COVID-19 Vaccine Hesitancy in Eight European Countries: Prevalence, Determinants and Heterogeneity

Abstract Vaccine hesitancy poses a major obstacle to containing COVID-19. Previous experimental studies of communication strategies for promoting COVID-19 vaccine uptake have been conducted in a single country each, often testing strategies that have differed from those studied in other countries. On the few occasions when two or more single-country studies have tested similar treatments, they have yielded inconsistent findings. For example, highlighting pro-social benefits increased participants’ willingness to get vaccinated in the UK and the US, but had no effect in France and the UK, thus calling into question the often implied generalisability of previous findings. We experimentally assess the effectiveness of different information treatments across eight European countries and examine heterogeneity in the willingness to get vaccinated against COVID-19, as well as in the perceptions of the different vaccines available, within and across countries. We reveal striking differences in COVID-19 vaccine hesitancy across countries, ranging from 5.5% of the adult population in Spain to 50.94% in Bulgaria. The main barriers to vaccine acceptance were fears regarding the quality and safety of the vaccines, as well as mistrust in government. Receiving information emphasising (i) COVID-19 risk reduction through vaccination, (ii) non-medical benefits of a vaccination certificate, and (iii) hedonistic benefits significantly increases vaccination willingness in Germany, but only the vaccination certificate message significantly increases willingness in the UK. No information treatment has significant effects in any other country. A machine-learning technique, model-based recursive partitioning, reveals that the effectiveness of some information treatments is highly heterogeneous among subsets of the population, with adverse effects for Spanish, German and Italian participants without active employment. The heterogeneity of vaccine hesitancy and responses to different messages suggests that health authorities should avoid one-size-fits-all messages and instead tailor vaccination campaigns to their specific target populations, with special care to more disadvantaged populations.

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Digital Gamification to Enhance Vaccine Knowledge and Uptake: Scoping Review (Preprint)

10.2196/preprints.16983 ◽

2019 ◽

Author(s):

Ilaria Montagni ◽

Inass Mabchour ◽

Christophe Tzourio

Keyword(s):

Scoping Review ◽

Synthesis Method ◽

Experimental Studies ◽

Vaccine Uptake ◽

Digital Tools ◽

Vaccine Hesitancy ◽

Public Health Issue ◽

Relative Paucity ◽

Effective Interventions ◽

Quasi Experimental

BACKGROUND Vaccine hesitancy is a growing threat to population health, and effective interventions are needed to reduce its frequency. Digital gamification is a promising new approach to tackle this public health issue. OBJECTIVE The purpose of this scoping review was to assess the amount and quality of outcomes in studies evaluating gamified digital tools created to increase vaccine knowledge and uptake. METHODS We searched for peer-reviewed articles published between July 2009 and August 2019 in PubMed, Google Scholar, Journal of Medical Internet Research, PsycINFO, PsycARTICLES, Psychology and Behavioral Sciences Collection, and SocINDEX. Studies were coded by author, year of publication, country, journal, research design, sample size and characteristics, type of vaccine, theory used, game content, game modality, gamification element(s), data analysis, type of outcomes, and mean quality score. Outcomes were synthesized through the textual narrative synthesis method. RESULTS A total of 7 articles met the inclusion criteria and were critically reviewed. Game modalities and gamification elements were diverse, but role play and a reward system were present in all studies. These articles included a mixture of randomized controlled trials, quasi-experimental studies, and studies comprising quantitative and qualitative measures. The majority of the studies were theory-driven. All the identified gamified digital tools were highly appreciated for their usability and were effective in increasing awareness of vaccine benefits and motivation for vaccine uptake. CONCLUSIONS Despite the relative paucity of studies on this topic, this scoping review suggests that digital gamification has strong potential for increasing vaccination knowledge and, eventually, vaccination coverage.

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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 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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Socioeconomic privilege and political ideology are associated with racial disparity in COVID-19 vaccination

Proceedings of the National Academy of Sciences ◽

10.1073/pnas.2107873118 ◽

2021 ◽

Vol 118 (33) ◽

pp. e2107873118

Author(s):

Ritu Agarwal ◽

Michelle Dugas ◽

Jui Ramaprasad ◽

Junjie Luo ◽

Gujie Li ◽

...

Keyword(s):

Racial Disparities ◽

Republican Party ◽

Political Ideology ◽

Adult Population ◽

The United States ◽

Vaccine Uptake ◽

Vaccine Hesitancy ◽

Median Income ◽

Structural Inequities ◽

The Impact

Vaccine uptake is critical for mitigating the impact of COVID-19 in the United States, but structural inequities pose a serious threat to progress. Racial disparities in vaccination persist despite the increased availability of vaccines. We ask what factors are associated with such disparities. We combine data from state, federal, and other sources to estimate the relationship between social determinants of health and racial disparities in COVID-19 vaccinations at the county level. Analyzing vaccination data from 19 April 2021, when nearly half of the US adult population was at least partially vaccinated, we find associations between racial disparities in COVID-19 vaccination and median income (negative), disparity in high school education (positive), and vote share for the Republican party in the 2020 presidential election (negative), while vaccine hesitancy is not related to disparities. We examine differences in associations for COVID-19 vaccine uptake as compared with influenza vaccine. Key differences include an amplified role for socioeconomic privilege factors and political ideology, reflective of the unique societal context in which the pandemic has unfolded.

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Digital Gamification to Enhance Vaccine Knowledge and Uptake: Scoping Review

JMIR Serious Games ◽

10.2196/16983 ◽

2020 ◽

Vol 8 (2) ◽

pp. e16983 ◽

Cited By ~ 1

Author(s):

Ilaria Montagni ◽

Inass Mabchour ◽

Christophe Tzourio

Keyword(s):

Scoping Review ◽

Synthesis Method ◽

Experimental Studies ◽

Vaccine Uptake ◽

Digital Tools ◽

Vaccine Hesitancy ◽

Public Health Issue ◽

Relative Paucity ◽

Effective Interventions ◽

Quasi Experimental

Background Vaccine hesitancy is a growing threat to population health, and effective interventions are needed to reduce its frequency. Digital gamification is a promising new approach to tackle this public health issue. Objective The purpose of this scoping review was to assess the amount and quality of outcomes in studies evaluating gamified digital tools created to increase vaccine knowledge and uptake. Methods We searched for peer-reviewed articles published between July 2009 and August 2019 in PubMed, Google Scholar, Journal of Medical Internet Research, PsycINFO, PsycARTICLES, Psychology and Behavioral Sciences Collection, and SocINDEX. Studies were coded by author, year of publication, country, journal, research design, sample size and characteristics, type of vaccine, theory used, game content, game modality, gamification element(s), data analysis, type of outcomes, and mean quality score. Outcomes were synthesized through the textual narrative synthesis method. Results A total of 7 articles met the inclusion criteria and were critically reviewed. Game modalities and gamification elements were diverse, but role play and a reward system were present in all studies. These articles included a mixture of randomized controlled trials, quasi-experimental studies, and studies comprising quantitative and qualitative measures. The majority of the studies were theory-driven. All the identified gamified digital tools were highly appreciated for their usability and were effective in increasing awareness of vaccine benefits and motivation for vaccine uptake. Conclusions Despite the relative paucity of studies on this topic, this scoping review suggests that digital gamification has strong potential for increasing vaccination knowledge and, eventually, vaccination coverage.

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A Rapid Systematic Review of Factors Influencing COVID-19 Vaccination Uptake in Minority Ethnic Groups in the UK

Vaccines ◽

10.3390/vaccines9101121 ◽

2021 ◽

Vol 9 (10) ◽

pp. 1121

Author(s):

Atiya Kamal ◽

Ava Hodson ◽

Julia M. Pearce

Keyword(s):

Ethnic Groups ◽

Grey Literature ◽

Vaccine Uptake ◽

Vaccine Hesitancy ◽

Vaccination Uptake ◽

Factors Influencing ◽

Minority Ethnic Groups ◽

Reported Data ◽

The Uk ◽

Minority Ethnic

COVID-19 has disproportionately affected minority ethnic groups in the United Kingdom. To maximise the effectiveness of the vaccination programme, it is important to understand and address disparities in vaccine uptake. The aim of this review was to identify factors influencing COVID-19 vaccination uptake between minority ethnic groups in the UK. A search was undertaken in peer-reviewed databases, polling websites and grey literature from January 2020–May 2021. Studies were included if they reported data on vaccine uptake or the reasons for or against accepting the COVID-19 vaccination for minority ethnic groups in the UK. Twenty-one papers met the inclusion criteria, all of which were rated as either good or moderate quality. Ethnic minority status was associated with higher vaccine hesitancy and lower vaccine uptake compared with White British groups. Barriers included pre-existing mistrust of formal services, lack of information about the vaccine’s safety, misinformation, inaccessible communications, and logistical issues. Facilitators included inclusive communications which address vaccine concerns via trusted communicators and increased visibility of minority ethnic groups in the media. Community engagement to address the concerns and informational needs of minority ethnic groups using trusted and collaborative community and healthcare networks is likely to increase vaccine equity and uptake.

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Information about herd immunity and empathy promote COVID-19 vaccination intentions

10.31234/osf.io/wzu6k ◽

2020 ◽

Author(s):

Stefan Pfattheicher ◽

Michael Bang Petersen ◽

Robert Böhm

Keyword(s):

Herd Immunity ◽

Vaccine Uptake ◽

Vaccine Hesitancy ◽

Effective Vaccine ◽

Evidence Based ◽

High Uptake ◽

Present Contribution ◽

Uptake Rates ◽

The Uk ◽

Affective Information

Objective: An effective vaccine against COVID-19 is a desired solution to curb the spread of the disease. However, vaccine hesitancy might hinder high uptake rates and thus undermine efforts to eliminate COVID-19 once an effective vaccine is available. The present contribution addresses this issue by examining two promising ways of increasing the intention to get vaccinated against COVID-19.Methods: We conducted two pre-registered online studies (N = 2,315 participants from the UK) in which we either measured (Study 1) or manipulated (Study 2) knowledge about and beliefs in herd immunity, as well as empathy for those most vulnerable to the virus. As a dependent variable, we assessed individuals’ self-reported vaccination intention if a vaccine against COVID-19 became available.Results: We show that the motivation to get vaccinated against COVID-19 is related to and causally promoted by both mere information about herd immunity and by empathy. Thus, interventions that combine cognitive and affective information related to others’ potential suffering appear most effective in increasing the intention to get vaccinated against COVID-19.Conclusions: The present research provides a better understanding of the intention to get vaccinated against COVID-19 and highlights two evidence-based possibilities for policymakers in promoting vaccine uptake.

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Stroke and TIA Survivors’ Perceptions of The COVID-19 Vaccine: Cross Sectional Survey

10.21203/rs.3.rs-543899/v1 ◽

2021 ◽

Author(s):

Grace Turner ◽

Neil Heron ◽

Jennifer Crow ◽

Eirini Kontou ◽

Sally Hughes

Keyword(s):

Information Needs ◽

Healthcare Services ◽

Vaccine Uptake ◽

Vaccine Hesitancy ◽

Free Text ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Lack Of Information ◽

Ischaemic Attack ◽

The Uk

Abstract BackgroundPeople who experience a stroke or transient ischaemic attack (TIA) have greater risks of complications from contracting COVID-19. Vaccine uptake in this vulnerable population is important to reduce the burden of COVID-19 on healthcare services and society. To prevent vaccine hesitancy and maximise compliance, we need to better understand individuals’ views on the vaccine. We aimed to explore perspectives of people with stroke/TIA on the COVID-19 vaccine and influences on its uptake.MethodWe conducted a cross-sectional, electronic open survey comprising multiple choice and free text questions. Convenience sampling was used to recruit people who have experienced a stroke and/or TIA, and were residents in the UK or Ireland.ResultsThe survey was completed by 377 stroke/TIA survivors. 87% (328/377) had either received the first vaccine or were booked to have it. The vaccine was declined by 2% (7/377) and 3% (11/377) had been offered the vaccine but not yet taken it up. 8% (30/377) had not been offered the vaccine despite being eligible.Many people expressed concerns around the safety of the vaccine (particularly risk of blood clots and stroke) and some were hesitant to have the second vaccine. Most people had no difficulty accessing the vaccine appointment. Societal and personal benefits were motivations for vaccine uptake. There was uncertainty and lack of information about risk of COVID-19 related complications specifically for people who had a stroke/TIA.ConclusionFor people with stroke and TIA, confidence in the vaccine’s safety is the overriding behavioural influence on vaccine uptake. Despite high uptake of the first vaccine, many have legitimate concerns and information needs that should be addressed. Our findings can be used to identify targets for behaviour change to improve vaccine uptake specific to stroke/TIA patients, in particular, increase trust in the vaccine’s safety (confidence) and improve understanding of the greater risks of complications from contracting COVID-19 (complacency).

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COVID-19 Vaccination Uptake and Hesitancy Among Current Tobacco Users

Tobacco Use Insights ◽

10.1177/1179173x211068027 ◽

2021 ◽

Vol 14 ◽

pp. 1179173X2110680

Author(s):

Nicolle M Krebs ◽

Gail D’Souza ◽

Candace Bordner ◽

Sophia I Allen ◽

Andrea L Hobkirk ◽

...

Keyword(s):

Adult Population ◽

The United States ◽

Vaccine Uptake ◽

Vaccine Hesitancy ◽

P Value ◽

Current Cigarette Smoking ◽

Chi Square ◽

Convenience Sample ◽

Increased Risk ◽

Current Tobacco

Novel mRNA vaccines have been developed and were first distributed to high-risk individuals (including smokers) in the United States starting in December 2020 to combat the coronavirus (COVID-19) pandemic. Over one-half of the U.S. adult population has received at least 1 dose of a COVID-19 vaccine, but many others have reported hesitation about becoming vaccinated. We examined COVID-19 vaccine uptake and hesitancy from a convenience sample of Pennsylvanian adult smokers in April 2021, approximately 3 months after tobacco users were eligible to receive vaccination in the state. Participants (n = 231) were 23.4% male, 90.5% white, and had a mean age of 48.1 (SD = 11.9) years. All participants were current tobacco users, with the majority reporting current cigarette smoking (90.9%) with an average of 16 (SD = 8.1) cigarettes smoked per day. Nearly 60% (n = 137) reported receiving at least 1 dose of the vaccine and of those who did not (n = 94), 84% (n = 79) said they were somewhat or very unlikely to get a vaccine. Those who were unvaccinated were more likely to not consume news about COVID-19 (chi-square P-value < .01) and less likely to believe government news sources as reliable information for COVID-19 (chi-square P-value < .01). Qualitative responses among those who were vaccine hesitant expressed concerns about the lack of research on the vaccine, distrust of the safety of the vaccine, and fears about side effects. Understanding vaccine hesitancy among tobacco users can help develop targeted communication strategies and directly address concerns to promote vaccination among this population who may be at an increased risk of severe complications from COVID-19.

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Public attitudes to COVID-19 vaccines: A qualitative study

10.31234/osf.io/h87s3 ◽

2021 ◽

Author(s):

Simon Nicholas Williams ◽

Kimberly 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 conferencingPARTICIPANTS: 29 adult UK-based participantsRESULTS: 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 four main ways: as “a necessary evil”; as “Orwellian”; as a “human rights problem”; and as a source of confidence”. 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 around vaccines is 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 may be unpopular in others. Earlier concerns that vaccination might reduce adherence to social distancing measures are not borne out in our data, with most people reporting adherence and caution.

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