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The worldwide impact of the COVID-19 pandemic has led to an unprecedented effort to develop vaccines against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in a timeframe never imagined before. . Although some vaccines have started to be administered on a large scale, scientists and governments are facing a difficult obstacle. This is the existence of hesitation and reluctance towards the vaccine among the general population. A new study published on the prepress server medRxiv * in December 2020, explore this phenomenon and the implications for public health.
Study details
Researchers looked at studies dealing with vaccine attitudes in large samples (1,000 or more subjects) of the population in a nationally representative picture. In order to cover the available data in a systematic way, they conducted both a review and a meta-analysis to find the proportion of the population with the following attitudes: willing to accept the vaccine, uncertain or unwilling to take it when it becomes available.
They got 28 samples, covering over 58,600 people from 13 countries. Most came from the US, UK and Canada, while the rest came from European countries, China and Australia. The data covered the period from June to October 2020.
Aggregate data for the period from March to October indicate that about 73% would accept the vaccine, while about 14% would reject it. About 22% said they were unsure. However, this option was not available in all studies and its presence significantly affected the number of “available” responses.
In other words, without this option, about 83% indicated their availability, but when it was given, only about 64%. However, the percentage of “unwilling” people has not changed significantly.
The 18 studies covering March to May had 79% “available” and 12% “reluctant” responses, which fell to 60% and 20% respectively in the ten studies covering June to October. The number of “uncertain” responses did not change over time. The variation of this trend was not related to the sampled country.
The results suggest that the percentage of willing and unwilling people has decreased and increased, respectively, as the pandemic continued.
However, there was a country-specific difference in the percentage of “available” responses, with over 90% of Chinese adults reporting their availability in March-April, compared to 76% in France. It is worth noting that in September-October the figures for France and the US were much lower, around 50%.
Proportion of populations intending to vaccinate by country and time
Risk factors for unwillingness
Risk factors for vaccine reluctance were being female, young, less educated, with a lower income, or belonging to a minority ethnic group. In the 7/11 studies, whites showed greater availability, but in four, this was not significant. The higher income showed a positive correlation with availability in 8/9 studies. Having a comorbidity was a positive factor for availability in only one of 5 studies.
In studies 12/14, availability was much more likely with the elderly. In one study, younger adults were more likely to be available than middle-aged adults, but older adults were not, and in the last there was no relationship to age. Males showed greater willingness to accept the vaccine in 9/14 studies and people with higher education levels in half of 14 studies.
What are the implications?
Therefore, with the continued release of misinformation on a huge number of social media sites, confidence in government interventions and vaccine safety began to erode. It became clear that vaccine intentions were split between 60% availability and 20% reluctance, depending on the sample tested.
Risk factors follow a similar pattern in all five high-quality studies, indicating that young people, women, and those with lower education, lower income, or from an ethnic minority are consistently less likely to be vaccinated. The association with the effects of such disinformation campaigns and with public concern that vaccine safety is compromised underlines the need to specifically win the public over to the benefits and safety of new vaccines. This may require both behavioral and scientific skills as the issue is one of trust and acceptability rather than validated scientific results.
Oddly, people with a chronic health condition did not show greater willingness to accept the vaccine despite being at a much higher risk of dying from COVID-19. This points to the need to target 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: “Intentions to vaccinate against COVID-19 among the general public when a vaccine becomes available are in decline and this will limit the effectiveness of COVID-19 vaccination programs. Findings highlight the need to improve public acceptability, trust and concern for the safety and benefits of COVID-19 vaccines and target vaccine uptake in disadvantaged groups that have already been disproportionately affected by the pandemic “.
*Important Notice
medRxiv publishes preliminary scientific reports that are not peer-reviewed and therefore should not be considered conclusive, guide clinical practice / health-related behavior, or treated as consolidated information.
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