Anti-vaccine attitudes and risk factors for not agreeing to vaccination against COVID-19 amongst 32,361 UK adults: Implications for public health communications

  1. Elise Paul
  2. Andrew Steptoe
  3. Daisy Fancourt

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Abstract

Background Negative attitudes towards vaccines and an uncertainty or unwillingness to receive vaccinations are major barriers to managing the COVID-19 pandemic in the long-term. We estimate predictors of four domains of negative attitudes towards vaccines and identify groups most at risk of uncertainty and unwillingness to receive a COVID-19 vaccine in a large sample of UK adults. Methods Data were from 32,361 adults in the UCL COVID-19 Social Study. Ordinary least squares regression analyses examined the impact of socio-demographic and COVID-19 related factors on four types of negative vaccine attitudes: mistrust of vaccine benefit, worries about unforeseen effects, concerns about commercial profiteering, and preference for natural immunity. Multinomial logistic regression examined the impact of socio-demographic and COVID-19 related factors, negative vaccine attitudes, and prior vaccine behaviour on uncertainty and unwillingness to be vaccinated for COVID-19. Findings 16% of respondents displayed high levels of mistrust or misinformation about vaccines across one or more domains. Distrustful attitudes towards vaccination were higher amongst individuals from ethnic minority backgrounds, with lower levels of education, lower annual income, poor knowledge of COVID-19, and poor compliance with government COVID-19 guidelines. Overall, 14% of respondents reported unwillingness to receive a vaccine for COVID-19, whilst 22% were unsure. The largest predictors of both COVID-19 vaccine uncertainty and refusal were low income (< 30,000 GBP a year), having not received a flu vaccine last year, poor adherence to COVID-19 government guidelines, female gender, and living with children. Amongst vaccine attitudes, intermediate to high levels of vaccine benefit mistrust and concerns about future unforeseen side effects were the most important determinants of both uncertainty and unwillingness to vaccinate against COVID-19. Interpretation Negative attitudes towards vaccines are major public health concerns in the UK. General mistrust in vaccines and concerns about future side effects in particular will be barriers to achieving population immunity to COVID-19 through vaccination. Public health messaging should be tailored to address these concerns. Funding The Nuffield Foundation [WEL/FR-000022583], the MARCH Mental Health Network funded by the Cross-Disciplinary Mental Health Network Plus initiative supported by UK Research and Innovation [ES/S002588/1], and the Wellcome Trust [221400/Z/20/Z and 205407/Z/16/Z].

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    SciScore for 10.1101/2020.10.21.20216218: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementIRB: The study was approved by the UCL Research Ethics Committee [12467/005] and all participants gave informed consent.
    Consent: The study was approved by the UCL Research Ethics Committee [12467/005] and all participants gave informed consent.
    Randomizationnot detected.
    Blindingnot detected.
    Power AnalysisDue to insufficient statistical power, we also excluded individuals who had selected “other” in response to gender (n = 134) and “prefer not to say” on ethnicity (n = 95).
    Sex as a biological variablenot detected.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    However, there are several limitations. The study is not nationally representative, although it does have good stratification across all major socio-demographic groups and analyses were weighted on the basis of population estimates of core demographics. Whilst the recruitment strategy deliberately over-sampled from groups such as ethnic minorities, it is possible that more extreme views on vaccines were not adequately captured. Because we lacked statistical power to look in more detail at sub-groups of different ethnicities, our binary representation likely led to an over-simplification of these diverse categories. Further, this analysis focused on attitudes towards vaccination at the start of the autumn 2020 as the second wave of the virus was beginning in the UK. Future research tracking changing attitudes towards vaccination will be important as this pandemic continues and if and when a vaccination is approved. Our findings suggest widespread misinformation and anti-vaccine attitudes amongst the general UK public. Many of the specific groups with the most misinformation about vaccines and who are less likely to vaccinate against COVID-19 are also at highest risk for becoming seriously ill with and dying from COVID-19. Despite calculations that more than two-thirds of the public will need to be vaccinated to bring the pandemic under control1 and vaccination being central to the UK government’s COVID-19 recovery strategy,24 less than half the UK population will be offered a ...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

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  2. Version published to 10.1101/2020.10.21.20216218v1 on medRxiv