Knowledge, attitude, and hesitancy towards COVID-19 vaccine among university students of Bangladesh

Md. Mostafizur Rahman; Musabber Ali Chisty; Md. Ashraful Alam; Mohammed Sadman Sakib; Masrur Abdul Quader; Ifta Alam Shobuj; Md. Abdul Halim; Farzana Rahman

doi:10.1371/journal.pone.0270684

Peer Review History

Original SubmissionMay 28, 2021
28 May 2021 Author Response Attachments Attachment Submitted filename: Rebuttal letter.docx https://doi.org/10.1371/journal.pone.0270684.r001
6 Dec 2021 Decision Letter - Jamie Males, Editor PONE-D-21-17512Knowledge, attitude, and hesitation towards covid-19 vaccine among university students of BangladeshPLOS ONE Dear Dr. Rahman, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. Three reviewers have evaluated your submission and have identified a range of points that need to be addressed in relation to the description of the study designs and the presentation of your manuscript. Please respond carefully to all of the reviewers concerns when preparing your revisions. Please submit your revised manuscript by Jan 08 2022 11:59PM. 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Please include captions for your Supporting Information files at the end of your manuscript, and update any in-text citations to match accordingly. Please see our Supporting Information guidelines for more information: http://journals.plos.org/plosone/s/supporting-information. [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Yes Reviewer #2: Partly Reviewer #3: Yes ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: No Reviewer #2: Yes Reviewer #3: Yes ****** 3. 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Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes Reviewer #2: Yes Reviewer #3: Yes ****** 5. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: Dear author(s), Thank you for your esteemed efforts that aimed to increase our collective knowledge about the ongoing situation COVID-19 vaccine hesitancy among young adults population. Please consider the following minor comments: 1. Add operational (working definitions) for electronic media, social media resources, etc. 2. Use CHERRIS guidelines in structring and reporting your study and cite it your Methods section. Ref: https://pubmed.ncbi.nlm.nih.gov/15471760 4. It is not clear nor validated how the question about "relevant subject to vaccine" can be used in this situation. Of course, the level of knowledge that a medical students in terms of infectious diseases and immunization is not comprable to the level of knowledge that a student in humantrian sciences will get. I would suggest you to omit this question from your manuscript and your analysis. 5. In Table 2, please correct (06) and (04). Remove the zero. 6. In Table 3, please add a dash in the coloumn of CI instead of the word "to". 7. In Line 169, you mentioned for the first time in the manuscript that a small fraction of your sample was already vaccinated. As long this small fraction is not useful for downstream analysis, I would strongly recommend you to remove them from the begining and exclude them because their inclusion will overestimate the results. 8. Line 271 - 281: you can compare your results to other results from different countries university students. Ref: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8470400 9. Line 282: you can mention the role of medical students as well within the context of public campaigns for vaccines and their particular drivers of vaccines hesitancy during COVID-19. Ref: https://pubmed.ncbi.nlm.nih.gov/34072500 10. Line 292, you can mention the COVID-19 vaccine safety studies that aim to provide independent evidence on the COVID-19 vaccine safety that can suppress the public levels of vaccine hesitancy. Ref: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8345554 Ref: https://pubmed.ncbi.nlm.nih.gov/34577573 Sincerely, Reviewer #2: This manuscript is noteworthy in the current era of COVID-19 pandemic because the issue of vaccine hesitancy is extremely important as WHO considers vaccine hesitancy as a significant threat to global health. The COVID-19 vaccine is one of the top priorities in the battle against the pandemic, but its effectiveness is dependent on individual decisions since vaccines are voluntary. Apart from scarcity in dose availability and inequity in vaccine delivery, vaccine hesitancy is one of the most serious challenges in this regard. A main finding of the study, that there is still a considerable vaccine hesitancy among university students despite their goog knowledge and positive attitude, which is consistent with studies in other countries and across broad demographic groups. However, some issues needed to be addressed first to improve the quality of the manuscript: though, the following are general outlines of the required modifications: Title: It is better to replace "hesitation" with "hesitancy" also along the whole manuscript. - Language editing is needed for multiple issues - Introduction: - It would be good to provide a background on COVID-specific reasons for vaccine hesitancy, along with the general ones. - Some background on vaccination plans in the Bangladesh should be displayed such as What vaccines are being considered, is the vaccination program already planned, number of currently vaccinated person. What is the perception of vaccines in Bangladesh, e.g., in the news? These are all crucial factors playing a role in vaccine hesitancy and affecting its dynamics. - The rationale, study hypothesis and the study questions should be clearly stated Methodology section: issues in the study design and settings. Methods: - " The current survey was performed among university students" - Each group should be defined; by mentioning the study plan of each faculty and whether their curriculum contain COVI-19 vaccination topics or not? - Also sample size calculation and sampling technique (details of methods of selection of participants) are not mentioned in the manuscript. - - Results: - What is the age of the participants? Knowledge leveling is either Good or poor or adequate & inadequate NOT positive or negative as the attitude What is the level of COVID-19 vaccination hesitancy? Where this percentage in the results?? It needs a separate table as knowledge and attitude as it is one if the study objectives - Discussion: - Generally, the discussion is somewhat redundant without adequate structure and should be focused to compare the results with similar studies and to explain and give the implications of the study results. - Please make the discussion more concise, without discussing too many details but the most important results and their general meaning. - Having some bullet points on how to address the observed hesitancy would be beneficial for the discussion and the entire manuscript. - References: - Needs revision as sometimes they are not consistent in their style. Some of them are incomplete Reviewer #3: This is a well-written manuscript that evaluates hesitancy towards the COVID-19 vaccine in University students in Bangladesh. The results are consistent with several other studies in other locations, if not entirely novel. My minor concern is that the university student population may be very different from the population at large. Although this is clearly a manuscript about university students, some effort to compare the university population to the population of Bangladesh as a whole would be appreciated. ****** 6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review?** For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: No Reviewer #2: No Reviewer #3: No [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step. Attachments Attachment Submitted filename: PONE-D-21-17512. report.docx https://doi.org/10.1371/journal.pone.0270684.r002
Revision 1
25 Feb 2022 Author Response Reviewer #1: Dear author(s), Thank you for your esteemed efforts that aimed to increase our collective knowledge about the ongoing situation COVID-19 vaccine hesitancy among young adults population. Please consider the following minor comments: 1. Add operational (working definitions) for electronic media, social media resources, etc. Response: Thank you for the comment. We have added operational definitions for the internet, electronic media, and social media after Table 2 in Results section. 2. Use CHERRIS guidelines in structring and reporting your study and cite it your Methods section. Ref: https://pubmed.ncbi.nlm.nih.gov/15471760 Response: Thank you for the suggestion. We have revised our Methods following CHERRIS guidelines. We have also cited it in our Methods section. 4. It is not clear nor validated how the question about "relevant subject to vaccine" can be used in this situation. Of course, the level of knowledge that a medical students in terms of infectious diseases and immunization is not comprable to the level of knowledge that a student in humantrian sciences will get. I would suggest you to omit this question from your manuscript and your analysis. Response: Thank you for pointing out it. We have omitted that question from our manuscript and our analysis. 5. In Table 2, please correct (06) and (04). Remove the zero. Response: Thank you. We have corrected those numbers. 6. In Table 3, please add a dash in the coloumn of CI instead of the word "to". Response: Thank you. We have replaced the word “to” by dash in the column of CI for all Table (including Table 3) to maintain the consistency. 7. In Line 169, you mentioned for the first time in the manuscript that a small fraction of your sample was already vaccinated. As long this small fraction is not useful for downstream analysis, I would strongly recommend you to remove them from the begining and exclude them because their inclusion will overestimate the results. Response: Thank you for the recommendation. We have removed that small fraction from our sample who were vaccinated. We have mentioned it in our Methods, and revised our Results from the beginning. 8. Line 271 - 281: you can compare your results to other results from different countries university students. Ref: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8470400 Response: Thank you. We have revised that part following your comment. We have also added the above reference. 9. Line 282: you can mention the role of medical students as well within the context of public campaigns for vaccines and their particular drivers of vaccines hesitancy during COVID-19. Ref: https://pubmed.ncbi.nlm.nih.gov/34072500 Response: Thank you. We have revised and cited some new references following the abovementioned reference. 10. Line 292, you can mention the COVID-19 vaccine safety studies that aim to provide independent evidence on the COVID-19 vaccine safety that can suppress the public levels of vaccine hesitancy. Ref: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8345554 Ref: https://pubmed.ncbi.nlm.nih.gov/34577573 Response: Thank you very much for all effective comments and suggestions which have improved the quality of our manuscript a lot. We have revised with the abovementioned references following you and another reviewer’s comments. Reviewer #2: This manuscript is noteworthy in the current era of COVID-19 pandemic because the issue of vaccine hesitancy is extremely important as WHO considers vaccine hesitancy as a significant threat to global health. The COVID-19 vaccine is one of the top priorities in the battle against the pandemic, but its effectiveness is dependent on individual decisions since vaccines are voluntary. Apart from scarcity in dose availability and inequity in vaccine delivery, vaccine hesitancy is one of the most serious challenges in this regard. A main finding of the study, that there is still a considerable vaccine hesitancy among university students despite their goog knowledge and positive attitude, which is consistent with studies in other countries and across broad demographic groups. However, some issues needed to be addressed first to improve the quality of the manuscript: though, the following are general outlines of the required modifications: Title: It is better to replace "hesitation" with "hesitancy" also along the whole manuscript. Response: Thank you very much for appreciating our work which will encourage us to conduct further research. We have replaced "hesitation" with "hesitancy" in both title and whole manuscript. - Language editing is needed for multiple issues Response: Thank you. We have done major revision and checked the language. We hope the current version would satisfy you. -Introduction: - It would be good to provide a background on COVID-specific reasons for vaccine hesitancy, along with the general ones. Response: Thank you again. We have revised and provide background on COVID-specific reasons for vaccine hesitancy, along with general ones. - Some background on vaccination plans in the Bangladesh should be displayed such as What vaccines are being considered, is the vaccination program already planned, number of currently vaccinated person. What is the perception of vaccines in Bangladesh, e.g., in the news? These are all crucial factors playing a role in vaccine hesitancy and affecting its dynamics. Response: Thank you. We have revised and added the information following your comment. Please check the introduction part. - The rationale, study hypothesis and the study questions should be clearly stated Response: Thank you. We have revised again following your comment. We hope that the current revised version will satisfy you. Methodology section: issues in the study design and settings. Methods: - " The current survey was performed among university students" - Each group should be defined; by mentioning the study plan of each faculty and whether their curriculum contain COVI-19 vaccination topics or not? Response: Thank you for pointing out it. Actually, we have divided 5 groups based on the major considering Bangladesh perspective. We wanted to examine if there were any differences among these groups. All these groups have diverse study plan and curriculum. For instance, Science and Engineering includes several study plans based on the university authority. However, we have revised our Research design following your comment. We discussed the differences among these groups based on our hypothesis in Methods and Discussion section. We have also deleted “COVID-19 relevant subject” from our manuscript following another reviewer’s suggestion. - Also sample size calculation and sampling technique (details of methods of selection of participants) are not mentioned in the manuscript. Response: Thank you. We have revised and put the information regarding sampling technique in Data collection and data analysis section as “We followed the convenience sampling technique. Convenience sampling is a technique for non-probabilistic sampling that is frequently used in clinical research. Typically, this sampling strategy draws clinical cases or participants from an easily accessible area, such as a medical records database, an internet site, or a customer membership list [39].” For sample size, we followed Morgan’s Table which determined the minimum required respondents were 384 for this perception-based study (95% Confidence Interval (CI)). We have also mentioned it in Data collection and data analysis section. -Results: - What is the age of the participants? Response: Thank you. The age of this young adult was 18-25 years. Since, majority of them were in same age group, we did not consider in our analysis. Knowledge leveling is either Good or poor or adequate & inadequate NOT positive or negative as the attitude What is the level of COVID-19 vaccination hesitancy? Where this percentage in the results?? It needs a separate table as knowledge and attitude as it is one if the study objectives. Response: Thank you again. We have mentioned that overall, 26.06% of the participants showed their positive hesitancy towards the COVID-19 vaccine. Hesitancy was measured based on their positive and negative response, and then the factors responsible for this hesitancy. Table 7 and Table 8 summarizes the result regarding hesitancy towards the COVID-19 vaccine. Table 8 also shows the percentages. -Discussion: - Generally, the discussion is somewhat redundant without adequate structure and should be focused to compare the results with similar studies and to explain and give the implications of the study results. Response: Thank you. We have revised and added some other similar studies following you and other reviewers’ comments. - Please make the discussion more concise, without discussing too many details but the most important results and their general meaning. Response: Thank you. We have revised the discussion part following your comment. We may still have some discussion to clarify the understanding following other relevant studies. - Having some bullet points on how to address the observed hesitancy would be beneficial for the discussion and the entire manuscript. Response: Thank you. We have revised and provided some bullet points before limitation of the research. -References: - Needs revision as sometimes they are not consistent in their style. Some of them are incomplete Response: Thank you. We have revised again. We actually used referencing management tool. Reviewer #3: This is a well-written manuscript that evaluates hesitancy towards the COVID-19 vaccine in University students in Bangladesh. The results are consistent with several other studies in other locations, if not entirely novel. My minor concern is that the university student population may be very different from the population at large. Although this is clearly a manuscript about university students, some effort to compare the university population to the population of Bangladesh as a whole would be appreciated. Response: Thank you very much. We have done major revision following all reviewers’ comments and suggestions which also included COVID-19 vaccine information regarding general population of Bangladesh (please check both introduction and discussion part). We also have added some references which considered general population of Bangladesh. Attachments Attachment Submitted filename: Response to Reviewers.docx https://doi.org/10.1371/journal.pone.0270684.r003
16 Jun 2022 Decision Letter - Jianhong Zhou, Editor Knowledge, attitude, and hesitancy towards COVID-19 vaccine among university students of Bangladesh PONE-D-21-17512R1 Dear Dr. Rahman, We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements. Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication. An invoice for payment will follow shortly after the formal acceptance. To ensure an efficient process, please log into Editorial Manager at http://www.editorialmanager.com/pone/, click the 'Update My Information' link at the top of the page, and double check that your user information is up-to-date. If you have any billing related questions, please contact our Author Billing department directly at authorbilling@plos.org. If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. Kind regards, Jianhong Zhou Staff Editor PLOS ONE Additional Editor Comments (optional): Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation. Reviewer #1: All comments have been addressed Reviewer #2: All comments have been addressed ******** 2. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Yes Reviewer #2: Yes ****** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #2: Yes ****** 4. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: Yes Reviewer #2: Yes ****** 5. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes Reviewer #2: Yes ****** 6. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: Dear Author(s), Thank you for your esteemed efforts in responding to all my previous points. I do believe that the manuscript is in good shape now for being accepted. Good luck! Sincerely, Reviewer #2: Thanks for doing the modifications... The manuscript now is suitable to be published as most of the corrections were done as needed ****** 7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review?** For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: No Reviewer #2: No https://doi.org/10.1371/journal.pone.0270684.r004
Formally Accepted
17 Jun 2022 Acceptance Letter - Jianhong Zhou, Editor PONE-D-21-17512R1 Knowledge, attitude, and hesitancy towards COVID-19 vaccine among university students of Bangladesh Dear Dr. Rahman: I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now with our production department. If your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information please contact onepress@plos.org. If we can help with anything else, please email us at plosone@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Jianhong Zhou Staff Editor PLOS ONE https://doi.org/10.1371/journal.pone.0270684.r005

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