Factors associated with vaccine intention in adults living in England who either do not want or have not yet decided whether to be vaccinated against COVID-19.
An effective vaccine requires an immunisation programme that has high and equitable uptake in order to deliver population-level protection against COVID-19 . Prior research on COVID-19 vaccine intention in the UK has focused on a nationally representative sample  or those at high-risk  where intention to vaccinate is relatively high. We wanted to identify the modifiable factors associated with intention to have a vaccine in people who were either undecided or more resistant to having a COVID-19 vaccine, with a specific interest in people deemed either high-priority for a COVID-19 vaccine or at high-risk of the virus by the Joint Committee on Vaccination and Immunisation (JCVI) * . These people included: those 50 years of age and over; health and social care workers; persons with an underlying health problem; and Black and Asian and minority ethnic groups.
- Public health messaging promoting a COVID-19 vaccine may be more successful if the focus is on the benefits that a mass COVID-19 immunisation programme will bring as well as the potential regret one might feel if they were not vaccinated and were to subsequently infect others. These factors are likely to be more successful than detailing the risk and potential consequences of an infection to the individual.
- It is also important to foster trust where possible in those organisations that are likely to be the brand associated with delivery. In this regard the NHS should be favoured over a UK Government body.
- A mass COVID-19 immunisation programme should be developed with specific consideration of, and in collaboration with, those who are of Black and mixed-Black heritage and those living in more deprived areas of England.
- Additional incentives may be required beyond messaging to increase COVID-19 vaccine uptake among health and social care workers to mitigate possible resistance.
We designed a questionnaire and surveyed 3,039 people through YouGov between 23 October and 4 November 2020. Each respondent was asked where in the decision-making process they were in regard to having a COVID-19 vaccine. These stages were: not yet considered (407, 13.4%); not sure, but probably will (783, 25.8%); not sure, but probably won’t (260, 8.6%); don’t want (210, 6.9%); and do want (1,379, 45.4%).
We captured socio-demographic information on all respondents using YouGov’s profiling data. Those that stated they do want a COVID-19 vaccine were excluded from completing a questionnaire on their beliefs about the pandemic, a potential COVID-19 vaccine and their personal health. The statements used to elicit respondents’ beliefs can be seen in our policy brief.
A total of 1,660 respondents’ intentions to vaccinate against COVID-19 were analysed using statistical methods to identify factors associated with COVID-19 vaccine intention (CVI). Factors included in the analysis were:
Sociodemographic characteristics: Age, gender, ethnicity, local area deprivation, and whether they are a health or social care worker.
Personal health details: Body mass index (BMI), previously been infected by COVID-19, whether they have been shielding during the pandemic, their general health, and their history of having an influenza vaccine.
Beliefs on the pandemic: Having anti-lockdown views; believing in COVID-19 conspiracy theories, perceptions of the severity of a COVID-19 infection to themselves, perceptions of their susceptibility to COVID-19, and their trust in the NHS and UK Government body’s approval of a COVID-19 vaccine.
Views on a COVID-19 vaccine: Favourable views on a vaccine, perceived social pressure to be vaccinated, perceived control over whether they are vaccinated, anticipated regret of not having a vaccine, knowledge of vaccine safety, and perceived benefits of a mass COVID-19 immunisation programme.
A summary of the results of the statistical analysis can be seen in our policy brief.
When including all variables detailed above in the analysis, they explained 60% of the variation in our study population’s responses to CVI. Factors that had a significant positive association with CVI were: perceived social pressure to be vaccinated, trust in NHS and UK Government body associated with vaccine approval, favourable views on vaccines, perceived benefits of vaccine, anticipated regret of not having a vaccine, knowledge of vaccine safety, and a history of having an influenza vaccine. Factors that had a significant negative association were: being a health or social care worker, and having anti-lockdown views. These findings suggest that public health vaccine promotion that focuses on the benefits of a mass COVID-19 immunisation programme, the anticipated regret of not having a vaccine, and the safety of a vaccine whilst ensuring or engendering trust in those bodies that brand a campaign may be most beneficial in increasing uptake of a COVID-19 vaccine. They also highlight the potential challenges from those holding anti-lockdown views, but also from those who are health and social care workers. However, it must be noted that health and social care workers only comprised a small number within our study population (110 (13%) of our respondents) and therefore this result should be treated with caution (as it may not represent the majority of the views of these professionals).
Publications from this work:
Journal: Factors associated with vaccine intention in adults living in England who either did not want or had not yet decided to be vaccinated against COVID-19 Human Vaccines & Immunotherapeutics, 17 (12) (2021) – see here
The research team would like to thank the following for their support with this research. The members of the NIHR PRU Behavioural Science Patient and Public Involvement Strategy Group, who gave their time to review the survey questionnaire. Louise Letley, Nurse Manager (Research) in the Immunisation and Countermeasures team at the National Infection service within Public Health England, who has supported development throughout and policy guidance to ensure that the work would provide insight that would be of value to Public Health England and associated UK Government bodies. YouGov for their responsive and timely delivery of the survey.
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