JMIR Publications

ABSTRACT

Background:

COVID-19 protective behaviours, such as receiving a full COVID-19 vaccine course, keeping a safe distance from others, and maintaining proper indoor ventilation, are key interventions advised by the World Health Organization (WHO) to combat the COVID-19 disease burden. However, compliance with this advice is often challenging, particularly among socially vulnerable groups.

Objective:

This study develops a social vulnerability index (SVI) to predict individuals’ propensity to adhere to the WHO advice on protective behaviours against COVID-19 and to identify changes in social vulnerability as Omicron evolved in African countries (AFCs) and Asia Pacific countries (APCs).

Methods:

In AFCs, baseline data were collected from 14 countries (n=15,375), and follow-up data were collected from seven countries (n=7,179) during and after the first wave of Omicron, respectively. In APCs, baseline data were from 14 countries (n=12,866) and follow-up data were collected from nine countries (n=8,737) before and after the Omicron wave, respectively. Variables at the national- and individual- level identified from the literature as determinants of the vulnerability to COVID-19 were included in the analyses to construct SVI. Factor analysis was conducted using polychoric correlation with varimax rotation to identify the specific domains of social vulnerability, which were combined to develop a composite index of social vulnerability. Individual-level data on COVID-19 protective behaviours were used to develop scores of the WHO advice compliance. Multiple linear regressions were used to assess the associations between the SVIs and WHO advice compliance scores to validate the index.

Results:

Factors contributing to Africa’s SVI included factors related to literacy and media use, trust in healthcare workers and government, and country income and infrastructure. APC’s SVI was contributed by factors related to literacy, country income and infrastructure, and population density. The developed index was associated with the scores of compliance at all times in AFCs and only during the follow-up period in APCs. At baseline, significant disparities in social vulnerability were observed between the most and least vulnerable countries in both regions, and these disparities widened during the follow-up in both regions.

Conclusions:

The predictability of the Social Vulnerability Index (SVI) varied based on the comprehensiveness of the variables used in SVI construction and the different stages of the Omicron outbreak. Socially vulnerable populations face challenges in adhering to WHO recommendations for COVID-19 protective behaviors, and the Omicron wave has exacerbated their social vulnerability. This vicious cycle hampers the global capacity to bring the acute phase of the COVID-19 pandemic to an end.