COVID-19 vaccination in the UK: Addressing vaccine hesitancy
Authors: Kalyani Sonawane, Catherine L. Troisi, Ashish A. Deshmukh
Journal: The Lancet Regional Health - Europe (2021)

With the success of COVID-19 vaccine trials and its official rollout in the UK, the attention has turned towards vaccine distribution and its uptake. Vaccine hesitancy, one of the top ten public health threats according to the World Health Organization, has taken a toll on immunization programmes globally and is lurking as a major barrier to achieving optimal vaccination goals. In the recent issue of The Lancet Regional Health-Europe, Paul et al present their findings on the prevalence of negative vaccination attitudes and the lack of willingness to receive the COVID-19 vaccine among sociodemographic subgroups in the UK [1Paul E, Steptoe A, Fancourt D. Attitudes towards vaccines and intention to vaccinate against COVID-19: Implications for public health communication. The Lancet Regional Health Eu. doi:10.1016/j.lanepe.2020.100012.Google Scholar]. The study utilized data from a large online survey that collected information on general vaccination attitudes [measured using the Vaccination Attitudes Examination (VAX) Scale] and the intention to receive the COVID-19 vaccine from 32,361 adult participants in the UK. About 16% of the participants expressed a high level of mistrust, with an extremely negative attitude [a score of 5–6 on a scale of 1 to 6] on at least one of the four dimensions of hesitancy, including vaccine safety concerns (16.3%), a preference for natural immunity (6.6%), concerns about commercial profiteering (5.8%), and a general distrust in the benefit of vaccines (5.3%). More than one-third of the participants reported unwillingness or uncertainty regarding the COVID-19 vaccination. Notably, females, participants living with children, and those with low-income appear to be at higher risk of COVID-19 vaccine refusal. Expectedly, acutely negative vaccination attitudes were associated with greater unwillingness or uncertainty to receive the COVID vaccine. Overall, the findings by Paul and colleagues resonate with other studies on COVID vaccine attitudes and willingness in the UK [2Covid-19: Global attitudes towards a COVID-19 vaccineInstitute of Global health Innovation. Imperial College London.2020https://www.imperial.ac.uk/media/imperial-college/institute-of-global-health-innovation/GlobalVaccineInsights_ICL-YouGov-Covid-19-Behaviour-Tracker_20201202_v6.pdf[15].pdfGoogle Scholar, 3Neumann-Böhme S Varghese NE Sabat I Barros PP Brouwer W van Exel J et al.Once we have it, will we use it? A European survey on willingness to be vaccinated against COVID-19.Eu J Health Econ. 2020; 21: 977-982Crossref PubMed Scopus (660) Google Scholar, 4Global attitudes on a COVID-19 vaccine. Ipsos survey for The World Economic Forum. [Available from: https://www.ipsos.com/sites/default/files/ct/news/documents/2020-11/global-attitudes-on-a-covid-19-vaccine-oct-2020.pdf.Google Scholar]. In general, a large majority of the population has a favorable perception regarding vaccines, with 65–80% expressing a willingness to receive the COVID-19 vaccine [2Covid-19: Global attitudes towards a COVID-19 vaccineInstitute of Global health Innovation. Imperial College London.2020https://www.imperial.ac.uk/media/imperial-college/institute-of-global-health-innovation/GlobalVaccineInsights_ICL-YouGov-Covid-19-Behaviour-Tracker_20201202_v6.pdf[15].pdfGoogle Scholar, 3Neumann-Böhme S Varghese NE Sabat I Barros PP Brouwer W van Exel J et al.Once we have it, will we use it? A European survey on willingness to be vaccinated against COVID-19.Eu J Health Econ. 2020; 21: 977-982Crossref PubMed Scopus (660) Google Scholar, 4Global attitudes on a COVID-19 vaccine. Ipsos survey for The World Economic Forum. [Available from: https://www.ipsos.com/sites/default/files/ct/news/documents/2020-11/global-attitudes-on-a-covid-19-vaccine-oct-2020.pdf.Google Scholar]. While 14% of participants in the current study expressed unwillingness, it is noteworthy that over 22% of survey participants were undecided regarding the vaccine. Given that the group constitutes a significant proportion of the population, generating vaccine confidence in these individuals will be extremely critical for achieving the minimal necessary coverage for achieving herd immunity. Addressing concerns of these 'on-the-fence' individuals should be a public health priority as the ongoing infodemic of vaccine myths and misinformation that is circulating online might steer them away resulting in vaccine delays and refusal. Fortunately, empirical data indicate that building vaccine trust among undecided individuals is possible with effective communication strategies [5Jarrett C Wilson R O'Leary M Eckersberger E Larson HJ SWGoV Hesitancy Strategies for addressing vaccine hesitancy - a systematic review.Vaccine. 2015; 33: 4180-4190Crossref PubMed Scopus (684) Google Scholar]. Addressing mistrust among individuals with acute hesitancy will be challenging. Data from this study provides a unique insight into the four dimensions of vaccine hesitancy and the sociodemographic subgroups that remain at-risk of COVID vaccine refusal. Targeting the at-risk groups with interventions that are tailored to address the psychological constructs contributing to vaccine mistrust will be essential. Safety concerns and mistrust in the benefits of vaccines, for instance, can be addressed at the individual level by using evidence-based approaches such as motivational interviewing. A strong vaccine recommendation from a healthcare provider combined with techniques to address vaccine hesitancy is one of the most effective ways to increase vaccine uptake [5Jarrett C Wilson R O'Leary M Eckersberger E Larson HJ SWGoV Hesitancy Strategies for addressing vaccine hesitancy - a systematic review.Vaccine. 2015; 33: 4180-4190Crossref PubMed Scopus (684) Google Scholar,6Sonawane K Zhu Y Montealegre JR Lairson DR Bauer C McGee LU et al.Parental intent to initiate and complete the human papillomavirus vaccine series in the USA: a nationwide, cross-sectional survey.The Lancet Public Health. 2020; Summary Full Text Full Text PDF PubMed Scopus (66) Google Scholar]. At the population-level, social marketing campaigns might help gain public trust in the COVID vaccine [7Opel DJ Diekema DS Lee NR Marcuse EK. Social marketing as a strategy to increase immunization rates.Arch Pediatr Adolesc Med. 2009; 163: 432-437Crossref PubMed Scopus (93) Google Scholar]. In comparison to other developed nations, unwillingness to receive the COVID vaccine in the UK is relatively lower [2Covid-19: Global attitudes towards a COVID-19 vaccineInstitute of Global health Innovation. Imperial College London.2020https://www.imperial.ac.uk/media/imperial-college/institute-of-global-health-innovation/GlobalVaccineInsights_ICL-YouGov-Covid-19-Behaviour-Tracker_20201202_v6.pdf[15].pdfGoogle Scholar,4Global attitudes on a COVID-19 vaccine. Ipsos survey for The World Economic Forum. [Available from: https://www.ipsos.com/sites/default/files/ct/news/documents/2020-11/global-attitudes-on-a-covid-19-vaccine-oct-2020.pdf.Google Scholar]. With strategies to address COVID vaccine hesitancy in place and vaccine-related resources available to the public, public health experts in the UK are prepared to handle behavioral barriers of vaccine uptake. The Royal Society and the British Academy recently put forth strategies for COVID-19 deployment with emphasis on tackling misinformation and behavioral aspects of vaccine hesitancy [8COVID-19 vaccine deployment: Behaviour, ethics, misinformation and policy strategies. The Royal Society and The British Academy. [Available from: https://royalsociety.org/-/media/policy/projects/set-c/set-c-vaccine-deployment.pdf.Google Scholar]. The European Centre for Disease Prevention and Control has identified interventions that can effectively address vaccine hesitancy [9Catalogue of interventions addressing vaccine hesitancy. Publications Office of the EU. [Available from: https://op.europa.eu/en/publication-detail/-/publication/432fc850-82f6-11e7-b5c6-01aa75ed71a1/language-en.Google Scholar]. The National Health Service (NHS) has laid out information pertaining to the effectiveness and safety of the vaccine on the website [10Coronavirus (COVID-19) vaccine. The National Health Service. [Available from:https://www.nhs.uk/conditions/coronavirus-covid-19/coronavirus-vaccination/coronavirus-vaccine/.Google Scholar]. Coordinated efforts of physicians, policymakers, health departments, and vaccine manufacturers at the national and grassroots-level to leverage these resources will be key to attaining COVID-19 vaccination goals in the UK. Attitudes towards vaccines and intention to vaccinate against COVID-19: Implications for public health communicationsNegative 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. Full-Text PDF Open Access