Singapore’s Older Adults Resist COVID-19 Vaccinations

Study by SMU’s Centre for Research on Successful Ageing (ROSA) examines why segments of older adults continue to resist vaccination against COVID-19

Singapore, 6 July 2021 (Tuesday) – Singapore may rank high in its pace of Covid-19 vaccination, but segments of the nation’s older adults (aged 71-75) were still reluctant to vaccinate because they were sceptical of either the efficacy or the safety of COVID-19 vaccines. A study conducted by SMU’s Centre for Research on Successful Ageing (ROSA) from February to June 2021 also revealed that respondents who did not intend to vaccinate were less socially integrated.

The study leveraged data collected from the Singapore Life Panel® (SLP), a population representative monthly survey of Singaporeans aged 56-75 (inclusive) in 2021 that has been conducted since 2015. The SLP has an average response rate of about 7,200 respondents per month and is web-based, allowing respondents to participate even during periods of full or partial social lockdown. In the months of February to June 2021, the average response rate was 7271 respondents per month, with 7228 respondents participating in the June 2021 wave where the reasons for not vaccinating was asked.

While vaccinations for those aged 70 and above started on the 22nd of February 2021 in Singapore and in mid-March 2021 for those 60 and above, about 25% of older adults above the age of 60 remain unvaccinated as of 24th June 2021. This is compared to a vaccination rate of 80% for individuals aged 12-39, despite this cohort having begun vaccinations only from 11th June 2021.

While the government has put in place additional initiatives to encourage older adults to vaccinate such as allowing them to walk-in to vaccination centres for their vaccines as compared to booking appointments in advance, the rate of vaccination among older adults remains a concern.

Full details of the study can be accessed here.

According to Professor Paulin Straughan, Director, ROSA, “Vaccines are one of the first line of defence in fighting a global pandemic. We hope that our collective work in surveying older adults through the Singapore Life Panel® enhances our understanding of what exactly is holding them back, and spurs more effective action that helps them to overcome their reservations towards vaccinations. To get to “Phase Endemic”, we need to protect our population, especially the elderly and vulnerable.”

Micah Tan, Research Associate at ROSA and lead author of the report, said that “Our findings suggest that we should try to understand the fears of older adults who have yet to vaccinate and support them by reassuring and guiding them through the vaccination process. This is especially so for family and friends of such individuals who play an important role in encouraging them. Only then can we provide them with the assurance they need to overcome their hesitation.”

Key findings:

1. Demographic profile of older adults less likely to have been vaccinated as of June 2021. They were more likely to:

- be relatively older (aged 71-75),

- be of lower socioeconomic status (lower education levels and living in 1-3 room HDB flats),

- have one or more chronic health conditions,

- be less socially integrated (more likely to live alone, have fewer household members on average, or have fewer ‘close contacts’ on average).

2. Reasons why said older adults were hesitant to vaccinate or against vaccination

- In June 2021, the two most cited reasons for waiting to get vaccinated among respondents were:  that they were waiting to find out whether there are reports of negative side-effects from the vaccine (54.50% of respondents), followed by that they were waiting until a majority of Singaporeans in their age group were vaccinated (25.71% of respondents).

- In terms of reasons for not wanting to be vaccinated, in June 2021 the two most cited reasons were: that they were worried about negative side-effects from the vaccine (79.23% of respondents), followed by that they did not believe in any form of vaccination (25.60% of respondents).  

3. How the usage and trust in various sources of information may shape their willingness to vaccinate

- Respondents who stated that they do not plan to vaccinate in June 2021 were the least likely to rely on Newspapers and Government Sources as sources of information for COVID-19 related news in November 2020.

- 37.91% and 32.13% of unvaccinated respondents indicated that they relied on Newspapers and Government Sources respectively, compared to 47.92% and 48.29% of vaccinated respondents (see Table 1 for full list of proportions). 

- Respondents who do not plan to vaccinate were the most likely to not be gathering any information about COVID-19 at all.

- 4.33% of such respondents stating that they were not doing so, compared to just 0.55% of individuals who were fully vaccinated.

- In terms of the average level of trust respondents had in different sources of information for information on COVID-19, we observe that respondents who stated that they did not want to vaccinate in June 2021 were least trusting of all sources of information.

4. How an individual’s level of social integration may shape their willingness to vaccinate

- On average, respondents who did not intend to vaccinate were less socially integrated.

- On average, they had a smaller household size (mean size of 3.06 household members) and a fewer number of close contacts (mean number of close contacts of 8.63) as compared to individuals who were fully vaccinated.

- They were also more likely to be living alone, with 14.58% of those not intending to vaccinate living alone, as compared to 7.05% of respondents who were fully vaccinated that live alone

- Individuals who are less socially integrated may have less social support and be less socially embedded.  As a result, they are less concerned about the implications of their health behaviour (in this case getting a vaccine) or are less aware of the benefits and risks of the vaccine due to their lack of information from their social contacts.

- The provision of other forms of instrumental support by close contacts, for instance having family members or friends to help older adults register for the vaccine, take care of them if they suffer from side-effects, and even accompany them for their vaccination appointments, may also be an important factor in encouraging older adults to vaccinate.

Report recommendations:

Based on the findings, SMU ROSA recommends that older individuals (aged 71 – 75 years) who are of a lower socioeconomic status, especially those living in 1-3 room HDB flats, should be the target of government initiatives to encourage vaccinations among the old. Such initiatives should focus on assuring individuals that the vaccines are effective and, more importantly, do not pose a significant risk to their health and well-being particularly for those who may be of poorer health but are still able to be vaccinated.

Unfortunately, the level of trust that respondents who were hesitant or unwilling to be vaccinated hold in official or formal sources of information from the Government and Local News sources is significantly lower as compared to other groups. That being said, in terms of the level of trust in sources for information on COVID-19, the highest average level of trust for individuals who were unwilling to vaccinate was placed in family members. This is congruent with findings from Straughan and Seow (2000) who also found that individuals were more likely to heed health advice from trusted personal contacts. Thus, authorities should opt to attempt to encourage older adults who are unwilling to vaccinate by reaching out to the younger relatives of such older adults who would be more likely to be able to encourage their older relatives to get vaccinated. This is especially so given the importance of social support in encouraging positive health behaviour and the fact that those who did not wish to vaccinate were more likely to be less socially integrated.

Specific policies to encourage older adult vaccination could therefore involve encouraging younger individuals to accompany their older family members to get their vaccines. Companies and authorities may consider allowing their employees to take time off work so as to bring their older family members to get their vaccines. Initiatives to encourage older adults who live alone or are less socially integrated to get vaccinated can also include running programmes with volunteers to accompany these older adults to get their vaccinations. In the absence of family (in particular, those who are living alone), community social support will have to step in to partner seniors as we strive to bring more onboard our vaccination programme.