-19 vaccine in developing countries.Research in China and Saudi Arabia shows that respondents who intend to vaccinate ranged from 28.7-64.7%(Al-Mohaithef and Padhi, 2020;Lin et al., 2020).These conditions were influenced by many factors such as trust in the health system, risk of exposure, health conditions, fear of COVID-19, and gender.Respondents who have high confidence in the country's health system are 3.05 times more likely to have the intention to use the COVID-19 vaccine (OR = 3.05; 1.13-4.92)(Al-Mohaithef and Padhi, 2020).Respondents who had a fear of COVID-19 have a 1.58 times greater risk of having the intention to receive the COVID-19 vaccine (OR = 1.58; 1.21-1.07)(Gagneux-Brunon et al., 2021).Respondents who are female have a 1.12 times greater risk of having the intention to receive the COVID-19 vaccine compared to those who are male (OR = 1.12; 0.97-1.30)(Lin et al., 2020).

Conclusion
The COVID-19 vaccine has generated both positive and negative responses in the community.The intention was the lowest positive response influenced by trust in the health system of countries (developing countries) and age (developed countries).The majority of respondents in developing countries said that they have the intention to use the COVID-19 vaccine when the vaccine is available.The level of intentions in a developing country was lower than in a developed country.However, when compared to other factors, trust in health systems in developing countries is the most influential factor in public acceptance of the COVID-19 vaccine.Whereas developed countries showed that the majority of respondents aged over 65 years will receive a COVID-19 vaccine if it is available.Compared to other risk factors in developed countries, age was the most influential factor in public acceptance of the COVID-19 vaccine.Further research is needed on the role of the country's health system in shaping people's intentions to receive the COVID-19 vaccine in developing countries.

Inclusion
Criteria -Research article on factors related to public response to the presence of vaccines and vaccines for COVID-19 -Can be accessed on indexed international journal portals -Published in 2016-2021 -Original article Exclusion Criteria -Only accessible in an abstracts and proceedings

TABLE 1 .
Inclusion and Exclusion Criteria of Previous Research Articles

TABLE 2 .
Distribution of Community Responses to the COVID-19 Vaccine

TABLE 3 .
Distribution of General Public Response to the COVID-19 Vaccine in Several Countries

TABLE 4 .
Table3shows that the general public has varying positive responses to the COVID-19 vaccine, including intention, belief, trust, and acceptance to access the COVID-19 vaccine.Intention to be the lowest positive response (49.64%) compared to other positive, and it cannot be denied that negative responses were also found in the form of quite high doubts (71.20%).Factors Related to Community Intention to Receive the COVID-19 Vaccine Sources: Literature review based on the references listed in the last column in the table) (