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A study by the SMU Centre for Research on Successful Ageing found that segments of older adults remained less inclined to vaccinate against COVID-19.
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How to crack vaccine resistance among older adults

Published on 5 October 2021

As of June 2021, the Singapore government has fully vaccinated almost half of the population in tandem with private clinics. This means the nation is on track to meet its goal of vaccinating at least 75 per cent of its 5.7million residents and citizens by October 2021.

The Singapore government kicked off its vaccination drive for eligible older adults (aged 70 and above) in the last week of February 2021, and mid-March 2021 for those aged 60 and up. However, despite measures put in place to encourage vaccinations among more vulnerable seniors, a study by the Centre for Research on Successful Ageing (ROSA) at SMU, found that segments of older adults remained less inclined to vaccinate against COVID-19. The Special Report on Covid-19 Vaccination Trends Among Older Adults in Singapore was authored by Micah Tan, Research Associate; Professor Paulin Straughan, Director of ROSA; Wensi Lim, Centre Manager; and Grace Cheong, Research Assistant. The study uses data from the Singapore Life Panel (SLP), a high frequency online survey conducted among Singaporeans aged between 56 and 75 years old. Each month, an average of 7,200 respondents participate in the SLP’s monthly surveys.

The insights and trends that surfaced during the research serve as valuable tools for public and private organisations working towards Singapore’s vaccination goals. Targeting the older adult population is crucial in the fight against the pandemic, as the vaccine helps protect high-risk seniors — who are more likely to be hospitalised or be critically ill from Covid-19, and suffer from chronic diseases or a weakened immune system. But before that can be achieved, policymakers need to better grasp the inclinations and mind-set of the older generation, and why seniors hesitate to get vaccinated.

Why are older adults resisting vaccination?

While almost half of the total population has received its vaccine shots, 25 per cent of older residents remain unvaccinated, despite the fact that the risk of serious illness associated with Covid increases with age. Using data from June 2021, Tan et. al. examined four factors that could influence the decision to get vaccinated:

1. Socioeconomic status

While the proportion of respondents who did not wish to receive the Covid-19 vaccine shrank by June 2021, there were still many older adults who remain unvaccinated. To identify demographic trends in older adults who resisted against vaccination, the researchers triangulated information based on age, highest educational attainment, and type of residence.

First, they found that adults aged 71 to 75 were the highest segment of respondents who were not yet vaccinated at the time of the study as compared to the other age groups (56-60, 61-65, 66-70).

Second, respondents who had no education or completed only primary schooling were most likely to be unvaccinated, while those with post-secondary education but without university education were also relatively unlikely to be vaccinated as compared to those with a post-secondary university education. It appears that the higher their educational attainment, the more likely an older person is likely to receive the vaccine.

Lastly, respondents living in one- to three-room Housing Development Board (HDB) flats were most likely to be unvaccinated in comparison to those living in four- or five-room HDB apartments and Executive Condominiums, or privately owned properties who were more likely to be vaccinated.

These differences found along socioeconomic lines suggest that older adults of lower socioeconomic statuses may face time and in not have the time to vaccinate or may be more be more fearful of the vaccine’s side effects due to the lack of knowledge of the risks.

2. Reasons for not getting vaccinated

Based on the same study, researchers found that the top reason for respondents putting off vaccination is that they are waiting to learn more about the vaccine’s possible adverse effects. These older adults seek to observe how others in their age group respond to the effects of the vaccines before considering receiving one themselves. Tellingly, almost 80 per cent of older adult respondents who are unwilling to be vaccinated cited worry about possible negative side effects from the vaccine.

3. Sources of information regarding Covid-19

Tan et al found a correlation between the news media sources upon which older adults rely for information about the pandemic and their willingness to get vaccinated. Older individuals who do not intend to get their vaccine shots are the “least trusting of all sources of Covid-related information” and are also least likely to actively gather any information about the virus. However, the same individuals were most likely to trust information from their family among all sources, implying that a more suitable means to convince such older adults to vaccinate would be to reach out to them through their families.

4. Social integration and relationships

The study also found that older adults who are averse to getting vaccinated have low levels of social integration — they likely live alone or in a smaller household, and were also more likely to have little to no close contacts among friends or family.

The size of Singapore’s silver population is growing at a rapid rate and requires an urgent need for social integration to improve well-being among older individuals and meet the needs of seniors. As the study has shown, the social integration of older adults is crucial to improving their well-being and health, during the pandemic and beyond.

What can the government do?

A potential solution for increasing the rate of vaccination among older adults is to make it mandatory for all above the age of 65. But, currently, Singapore residents are only required to be vaccinated against measles and diphtheria. Forcing the Covid vaccination as a requirement on older residents will be challenging and might result in mental health challenges for many.

Instead, Tan et al concluded that a better strategy will be to raise awareness among older adults through redesigned vaccination campaigns which aim to reach out to older adults not willing to vaccinate through their family and personal contacts who are more trusted such individuals. Furthermore, tailoring campaigns to educate older adults, particularly those aged between 71 and 75 and who are less socially integrated, on vaccination facts may help mitigate fears of side effects. To help persuade seniors to get vaccinated against Covid, the Singapore government should thus encourage younger individuals to accompany older family members to get vaccinated and help combat misinformation relating to vaccines.