Trends, patterns and psychological influences on COVID-19 vaccination intention: findings from a large prospective community cohort study in England and Wales (Virus Watch)
Authors: Byrne Thomas , Patel Parth , Shrotri Madhumita , Beale Sarah , Michie Susan , Butt Jabeer , Hawkins Nicky , Hardelid Pia , Rodger Alison , Aryee Anna , Braithwaite Isobel , Fong Wing Lam Erica , Fragaszy Ellen , Geismar Cyril , Kovar Jana , Navaratnam Annalan M D , Nguyen Vincent , Hayward Andrew , Aldridge Robert W 
Published: March 2021

Objectives

To assess trends in intention to accept a COVID-19 vaccine between 1 December 2020 and 25 February 2021, explore associations between socio-demographic factors and vaccination intention and investigate how COVID-19 vaccine- and illness-related attitudes, beliefs and emotions influence vaccination intention.

Design

Prospective household community cohort study of COVID-19 infection (Virus Watch).

Settin

Online survey of Virus Watch study participants in the community across England and Wales.

Participants

Individuals could enrol in Virus Watch if all household members agreed to participate and at least one household member had access to the internet, an email address, and could read English. All Virus Watch participants aged 16 years and over who responded to questions relating to COVID-19 vaccine intention in questionnaires between December 2020 and February 2021 were included in this analysis.

Main outcome measures

Vaccination intention was measured by individual participant responses to ‘Would you accept a COVID-19 vaccine if offered?’, collected between 1-14 December 2020 and 17-25 February 2021. Possible responses were ‘Yes’, ‘No’ and ‘Unsure’ (December 2020 &February 2021) and ‘Already had a COVID-19 vaccine’ (February 2021 only). Responses to a 13-item questionnaire collected between 4-11 January 2021 were analysed using factor analysis to investigate psychological influences (attitudes, beliefs and emotions) on vaccination intention.

Results

Survey response rate was 56% (20,792/36,998) in December 2020 and 52% (20,284/38,727) in February 2021, with 14,713 adults reporting across both time points. Of participants reporting across both timepoints, 13,281 (90%) answered ‘Yes’ and 1,432 (10%) responded ‘No’ or ‘Unsure’ in December 2020. Of those answering ‘No’ or ‘Unsure’ in December 2020, 1,233 (86%) went on to answer ‘Yes’ or ‘Already had a COVID-19 vaccine’ in February 2021. The magnitude of this shift was consistent across all ethnic groups measured and all levels of social deprivation. Age was most strongly associated with vaccination intention, with 16–24-year-olds more likely to respond “No” or “Unsure” than those aged 75+ in December 2020 (RR: 4.32, 95% CI: 2.40-7.78 &2.93 95% CI: 2.19-3.92, respectively) and February 2021 (RR: 5.30 95% CI: 1.39-20.20 &20.21 95%CI: 7.19-56.78). The association between ethnicity and vaccination intention has weakened, but not disappeared, over time. Both vaccine- and illness-related psychological factors were shown to influence vaccination intention.

Conclusions

Over four in five adults (86%) who were reluctant or intending to refuse a COVID-19 vaccine in December 2020 had changed their mind in February 2021 and planned on accepting, or had already accepted, a vaccine.