Abstract
SummaryBackgroundThe effectiveness of the COVID-19 vaccination programme depends on mass participation: the greater the number of people vaccinated, the less risk to the population. Concise, persuasive messaging is crucial, particularly given substantial levels of vaccine hesitancy in the UK. Our aim was to test which types of written information about COVID-19 vaccination, in addition to a statement of efficacy and safety, might increase vaccine acceptance.MethodsFor this single-blind, parallel-group, randomised controlled trial, we aimed to recruit 15 000 adults in the UK, who were quota sampled to be representative. Participants were randomly assigned equally across ten information conditions stratified by level of vaccine acceptance (willing, doubtful, or strongly hesitant). The control information condition comprised the safety and effectiveness statement taken from the UK National Health Service website; the remaining conditions addressed collective benefit, personal benefit, seriousness of the pandemic, and safety concerns. After online provision of vaccination information, participants completed the Oxford COVID-19 Vaccine Hesitancy Scale (outcome measure; score range 7–35) and the Oxford Vaccine Confidence and Complacency Scale (mediation measure). The primary outcome was willingness to be vaccinated. Participants were analysed in the groups they were allocated. p values were adjusted for multiple comparisons. The study was registered with ISRCTN, ISRCTN37254291.FindingsFrom Jan 19 to Feb 5, 2021, 15 014 adults were recruited. Vaccine hesitancy had reduced from 26·9% the previous year to 16·9%, so recruitment was extended to Feb 18 to recruit 3841 additional vaccine-hesitant adults. 12 463 (66·1%) participants were classified as willing, 2932 (15·6%) as doubtful, and 3460 (18·4%) as strongly hesitant (ie, report that they will avoid being vaccinated for as long as possible or will never get vaccinated). Information conditions did not alter COVID-19 vaccine hesitancy in those willing or doubtful (adjusted p values >0·70). In those strongly hesitant, COVID-19 vaccine hesitancy was reduced, in comparison to the control condition, by personal benefit information (mean difference –1·49, 95% CI –2·16 to –0·82; adjusted p=0·0015), directly addressing safety concerns about speed of development (−0·91, –1·58 to –0·23; adjusted p=0·0261), and a combination of all information (−0·86, –1·53 to –0·18; adjusted p=0·0313). In those strongly hesitant, provision of personal benefit information reduced hesitancy to a greater extent than provision of information on the collective benefit of not personally getting ill (−0·97, 95% CI –1·64 to –0·30; adjusted p=0·0165) or the collective benefit of not transmitting the virus (−1·01, –1·68 to –0·35; adjusted p=0·0150). Ethnicity and gender were found to moderate information condition outcomes.InterpretationIn the approximately 10% of the population who are strongly hesitant about COVID-19 vaccines, provision of information on personal benefit reduces hesitancy to a greater extent than information on collective benefits. Where perception of risk from vaccines is most salient, decision making becomes centred on the personal. As such, messaging that stresses the counterbalancing personal benefits is likely to prove most effective. The messaging from this study could be used in public health communications. Going forwards, the study highlights the need for future health campaigns to engage with the public on the terrain that is most salient to them.FundingNational Institute for Health Research (NIHR) Oxford Biomedical Research Centre and NIHR Oxford Health Biomedical Research Centre.
Highlights
In October, 2020, we did a survey of UK adults to estimate how many people would agree to be vaccinated for COVID-19, to discover whether there were parts of the population who were especially reluctant and, most importantly, to determine why people might not agree to take an approved vaccine.[1]
We considered two specific primary outcome questions: (1) whether adding information about the collective benefit of vaccination from not getting ill, the collective benefit of vaccination from not spreading the virus, the personal benefit of getting vaccinated, the seriousness of SARS-CoV-2, or why speed of development is not a problem lead to lower levels of COVID-19 vaccine hesitancy compared with a simple statement that vaccination is efficacious and safe; and (2) whether combining information about collective and personal benefits, or about collective and personal benefits, the seriousness of the virus, and indirectly why the speed of development is not a problem, lead to lower levels of COVID-19 vaccine hesitancy than a simple statement that vaccination is efficacious and safe
As part of our primary analysis, we investigated whether the effect of information provision on COVID-19 vaccine hesitancy was moderated by the three levels of hesitancy groupings
Summary
In October, 2020, we did a survey of UK adults to estimate how many people would agree to be vaccinated for COVID-19, to discover whether there were parts of the population who were especially reluctant and, most importantly, to determine why people might not agree to take an approved vaccine.[1]. A US study done in August, 2020, with 1123 respondents found that providing information that a vaccine is safe and effective, compared with no information, increased vaccine acceptance. In a French study done in July, 2020, with a representative group of 1942 people, there was no overall effect on vaccine acceptance from the provision of information on the benefit of herd immunity. Those individuals who outright refused vaccination (28·8%) were not affected by information on the benefit of herd immunity, but for those who did not refuse vaccination outright (71·2%), information on the benefit of herd immunity increased acceptance slightly. In a German study with 1349 members of the general population done in November, 2020, vaccine acceptance was not influenced by information on the individual and prosocial benefits of herd immunity. In a study of 8000 people in the UK and the USA in September, 2020, provision of negative misinformation, compared with factual information, reduced acceptance
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
