Researcher Dr. Alex de Figueiredo from the London School of Hygiene and Tropical Medicine has conducted a study showing that a significant proportion of people in the UK will probably be reluctant to receive a vaccine to protect against coronavirus disease 2019 (COVID-19).
The study highlights regions and socio-economic groups where reluctance to receive a vaccine is more likely. This could present challenges in achieving population or “herd immunity” more broadly, across all regions of the UK regions, says Figueiredo.
Notably, 13 of the 20 regions with the lowest predicted vaccine acceptance rates were in London and four were in the North West, where rates of COVID-19 are among the highest in the UK.
A pre-print version of the paper is available on the medRxiv* server, while the article undergoes peer review.
Hesitancy regarding immunization has increased in the UK
The availability of a vaccine that can protect against COVID-19 would represent a major step towards reducing the health, economic and societal burdens associated with the pandemic.
The UK’s National Health Service has now started to rollout the recently approved Pfizer/BioNTech vaccine, thereby paving the way for mass vaccination
However, hesitancy regarding the uptake of routine immunizations has been increasing in the UK over recent years. This has corresponded with outbreaks of vaccine-preventable diseases and, ultimately, a loss of the nation’s measles-free status.
Recent data also suggest that a large proportion of the UK public are unsure whether they would accept a novel COVID-19 vaccine.
One study conducted during September and October 2020 indicated that at least 36% of the public would not be “very likely” to have the vaccine.
Addressing such attitudinal barriers in advance of vaccine rollout is essential to ensuring an effective immunization campaign. This hesitancy towards vaccine uptake not only puts individuals directly at risk but can contribute to lowering the vaccination thresholds required for herd immunity to develop, says Figueiredo.
“Geographic clustering of non-vaccinators can be particularly troublesome, as these ‘cold spots’ can disproportionately increase required vaccination levels for herd immunity in adjacent settings, as they serve as infection hubs amplifying the spread of disease,” he writes.
What did the current study involve?
The study estimated the intent to accept a COVID-19 vaccine in the UK at the sub-national level using large-scale, state-of the-art modeling of public opinion survey data.
Between September 24 and October 14 2020, a cross-sectional online survey probing acceptance of a vaccine was administered to 17,684 adult UK residents across 174 sub-national regions.
Respondents were asked whether they would accept a new COVID-19 vaccine if one became available. Participants could reply with one of four answers: “yes, definitely;” “unsure, but leaning towards yes;” “unsure, but leaning towards no,” or “definitely not.”
Covariate data were collected for each individual, including information on sex, age, educational attainment, religious affiliation, ethnicity, employment status, and primary language.
Less than half said they would definitely have a vaccine
Less than half (47.5%) of the respondents said they would “definitely” have a vaccine, while 8.7% said they would “definitely not.” A further 32.6% said they were unsure, but leaning towards a “yes,” while 11.2% said they were unsure, but leaning towards a “no.”
The study predicted that clusters of non-vaccinators would likely emerge in many regions.
Although a relatively small proportion (8·7%) of the respondents overall said they would “definitely not” accept a vaccine, rejection rates were significantly higher in London and the North West, where they were as high as 18.0% in Haringey and Islington.
Thirteen of the 20 regions with the lowest predicted acceptance rates were in London and four were in the North West, including Greater Manchester and Liverpool.
Intent to accept a COVID-19 vaccine. The estimated proportion of respondents in each of the UK’s 174 NUTS3 region who would definitely accept a COVID-19 vaccine are shown.
These low-ranking regions in parts of London and the North West are of particular concern, says Figueiredo, since many of them have among the highest rates of COVID-19 in the UK.
Low vaccine uptake in these regions may result in disease ‘hotspots’ that amplify the spread of the disease and require increases in vaccination levels in adjacent regions to provide nationwide herd/community immunity,” he writes.
Other factors affecting intent to accept a vaccine
The study also suggested that males are 59% more likely to accept a vaccine than females; while Muslims are 25% less likely than atheists or agnostics and Black and Black British individuals are 53% less likely than Whites.
Individuals reporting Polish as their primary language are also 55% less likely to accept a vaccine than those reporting English or Welsh as their primary language.
Encouragingly, intent to accept a COVID-19 vaccine was significantly higher among older age-groups (who are prioritized for vaccination) than among those aged 18 to 24.
What does Figueiredo advise?
Figueiredo says policymakers will need to be prepared to address vaccine concerns.
“Intent to accept a COVID-19 is strongly dependent on socio-economic background and is thus also therefore highly heterogeneous across the UK,” he writes.
Designing effective communication materials, while emphasizing the benefits of vaccinating for yourself and others, may also be needed to address group-specific concerns,” he concludes.
medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information.