Vaccine Confidence and Hesitancy at the Start of COVID-19 Vaccine Deployment in the UK: An Embedded Mixed-Methods Study

  1. Chrissy h. Roberts
  2. Hannah Brindle
  3. Nina T. Rogers
  4. Rosalind M. Eggo
  5. Luisa Enria
  6. Shelley Lees

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Abstract

Background: Approval for the use of COVID-19 vaccines has been granted in a number of countries but there are concerns that vaccine uptake may be low amongst certain groups.

Methods: This study used a mixed methods approach based on online survey and an embedded quantitative/qualitative design to explore perceptions and attitudes that were associated with intention to either accept or refuse offers of vaccination in different demographic groups during the early stages of the UK's mass COVID-19 vaccination programme (December 2020). Analysis used multivariate logistic regression, structural text modeling and anthropological assessments.

Results: Of 4,535 respondents, 85% ( n = 3,859) were willing to have a COVID-19 vaccine. The rapidity of vaccine development and uncertainties about safety were common reasons for COVID-19 vaccine hesitancy. There was no evidence for the widespread influence of mis-information, although broader vaccine hesitancy was associated with intentions to refuse COVID-19 vaccines (OR 20.60, 95% CI 14.20–30.30, p < 0.001). Low levels of trust in the decision-making (OR 1.63, 95% CI 1.08, 2.48, p = 0.021) and truthfulness (OR 8.76, 95% CI 4.15–19.90, p < 0.001) of the UK government were independently associated with higher odds of refusing COVID-19 vaccines. Compared to political centrists, conservatives and liberals were, respectively, more (OR 2.05, 95%CI 1.51–2.80, p < 0.001) and less (OR 0.30, 95% CI 0.22–0.41, p < 0.001) likely to refuse offered vaccines. Those who were willing to be vaccinated cited both personal and public protection as reasons, with some alluding to having a sense of collective responsibility.

Conclusion: Dominant narratives of COVID-19 vaccine hesitancy are misconceived as primarily being driven by misinformation. Key indicators of UK vaccine acceptance include prior behaviors, transparency of the scientific process of vaccine development, mistrust in science and leadership and individual political views. Vaccine programmes should leverage the sense of altruism, citizenship and collective responsibility that motivated many participants to get vaccinated.

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  1. Version published to 10.3389/fpubh.2021.745630
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    SciScore for 10.1101/2021.07.13.21260425: (What is this?)

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

    Table 1: Rigor

    EthicsConsent: All participants were asked to provide informed consent and to confirm their eligibility.
    Sex as a biological variableDemographic variables included in the analysis were age group [18 - 29 years, 30 - 49 years, 50 - 69 years and 70+], gender [Female | Male | Another gender], highest educational attainment [GCSEs/O-levels | A levels/Highers | Degree or higher degree], ethnicity [using UK Government 2011 census groups [15]] employment [Full time | Part time | Home-maker | Retired | Student | Unemployed], annual household income [Less than £15,000 | £15,000 - £24,999 | £25,000 - £39,999 | £40,000 - £59,999 | £60,000 - £99,999 | £100,000+], political views [Conservative/Right” | Floating/Centre | Liberal/Left] and UK postcode area.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot 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:
    Key limitations of this study were that it was non-representative and that the sampling-method was not random; meaning that the study findings are not generalisable either in the UK or elsewhere. We caution in particular that whilst vaccine dis- or mis-information did not appear to be a major influencer of vaccine choice in this UK cohort, this may not be the case in other jurisdictions. The study’s participants were disproportionately likely to be highly educated, white and aged over 50 years. Ethnic minority groups are at greater risk from COVID-19 [24,43] and are also less likely to report that they will accept COVID-19 vaccination [44] but these groups were under-represented among those responding to the survey. Facebook’s advertising policies preclude the targeting of boosted posts to specific ethnic minority groups, and we were therefore unable to influence the degree to which the advert was seen by, or engaged with by members of ethnic minority groups. The study was observational and causal links between the outcomes and statistically associated explanatory variables cannot be assumed. Additionally, covariates which were not included in the study, or any that were misclassified, could have led to residual confounding. As the study relied on self-reported information, there was scope for response bias, although we designed the questions to minimise this wherever possible. Finally, whilst the STM analysis is fully reproducible using statistical software, the assignment o...

    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.

    Results from scite Reference Check: We found no unreliable references.

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  3. Version published to 10.1101/2021.07.13.21260425v1 on medRxiv