COVID-19 vaccine hesitancy and attitudes in Pakistan: a cross-sectional phone survey of major urban cities.

BACKGROUND: COVID-19 mass vaccination is the only hopeful savior to curb the pandemic. Vaccine distribution to achieve herd immunity is hindered by hesitance and negative attitude of the public against COVID-19 vaccination. This study aims to evaluate the vaccine hesitancy and attitudes in major cities in Pakistan as well as their determinants. METHODS: A cross-sectional telephonic survey was conducted in June 2021 in major cities of Pakistan including Karachi, Lahore, Islamabad, Peshawar, and Gilgit, from unvaccinated urban population aged 18 years or older. Random Digit Dialing through multi-stage stratified random sampling was used to ensure representation of each target city and socio-economic classes. Questionnaire collected information on socio-demographics, COVID-19-related experiences, risk perception of infection, and receptivity of COVID-19 vaccination. Multivariate logistic regression analyses were performed to identify key determinants of vaccine hesitancy and acceptance. RESULTS: The prevalence of vaccinated population in this survey was 15%. Of the 2270 respondents, 65% respondents were willing to vaccinate, while only 19% were registered for vaccination. Factors significantly associated with vaccine willingness were older age (aOR: 6.48, 95% CI: 1.94-21.58), tertiary education (aOR: 2.02, 95% CI: 1.36, 3.01), being employed (aOR: 1.34, 95% CI: 1.01, 1.78), perceived risk of COVID-19 (aOR: 4.38, 95% CI: 2.70, 7.12), and higher compliance with standard operating procedures (aOR: 1.72, 95% CI: 1.26, 2.35). The most common vaccine hesitancy reasons were 'no need' (n = 284, 36%) and concerns with 'vaccine safety and side effects' (n = 251, 31%), while most reported vaccine motivation reasons were 'health safety' (n = 1029, 70%) and 'to end the pandemic' (n = 357, 24%). CONCLUSIONS: Although our study found 35% hesitancy rate of COVID-19 vaccine, there were noticeable demographic differences that suggest tailored communication strategy to address concerns held by most hesitant subpopulation. Use of mobile vaccination facilities particularly for less mobile and disadvantaged, and implementation and evaluation of social mobilization strategy should be considered to increase overall COVID-19 vaccination acceptance and coverage.

Correction: Malik et al. Integrated Tuberculosis and COVID-19 Activities in Karachi and Tuberculosis Case Notifications. Trop. Med. Infect. Dis. 2022, 7, 12.

The authors wish to revise the second citation of reference [26] to [27] in the original article main text [...].

Proactive Teleconsultation for Coronavirus Disease 2019 Cases Identified Through the Community-Testing Initiative in Karachi, Pakistan: A Low-Cost Value-Added Service to Support a Pandemic Response in a Resource-Limited Setting.

Introduction: Coronavirus disease 2019 (COVID-19) struck Pakistan with a magnitude that required micro- and macro-level adjustments at national and provincial levels. Access to medical consultation became a challenge; hospitals were flooded with cases beyond their capacity and transport was halted due to lockdown. Global Health Directorate of The Indus Health Network supported the provincial government by rolling out several walk-in community-based testing initiatives across Karachi. Results were conveyed to the patients through each district government. With a disproportionate rise in cases, an increasing delay in reporting results was observed. Methods: To help the district government bridge this gap, two physicians were engaged to convey timely results to patients who tested positive, through a helpline. Subsequently, proactive teleconsultation was initiated. We present a retrospective review of data collected during teleconsultation for COVID-19 cases identified through community-based testing between April 5 and June 10, 2020. Results: A total of 4,279 tests were conducted, revealing a 28% positivity rate (1,196 cases). Out of these, 752 (62.9%) baseline positive patients were contactable. Most patients identified either a close contact (46.8%) or a household contact (30.1%) as the source of infection. 41.8% patients were asymptomatic, 52.9% had mild to moderate illness, and 1.1% needed referral to the emergency department. 82.7% patients reported no comorbidities. Conclusion: The rapid surge of cases could not be handled by a small team and an institutional strategy of integration into an existing call center service was adopted. We share our insights to help develop evidence-based policies to effectively tackle current or future threats in similar settings.

Integrated Tuberculosis and COVID-19 Activities in Karachi and Tuberculosis Case Notifications.

As the COVID-19 pandemic surged, lockdowns led to the cancellation of essential health services. As part of our Zero TB activities in Karachi, we adapted our approach to integrate activities for TB and COVID-19 to decrease the impact on diagnosis and linkage to care for TB treatment. We implemented the following: (1) integrated COVID-19 screening and testing within existing TB program activities, along with the use of an artificial intelligence (AI) software reader on digital chest X-rays; (2) home delivery of medication; (3) use of telehealth and mental health counseling; (4) provision of PPE; (5) burnout monitoring of health workers; and (6) patient safety and disinfectant protocol. We used programmatic data for six districts of Karachi from January 2018 to March 2021 to explore the time trends in case notifications, the impact of the COVID-19 pandemic, and service adaptations in the city. The case notifications in all six districts in Karachi were over 80% of the trend-adjusted expected notifications with three districts having over 90% of the expected case notifications. Overall, Karachi reached 90% of the expected case notifications during the COVID-19 pandemic. The collaborative efforts by the provincial TB program and private sector partners facilitated this reduced loss in case notifications.