Zika Virus Knowledge and Vaccine Acceptance among Undergraduate Students in Guayaquil, Ecuador

"Considering the complicated and unique combination of factors influencing vaccine hesitancy in different communities, efforts to increase vaccine acceptance must be individual and suited to a community's specific needs."

Zika virus (ZIKV) was declared a Public Health Emergency of International Concern (PHEIC) in 2016. Concerns surrounding the effects of ZIKV persist today, and several vaccine candidates are currently in various stages of development worldwide. Globally, views on vaccines are highly polarised, making it important to allocate resources to effective outreach measures that help promote vaccine acceptance. It is also valuable to understand a specific population's general beliefs and acceptance of vaccines so effective public health outreach efforts can be implemented. To that end, this research aims to identify the general beliefs and acceptance of a potential ZIKV vaccine in the undergraduate population at Escuela Superior Politécnica del Litoral (ESPOL) in Guayaquil, Ecuador, a ZIKV-endemic region where risk for contracting the virus is high.

Between January and November 2019, 429 undergraduate students at ESPOL responded anonymously to a ZIKV vaccine survey. Frequencies, percentages, simple correspondence analysis, and bivariate inferential analyses were conducted. Tests explored associations between likelihood of receiving a ZIKV vaccine and demographic, ZIKV information seeking, ZIKV psychosocial variables, and ZIKV information source variables.

Among the eligible participants, 241 (56.2%) were willing to receive a ZIKV vaccine if one was made commercially available. The most common reported reason for vaccine hesitancy among ESPOL students was skepticism of a novel vaccine. Specifically, the three most common responses were that others should receive the vaccine first, vaccines have risks/adverse events, and ZIKV vaccine is not a priority now. Responses were similar among females and males.

Bivariate results revealed:

• There was a statistically significant relationship between searching for accurate information on ZIKV and likelihood of receiving the ZIKV vaccine (p < 0.001).
• Knowing where to obtain up-to-date information on ZIKV was also significantly associated with likelihood of receiving a ZIKV vaccine (p = 0.005).
• There was a statistically significant association between likelihood of receiving a ZIKV vaccine and concern about ZIKV (p = 0.036), thought of ZIKV inciting fear (p = 0.014), feeling personally threatened by ZIKV (p = 0.011), feeling the World Health Organization (WHO) is exaggerating ZIKV issues (p = 0.032), and believing that the Ecuadorian government should invest in treatment options (p = 0.012) and develop a ZIKV vaccine (p < 0.001).

Most students had an incomplete understanding of ZIKV characteristics such as contracting the disease, symptoms, populations at risk, potentially associated health conditions, and treatment. Most students (72.0%) obtained ZIKV information from television and social networks. Research on the ZIKV outbreak has identified social media specifically as a common source of misinformation. These findings suggest targeted public health messaging on television and social network platforms could improve engagement among ESPOL university students and increase spread of accurate information on ZIKV in this population. Healthcare professionals, researchers and governments should promote education on the appropriate use of social media and enhance online health literacy capacity.

In addition, to combat misinformation and improve students' understanding of ZIKV, ESPOL university could implement a ZIKV education initiative for students using best practices for prevention and treatment method recommendations such as those outlined by WHO and the United States Centers for Disease Control and Prevention (CDC).

Results also highlight an opportunity to improve sexual education for students. The survey found that most respondents did not know that ZIKV can be sexually transmitted from males who have contracted the disease to females. Previous research indicates university students ages 20-24 who are less knowledgeable in practicing safe sex are more willing to engage in risky sexual behaviours when compared to those who are more knowledgeable. Further, past research in Ecuador suggests that young people want to learn more about sexual health and risk reduction. According to the researchers, improved sexual education among ESPOL university students with a focus on practicing protected sex could be a component of a comprehensive effort to decrease the spread of ZIKV in this population.

Future research could, for example, implement surveys pre- and post-ZIKV education initiatives to determine whether they influence likelihood of ESPOL university students receiving a ZIKV vaccine.

The researchers conclude that public health campaigns should focus on comprehensive ZIKV education efforts in this population: "Moving forward, population specific and accurate information on ZIKV should be provided to encourage the acceptance and uptake of a ZIKV vaccine if one is to become commercially available."