Scientific Foundation SPIROSKI, Skopje, Republic of Macedonia

Open Access Macedonian Journal of Medical Sciences. 2021 Aug 05; 9(E):717-721.
https://doi.org/10.3889/oamjms.2021.6635
eISSN: 1857-9655
Category: E - Public Health
Section: Public Health Legislation

Attitude, Risk Perception and Public Acceptance against

Coronavirus Disease 2019 Vaccination in Indonesia
Andi Susilawaty1 , Fajrin Noviyanto2 , Iis Afrianty3 , Armia Syahputra4 , Lia Kurniasari5 , Lukman Handoko6 ,
Respati Wulandari7 , Cipta Pramana8*
1
Department of Public Health, Medical and Health Science Faculty, UIN Alauddin Makassar, South Sulawesi, Indonesia;
2
Pharmacy Study Program, STIKes Salsabila Serang, Serang, Indonesia; 3Department of Nursing, Sembilanbelas November
University Kolaka, Kolaka, Indonesia; 4Department of Periodontics, Faculty of Dentistry, Universitas Sumatera Utara, Medan,
Indonesia; 5Program Study of Public Health, Universitas Muhammadiyah Kalimantan Timur, East Kalimantan, Indonesia;
6
Occupational Safety and Health Study Program, Politeknik Perkapalan Negeri Surabaya, Surabaya, Indonesia; 7Public Health
Study Program, Dian Nuswantoro University, Semarang, Indonesia; 8Department of Obstetrics and Gynecology, Faculty of
Medical, Tarumanagara University, Jakarta, Indonesia

Abstract
Edited by: Sasho Stoleski BACKGROUND: The presence of a coronavirus disease 2019 (COVID-19) vaccine is very important to produce an
Citation: Susilawaty A, Noviyanto F, Afrianty I,
Syahputra A, Kurniasari L, Handoko L, Wulandari R,
immune response that slows down the pandemic.
Pramana C. Attitude, Risk Perception and Public
Acceptance against Coronavirus Disease 2019 AIM: This study aims to find out more about the perspective of the Indonesian people which is predicted to affect
Vaccination in Indonesia. Open Access Maced J Med vaccine acceptance by the public.
Sci. 2021 Aug 05;9(E):717-721. https://doi.org/10.3889/
oamjms.2021.6635 METHODS: Quantitative research was conducted using an online survey via a Google form. The survey was
Keywords: Coronavirus disease 2019; Vaccination;
Attitude; Acceptance; Risk perception conducted from January to February 2021.
*Correspondence: Cipta Pramana, Medical Faculty
Tarumanagara University, Jakarta, Indonesia. RESULTS: There were 225 respondents. The attitude of the community towards the COVID-19 vaccination program,
E-mail: pramanacipta@yahoo.com almost all respondents know the free vaccination program (94.4%) and know the purpose of the program (91.8%).
Received: 16-Jun-2021
Revised: 07-Jul-2021 There were 23% of respondents who felt that after being vaccinated they would be free from COVID-19 infection and
Accepted: 26-Jul-2021 2.4% stated that they no longer needed to apply health protocols after being vaccinated. There were 8.2% who did
Copyright: © 2021 Andi Susilawaty, Fajrin Noviyanto,
Iis Afrianty, Armia Syahputra, Lia Kurniasari, not agree with the reasons they did not know its effectiveness, were worried about the side effects and were unsure
Lukman Handoko, Respati Wulandari, Cipta Pramana about the safety of the COVID-19 vaccine.
Funding: This research did not receive any financial
support CONCLUSION: In general, self-confidence, comfort, calculation of benefits versus disadvantages, and shared
Competing Interests: The authors have declared that no
competing interests exist responsibility, influence a person’s decision to refuse or accept the vaccine.
Open Access: This is an open-access article distributed
under the terms of the Creative Commons Attribution-
NonCommercial 4.0 International License (CC BY-NC 4.0)

Introduction hundreds of millions of people requires good planning.

The government as the organizer must ensure that
the program can be implemented effectively so that
Indonesia has passed 1  year of coronavirus people throughout Indonesia can immediately receive
disease 2019 (COVID-19) after being declared a global the vaccine in the shortest possible time. Procurement
public health crisis by the WHO following the discovery and implementation of vaccine delivery programs
of the first case in March 2020. New hope in February as a measure to overcome the COVID-19 pandemic
2021 for Indonesian citizens due to the start of the are regulated through Presidential Regulation of the
vaccine program for health workers in Indonesia. Republic of Indonesia No. 99 of 2020 concerning Vaccine
The COVID-19 vaccine has developed rapidly Procurement and Vaccination Implementation in the
in recent months. The presence of this vaccine is Context of Coping with COVID-19 [2]. The Presidential
critical to generating an immune response that slows Regulation stipulates that PT. Bio Farma, a state-
the pandemic. There are now several vaccines that are owned pharmaceutical company, provides vaccines in
effective in preventing COVID-19 infection. Indonesia collaboration with various international institutions.
is one of the vaccine users with a total target of This Presidential Regulation also stipulates the
181,554,468 people, until March only 4,468,951 people Ministry of Health to regulate the distribution of vaccines
were realized for the first vaccine and 1,716,749 people and the national vaccination program. The National
for the second vaccine [1]. Immunization Expert Advisory Committee Indonesian
The vaccination program for the people Technical Advisory Group on Immunization (ITAGI) has
of Indonesia with a large area and a population of evaluated the situation related to COVID-19 vaccination
Open Access Maced J Med Sci. 2021 Aug 05; 9(E):717-721.717
E - Public Health Public Health Legislation

and provided several recommendations regarding conducted from January to February 2021 and obtained
vaccine access for priority groups. The Ministry of Health, as many as 225 respondents. Data are collected by
supported by ITAGI and development partners, has sending questionnaire forms to various social media
compiled standard operating procedures and a roadmap such as Facebook, Wechat, WhatsApp, Instagram,
for COVID-19 vaccination. These instruments have Twitter, Messenger, and/or Websites and official email
been distributed to all provinces, including instruments accounts from several organizations, agents, or other
to assess public acceptance of the ongoing COVID-19 media. Their responses will be automatically stored
vaccination program. The Ministry of Health, with support in the database and will be kept confidential, the time
from UNICEF and WHO, has conducted an online survey allotted to answer is approximately 5 min. The study has
in Indonesia to understand the public’s views, perceptions, received approval from the ethics committee of KRMT
and concerns regarding the COVID-19 vaccination [3]. Wongsonegoro Hospital Semarang No.B/0793/070/
Public perception of health and disease II/2021.
prevention with vaccines is an important factor in the
success of this COVID-19 vaccine program. Research
Analyses
on the COVID-19 vaccine conducted by Callaghan
et al. shows that one-third of adults in the USA are not Processing and data analysis using a computer
willing to be vaccinated even though the vaccine is statistics program (SPSS16.0). The results of processing
available, in contrast to the results of a study conducted and statistical tests obtained are presented in the form
by Detoc et al., which stated that 75% of respondents of tables and graphs. In this study using univariate
received the vaccine. Doubts about vaccines will be a analysis, namely, the analysis used on each variable
major barrier to any COVID-19 vaccination program. from the results of the study in this analysis resulted in
There are several things that contribute to vaccine the distribution and frequency of each variable studied,
doubt, including demographic characteristics, vaccine namely the demographic characteristics of respondents
knowledge, perceptions of susceptibility to COVID- consisting of age, gender, marital status, last education,
19, COVID-19 risk factors, and politics. The increased occupation, income, and characteristics of the area of
perception of risk will be accompanied by an increased residence. Other variables studied were attitudes, risk
desire to vaccinate against COVID-19. Intention perceptions, and public acceptance of the COVID-19
for vaccines is related to positive attitudes toward vaccination program.
vaccines in the form of benefits and perceptions of
vaccines [4], [5], [6], [7], [8].
The results of the initial survey on preparations
for the COVID-19 vaccination in Indonesia by the Results
Ministry of Health showed that around 74% of
respondents admitted to more or less know the
Government’s plan to carry out COVID-19 vaccination Demographic characteristics
nationally. The percentage varies between provinces. A total of 255 respondents participated in
Around 61% of respondents in Aceh answered that they this study. The demographic characteristics of the
knew the Government’s plan related to the distribution respondents are presented in Table  1. Of the total
of the COVID-19 vaccine; while in several provinces in respondents, most of them are in the age range of
Sumatra, Sulawesi, and the Nusa Tenggara Islands, 18–25 years (late teens) as many as 131 people (51.4%),
65–70% of respondents know this information. The by gender 179 respondents are female (70.2%), some
number of respondents in the provinces of Java, respondents have not/unmarried (58%), 96 people
Maluku, Kalimantan, Papua, and some other provinces (37.6%) have a high school education or equivalent,
who know this information is higher, at around 70%. generally, respondents are students (46.3%). In terms
This survey does not reveal the factors that cause of income, 139 people (54.5%) have an average
variation [3]. This study aims to find out more about the income of <2 million and live in administrative districts/
perspective of the Indonesian people which is predicted cities (40%).
to affect vaccine acceptance by the community.

Public attitudes regarding the COVID-19

vaccination program
Methods When viewed from the attitude of the community
regarding the COVID-19 vaccination program, almost
all respondents were aware of the free vaccination
Study design
program (94.4%) and knew the purpose of the program
Quantitative research was conducted using (91.8%). 54.1% of the public obtain information from
an online survey via a google form. The survey was social media (Facebook, Whatsapp. Twitter, Telegram,

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 Susilawaty et al. Attitudes, Risk Perceptions and Public Acceptance of Covid-19 a
V ccination

Table 1: Demographic characteristics of respondents Table 2: Distribution of respondents’ attitudes regarding the
Demographic characteristics Frequency Percentage
COVID-19 vaccination program
Age group Attitude Frequency Percentage
18–25 years (late teens) 131 51.4 Knowing the COVID-19 vaccination program that will be
26–35 years old (early adulthood) 54 21.2
provided by the government for free for the general public
36–45 years (late adulthood) 23 9.0
Do not know 13 5.1
46–55 years old (early elderly) 40 15.7
Tofu 242 94.9
56–65 years (late seniors) 7 2.7
Knowing the purpose of the COVID-19 vaccination program for
Gender
all Indonesian people
Man 76 29.8
Do not know 21 8.2
Women 179 70.2
Tofu 234 91.8
Marital status
Sources of information about vaccines
Not yet/not married 148 58.0
Electronic Media (TV and Radio) 83 32.5
Married 103 40.4
Mass Media (Newspaper, Magazine, Bulletin) 6 2.4
Widow widower 3 1.2
Friends, relatives, colleagues 10 3.9
Choose not to submit 1 0.4
Social Media (Facebook, Whatsapp. Twitter, Telegram, 138 54.1
Last education
High school/equivalent 96 37.6 Instagram, etc)
Diploma 36 14.1 World Health Organization Website 4 1.6
Bachelor-S1 or equivalent 91 35.7 Indonesian government official website 14 5.5
Postgraduate-S2. Profession/equivalent 28 11.0 Receive information about the COVID-19 vaccination program
Doctoral-S3 or equivalent 4 1.6 directly from official government sources (local government,
Profession health officials/officers)
Private employees 60 23.5 Not yet 179 70.2
Civil Servants (PNS/ASN) 37 14.5 Already 76 29.8
TNI/Polri 2 0.8 Agree with the vaccine program provided by the government
Business/Business Owner 22 8.6 for the general public
Student/Student 118 46.3 Disagree 21 8.2
Retired 1 0.4 Agree 234 91.8
Unemployed/Not working 15 5.9 Reasons for disagreeing with the COVID-19 vaccine program
Income Don’t know how effective it is 4 1.6
<2 million 139 54.5 Worried about the side effects 4 1.6
2–3 million 25 9.8 Not sure the safety 13 5.1
3–5 million 41 16.1 Source: Primary Data, 2020.
More than 5 million 50 19.6
Characteristics of the area of residence
Rural 66 25.9 Table 3: Community risk perception of COVID-19 infection after
Administrative District/City 102 40.0
Big city 87 34.1 vaccination
Risk perception Frequency Percentage
After being vaccinated, you will be free from COVID-19
Instagram, etc.) and another 32.5% obtain information Yes 61 23.9
Not 194 76.1
from electronic media (TV and radio). Nevertheless, After being vaccinated, it is still necessary to apply the (3 M)
there are still 5.1% of the public who have not been health protocol
Yes 249 97.6
exposed to free vaccination information and 8.2% do Not 6 2.4
Source: Primary Data, 2020.
not know the purpose of the COVID-19 vaccination
program.
Public acceptance of COVID-19 vaccination
Of the 255 respondents, 179 people (70.2%)
have not received information about the COVID-19 A total of nine statements were used to see
vaccination program directly from official government public acceptance of the COVID-19 vaccination using
sources (local government, health officials/officers). the answer choices from very inappropriate (Score 1)
to very appropriate with the conditions experienced by
Almost all people (91.8%) agree with the vaccine
the respondent (Score 5) measured by a differential
program provided by the government for the general
semantic scale arranged in a continuum line. On
public, but there are still 8.2% who disagree because average, people are happy because they will get free
that they do not know its effectiveness, are worried vaccinations, but they are still worried because there
about side effects, and are unsure of the safety of the is no clear information on the choice of the type of
COVID-19 vaccine. Respondents’ attitudes regarding COVID-19 vaccine that will be given. In principle,
the COVID-19 vaccination program are presented in the average community feels ready to be vaccinated
Table 2. against COVID-19 as long as the choice of the type of
COVID-19 vaccine that will be given to the community
has clear benefits and effectiveness, and it has been
Community risk perception after receiving proven that the benefits are greater than the side effects
COVID-19 vaccination that will be caused. The average community answers
are presented in Table 4.
Two questions were used to assess the
community’s perceived risk of COVID-19 infection after
vaccination. 23% of respondents perceived that after
being vaccinated, they would be free from COVID-19 Discussion
infection and 2.4% stated that they no longer needed to
apply the (3M) health protocol after being vaccinated.
The distribution of respondents’ answers is shown in Vaccination is one of the important programs
Table 3. carried out by various countries to control the COVID-19

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Table 4: Public acceptance of the COVID-19 vaccine Others, 7.6% strongly rejected the COVID vaccination
Statement Mean SD and 27.6% said they did not know [3].
1. People are happy because they will get the COVID-19 vaccination 3.96 1.062
for free Some of the reasons for disapproval were not
2. People are worried because there is no clear information on the
choice of the type of COVID-19 vaccine that will be given to the
3.46 1,248
knowing its effectiveness, worrying about side effects,
general public for free and not knowing the safety level of the vaccine to be
3. The public is willing to be vaccinated if the choice of the type of
COVID-19 vaccine to be given to the community has clear benefits
4.27 .943
given. Researchers and the government in this case as
and effectiveness vaccination implementers need to understand the levels
4. The public feels that it is better to be vaccinated if the choice of the 4.37 .938
COVID-19 vaccine to be given to the community has proven to be of
of public doubt about vaccines including their reasons
greater benefit than the side effects that will be caused so that they can develop the right campaign to change
5. People feel calm and safe if they have participated in the COVID-19 3.73 1.153
vaccination program
the attitudes and thoughts of the targeted people [9].
6. Following the COVID-19 vaccine program is one of the efforts to avoid 3.91 1,110
the COVID-19 virus Public trust in the benefits of vaccines is a
7. The public will accept, whatever the choice of the type of COVID-19 3.27 1,289 series that has gradations. Some people accept all
vaccine that will be given by the government
8. The community will invite family members to get vaccinated according 3.85 1.089 vaccination programs and ideally believe in their efficacy
to the government program
9. In principle, people feel ready to be vaccinated against COVID-19 3.92 1.169
until some reject it altogether even though the vaccine
Source: Primary Data, 2020. is available. A person’s attitude and decision-making to
participate in a vaccination program is a complex issue
pandemic. Several important variables in the success because it is intertwined with demand for and access
of the COVID-19 vaccination coverage examined in to health services [10]. In addition, this phenomenon is
this survey are attitudes, perceptions of risk, and public very sensitive to context, varies between times, places,
acceptance of vaccinations that were started last week. and types of vaccines. A  person may refuse to be
The more people who are willing to be vaccinated, the vaccinated against polio for their child, for example, but
bigger the coverage. the same person is willing to accept being vaccinated
against COVID-19 [9]. A  person’s decision to refuse
The high coverage of vaccination is largely
vaccination is not entirely based on unreasonable
determined by the level of public knowledge. When
or even conspiratorial reasons. The same thing was
viewed from the public’s knowledge regarding the
obtained from the Ministry of Health survey, in the group
COVID-19 vaccination program, almost all respondents that refused the vaccine at all (7.6%), the majority of
(94.4%) already knew about the implementation respondents (52%) planned to refuse the COVID-19
(94.4%) and objectives (91.8%) of the free vaccination vaccination because they were not sure about its safety
program that will be provided by the government. and effectiveness [3].
Information on this program was obtained from various
social media platforms, including Facebook, Whatsapp. Since the government announced the COVID-
Twitter, Telegram, Instagram, etc. Nevertheless, there 19 vaccination in Indonesia, the public has been faced
are still 5.1% of the public who have not been exposed with various dilemmas in implementing this policy.
to free vaccination information and 8.2% do not know This dilemma also arises due to the perception of
the purpose of the COVID-19 vaccination program. the risks that exist in society regarding the COVID-19
In this case, the role of social media is very large to vaccine [11]. Two questions were used to assess the
encourage people to be willing to be vaccinated. community’s risk perception of COVID-19 infection after
vaccination. 23% of respondents felt that after being
From the results of this study, it can be vaccinated they would be free from COVID-19 infection
seen that if in the next 15  months, the Indonesian and 2.4% stated that they no longer needed to apply
government targets more than 180 million people health protocols (wearing a face masks, physical/social
(equivalent to 70% of the total population) to be distancing, and washing hands with soap) after being
vaccinated to create community immunity in the face of vaccinated.
the vicious coronavirus so that this vaccination program
Vaccination decisions will depend on the
is successful, the campaign design of this free mass
calculation of benefits resulting from a person’s
vaccination program should be more intensely aimed at
evaluation of the various information he receives about
people who have not been exposed to free vaccination
the vaccination program. In addition, the vaccination
information and do not yet know the purpose of the
program must be seen as a collective responsibility
COVID-19 vaccination program.
because a new vaccination program can only see the
In the attitude aspect, this study shows that benefits if there are enough people who are successfully
almost all people (91.8%) agree with the vaccine vaccinated to form community immunity. The weakness
program provided by the government for the general of the COVID-19 vaccination program is that there is no
public but there are still 8.2% who disagree because marker for the formation of community immunity which
they do not know its effectiveness, are worried about is the goal of community vaccination [12]. It can be seen
side effects and are unsure of the safety of the from the answers of the respondents in this study that
COVID-19 vaccine. The same survey has been carried the average community is happy because they will get
out by the Ministry of Health showed relatively similar free vaccinations, but they are still worried because the
results that only 64.8% were willing to be vaccinated. information on the choice of the type of COVID-19 vaccine

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 Susilawaty et al. Attitudes, Risk Perceptions and Public Acceptance of Covid-19 a
V ccination

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