The global impact of the COVID-19 pandemic led to unprecedented efforts to develop vaccines against severe Coronavirus 2 (SARS-CoV-2) infection of acute respiratory syndrome in an unprecedented time frame. Although some vaccines are already being used on a large scale, scientists and governments are facing a difficult obstacle. This is the persistence of vaccine reluctance and unwillingness among the general population. A new study published in December 2020 on the preprint server medRxiv * examines this phenomenon and the effects on public health.
The researchers examined studies of vaccine behavior in large samples (1,000 or more subjects) of the population in a nationally representative framework. To systematically capture the available data, they conducted both a review and meta-analysis to identify the proportion of the population with the following attitudes: willingness to accept the vaccine, unsure or unwilling to take it when it becomes available .
They received 28 samples from over 58,600 people from 13 countries. Most came from the US, UK and Canada, the rest from European countries, China and Australia. The data covered the period from June to October 2020.
Pooled data from March-October shows that around 73% would accept the vaccine while ~ 14% would reject it. About 22% said they were not sure. However, this option was not available in all studies and its presence significantly affected the number of “willing” responses.
In other words, without this option, around 83% said they were willing, but when it was given, only around 64%. However, the proportion of “unwilling” people did not change significantly.
The 18 studies from March to May had a share of 79% of “willing” answers and 12% of “unwilling” answers, which fell in the ten studies from June to October to 60% and 20% respectively. The number of “uncertain” answers did not vary over time. The change in this trend did not correlate with the country studied.
The results suggest that the percentage of willing and unwilling people has decreased or increased in the wake of the pandemic.
However, there was a country-specific difference in the proportion of “willing” responses. Over 90% of Chinese adults said they were ready from March to April, compared with 76% in France. It’s worth noting that the numbers for France and the US were much lower at around 50% from September to October.
Proportion of population groups who want to vaccinate, by country and time
Risk factors for unwillingness
The risk factors for vaccine unwillingness were female, younger, less educated, on lower income, or being part of an ethnic minority. In 7/11 studies, white people showed greater willingness, but in four it was not significant. A higher income showed a positive correlation with willingness in 8/9 studies. Comorbidity was a positive factor for willingness in only one study out of 5.
In 12/14 studies, willingness was far more likely in older adults. In one study, younger adults were more willing than middle-aged adults but not older adults, and in the last there was no association with age. Men showed greater willingness to accept the vaccine in 9/14 studies, and people with a higher level of education in half of 14 studies.
What are the implications?
As disinformation continued to be posted on a variety of social media sites, confidence in government intervention and the safety of vaccines began to decline. It became clear that the vaccination intentions were divided between 60% willingness and 20% reluctance, depending on the sample tested.
Risk factors follow a similar pattern across all five high-quality studies, suggesting that younger people, women, and those with less education, lower incomes, or an ethnic minority are consistently less likely to be vaccinated. The link to the impact of such misinformation campaigns and public concerns that vaccine safety is being compromised underscores the need to target the public’s awareness of the benefits and safety of the new vaccines. This can require both behavioral and scientific expertise as it is more about trust and acceptance than validated scientific results.
Oddly enough, people with chronic health conditions showed no greater willingness to accept the vaccine, even though they were at a much higher risk of dying from COVID-19. This indicates the need to reach out to both poor and marginalized communities and medically vulnerable groups for vaccine acceptance, as both have already suffered far more than others from the pandemic.
The authors summarize: “The intentions to vaccinate against COVID-19 in public when a vaccine becomes available has declined, and this will limit the effectiveness of COVID-19 vaccination programs. The results highlight the need to improve public acceptance, trust and concern about the safety and benefits of COVID-19 vaccines, as well as targeted vaccine uptake in disadvantaged groups already disproportionately affected by the pandemic. “
* Important NOTE
medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be considered conclusive, guide clinical practice / health-related behavior, or be treated as established information.