What are the main drivers of COVID-19 vaccine hesitancy?

A study conducted in the UK has examined attitudes towards vaccination protecting against coronavirus disease 2019 (COVID-19) and highlighted some of the main drivers of willingness or unwillingness to be immunized.

Study: Lack of trust and social media echo chambers predict COVID-19 vaccine hesitancy. Image Credit: Viacheslav Lopatin / Shutterstock.
Study: Lack of trust and social media echo chambers predict COVID-19 vaccine hesitancy. Image Credit: Viacheslav Lopatin / Shutterstock

The nationally representative survey of more than 1,400 adults and five focus groups conducted in December 2020 revealed that trust is a key predictor of vaccine hesitancy.

An overall distrust of vaccines and the government increases the likelihood of vaccine hesitancy, while trust in health institutions and experts decreases the likelihood of hesitancy.

Perceived personal threat is also a vital factor, with fear of accelerated vaccine development, concerns about side effects, misunderstanding of herd immunity, and beliefs that the virus is manmade all increasing the likelihood of vaccine unwillingness.

People who obtain information from relatively unregulated social media sources are especially likely to be vaccine hesitant, says the team from the University of Southampton and University of Oxford.

Since an increasing number of individuals use social media for gathering health information, interventions require action from governments, health officials and social media companies,” writes Melinda Mills and colleagues.

A pre-print version of the paper is available on the medRxiv* server, while the article undergoes peer review.

Concerns are growing as governments rollout vaccines

As governments rapidly roll out vaccination programs across the world, concerns are growing about how distrust of immunization and the government may be impacting vaccine hesitancy.

Trust is vital to ensuring compliance with public health measures. However, the communication of changing and conflicting messages from governments, health experts and the media have driven an increase in vaccine hesitancy among the general public. The spread of misinformation via social media and beliefs in conspiracy theories have also played a significant role in eroding the public’s trust.

But who does the public trust and does this depend on where they acquire their information?” asks Mills and the team.

What did the researchers do?

The researchers conducted a nationally representative online survey of 1,476 adults between the 12th and 18th of December 2020 (during the first UK vaccine rollout) and five focus groups between the 30th November and 7th December 2020.

The questionnaire was designed to help ascertain the strength of three hypotheses.

The first was that trust in the government, health institutions and experts would predict a higher degree of vaccine willingness, while distrust of the government and vaccines would predict increased hesitancy.

The second hypothesis was that those who did not perceive COVID-19 as a personal threat would express more vaccine hesitancy.

Thirdly, the researchers proposed that social media consumers would be more likely to be vaccine hesitant compared with consumers of the more traditional TV, newspaper and radio. Believing the conspiracy theories and misinformation promoted on social media sites would also be likely to increase hesitancy, says the team.

What did they find?

When survey participants were asked to answer the question “If a vaccine for COVID-19 were available to me, I would get it,” almost half (49%) chose “strongly agree;” 22% chose “tend to agree;” 11% chose “neither agree nor disagree,” 7% “tend to disagree,” 7% “strongly disagree,” and 5% said they “don’t know.”

Trust was a core predictor of vaccine hesitancy, with those who distrusted immunization the most only having a 10% likelihood of vaccine willingness. Among those with the highest levels of distrust in the government, the likelihood of vaccine willingness was only 25%. Those with the highest level of trust in health institutions were twice as likely to express vaccine willingness compared to those with the lowest levels. The researchers also observed a positive association for trust in experts

Whether COVID-19 or a vaccine was perceived as a personal threat was also an important factor. Those who regarded vaccination a personal threat due to potential side effects, beliefs that it is linked to population control, and misunderstanding of “herd immunity” were all more likely to express vaccine hesitancy. On the other hand, people who perceived COVID-19 as a personal threat were more than twice as likely to express vaccine willingness.

A strong theme that emerged throughout the study was the belief that only the most vulnerable groups should get vaccinated, because herd immunity would mean most people would not require a vaccine. This was a message conveyed by the government during early communications pitting lockdowns versus natural herd immunity, say the researchers.

Finally, people who obtained information from relatively unregulated social media sources such as YouTube were especially unlikely to express vaccine willingness. Those who believed in general conspiracy theories were also much less likely to show vaccine willingness.

What do the authors advise?

We provide new evidence on how trust and information is linked with COVID-19 vaccine hesitancy, informing policy in key ways,” writes the team

The researchers say that since an increasing number of people use social media as a source of health information, interventions are needed from governments, health officials and social media companies.

“Governments should establish an engaging web presence to fill knowledge gaps,” they advise. “More attention needs to help people understand their own risks, unpack complex concepts and fill knowledge voids.”

“A broader lesson is the need for authorities to communicate truthfully and consistently,” concludes the team.

*Important Notice

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.

Journal reference:
Sally Robertson

Written by

Sally Robertson

Sally first developed an interest in medical communications when she took on the role of Journal Development Editor for BioMed Central (BMC), after having graduated with a degree in biomedical science from Greenwich University.

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