



The survey had seven sections: 1) general/demographics, 2) health history, 3) practices, 4) knowledge on COVID-19, 5) perceptions of COVID-19, 6) source of information, and 7) self-efficacy (Supplementary Table 1 for the survey).Ī total of 21-items related to practices were designed to understand what safety measures were undertaken by respondents to reduce the risk of contracting/spreading SARS-CoV-2 virus after the first case was detected in their country and before any measures were enforced/advised by their respective governments. This study aims to identify key perception constructs and risk factors between residents with high and low COVID-19 vaccine intent from three countries: Australia, Hong Kong and Singapore. However, few studies have adopted a combination of this conceptual framework to assess the COVID-19 vaccine intent among population. stated that, “Acceptance of vaccination is an outcome behaviour resulting from a complex decision-making process that can be potentially influenced by multiple factors”” While there have been studies looking into various risk factors associated with vaccine uptake, a population-based study in Hong Kong concluded that Health Belief Model (HBM) constructs along with independent risk factors can provide an evidence-based model and help implement various vaccination strategies. While studies have looked at cultural, political and racial differences to explain vaccine hesitancy, acceptance and likelihood, COVID-19 vaccination rate has been shown to vary across different phases of the pandemic in each affected country with introduction of newer variants and vaccine options. Vaccinating against COVID-19 can help prevent serious illness and death. By understanding the risk factors and perceptions that affect people’s intention to get vaccinated may guide policy-decision making process to enhance risk communication so as to increase vaccination uptake. Since then, as vaccination campaigns continue, Australia, Hong Kong and Singapore have 94.1% (population aged 16 and above), 74.9 (population aged 12 and above) and 90% (total population) population vaccinated as of 17 February 2022. When COVID-19 vaccines were first approved, vaccine hesitancy and reluctance were observed in certain population, threatening the success of prevention measures against COVID-19. EUA was issued on 14 December 2020 in Singapore and 25 January 2021 in Australia and Hong Kong, , Subsequently, more vaccines such as Moderna, AstraZeneca, Sinovac and others have been authorized for emergency use across the world.

On 11 December 2020, United States Food and Drug Administration (FDA) issued the first emergency use authorization (EUA) of Pfizer-BioNTech COVID-19 vaccine for use in United States. The disease has since spread worldwide causing great concerns with countries imposing various degrees of lockdown and travel restrictions. In December 2019, a cluster of coronavirus disease 2019 (COVID-19) cases were first identified in Wuhan, China. Among the eight perception constructs, perceived susceptibility and perceived response efficacy were positively associated, while perceived barriers were negatively associated with high vaccine acceptance. Increased likelihood of vaccine acceptance was seen among those that obtained COVID-19 information less frequently and used digital media or non-health-related sources like influencers as a source of information. While specific practices like taking micronutrients more frequently, cleaning and disinfecting their house more often were positively associated with increased vaccine acceptance, seeking medical help for COVID-19 symptoms like loss of smell/taste and overall COVID-19 knowledge score were negatively associated. While age and gender were not significantly associated, Asian ethnicity, current smokers and self-efficacy were significant associated factors of increased vaccine acceptance. A total of 3,133 anonymised participants from Singapore (n = 1,009), Australia (n = 1,118) and Hong Kong (n = 1,006) completed the survey.
