Table 1. Dominant beliefs and contextual factors in relation to COVID-19 vaccine intention identified in open-ended responses and interviews distilled into statements used in subsequent waves of the national cohort survey, the Netherlands, November and December 2020.
| Beliefs and contextual factors | Open-ended answers (Wave 8; Nov 2020) |
Interviews (Wave 9; Dec 2020) |
Statements, questions and response options used in cohort surveya
(Wave 10; Feb 2021 and Wave 11; Mar 2021) |
||
|---|---|---|---|---|---|
| Yes, because… | No, because… | Drivers | Barriers | ||
| Belief 1: Concerns about short-term side effects |
Na | Potential side effects: “First I want to know if there are really no side-effects.” Participants indicated that they did not wish to get vaccinated because of their physical condition “I have allergies.”, “I always get sick from vaccinations.”, “I can’t in my current condition.” |
Na | Current side effects, for example in relation to medication use. Recommendation from health professional were also mentioned as deciding factor: “I let myself be guided by the recommendation of my cardiologist. I am not against vaccinations, but I am also a heart patient and any potential side- effects are, therefore of critical importance.” | I am scared of potential side effects of the vaccine. Response options: Completely disagree; disagree; neutral; agree; completely agree |
| Belief 2: Concerns about unknown long-term side effects |
Na | As a result from rapid development participants reported that long term consequences are a concern, in particular in relation to fertility “We don’t know about pregnancy yet.”; Participants mentioned that they preferred to wait a bit longer until more is known. | Na | Long-term consequences: “If it is only effective for three months, then I won’t get it”. Examples: medications which were discovered to have negative side-effects later. Some women expressed concerns about potential effect on fertility. Others employed the wait and see approach: one is inclined not to vaccinate until more knowledge on long-term side effects gives greater confidence in the vaccine. |
I am scared of possible unknown long-term effects of the vaccine. Response options: Completely disagree; disagree; neutral; agree; completely agree |
| Belief 3: Personal vaccination will protect others (moral duty) |
Protecting (vulnerable) loved ones was an important reason “It feels safer for my husband.” “My parents are old.”; “To protect my family.” Some people noted protection of others as a moral duty “It’s just important”; “I am doing this for the social good.” |
Na | To protect others, including for the greater good. “I want the vaccine to contribute to protecting others.” |
Na | If I am vaccinated, I protect others from the coronavirus. Response options: Completely disagree; disagree; neutral; agree; completely agree |
| Belief 4: Personal vaccination will protect oneself |
Protect oneself for fear of getting sick or risk trade-off between COVID-19 and vaccination “Better safe than sorry.” | No need to protect oneself. In risk trade off, no or little fear of illness “Coronavirus is not dangerous for me.”; “Chances that I get ill are small.”; “I prefer getting corona than getting a jab.” |
“By getting vaccinated I protect myself and regain some freedom.” |
Na | If I get vaccinated, I am protected from the coronavirus. Response options: Completely disagree; disagree; neutral; agree; completely agree |
| Belief 5: Trust in science or institutions |
Trust in national institutions “If it’s approved it should be fine.” No different from other vaccines. |
Generalised lack of trust “I don’t trust it.”; “No government will invade my body.”; Speed of development could not have allowed for appropriate testing: “I think it went too fast.”; “It was brought to the market too quickly.” | Trust in other organisations. Comparison with other vaccines: “I wouldn’t usually question this.”; confidence that government acts for the good of society and that the scientific community acts responsibly and carefully. | Concerns over rapid development raises questions about safety of the vaccine and potential (long-term) side effects; distrust of the mRNA vaccines, as this is a new type of vaccine. | If the vaccine has been approved on the Dutch market, I believe that it is safe. Response options: Completely disagree; disagree; neutral; agree; completely agree |
| Belief 6: Vaccination is key to reopening society |
Wanting to get vaccinated to fight the pandemic “It will help to slow the virus and stop the pandemic.”; or to reopen society: “So we can go back to normal.” | Na | Contributing to a way out of the crisis to be able to have more social contacts, hug or take part in non-essential activities again. | Na | If I get vaccinated, I contribute to a way out of the corona crisis for the Netherlands. Response options: Completely disagree; disagree; neutral; agree; completely agree |
| Contextual factor 1: Social context |
Na | Na | An increasing/high vaccination rate works as a driver (greater confidence in safety/effectiveness) “The more people that are vaccinated, the safer it is for me to also be vaccinated.” |
Increasing/high vaccination rate works as a barrier. If already high: “I no longer need to do it.”. This is also known as “free-riding”. | Most of my friends and family have been vaccinated against corona or are planning to do so. Response options: Completely disagree; disagree; neutral; agree; completely agree |
| Contextual factor 2: Cue to action | Invitation letter: “I am being asked to.”; or through trusted messengers: “My doctor says I should.” | Na | Invitation letter: “I will make my decision when it becomes relevant.”; information from trusted individuals (medical experts), e.g. on TV. “If I see a reputable doctor on TV who answers a number of questions, then it makes me more relaxed and, despite my doubts, also gives me confidence to be vaccinated.” |
Na | Have you already received an invitation, or are you due to be vaccinated against the coronavirus?b
Response options: Yes; no; I don’t knowc. |
COVID-19: coronavirus disease; Na: not applicable; TV: television.
a Wording of the statements and questions used in the national survey was adjusted in language to accommodate colloquial referral to COVID-19.
b We noted both the invitation letter and trusted public messengers as a salient environmental cues, however opted to incorporate only an item on invitation letters into the cohort survey. This was for two reasons: we had restrictions in the number of items that could be incorporated, and campaigning and influence of trusted messengers we believed may be harder to retrace or identify for the individual. We therefore opted to incorporate only the cue to action of the invitation letter as a single item statement in the cohort survey.
c Only 26 participants answered “I don’t know”. Due to the small sample size this group was removed from the analysis and the variable was entered as a dichotomous variable ‘yes/no’ in the regression model.