Abstract
BackgroundNegative attitudes towards vaccines and an uncertainty or unwillingness to receive vaccinations are major barriers to managing the COVID-19 pandemic in the long-term. We estimate predictors of four domains of negative attitudes towards vaccines and identify groups most at risk of uncertainty and unwillingness to receive a COVID-19 vaccine in a large sample of UK adults.MethodsData were cross-sectional and from 32,361 adults in the UCL COVID-19 Social Study. Ordinary least squares regression analyses examined the impact of socio-demographic and COVID-19 related factors on four types of negative vaccine attitudes: mistrust of vaccine benefit, worries about unforeseen effects, concerns about commercial profiteering, and preference for natural immunity. Multinomial regression examined the impact of socio-demographic and COVID-19 related factors, negative vaccine attitudes, and prior vaccine behaviour on uncertainty and unwillingness to be vaccinated for COVID-19.Findings16% of respondents displayed high levels of mistrust about vaccines across one or more domains. Distrustful attitudes towards vaccination were higher amongst individuals from ethnic minority backgrounds, with lower levels of education, lower annual income, poor knowledge of COVID-19, and poor compliance with government COVID-19 guidelines. Overall, 14% of respondents reported unwillingness to receive a vaccine for COVID-19, whilst 23% were unsure. The largest predictors of both COVID-19 vaccine uncertainty and refusal were low-income groups (< £16,000, a year), having not received a flu vaccine last year, poor adherence to COVID-19 government guidelines, female gender, and living with children. Amongst vaccine attitudes, intermediate to high levels of mistrust of vaccine benefit and concerns about future unforeseen side effects were the most important determinants of both uncertainty and unwillingness to vaccinate against COVID-19.InterpretationNegative attitudes towards vaccines are a major public health concern in the UK. General mistrust in vaccines and concerns about future side effects in particular will be barriers to achieving population immunity to COVID-19 through vaccination. Public health messaging should be tailored to address these concerns and specifically to women, ethnic minorities, and people with lower levels of education and incomes.FundingThe Nuffield Foundation [WEL/FR-000022583], the MARCH Mental Health Network funded by the Cross-Disciplinary Mental Health Network Plus initiative supported by UK Research and Innovation [ES/S002588/1], and the Wellcome Trust [221400/Z/20/Z and 205407/Z/16/Z].
Highlights
The long-term success of the public health response to the coronavirus disease 2019 (COVID-19) pandemic will depend on acquired immunity in a sufficient proportion of the population, which is estimated to be 67% for COVID-19 [1]
All authors had full access to all the data in the study and had final responsibility for the decision to submit for publication. Characteristics of both the unweighted and weighted samples are presented in Table 1. 7.2% of the sample expressed high mistrust of vaccine safety, whilst 17.2% were uncertain about their levels of trust (Fig. 1). 16.3% expressed strong worries about unforeseen effects, whilst 52.9% expressed moderate worries. 8.1% expressed strong concerns and 28.8% moderate concerns about commercial profiteering. 8.5% expressed a strong preference for natural immunity, whilst 44.7% expressed some feelings that natural immunity might be better than a vaccine
Ethnicity, long-term mental and physical health conditions, and low confidence in government to handle the pandemic were unrelated to intentions relating to the COVID19 vaccine. This is the first study to comprehensively describe predictors of negative vaccine attitudes and factors influencing uncertainty and unwillingness to vaccinate against COVID-19 as separate outcomes
Summary
The long-term success of the public health response to the coronavirus disease 2019 (COVID-19) pandemic will depend on acquired immunity in a sufficient proportion of the population (herd immunity), which is estimated to be 67% for COVID-19 [1]. Thousands of people have taken to the streets around the world to protest COVID-19 social distancing policies and the prospect of mass vaccinations This is concerning as public attitudes towards vaccine safety, their importance, and effectiveness are consistently associated with vaccine uptake [3]. Negative attitudes towards vaccines and an uncertainty or unwillingness to receive vaccinations are major barriers to managing the COVID-19 pandemic in the long-term. Ordinary least squares regression analyses examined the impact of socio-demographic and COVID-19 related factors on four types of negative vaccine attitudes: mistrust of vaccine benefit, worries about unforeseen effects, concerns about commercial profiteering, and preference for natural immunity. Intermediate to high levels of mistrust of vaccine benefit and concerns about future unforeseen side effects were the most important determinants of both uncertainty and unwillingness to vaccinate against COVID-19.
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