Concerns and motivations about COVID-19 vaccination
Authors: Rachael H Dodd, Kristen Pickles, Brooke Nickel, Erin Cvejic, Julie Ayre, Carys Batcup, Carissa Bonner, Tessa Copp, Samuel Cornell, Thomas Dakin, Jennifer Isautier, Kirsten J McCaffery
Journal: The Lancet Infectious Diseases (2020)

More than 200 COVID-19 vaccines are in development worldwide, with governments securing deals to access advance doses. But access is only one issue. Willingness to accept a COVID-19 vaccine when it becomes available has varied considerably across countries over the course of the pandemic. In The Lancet Infectious Diseases, we presented data collected in Australia in April, 2020,1Dodd RH Cvejic E Bonner C Pickles K McCaffery K Willingness to vaccinate against COVID-19 in Australia.Lancet Infect Dis. 2020; (published online June 30.)https://doi.org/10.1016/S1473-3099(20)30559-4Summary Full Text Full Text PDF PubMed Scopus (183) Google Scholar which suggested 86% of people surveyed (3741 of 4362) would be willing to vaccinate against COVID-19 if a vaccine became available. Furthermore, the COCONEL group2The COCONEL GroupA future vaccination campaign against COVID-19 at risk of vaccine hesitancy and politicisation.Lancet Infect Dis. 2020; 20: 769-770Summary Full Text Full Text PDF PubMed Scopus (387) Google Scholar showed in March, 2020, that 74% of French citizens would vaccinate. Between April and July, 2020, willingness to vaccinate has ranged from 58% in the USA3Fisher KA Bloomstone SJ Walder J Crawford S Fouayzi H Mazor KM Attitudes toward a potential SARS-CoV-2 vaccine: a survey of US adults.Ann Intern Med. 2020; (published online Sept 4.)https://doi.org/10.7326/M20-3569Crossref Scopus (847) Google Scholar to 64% in the UK4Sherman S Smith L Sim J et al.COVID-19 vaccination intention in the UK: results from the COVID-19 Vaccination Acceptability Study (CoVAccS), a nationally representative cross-sectional survey.medRxiv. 2020; (published online Aug 14.) (preprint, version 1)https://doi.org/10.1101/2020.08.13.20174045Google Scholar and 74% in New Zealand.5Menon RGV Thaker J Aotearoa-New Zealand public attitudes to COVID-19 vaccine.https://mro.massey.ac.nz/handle/10179/15567Date: Aug 20, 2020Google Scholar The New Zealand data showed that the most commonly reported reasons to get vaccinated were to protect family and self, with safety being the chief concern about the vaccine. It is important to investigate both motivations and concerns about a future COVID-19 vaccine to help shape communication strategies. In the latest two surveys from an Australian longitudinal study,1Dodd RH Cvejic E Bonner C Pickles K McCaffery K Willingness to vaccinate against COVID-19 in Australia.Lancet Infect Dis. 2020; (published online June 30.)https://doi.org/10.1016/S1473-3099(20)30559-4Summary Full Text Full Text PDF PubMed Scopus (183) Google Scholar participants in June and July, 2020, were asked to respond on a seven-point Likert scale to the statement "If a COVID-19 vaccine becomes available, I will get it" (strongly agree, agree, somewhat agree [yes], neither agree nor disagree (indifferent), and somewhat disagree, disagree, strongly disagree [no]). In June, 2020, 87% (1195 of 1371) of the sample said they would get the COVID-19 vaccine if it became available; in July, 2020, this percentage was 90% (1144 of 1274), a slight increase of 1·91% (95% CI 0·08–3·73; p=0·030, McNemar's test of paired proportions, n=997). The appendix (pp 1–2) presents results of a content analysis6Weber RP Content analysis.in: Basic content analysis. 2nd edn. Sage, Thousand Oaks, CA1990: 117-124Google Scholar showing the most common reasons for willingness or reluctance to get a COVID-19 vaccine, including example free-text responses. The top three reasons across the two surveys for agreeing to vaccinate were "to protect themselves and others" (29% [817 of 2859]), "belief in vaccination and science" (16% [448 of 2859]), and "to help stop the virus spread" (15% [419 of 2859]). Willingness to vaccinate differed by both age (June, p<0·0001; July, p=0·0012) and education (June, p<0·0001; July, p=0·0003; appendix p 3). For those who were indifferent (June, 7% [102 of 1371]; July, 5% [59 of 1274]) or said they would not get the vaccine (June, 5% [74 of 1371]; July, 6% [71 of 1274]), the top reasons across the two surveys were "concern about the safety of the vaccine in its development" (36% [139 of 388]) and "potential side effects" (10% [38 of 388]). Importantly, among people who were willing to vaccinate, some hesitancy was noted regarding safety of the vaccine (11% [311 of 2859]). These findings are important because they highlight some of the determinants of willingness to accept a COVID-19 vaccine if one becomes available. Concerns are not surprising since vaccine development can take 10–15 years.7Lurie N Saville M Hatchett R Halton J Developing Covid-19 vaccines at pandemic speed.N Engl J Med. 2020; 382: 1969-1973Crossref PubMed Scopus (1065) Google Scholar The vaccine development process must be transparent to increase public trust in safety and effectiveness, even for those who are already willing to vaccinate. Involving vaccine communication experts and the public in developing messaging and long-term vaccine strategy is crucial, and governments worldwide should begin preparing these strategies imminently.8DeRoo S Pudalov N Fu L Planning for a COVID-19 vaccination program.JAMA. 2020; 323: 2458-2459Crossref PubMed Scopus (430) Google Scholar A prioritisation framework proposed by health economists might aid with the development of these strategies.9Roope LSJ Buckell J Becker F et al.How should a safe and effective COVID-19 vaccine be allocated? Health economists need to be ready to take the baton.PharmacoEconomics Open. 2020; (published online Sept 3.)https://doi.org/10.1007/s41669-020-00228-5Crossref Scopus (17) Google Scholar With the Australian Government aiming for 95% uptake of the COVID-19 vaccine, communication formats used to inform members of the public about a vaccine should be suitable for people with low health literacy and education and appropriate for culturally and linguistically diverse groups and Indigenous populations.1Dodd RH Cvejic E Bonner C Pickles K McCaffery K Willingness to vaccinate against COVID-19 in Australia.Lancet Infect Dis. 2020; (published online June 30.)https://doi.org/10.1016/S1473-3099(20)30559-4Summary Full Text Full Text PDF PubMed Scopus (183) Google Scholar Primary-care doctors are likely to be at the forefront of education and administration of a COVID-19 vaccine.10Danchin M Biezen R Leask J Preparing the public for COVID-19 vaccines.Aust J Gen Pract. 2020; 49: 625-629Crossref PubMed Scopus (58) Google Scholar Since these doctors are a trusted source, it is important that they are supported in delivering recommendations about the COVID-19 vaccine while alleviating concerns, if we are to reach the vaccine uptake target in Australia. We should not forget about the success of previous novel vaccines and ensure that we build on lessons learned in their implementation, including capitalising on early public enthusiasm shown during a pandemic.8DeRoo S Pudalov N Fu L Planning for a COVID-19 vaccination program.JAMA. 2020; 323: 2458-2459Crossref PubMed Scopus (430) Google Scholar We need to understand and address citizen's concerns that can prevent optimal uptake, build motivations into messaging, and prioritise public trust by informing and involving the community in the process. Supporting health-care professionals in their role as educators will ensure people have adequate and accessible information from a trusted source, to optimise vaccine uptake and ultimately reduce community transmission of COVID-19. We declare no competing interests. Download .pdf (.17 MB) Help with pdf files Supplementary appendix COVID-19 vaccine intentions in AustraliaPrior to the availability of a COVID-19 vaccine and when case numbers were low, our longitudinal survey with Australian adults showed that 85·8% (3741 of 4362) were willing to be vaccinated in April, 2020, and 89·8% (1144 of 1274) in July, 2020.1,2 Younger adults perceived themselves to be at less risk of infection and were less willing to receive a vaccine. Full-Text PDF