Attitudes to Vaccination After the First Wave of COVID-19

Acceptance and use of available vaccinations are a basic requirement for population-wide protection against infection in general, and not only in the current COVID-19 pandemic (1, 2). Ongoing studies show that a significant portion of the population is willing to be vaccinated against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), but this number varies, depending on the study and the point in time (3, 4). In this article, however, we look at vaccination attitudes and behavior over a longer-term and cross-pathogen perspective; based on a repeated representative survey, we reveal trends between 2012 and 2020 as well as differences between the general population and medical staff, who are important mediators of information about vaccinations.

Methods

Since 2012, the Federal Center for Health Education (BZgA, Bundeszentrale für gesundheitliche Aufklärung) has carried out a representative computer-assisted telephone interview (CATI) survey on attitudes, knowledge, and behavior towards vaccinations every two years (N: 4483 [2012], 4491 [2014], 5012 [2016], 5054 [2018], 5002 [2020]). The latest survey wave (15 July to 1September, 2020) contains questions about the SARS-CoV-2 vaccination (5). The survey is based on a multi-stage random sample of the German-speaking resident population (16- to 85year-olds). The target persons were selected using a dual-frame design (combination of landline and mobile network sample). The survey method, demographic composition of the sample, and question formulations are comparable throughout the waves. Trends and group differences were examined and weighted using descriptive methods and multiple logistic regression analyses (design and adjustment weighting). The multivariate models controlled for the following variables: sex, age group, federal state residency, level of education, employment status, migration background, and health status.

Results

In the period from 2012 to 2020, positive descriptive trends can be seen for several indicators (figure 1). The confidence intervals are ±3 percentage points or less. The proportion of respondents who (somewhat) support vaccinations rose from 61% in 2012 to 79% in 2020, with the most noticeable increase (of 16%) by 2016. Likewise, for the perceived importance of the distinct vaccinations, the proportion of respondents who rated at least nine out of twelve distinct vaccinations as (very) important increased significantly, from 53% to 71%. A slightly positive development can be seen in the proportion of respondents who feel (very) well-informed about vaccinations, from 56% in 2012 to 60% in 2020. Data on trust in the safety of vaccinations have been available since 2016. Here, too, there is a positive trend, from 56% in 2016 to 63% in 2020. The proportion of respondents who reported having received a vaccination in the past five years rose slightly, from 70% to 73%. All trends are statistically significant in bivariate regression models; in the case of informedness, vaccination status, and trust, however, this is only the case for individual survey time points.

Figure 1.

Weighted descriptive trends in selected vaccination attitudes and vaccination behavior. Perceived importance: (very) important; support: (somewhat) in favor; trust: somewhat agree / completely agree; level of informedness: (very) well-informed; vaccination status: vaccinated in the last 5 years

Source: BZgA Representative Surveys on Infection Protection 2012–2020

Medical staff form an important knowledge dissemination group for the general population when it comes to vaccination. In 2020, 98% of the respondents consider a personal conversation with a physician to be a suitable source of information about vaccinations. Overall, 94% of those who received advice on vaccinations in the past two years (N=1844, 32%) received it from a physician, and 18%, from the medical assistants associated with a physician’s practice (before a pharmacist, a sickness fund, or a public health department); 14% of pregnant women received advice from their midwife (5).

Figure 2 shows the attitudes towards vaccination for medical staff as compared to the general population (excluding healthcare professionals) for the current survey wave. Healthcare professionals stated significantly more often that they were (very) well-informed about vaccinations. Nonetheless, 29% of healthcare professionals are less well-informed or poorly informed. A significantly higher proportion of healthcare professionals perceived at least nine out of twelve distinct vaccinations to be important. A greater proportion of the healthcare professionals than the general population are generally in favor of vaccination—but this difference is not significant. Healthcare professionals also did not have a (significantly) higher level of trust in the safety of vaccinations. With respect to a possible COVID-19 vaccination at the time of the survey (from July to September 2020), there are also no significant differences. Indeed, at the time of the survey, even a smaller proportion of healthcare professionals tended to have confidence in a possible SARS-CoV-2 vaccine and were willing to be vaccinated. The multivariate analyses confirmed these relationships and showed that sex, age, migration background, level of education, health status, and federal state of residency were also associated with attitudes towards vaccination (5).

Figure 2.

Vaccination attitudes among healthcare professionals and in the general population in Germany 2020; weighted means and 95% confidence intervals. Perceived importance: (very) important; acceptance: (somewhat) in favor; trust: somewhat agree/completely agree; level of informedness: (very) well-informed; trust in the COVID-19 vaccine (e.g,. believe that the vaccination against the coronavirus is safe): somewhat agree/completely agree; willingness to receive a COVID-19 vaccine (“If you had the opportunity to be vaccinated next week…”): definitely/most likely.

Source: BZgA Representative Surveys on Infection Protection 2020

Discussion

Vaccination acceptance and willingness to be vaccinated have developed positively since 2012. However, there is still a need for action for all indicators, especially with regard to the informed status and trust in vaccinations. Despite the drastic experience of the first wave of the 2020 COVID-19 pandemic, no particular changes can be identified in the latest wave of surveys. The impact of the experiences of the second and third waves of COVID-19, as well of the approval of the various vaccines, can only be addressed in the next CATI survey.

In the opinion of the respondents, healthcare professionals play a key role in providing information and building trust. Nevertheless, this group also has a need for information, and the confidence it shows in the safety of vaccines is not higher than that for the general population. Possible differences between the different types of healthcare professionals cannot be investigated based on these data.

Summary

Despite the positive long-term trend, the general willingness to be vaccinated has hardly increased during the pandemic situation. Vaccination educational activities should address uncertainties in the general population as well as the information needs of medical staff, who represent the most important group of medical knowledge dissemination.