Concerns and motivations about COVID-19 vaccination

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, 2020,¹ 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 group² 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 USA³ to 64% in the UK⁴ and 74% in New Zealand.⁵ 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,¹ 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 analysis⁶ 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.⁷ 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.⁸ A prioritisation framework proposed by health economists might aid with the development of these strategies.⁹

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.¹ Primary-care doctors are likely to be at the forefront of education and administration of a COVID-19 vaccine.¹⁰ 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.⁸ 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.

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