Changes in attitudes to vaccination as a result of the COVID-19 pandemic: A longitudinal study of older adults in the UK

Background The rapid development of COVID-19 vaccines has brought an unprecedented focus on public attitudes to vaccines, with intention to accept a COVID-19 vaccine fluctuating during the pandemic. However, it is unclear how the pandemic may influence attitudes and behaviour in relation to vaccines in general. The aim of the current study is to examine older adults’ changes in vaccination attitudes and behaviour over the first year of the pandemic. Methods In February-March 2020 (before the first COVID-19 national lockdown in the UK), 372 older adults (aged 65+) provided sociodemographic information, self-reported influenza vaccine uptake, and completed two measures of vaccination attitudes: the 5C scale and the Vaccination Attitudes Examination Scale. One-year later, following rollout of COVID-19 vaccines to older adults, participants provided information on their COVID-19 and influenza vaccine uptake in the previous 12 months, and completed the 5C and VAX scales again. Paired samples t-tests were used to examine changes in vaccination attitudes over time. Results Almost all participants (98.7%) had received at least one dose of a COVID-19 vaccine, and a significant increase in influenza uptake was identified (83.6% in 2020 to 91.6% in 2021). Complacency, mistrust of vaccine benefit, concerns about commercial profiteering, and constraints to vaccination had significantly decreased between Time 1 and Time 2, and collective responsibility had significant increased. However, calculation and worries about unforeseen future effects had increased, indicating that participants now perceived higher risks related to vaccination and were taking a more deliberative information-seeking approach. Conclusion The results show significant changes in vaccination attitudes across the pandemic. These changes suggest that while older adults became less complacent about the importance of vaccines, concerns about potential risks associated with vaccination increased. It will be important for public health communication to address these concerns for all vaccines offered to this group.

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Older adults’ vaccine hesitancy: psychosocial predictors of influenza, pneumococcal, & shingles vaccine uptake

Innovation in Aging ◽

10.1093/geroni/igaa057.3358 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 913-914

Author(s):

Louise Brown Nicholls ◽

Allyson Gallant ◽

Nicola Cogan ◽

Susan Rasmussen ◽

David Young ◽

...

Keyword(s):

Older Adults ◽

Influenza Vaccine ◽

Demographic Data ◽

Collective Responsibility ◽

Vaccine Uptake ◽

Vaccine Hesitancy ◽

Natural Immunity ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Increased Risk

Abstract Influenza, pneumococcal disease, and shingles are more prevalent in older people, with this group having an increased risk of developing severe illnesses and complications. These illnesses are preventable via vaccination, but uptake of these vaccines is low and decreasing year-on-year. However, little research has focused on understanding the reasons behind vaccine hesitancy in older adults. We implemented a cross-sectional survey to determine the self-reported vaccination behaviours of 372 UK-based adults aged 65-92 years. We assessed previous uptake and future intention to receive the influenza, pneumococcal, and shingles vaccines. Participants also self-reported their health and socio-demographic data, and completed two scales measuring the psychological factors associated with vaccination behaviour (5C and VAX scales). Self-reported daily functioning, cognitive ability, and social support were also assessed. Considerably more participants had received the influenza vaccine in the last 12 months (83.6%), relative to having ever received the pneumococcal (60.2%) and shingles vaccines (58.9%). Multivariate logistic regression analyses showed that a lower sense of collective responsibility independently predicted lack of uptake of all three vaccines in this population. Greater calculation of the disease/vaccination risk and preference for natural immunity also predicted not getting the influenza vaccine. For both the pneumococcal and shingles vaccines, concerns about profiteering predicted lack of uptake. Therefore, more understanding of vaccine benefits and disease risks may be required for these vaccines. Additional qualitative data generally supported these findings, which can contribute to future intervention development and research targeted at more diverse groups (e.g. older adults with cognitive impairments).

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Older adults' vaccine hesitancy: psychosocial factors associated with influenza, pneumococcal, and shingles vaccine uptake.

10.31234/osf.io/xzb8y ◽

2020 ◽

Author(s):

Louise A. Brown Nicholls ◽

Allyson Gallant ◽

Nicola Cogan ◽

Susan Rasmussen ◽

David Young ◽

...

Keyword(s):

Older Adults ◽

Influenza Vaccine ◽

Psychosocial Factors ◽

Demographic Data ◽

Collective Responsibility ◽

Vaccine Uptake ◽

Vaccine Hesitancy ◽

Free Text ◽

Natural Immunity ◽

Factors Associated

Influenza, pneumococcal disease, and shingles (herpes zoster) are more prevalent in older people. These illnesses are preventable via vaccination, but uptake is low and decreasing. Little research has focused on understanding the psychosocial reasons behind older adults’ hesitancy towards different vaccines. A cross-sectional survey with 372 UK-based adults aged 65-92 years (M = 70.5) assessed awareness and uptake of the influenza, pneumococcal, and shingles vaccines. Participants provided health and socio-demographic data and completed two scales measuring the psychosocial factors associated with vaccination behaviour. Self-reported daily functioning, cognitive difficulties, and social support were also assessed. Participants were additionally given the opportunity to provide free text responses outlining up to three main reasons for their vaccination decisions. We found that considerably more participants had received the influenza vaccine in the last 12 months (83.6%), relative to having ever received the pneumococcal (60.2%) and shingles vaccines (58.9%). Participants were more aware of their eligibility for the influenza vaccine, and were more likely to have been offered it. Multivariate logistic regression analyses showed that a lower sense of collective responsibility independently predicted lack of uptake of all three vaccines. Greater calculation of disease and vaccination risk, and preference for natural immunity, also predicted not getting the influenza vaccine. For both the pneumococcal and shingles vaccines, concerns about profiteering further predicted lack of uptake. Analysis of the qualitative responses highlighted that participants vaccinated to protect their own health and that of others. Our findings suggest that interventions targeted towards older adults would benefit from being vaccine-specific and that they should emphasise disease risks and vaccine benefits for the individual, as well as the benefits of vaccination for the wider community. These findings can help inform intervention development aimed at increasing vaccination uptake in future.

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Public attitudes towards COVID-19 contact tracing apps: a UK-based focus group study

10.31234/osf.io/ra93b ◽

2020 ◽

Author(s):

Simon Nicholas ◽

Chris Armitage ◽

Tova Tampe ◽

Kimberly Dienes

Keyword(s):

Text Messaging ◽

Public Attitudes ◽

News Coverage ◽

Collective Responsibility ◽

Contact Tracing ◽

Focus Group Study ◽

The Public ◽

Lack Of Information ◽

Greater Good ◽

The Uk

OBJECTIVE: To explore public attitudes to the proposed COVID-19 contact tracing app in the United Kingdom.DESIGN: Qualitative study consisting of five focus groups carried out between 1st-4th May, 2020 (39-42 days after the official start of the UK lockdown). SETTING: Online video-conferencingPARTICIPANTS: 22 participants, all UK residents aged 18 years and older, representing a range of different genders, ages, ethnicities and locations.RESULTS: Participants were split roughly equally in number across three groups: will use the app; will not be using the app; and undecided as to whether they will use the app. Analysis revealed five main themes: (1) Lack of information and misconceptions surrounding COVID-19 contact tracing apps; (2) concerns over privacy; (3) concerns over stigma; (4) concerns over uptake; and (5) contact tracing as the ‘greater good’. These themes were found across the sample and the three groups. However, concerns over privacy, uptake and stigma were particularly significant amongst those state they will not be using the app and the view that the app is for the “greater good” was particularly significant amongst those who stated they will be using the app. One of the most common misconceptions about the app was that it could allow users to specifically identify and map COVID-19 cases amongst their contacts and in their vicinity.CONCLUSIONS: We offer four recommendations: (1) To offset the fact that many people may not be accessing, or might be avoiding, news coverage on COVID-19, authorities must communicate to the public via a range of methods including but not limited to: social media ads, postal information, text messaging and other emergency alert systems. (2) Communications should emphasise that the app cannot enable the user to identify which of their contacts has reported COVID-19 symptoms or tested positive. (3) Communication should emphasise collective responsibility (‘the greater good’) to promote social norms around use of the app (4) Communication should provide a slogan that maximises clarity of message, for example: ‘Download the app, protect the NHS, save lives’.

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Are we ready when COVID-19 vaccine is available? Study on nurses′ vaccine hesitancy in Hong Kong

10.1101/2020.07.17.20156026 ◽

2020 ◽

Cited By ~ 1

Author(s):

Kin On Kwok ◽

Kin Kit Li ◽

Wan In Wei ◽

Kwok Hung Tang ◽

Samuel Yeung Shan Wong ◽

...

Keyword(s):

Hong Kong ◽

Influenza Vaccine ◽

Influenza Vaccination ◽

Work Stress ◽

Research Work ◽

Collective Responsibility ◽

Public Hospitals ◽

Vaccine Uptake ◽

Vaccine Hesitancy ◽

Public Confidence

Introduction: Nurses are considered a trustworthy source of vaccine-related information to build public confidence in vaccination. This study estimated nurses′ influenza vaccine uptake and intention to receive COVID-19 vaccine when available, and examined the corresponding psychological antecedents. Methods : A cross-sectional online survey among nurses was conducted during the main COVID-19 outbreak in Hong Kong between mid-March and late April 2020. Demographics, influenza vaccination, intention to have COVID-19 vaccine, the 5C vaccine hesitancy components (i.e., confidence, complacency, constraints, calculation, and collective responsibility), work stress and COVID-related work demands (i.e., insufficient supply of personal protective equipment, involvement in isolation rooms, and unfavorable attitudes towards workplace infection control policies) were reported. Results: The influenza vaccination coverage and the proportion intending to take COVID-19 vaccine were 49% and 63%, respectively, among 1205 eligible nurses. Influenza vaccine uptake was associated with working in public hospitals and all 5C constructs, whereas stronger COVID-19 vaccination intention was associated with younger age, more confidence, less complacency and more collective responsibility towards the vaccine. COVID-19-related demands were associated with greater work stress, and hence stronger COVID-19 vaccination intention. Conclusion: Vaccine uptake/intention was well predicted by the 5C constructs. With less work stress among nurses in the post-pandemic period, the intention to take COVID-19 vaccine will likely drop. The 5C constructs should be infused in vaccination campaigns. While a COVID-19 vaccine could be ready soon, communities are not ready to accept it. More research work is needed to boost the uptake.

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Factors associated with influenza vaccine uptake in older adults living in the community in Singapore

Epidemiology and Infection ◽

10.1017/s0950268816002491 ◽

2016 ◽

Vol 145 (4) ◽

pp. 775-786 ◽

Cited By ~ 20

Author(s):

L. W. ANG ◽

J. CUTTER ◽

L. JAMES ◽

K. T. GOH

Keyword(s):

Older Adults ◽

Influenza Vaccine ◽

Influenza Vaccination ◽

Seasonal Influenza ◽

Medical Condition ◽

Family Doctor ◽

Community Dwelling ◽

Vaccine Uptake ◽

Factors Associated ◽

Health Related

SUMMARYIn Singapore, influenza vaccination is recommended for persons at higher risk of complications of seasonal influenza, including those with chronic medical conditions and the elderly (individuals aged ⩾65 years). We investigated the factors associated with influenza vaccine uptake based on a nationally representative sample of community-dwelling adults aged >50 years. The data for this study were obtained from the National Health Surveillance Survey (NHSS) 2013. The association between influenza vaccine uptake and socio-demographic and health-related variables was analysed using univariable and multivariable logistic regression models. Of 3700 respondents aged ⩾50 years in the NHSS, 15·2% had received seasonal influenza vaccination in the past year. Older age, single marital status and economic inactivity were the socio-demographic variables independently associated with vaccine uptake. Health-related factors which were predictive of influenza vaccine uptake were sufficient total physical activity, better self-rated health, having at least one medical condition at risk of influenza complications and a regular family doctor/general practitioner. Influenza vaccine uptake in community-dwelling older adults was low. Our findings are of relevance in the formulation of public health policies and targeted health promotion strategies to increase vaccine uptake in this population group.

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An evaluation of influenza vaccine uptake in UK medical students

Occupational Medicine ◽

10.1093/occmed/kqab014 ◽

2021 ◽

Author(s):

G Gray ◽

J Cooper

Keyword(s):

Medical Students ◽

Influenza Vaccine ◽

Medical School ◽

Influenza Vaccination ◽

Service Evaluation ◽

Vaccination Status ◽

Vaccine Uptake ◽

Vaccination Rates ◽

Increased Risk ◽

The Uk

Abstract Background The annual influenza vaccination is recommended for all front-line healthcare workers in the UK and is a crucial way of reducing mortality for vulnerable patient groups. However, to date the UK government has never explicitly monitored influenza vaccine uptake in medical students. This is important to ascertain, as students regularly move between clinical areas and are both a perfect vector for the spread of influenza and at an increased risk of contracting influenza themselves. Aims This service evaluation was designed to evaluate the effectiveness of an influenza vaccination programme in one UK medical school and make recommendations to increase vaccination rates in the future. Methods This service evaluation collected data about medical student uptake of influenza vaccination in one UK medical school. Two hundred and fifty-one students at different course stages completed questionnaires, answering questions on vaccination status and Likert-scale ‘belief’ questions to assess the subjective reasons behind vaccine refusal. Results There was a substantial difference between year group cohorts (~20%), with significantly higher vaccination rates in the preclinical year group. Two significant negative predictors of vaccination were found (P < 0.001), related to scepticism over the effectiveness of the vaccine and lack of convenient access to the vaccination. Results indicated that integrating information about the influenza vaccine into the curriculum would reduce lack of knowledge over the efficacy of the vaccine. The centralization of vaccination programmes at mandatory university-based learning events would mitigate against the problem of diversity of vaccination locations and lack of central accountability. Conclusions The results of this service evaluation provide significant predictors of vaccination status for medical students and potential occupational health interventions to improve vaccine uptake in this group.

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The role of health determinants in the influenza vaccination uptake among older adults (65+): a scope review

Aging Clinical and Experimental Research ◽

10.1007/s40520-021-01793-3 ◽

2021 ◽

Author(s):

Regina Roller-Wirnsberger ◽

Sonja Lindner ◽

Lea Kolosovski ◽

Elisabeth Platzer ◽

Peter Dovjak ◽

...

Keyword(s):

Older Adults ◽

Influenza Vaccine ◽

Influenza Vaccination ◽

Seasonal Influenza ◽

Vaccine Uptake ◽

Health Determinants ◽

Bibliographic Databases ◽

Factors Affecting ◽

Vaccination Uptake

Abstract Background Although the burden of influenza infection is the highest in older adults, vaccination coverage remains low, despite this age group being more vulnerable than others. Aims Given the current pandemic of SARS-CoV-2, it was the aim of this scope review to update knowledge on factors affecting seasonal influenza vaccine uptake among older adults to strengthen prevention approaches in the context of an overall burden of infectious diseases. Methods We searched bibliographic databases from 2012 to 2019. All studies reviewed one or more social determinant of health listed by WHO, or factors affecting the decision-making process whether to accept influenza vaccine or not. Results Overall, 44 studies were included, 41 determinants were extracted and summarized into six categories. Older age and constitutional factors including multiple chronic diseases as well as preventive lifestyle and frequent routine healthcare utilization positively affected vaccination uptake (VU). Living and working conditions are also researched determinants of influenza vaccine uptake. A small number of studies explored the role of social inclusion and system-based interventions. Discussion and conclusions This scope review provides a comprehensive overview on factors affecting seasonal influenza vaccination uptake among older citizens. The review also clearly shows gaps for evidence on system-based level or political strategies to improve vaccination uptake.

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Vaccine Confidence and Hesitancy at the Start of COVID-19 Vaccine Deployment in the UK: An Embedded Mixed-Methods Study

Frontiers in Public Health ◽

10.3389/fpubh.2021.745630 ◽

2021 ◽

Vol 9 ◽

Author(s):

Chrissy h. Roberts ◽

Hannah Brindle ◽

Nina T. Rogers ◽

Rosalind M. Eggo ◽

Luisa Enria ◽

...

Keyword(s):

Mixed Methods ◽

Online Survey ◽

Vaccine Development ◽

Collective Responsibility ◽

Vaccine Uptake ◽

Vaccine Hesitancy ◽

Demographic Groups ◽

Vaccine Confidence ◽

The Uk ◽

Dominant Narratives

Background: Approval for the use of COVID-19 vaccines has been granted in a number of countries but there are concerns that vaccine uptake may be low amongst certain groups.Methods: This study used a mixed methods approach based on online survey and an embedded quantitative/qualitative design to explore perceptions and attitudes that were associated with intention to either accept or refuse offers of vaccination in different demographic groups during the early stages of the UK's mass COVID-19 vaccination programme (December 2020). Analysis used multivariate logistic regression, structural text modeling and anthropological assessments.Results: Of 4,535 respondents, 85% (n = 3,859) were willing to have a COVID-19 vaccine. The rapidity of vaccine development and uncertainties about safety were common reasons for COVID-19 vaccine hesitancy. There was no evidence for the widespread influence of mis-information, although broader vaccine hesitancy was associated with intentions to refuse COVID-19 vaccines (OR 20.60, 95% CI 14.20–30.30, p < 0.001). Low levels of trust in the decision-making (OR 1.63, 95% CI 1.08, 2.48, p = 0.021) and truthfulness (OR 8.76, 95% CI 4.15–19.90, p < 0.001) of the UK government were independently associated with higher odds of refusing COVID-19 vaccines. Compared to political centrists, conservatives and liberals were, respectively, more (OR 2.05, 95%CI 1.51–2.80, p < 0.001) and less (OR 0.30, 95% CI 0.22–0.41, p < 0.001) likely to refuse offered vaccines. Those who were willing to be vaccinated cited both personal and public protection as reasons, with some alluding to having a sense of collective responsibility.Conclusion: Dominant narratives of COVID-19 vaccine hesitancy are misconceived as primarily being driven by misinformation. Key indicators of UK vaccine acceptance include prior behaviors, transparency of the scientific process of vaccine development, mistrust in science and leadership and individual political views. Vaccine programmes should leverage the sense of altruism, citizenship and collective responsibility that motivated many participants to get vaccinated.

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Public attitudes towards COVID-19 vaccines in children: A qualitative study

10.1101/2021.07.28.21261252 ◽

2021 ◽

Author(s):

Simon N Williams

Keyword(s):

Public Health ◽

Public Health Policy ◽

Lower Risk ◽

Public Attitudes ◽

Complex Problem ◽

Risk Tolerance ◽

Parental Choice ◽

Vaccine Uptake ◽

The Uk ◽

Vulnerable Adults

Background COVID-19 vaccinations in children remains controversial. In the UK, as of August 2021, they have not been approved, except in a few limited circumstances. To date, little qualitative research exists to explain the reasons and nuances behind public attitudes on this issue. Methods Qualitative group and one-to-one online interviews were conducted with a diverse sample of 24 adults to explore their views on the issue of COVID-19 vaccination in children. Results COVID-19 vaccination in children was framed as a complex problem (a 'minefield'). Six themes emerged to explain participants views: (1) Uncertainty over whether children can catch, transmit or be severely harmed by COVID-19; (2) Lower risk tolerance for unknown longer-term effects of the vaccine in children; (3) Association of the vaccine program with government's handling of the pandemic; (4) Local social norms as a driver of hesitancy; (5) Vaccinating children as a way to protect vulnerable adults; (6) Children's vaccination as parental choice. Conclusions Public attitudes to COVID-19 vaccination in children are likely to be met with more hesitancy compared to adult vaccinations. Public health communications will need to combat this hesitancy if vaccine uptake for children is to be pursued as a public health policy.

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Public attitudes to COVID-19 vaccines: A qualitative study

10.1101/2021.05.17.21257092 ◽

2021 ◽

Author(s):

Simon N Williams ◽

Kimberly A Dienes

Keyword(s):

Qualitative Study ◽

Public Attitudes ◽

Vaccine Uptake ◽

Vaccine Hesitancy ◽

Natural Immunity ◽

Perceived Need ◽

Lack Of Information ◽

The Future ◽

The Uk ◽

Necessary Evil

OBJECTIVE: To explore public attitudes to COVID-19 vaccines in the UK, focused on intentions and decisions around taking vaccines, views on 'vaccine passports', and experiences and perspectives on post-vaccination behaviour. DESIGN: Qualitative study consisting of 6 online focus groups conducted between 15th March - 22nd April 2021. SETTING: Online video conferencing PARTICIPANTS: 29 adult UK-based participants RESULTS: Three main groups regarding participants' decision or intention to receive a COVID-19 vaccine were identified: (1) Accepters, (2) Delayers and (3) Refusers. Two reasons for vaccine delay were identified: delay due to a perceived need more information and delay until vaccine was 'required' in the future. Three main facilitators (Vaccination as a social norm; Vaccination as a necessity; Trust in science) and six barriers (Preference for 'natural immunity'; Concerns over possible side effects; Distrust in government; Perceived lack of information; Conspiracy theories; 'Covid echo chambers') to vaccine uptake were identified. For some delayers, vaccine passports were perceived to be a reason why they would get vaccinated in the future. However, vaccine passports were controversial, and were framed in three main ways: as 'a necessary evil'; as 'Orwellian'; and as a 'human rights problem'. Participants generally felt that receiving a vaccine was not changing the extent to which people were adhering to COVID-19 measures. CONCLUSIONS: Overall, positive sentiment toward vaccines was high. However, there remains a number of potential barriers which might be leading to vaccine delay in some. 'Vaccine delay' might be a more useful and precise construct than vaccine hesitancy in explaining why some may initially ignore or be uncertain about vaccination invitations. Vaccine passports may increase or 'nudge' uptake in some delayers but remain controversial. Earlier concerns that vaccination might reduce adherence to social distancing measures are not borne out in our data, with most people reporting ongoing adherence and caution.

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