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\begin{document}

\title{Myths, beliefs, and conspiracies about COVID-19 Vaccines in Sindh,
Pakistan: An online cross-sectional survey}



\author[1]{Qamar Abbas}%
\author[2]{Fatima Mangrio}%
\author[2]{Sunil Kumar}%
\affil[1]{University of Bahrain}%
\affil[2]{University of Sindh}%


\vspace{-1em}



  
  \date{May 28, 2024}


\begingroup
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\selectlanguage{english}
\begin{abstract}
Abstract Background Pakistan has already encountered intense opposition
to polio vaccination due to myths and misinformation, now the
unfavorable opinions of COVID-19 vaccinations among the population would
have catastrophic consequences for attempts to end the pandemic. Methods
A web-based cross-sectional study was conducted in the general
population of Sindh, Pakistan in January 2021. 31 items based on
vaccines availability, safety, and myths, the questionnaire was designed
and randomly distributed through a google form link. Results were
analyzed using descriptive and Chi-square tests. Results A total of 774
responses were recorded from 23 districts of Sindh, Pakistan. The
majority of participants (n=00, 00.0\%) were not aware of the presence
of the COVID-19 vaccine in Pakistan. Results found the significant
relationship of conspiracies and myths with an education level of
participants, to make Muslims infertile, illiterate showed (Yes n=45,
No=27) while postgraduate (Yes n=11, No=88) (\selectlanguage{greek}χ\selectlanguage{english}2 = 109.6, P\textgreater{}
0.000). Participants showed doubt about the safety of vaccines, (Yes n=
464, 59.9\%, No= 310, 40.1\%). Other responses related to side effects
of the vaccine were also highly significant, participants showed that
vaccine side effects (Yes n= 462, 59.7\%, No= 312, 40.3\%), Pregnant or
breastfeeding women should not get vaccinated (Yes n= 468, 59.8\%, No=
311, 40.1\%) and people with underlying conditions should not get
vaccinated (True n= 389, 50.3\%, False= 385, 49.7\%). Conclusion The
proportion of varying public doubts in vaccines' safety and efficacy and
the presence of myths, conspiracies will be a major barrier to vaccine
uptake.%
\end{abstract}%



\sloppy


\textbf{Myths, beliefs, and conspiracies about COVID-19 Vaccines in
Sindh, Pakistan: An online cross-sectional survey}

\textbf{Running title:} COVID-19 Vaccines awareness

\textbf{Qamar Abbas} \textsuperscript{1}\textbf{, Fatima Mangrio}
\textsuperscript{2}\textbf{, Sunil Kumar} \textsuperscript{2}

\textsuperscript{1}Department of Biology, College of Science, University
of Bahrain, Sakhir, 32038 Kingdom of Bahrain

\textsuperscript{21}Department of Physiology and Medical Laboratory
Technology, University of Sindh, Jamshoro, 76080Sindh, Pakistan

\textbf{Keywords}

COVID-19, vaccines, Myths, Sindh Pakistan, Vaccines awareness, Pandemic

\textbf{Corresponding Author}

\textbf{Qamar Abbas, PhD}

Department of Biology, College of Science, University of Bahrain,
Sakhir, 32038 Kingdom of Bahrain

qamar.abbas.qau@gmai.com

\textbf{Disclosures}

Authors declare no any conflict of interest

\textbf{Myths, beliefs, and conspiracies about COVID-19 Vaccines in
Sindh, Pakistan: An online cross-sectional survey}

\textbf{Qamar Abbas} \textsuperscript{1}\textbf{, Fatima Mangrio}
\textsuperscript{2}\textbf{, Sunil Kumar} \textsuperscript{2}

\textsuperscript{1}Department of Biology, College of Science, University
of Bahrain, Sakhir, 32038 Kingdom of Bahrain

\textsuperscript{2}Department of Physiology and Medical Laboratory
Technology, University of Sindh, Jamshoro, Sindh, Pakistan

\textbf{Abstract}

\emph{Background}

Pakistan has already encountered intense opposition to polio vaccination
due to myths and misinformation, now the unfavorable opinions of
COVID-19 vaccinations among the population would have catastrophic
consequences for attempts to end the pandemic.

\emph{Methods}

A web-based cross-sectional study was conducted in the general
population of Sindh, Pakistan in January 2021. 31 items based on
vaccines availability, safety, and myths, the questionnaire was designed
and randomly distributed through a google form link. Results were
analyzed using descriptive and Chi-square tests.

\emph{Results}

A total of 774 responses were recorded from 23 districts of Sindh,
Pakistan. The majority of participants (n=00, 00.0\%) were not aware of
the presence of the COVID-19 vaccine in Pakistan. Results found the
significant relationship of conspiracies and myths with an education
level of participants, to make Muslims infertile, illiterate showed (Yes
n=45, No=27) while postgraduate (Yes n=11, No=88) (\selectlanguage{greek}χ\selectlanguage{english}2 = 109.6,
P\textgreater{} 0.000). Participants showed doubt about the safety of
vaccines, (Yes n= 464, 59.9\%, No= 310, 40.1\%). Other responses related
to side effects of the vaccine were also highly significant,
participants showed that vaccine side effects (Yes n= 462, 59.7\%, No=
312, 40.3\%), Pregnant or breastfeeding women should not get vaccinated
(Yes n= 468, 59.8\%, No= 311, 40.1\%) and people with underlying
conditions should not get vaccinated (True n= 389, 50.3\%, False= 385,
49.7\%).

\emph{Conclusion}

The proportion of varying public doubts in vaccines' safety and efficacy
and the presence of myths, conspiracies will be a major barrier to
vaccine uptake.

\textbf{Keywords}

COVID-19, vaccines, myths, Sindh Pakistan, Vaccines awareness, Pandemic

\textbf{What's known?}

Perception, attitudes and awareness about COVID-19

Prevalence of COVID-19

\textbf{What's new?}

Safety and efficacy of COVID-19 vaccines

Myths and conspiracies regarding COVID-19 vaccines

Education level and COVID-19 vaccines information of peoples

\textbf{Introduction}

COVID-19 has been quickly circulating across the world since December
2019. Not surprisingly, discussion about COVID-19 is also on the rise
{[}1{]}. Because of the exponential growth in Covid-19 cases, widespread
myths and misinformation regarding the disease's transmission triggered
an ''infodemic,'' according to the Global Health Organization {[}2{]}.
Myth is commonly thought of as a folktale category that involves tales
that play an important role in people's everyday lives {[}3{]}. These
are often endorsed by religious and government figures, and they express
the general workings of a collective public and form people's trust.
Social and religious views play an important role in affecting popular
opinion in a given country and influencing the formation or adoption of
myths {[}4{]}.

Vital oils, colloidal silver, and other myths about how to cure manage,
and defend against COVID--19 continue to circulate across face-to-face
and often web-based media {[}5{]}. While some believe that a hot climate
destroys viruses, COVID-19 is spreading to some hot countries as well.
Few people consider taking zinc, ginger, nectar, a lot of Indian spices,
and other vitamins to prevent COVID-19 {[}6{]}.

According to research, those with a lower level of education or who are
illiterate, the unemployed, younger generations, and certain ethnic
groups are more hesitant.

Vaccine apprehension continues to be a significant challenge for
Pakistan, despite various conspiracy theories. Such theories are largely
to blame for the country's failure to eradicate polio. Among others,
reports of low vaccine consistency, concerns regarding dosing
guidelines, religious bans (``infidel vaccine''), and speculation about
the existence of the active virus in vaccinations are some of the more
popular arguments obstructing the country's anti-polio drive {[}7{]}.

Unfortunately, in Pakistan, a conspiracy hypothesis about the COVID-19
vaccine is reportedly circulating. Recently, a well-known Pakistani
political commentator and columnist reported that the virus was a grand
illusion intended to attack Islamic countries and allow Jews to dominate
the world, with nano-chips implanted in people's bodies to gain power
over 5G towers {[}8{]}. An ex-foreign minister of Pakistan proposed a
parallel theory, accusing the US of inventing the virus in the United
Kingdom and then moving it to China for global dissemination {[}9{]}.

These theories are widely debated on social media in the Pakistani
culture. Such conspiracy narratives could sow seeds of resistance
against upcoming COVID-19 vaccination programs in the world, where
vaccine apprehension is a major barrier to preventing
vaccine-preventable diseases. Since a long-term lockdown is not feasible
in many countries due to economic instability, vaccination supply could
be the best solution to prevent the pandemic from spreading.

It was recently discovered that public knowledge of infectious diseases
is strongly linked to vaccine confidence {[}10{]}. A global survey of
140,000 people on ``attitudes to vaccines'' found that countries with
successful public-awareness programs against multiple infectious
diseases have very high rates of consensus on vaccine prevention,
efficacy, and value {[}11{]}. In a pandemic, recognizing myths and
beliefs is important because they can impact preventative and
containment efforts. As a result, in this study, myths and
misconceptions regarding COVID-19 vaccines were analyzed in the general
population of Sindh. To our best of knowledge, there hasn't been any
research done in Sindh on myths and misconceptions about Covid-19
vaccines.

\textbf{Methods}

A web-based cross-sectional survey study was designed through ``Google
Form'' to record responses from the Sindh province of Pakistan in
January 2021.

Study area

Sindh is one of the four provinces of Pakistan located in its south.
Sindh is the home of almost 47.9 million humans. Sindh province is
comprised of seven divisions 29 districts further these districts are
subdivided into Tehsils and union councils {[}12{]}.

\emph{2.1 Development of research tool}

A questionnaire with 31 items was designed in English and in the local
language (Sindhi) using already published material on COVID-19, after
listening to local community concerns and discussion regarding COVID-19
vaccines and myths related to other vaccines in Sindh, Pakistan.

\emph{Content of the survey questionnaire}

The questionnaire contains 31 items that take 4-6 min to complete. The
questionnaire was divided into four sections; the first section contains
10 questions about demographic information of the participants, 2
questions about COVID-19 vaccines availability in Pakistan, 13 questions
related to vaccines safety and potency, and six questions about myths
and conspiracies about COVID-19 vaccines \& last question about the
consent of respondent for participation in the study.

\emph{2.3 Ethical consideration}

The questionnaire was reviewed and approved by the ethical committee of
the Department of Physiology University of Sindh, Jamshoro, Sindh,
Pakistan. The participants were requested for consent and willingness in
study and confidentiality of all the participants was maintained.

\emph{2.4 Distribution of questionnaire}

The final survey link was disseminated among the peoples of Sindh
province in the form of ''Google Form'' by means of different media
platforms, for example, E-mail, WhatsApp, and Facebook. Accordingly, the
link was sent to individuals apart from the first main point of contact
and was requested to forward to others. Responses from illiterate
peoples were obtained physically after explaining the questionnaire in
the local language and then these responses were transformed into the
online form.

\emph{2.5 Statistical analysis}

Data were analyzed using IBM SPSS statistics version 23. To determine
the associated factors with misinformation and myths, chi-square was
calculated with the significant level was determined as p-value,
p\textless{}0.05 was considered as statistically significant.

\textbf{Results}

An online survey, about COVID-19 vaccine misinformation, mistrust, and
myths were conducted in the Sindh province of Pakistan. A total of 774
responses were recorded. All the participants give their consent in
publishing the data without mentioning their identity. All the
respondents were from Sindh province and above 16 years of age. The
responses of illiterate and those who don't have access to the internet
their responses were recorded physically and then shifted to online.

\emph{Part-I: Demographics}

Geographic patterns of study sample across various districts of Sindh
province was created using ArcGIS 10.8, the responses were recorded from
23 major district of Sindh Pakistan. 66.3\% of participants were from
rural areas and 34.7\% of the participants from urban areas. Highest
number of responses were recorded from Larkana (20.93\%) followed by
Mirpurkhas (13.30\%) and Hyderabad (12.27\%, Fig.1). The majority of the
respondent were male (n= 561, 72.5\%) female (n= 210, 27.1\%) and (n=
03, 0.041\%) transgender were recorded. Age of participants were divided
into five groups, highest number of responses were from youngest peoples
age group 21-30 year (n= 435, 56.2\%) 16-20 (n= 167, 21.6\%), 31-40 (n=
114, 14.7\%), 41-60 (n= 48, 6.2\%) and lowest responses from older
peoples above 60 (n= 10, 1.3\%). In marital status 3 peoples did not
showed their marital status while singles were (n= 545, 70.4\%), married
(n= 224, 28.9\%) and 3 (0.4\%) were divorced. Education was the main
indicator of the present study respondent education qualification was
divided into five categories among all categories highest responses from
graduates (n= 414, 53.5\%) followed by secondary (n= 124, 16\%),
postgraduate (n= 99, 12.8\%), Illiterate (n= 72, 9.3\%) and Primary (n=
65, 8.4\%). Most of the participants were students (n= 434, 56.1\%),
labourer were (n= 94, 12.1\%) and govt employee were (n= 87, 11.2\%). In
religious column most of the responses were from Muslim's (n= 589,
76.1\%), Hinduisim (n= 181, 23.4\%) and Christian were (n= 3, 0.4\%).
Most of the respondents were from lower income position (n= 490, 63.3\%)
earns only less than 20,000PKR per month (Table.1)

\emph{Part-II: Vaccine availability}

A significant number of participants were aware of the COVID-19 vaccine
(Yes, n=506, 65.4\% and No, n=268, 34.6\%). Interestingly when the
response of vaccine availability in Pakistan was analyzed, results
showed that significantly (No, n=503, 65\% and Yes, n=271, 35\%)
majority of participants were not aware of the presence of COVID-19
vaccine in Pakistan, these responses were further analyzed among gender,
education and with the living area, there was not any significant
difference obtained (Table. 2).

\emph{Part-III: Vaccine conspiracies and myths}

There were six questions about the vaccine myths and conspiracies
included. In general, the majority of the responses showed COVID-19
vaccine is not a conspiracy, to make infertile Muslims/ any Haram
ingredients (forbidden in Islam) or anti-Islamic agenda (Fig. 2.), these
responses were further statistically analyzed using \selectlanguage{greek}χ\selectlanguage{english}2 with the
education level of participants. Surprisingly, the results found the
significant relationship of conspiracies and myths with the education
level of participants, to make Muslims infertile illiterate showed (Yes
n=45, No=27) while postgraduate (Yes n=11, No=88) (\selectlanguage{greek}χ\selectlanguage{english}2 = 109.6,
P\textgreater{} 0.000). In other question COVID-19 vaccine is prepared
only for making money similar type difference was obtained illiterate
showed (Yes n= 67, No= 5) while postgraduate (Yes n= 34, No= 65) (\selectlanguage{greek}χ\selectlanguage{english}2 =
140.8, P\textgreater{} 0.000). Similarly, for other myths and
conspiracies like a vaccine contains Haram ingredients (forbidden in
Islam) or anti-Islamic agenda highly significant difference was showed
between illiterate and educated respondents (P\textgreater{} 0.000,
Table\ldots{})

\emph{Part-IV: Vaccine} \emph{safety} \emph{and} \emph{potency}

In this section, the 12 questions related to vaccine safety and potency
were included. In the first question, as shown in Fig. 3 participants
showed doubt about the safety of the vaccine, because participants think
that vaccine prepared quickly which's why the vaccine is not safe for
use (Yes n= 464, 59.9\%, No= 310, 40.1\%). Other responses related with
side effects of vaccine were also in negative, participants showed that
vaccine side effects (Yes n= 462, 59.7\%, No= 312, 40.3\%), Pregnant or
breastfeeding women should not get vaccinated (Yes n= 468, 59.8\%, No=
311, 40.1\%) and people with underlying conditions should not get
vaccinated (True n= 389, 50.3\%, False= 385, 49.7\%). On the other hand,
participants showed significant trust in the potency of the vaccine,
despite the less than 100\% efficacy of the COVID-19 vaccine, would you
still prefer to be vaccinated (Yes n= 407, 52.6\%, No= 367, 47.4\%)
similar trust in potency of the vaccine was recorded in all related
questions as shown in table 2 \& fig. 2 \&3. Moreover, we found strong
significant (P\textgreater{} 0.000) relationships between vaccine myths,
misinformation, and conspiracies with the education levels.

\textbf{Discussion}

In the present study, we aimed to investigate how people of Sindh view a
COVID-19 vaccine, particularly in terms of quick formulation of vaccine,
availability, side effects, myths, and misinformation in the local
community. To the best of our literature search, this is the first study
in investigating the myths misinformation of the COVID-19 vaccine in the
local community of Sindh, Pakistan. Nowadays, vaccine acceptance has
been a big challenge, which upraised the concern of trust in the
immunization process of COVID-19 for the public even in developed
countries, a similar type of myths and conspiracies were also faced for
measles, polio, rubella, and mumps due to myths and misinformation
results in decreased vaccination {[}13, 14{]}. Pakistan has faced these
issues for decades for Polio vaccines and now the same issue raised for
COVID-19. Trust in vaccination impair can coexist in various forms of
vaccination hesitancy {[}15{]}, as it can be associated with myths,
misinformation, and conspiracies in vaccination efficacy and
practicality, or comprehensive rejection of vaccination {[}16{]}. These
are the constant issues in public trust regarding the adverse effects of
vaccines.

Beliefs in vaccines associated with education level have been studied in
Canada, the US, and other countries. Importantly, concerns regarding
vaccine safety were also found in well-educated areas {[}17{]}. Our
findings are also accordingly, educated participants were also in doubts
about the safety of vaccines, and moreover, our results indicated that
educated participants were in favor of immunity through vaccines, and
with the increasing education level the results showed that participants
were against the myths.

The most widely repeatedly cited trust comprised that vaccines can cause
disease; infants immune system can be saturated if injected too many
vaccines frequently, vaccines contains dangerous elements in the
formulation, Children with underlying health conditions are more
vulnerable to vaccines side effects; the purpose of vaccines is making
money; naturally immunity is more powerful than with vaccines {[}18{]},
our findings were also similar, results suggested that majority of
participants were in belief that peoples with underlying conditions and
pregnant or breastfeeding should not get vaccinated as it can be
harmful.

Globally, another predictor is religion's most widely studied indicator
in vaccine hesitancy researches. Studies indicated that higher
religiosity was connected with an increasing ratio of vaccine rejection
{[}19{]}. Our results did not show any religious involvement in vaccines
myths conspiracies or misinformation which lead to vaccines refusal.
Associated with the already published findings from Canada and other
countries {[}20{]}, importantly we also found that education level is
the key indicator of vaccine rejections illiterate and less educated
showed higher rejection and more trust in myths and conspiracies.

\textbf{Conclusion}

The results from the present study suggest that the myths, mistrust, and
conspiracies about the COVID-19 vaccine's safety and efficacy are
present in less educated most significantly in illiterate peoples.
Therefore, it's very important for policymakers and the government to
educate the people to minimize vaccine hesitancy. Public health experts
and policymakers should start awareness campaigns on TV, radio, and
other media platform and also through distributing the vaccine
information leaflets or broachers to the general public for cracking
myths and misinformation that leads to vaccine hesitancy.

\textbf{Disclosures}

Authors declare no any conflict of interest

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