The large margin of the population that has not yet been vaccinated has a high risk of becoming infected with any variant, especially the young or those who have not accepted vaccination for different reasons. 20 The main groups immunized so far are older adults and people with certain comorbidities. 19 In Peru, despite increasing vaccination levels every day, only 29% of the population has been immunized by September 18, 2021. 18 The exact proportion of the population that must be vaccinated against COVID-19 to begin to observe effective herd immunity is unknown, however, it is estimated to be between 70% and 80%. Public health institutions around the world have developed vaccination strategies to control the pandemic, and surveys show that participants are reluctant to vaccinate or to receive any particular vaccine. 16 Indeed, trust in government and health professionals plays a key role in people’s decision to vaccinate against COVID-19. 15 In Peru, scandals related to the misuse of vaccines by senior government officials, authorities, and staff in the Ministry of Health, including research team members and university administrators where clinical trials of Sinopharm’s SARS-CoV-2 vaccine were being conducted in the midst of a health, political, and economic crisis, influence risk behavior toward vaccination. 14 These aspects become potential agents based, generally, on conspiracy theories. 13 Confidence in the vaccine provides assurance of its efficacy, but by resorting to a wide range of false information about vaccination, it leads to the formation of beliefs contrary to scientific evidence about the importance of vaccination, which, in turn, leads to risky and fearful behaviors. Vaccine hesitancy is a globally common phenomenon and is characterized by the acceptance or refusal of vaccination despite its availability and active service. 10, 11 Therefore, understanding the factors that influence vaccination in developing countries, with scarce economic resources, low levels of education, health systems on the verge of collapse, distrust toward manufacturing countries, fear of side effects, and serious misinformation problems such as Peru, is of vital importance to develop solid public health policies. 10, 11 These factors differ according to ideological, regional, social, and cultural factors. 9 Different studies indicate the influence of various factors on confidence acceptance or risk attitudes when receiving a vaccine. In Latin America, low-income countries such as Peru have reported the highest per capita deaths globally and an increasing number of cases 8 it is therefore necessary to promote vaccination against COVID-19 to reduce the number of infected and dead people and to reactivate the economy to achieve a better quality of life and equal opportunities for the population. 6 It is therefore crucial to convince populations that doubt vaccines of their vital importance in the fight against this virus and in the prevention of the appearance of new variants. 5 All of these vaccines, in addition to providing direct immunity, can help reduce infections, even among unvaccinated people, through herd immunity. 3, 4 As of January 28, 2022, 33 vaccines have regulatory approval in at least 1 country, based on the results of interim Phase III clinical trials, with published data reporting efficacies between 50% and 95% and, in some cases, no published results. and thus face the imminent epidemic waves caused by the new variants of COVID-19. Additionally, high-income countries retain their intellectual property for COVID-19 vaccines and other technologies, sparking outrage over vaccine inequities as global access to the vaccine enables diverse immunization strategies. 1, 2 On the other hand, several high- and middle-income countries compete unequally with low-income countries for vaccine procurement. 1, 2 In addition, COVID-19 has instilled fear in the population due to the dead consequences and negative impacts on the health and economic systems. COVID-19 infection caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused enormous disruption to societies and the loss of millions human lives.
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