Considerable COVID-19 vaccination hesitancy in UK may affect herd immunity, study finds

By Dr. Sanchari Sinha Dutta, Ph.D.Dec 9 2020

Scientists from the Imperial College London and the Imperial College Healthcare NHS Trust, UK, have conducted a cross-sectional, questionnaire-based survey to evaluate the public’s willingness to receive coronavirus disease 2019 (COVID-19) vaccination and their attitude toward prioritization. The findings indicate that the percentage of people willing to receive COVID-19 vaccination is insufficient to achieve herd immunity. The study is currently available on the medRxiv* preprint server.

Study: Inadequate intention to receive Covid-19 vaccination: indicators for public health messaging needed to improve uptake in UK. Image Credit: hedgehog94 / Shutterstock

Since its emergence in China in December 2019, the ever-growing trajectory of the COVID-19 pandemic has placed a large burden on the socioeconomic and healthcare structures of many countries across the world. To curb the rapid transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative pathogen of COVID-19, it is of prime importance to achieve population-level immunity (herd immunity) through vaccination.

In the United Kingdom, the mass vaccination program has been augmented after obtaining promising results in COVID-19 vaccine clinical trials. The prioritization list made by the UK government is primarily based on age, comorbidities, care-home residency, and frontline workers, including healthcare workers. However, to achieve the threshold of herd immunity, the majority of people outside the prioritization list should be vaccinated.

In the current study, the scientists aimed to evaluate the public’s willingness to receive the COVID-19 vaccine, as well as their perception about the criteria of prioritizing population subgroups for vaccination.

Current study design

The study was conducted on 9,122 registrants of the largest personal health record of the National Health Service (NHS), UK. A questionnaire was sent to all participants through email to record their vaccine-related responses.

The questionnaire was designed to get information about following items:

• Willingness to receive COVID-19 vaccine
• Attitude about accepting the delay in vaccination process
• Opinion about the UK government’s prioritization list
• Opinion about which population subgroups should be prioritized after completion of the initial list

Important observations

Of all participants, about 72% reported willingness to receive the COVID-19 vaccine, whereas 10% responded negatively. About 23% of participants did not agree with the criteria set out by the government to prepare the prioritization list, and 70% of participants responded negatively against being able to accelerate the vaccination by payment. Compared to 80% of male participants with an affirmative response, only 64% of female participants reported a willingness to receive the vaccine. Moreover, a strong positive correlation was observed between a yearly increase in age and the likelihood of vaccination.   

As reported by the participants, teachers, Black, Asian and Minority Ethnic (BAME) groups, frontline workers, children, and university students should be prioritized to receive the vaccine. Importantly, about 33% of participants expressed concern about the current exclusion of BAME groups in the prioritization list.   

Study significance

The current study findings indicate that only 71.5% of the UK population are willing to receive the COVID-19 vaccine. To achieve the threshold of population immunity or herd immunity, about 90% of a given population should be vaccinated. Thus, the affirmative response obtained in the study is potentially inadequate for achieving herd immunity.

Based on the study findings, the scientists believe that younger people and females should be adequately addressed by the public health messaging approaches to improve vaccine acceptance behaviors.

The BAME groups, which are known to have poor acceptance toward existing vaccination programs, are particularly at higher risk of getting COVID-19. Thus, not prioritizing these groups could be a particular challenge to the UK government.

Overall, the current study highlights the need for improving public awareness toward the COVID-19 vaccination program as well as extending the prioritization list to people associated with education sectors.