Study suggests COVID-19 vaccine confidence and hesitancy in the UK driven by trust, not misinformation

An interesting new study, released as a preprint on the medRxiv* server, reports that vaccine hesitancy in the UK is driven not, as is commonly thought, by the so-called ‘infodemic’ of misinformation that has characterized much public messaging during the coronavirus disease 2019 (COVID-19) pandemic.

Instead, the personality of the individual, the ability to trust scientific and government leadership, political affiliations, and openness relative to the process of vaccine development was found to be key in the development of this attitude.

Background

The UK was the earliest country to approve a COVID-19 vaccine against the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Namely, the Pfizer/BioNTech BNT162b2 mRNA (messenger ribonucleic acid) vaccine. This was followed by the approval of the adenovirus vector vaccine, the Oxford University/AstraZeneca ChAdOx1, and the Moderna mRNA-1273 vaccines shortly thereafter.

The UK vaccination policy shifted quite early to maximizing coverage, based on the shortage in vaccine supply, by giving a single dose of one of these vaccines to as many people as possible in the eligible categories. Evidence proved that this pragmatic approach worked since a single dose of the Pfizer vaccine provided high protection against severe and critical COVID-19 and deaths related to the SARS-CoV-2.

Similarly, a single ChAdOx1 dose provided effective protection against severe disease. As hoped by many scientists, vaccination also reduced the secondary attack rate, that is, the number of people infected from a given index patient.

At present, almost 85% of all UK adults have received one or more doses of a COVID-19 vaccine, and about two-thirds have had two doses. This indicates high vaccine confidence, increasing over time.

Conversely, it contradicts commonly reported trends among the vaccine-hesitant. Namely, that their long-term safety is unknown, at best, and that both within the UK and globally, vaccine hesitancy is a significant challenge with relation to COVID-19 vaccines.

According to the World Health Organization (WHO) SAGE Working Group on Vaccine Hesitancy, Confidence, Complacency, Convenience are the three Cs that play key roles in the unwillingness to take vaccines. These have been countered in the UK by making vaccination extremely convenient, such as ensuring a ready stock of vaccine at local health centers at no cost. Complacency is not considered a problem as Britain was badly affected by the first wave.

What about confidence?

The researchers aimed to understand what made individuals decide to accept or refuse the vaccine at the start of the rollout in the UK. Using a mixed-methods approach, on about 4,500 adults, the survey covered mostly Whites, with 65% being female.

In this survey, 85% of the participants expressed vaccine willingness. Only about one in five, however, said they believed the UK government was acting rightly in its COVID-19 control strategies. Many said the government’s step in distributing vaccines was “sensible and responsible,” both for themselves and for the community at large.

These people also felt that the vaccine was essential to protect those most vulnerable, who were not eligible for vaccination. Many also felt it was the only way to restore one’s freedom to return to a normal life.

Reasons for vaccine hesitancy

Those who did not feel this way had, not surprisingly, 63% higher odds of refusing the vaccine.

When queried in greater detail, the reasons for skepticism directed at government actions centered around the motives for such actions, truthfulness and political or social agenda. About a third stated the government could never/rarely be trusted for its truthfulness in this area, and these subsets had approximately nine times, and five times, higher odds for vaccine hesitancy, respectively.

Another often-cited reason was the perceived excessive haste and lack of transparency in the vaccine development process, often accompanied by mistrust of the pharmaceutical company that developed it. The latter was often pointed to as having an unproven or negative track record.

Some also indicated the lack of success in developing a coronavirus vaccine for over 20 years until the pandemic occurred, implying or even stating outright that this meant the vaccines had been manufactured before the current outbreak.

The fact that COVID-19 was mild or asymptomatic in most cases also led some to suppose that a vaccine was unnecessary.

Over 80% said they generally trusted vaccines. In fact, about 60% of the respondents said they took annual flu shots. Predictably, those who denied ever having taken, or who reported rarely taking, a flu shot, had >5 times, and approximately twice, the odds of not accepting the COVID-19 vaccine either, respectively.

The former ‘acceptor’ group often compared the two shots and their reasons for taking them, seeing little difference between them. The second group sometimes traced their hesitancy to a negative experience with the flu shot.

Being able to remember the impact of measles and polio vaccines on these deadly diseases had a generally favorable effect on vaccine willingness.

In general, participants who were worried about the vaccine were more likely to refuse it. If they had already refused other shots, they had 20 times the risk of refusing the COVID-19 jab, too, while those who had accepted other shots offered to them had four times the odds of hesitancy towards this shot.

A clash was perceived between the vaccine willingness of some people, who confessed they took the vaccine only because it was a mandatory requirement for travelers; or because they wanted to protect vulnerable people with whom they came into contact.

Others said they were determined not to take the vaccine at present but were open to change once further evidence came in. Some individuals in this category pointed out that they had medical conditions in which the vaccine had not been tested.

Rather than specific medical conditions, however, the perception of one’s health was more important in driving vaccine hesitancy, with people who felt they were in good shape being more likely to refuse the vaccine.

Employment status and income were independent of vaccine intentions for the most part, except for retired people who were more likely to accept the vaccine.

The impact of political affiliations was obvious, with left-leaning individuals being 30% less likely, but rightists being twice as likely, to refuse the vaccine, compared to centrists.

What are the implications?

The survey results were meant to describe how people reacted to a novel vaccine being rolled out during a period of a health emergency.

The results indicate a high likelihood of widespread vaccine acceptance throughout the UK. Conducted in December 2020, it showed 85% vaccine willingness among UK adults, independent of age, education, gender, location, comorbidities, or history of COVID-19.

This contrasts with other studies showing that age is linked to higher acceptance. This may correspond with the increased chances of vaccine acceptance by retirees.

Smokers have a negative attitude to the vaccine, with smoking being known to be associated with higher risk-taking, poor ability to make good decisions, and impaired ability to evaluate the future consequences of actions – all of which are possible explanations of their refusal of the vaccine.

Political affiliations were linked to vaccine acceptance, but in a manner, that contrasts with the trend in the USA, which may indicate that anti-vaccination attitudes are driven by suspicion of experts, similar to leftist parties, while the individual continues to support conservative policies.

Mistrust of the government’s COVID-19 strategy grew from approximately half the survey participants in April 2020, to about 80% by December of the same year, while about 40% thought that the government was consistently truthful about the pandemic. Suspicion of governmental truth and actions in this area is linked to vaccine hesitancy.

The study shows that misinformation played a minor role in driving vaccine hesitancy, overall, with trust being a major factor instead. The anti-vaccination group cited trust issues with the vaccine quality and safety, and suspicion of the motives and track record of the manufacturers and of the government (the need for a global vaccination program).

These are legitimate concerns and cannot be dismissed as pseudoscientific or misinformation-related hesitancy. Instead, the government and health agencies must interact at this level to regain public trust in science and in leaders.  

In contrast, those who elected to take the vaccine cited social responsibility and a desire to return to normalcy as their driving motives.

This supports critical insights into vaccine hesitancy which reject “knowledge deficit” framings of the problem, recasting it instead into a question of trust in scientific expertise,” write the researchers.

The need of the hour is therefore to “address these issues through effective engagement with the public through a process of transparency, ethical reasoning and both formal & informal deliberation.”

*Important notice

medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information.

Written by

Dr. Liji Thomas

Dr. Liji Thomas is an OB-GYN, who graduated from the Government Medical College, University of Calicut, Kerala, in 2001. Liji practiced as a full-time consultant in obstetrics/gynecology in a private hospital for a few years following her graduation. She has counseled hundreds of patients facing issues from pregnancy-related problems and infertility, and has been in charge of over 2,000 deliveries, striving always to achieve a normal delivery rather than operative.