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# System prepended metadata

title: Variables determining COVID-19 vaccine uptake
tags: [' policy', under-construction, ' behaviour']

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title: Variables determining COVID-19 vaccine uptake
tags: under-construction, behaviour, policy
permalink: https://c19vax.scibeh.org/pages/vaxuptake
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# Variables determining COVID-19 vaccine intention and uptake

<sub>(Last updated 4 Jan 2021)</sub>


Latest paper by Motta on vax characteristics that appeal to Americans: 10.1016/j.socscimed.2020.113642

Information about herd immunity and empathy promote COVID-19 vaccination intentions: https://psyarxiv.com/wzu6k/

Royal Society review of a lot of this material: https://osf.io/fzhu9/ 

## What variables will increase COVID-19 vaccine uptake?


Studies that have examined the factors that shape people’s intentions to get vaccinated against COVID-19 show that people are more likely to want to be vaccinated when:
•	They believe that the COVID-19 vaccine has more benefits than risks [@Juanchich20]. 
•	They recognize the risk of the disease [@VanBavel20 @Karlsson21]
•	They believe that the vaccine is safe, effective, and the risk of vaccination is low (Perlis et al. 2020: covidstates.org Report #9 August 2020).
•	They have previously had an influenza vaccine [REF: Kim, J., Orcutt, E., Butterfuss, R., Harsch, R., Choi, D., Johnson, V., Will, K., & Kendeou, P. (2020, November). What Predicts Intention to Receive a Future COVID-19 Vaccine? Role of Knowledge, Attitudes, and Behavior. Poster presented at the Annual Meeting of the Psychonomics Society. (Virtual Conference); Malik et al., 2020 REF:10.1016/j.eclinm.2020.100495 ].
•	They believe that vaccinating can protect themselves, their families, and people in their community (Perlis et al 2020: covidstates.org Report #9 August 2020)
•	The vaccine has been recommended by medical professionals  (Perlis et al. 2020: covidstates.org Report #9 August 2020)
•	They trust science and scientists (Baum et al., 2020; covidstates.org Report #13 August 2020)
They trust information in government sources (Lazarus et al., 2020 REF: https://doi.org/10.1038/s41591-020-1124-9)

## What variables affects vaccination intention and uptake?

Non-adoption of the COVID-19 vaccine may be owed to one (or a combination) of the following reasons:
•	A large percentage of the people who are reluctant or reject the vaccine have an ideological opposition to the vaccine.
o	Some may be hardcore vaccine deniers / anti-vax exteremists [DOI: 10.37016/mr-2020-44 - Link to wiki: vaccine deniers]. These people often also believe in misinformation and / or conspiracy theories about COVID-19 [DOI: 10.1098/rsos.201199] and they are difficult to convince about the necessity, efficiency and safety of the COVID-19 vaccines. 
=> They should be the target of systematic debunking efforts against misinformation (see below & Link to wiki: Debunking misinformation and conspiracy theories). 
o	In many cases, COVID-19 and its vaccines have become politicized, leading to polarization of attitudes towards COVID-19 depending on political views. 
pposition is greater on the political right [@Newhagen20; @Lewandowsky20g] and people on the right are more susceptible to misinformation  [@Roozenbeek20b].
Populist politicians and voters are more likely to reject vaccinations [@Kennedy19] - for example, in a sample of around 5,000 Americans surveyed in Ma 2020, conservative voters were 35% more likely (relative increase) to refuse the COVID-19 vaccine [DOI: 10.2139/ssrn.3667971] [DOI: 10.1097/JAC.0000000000000360].
Individuals who do not trust their local authorities / government (https://projekte.uni-erfurt.de/cosmo2020/web/topic/impfung/10-impfungen/), who have far-left or far-right political views, and/or who did not vote in the previous elections have a stronger tendency to reject social distancing and mask wearing, as well as the vaccine [@Peretti-Watel20].


•	Many people understand the need for a vaccine but have safety concerns due to the fast development of the vaccine (months instead of years normally needed for the development of a vaccine) and / or the mRNA type of the vaccine (new technology - difficult to understand and accept):

o	One third of Americans seriously doubt that the vaccine(s) will be properly tested in terms of safety due to the short time of development [APNORC]. 
=> The answer to this is a set of facts about why vaccines normally take long and why the COVID vaccines did not face any delays. [REF: ] (Link to wiki: COVID-19 vaccine development process explanation / Why you should not worry about the fast development of COVID-19 vaccines)
o	Like for other vaccines, there are a number of people who (unjustifiably) think that the vaccine could make them sick with COVID-19. 
=> This needs to be explicitly debunked, as the vaccine is not “live”, so it cannot make someone contract COVID-19. [REF:]
o	More than half of Americans said they would prefer to wait for others to go first before they get the vaccine [https://projekte.uni-erfurt.de/cosmo2020/web/topic/impfung/10-impfungen/,  APNORC]. This is more likely to occur with new vaccine programs. This is a standard attitude towards vaccination with many parents electing to be ‘late vaccinators’ in regards to their children [DOI: 10.4161/hv.24657] 

=> This could probably be dealt with by publishing a specific order of population groups in which they should get the vaccine, as for example the U.K. Government has done [Priority groups for coronavirus (COVID-19) vaccination]
Also, ingroup norms have big influence on their group members so mentioning positive norms towards vaccination from various communities could be helpful [DOI: 10.1037/hea0000771] Media organisations should avoid over-emphasising rejection of vaccines in news headlines. 
o	Some people intend to become freeriders and let others do the vaccine while they get the beneficial effect of herd immunity without getting the vaccine. However, if this attitude becomes a norm, the necessary percentage of the vaccinated population needed to reach herd immunity will not be reached and everyone will continue to suffer for much longer [REF] (Link to wiki: COVID: Why freeriding might be a disastrous strategy). 

o	Immunosuppressed / -compromised individuals, patients with autoimmune disorders, pregnant women and parents of small children are worried about the possible side-effects given that such profiles were not included in the clinical trials [Pfizer protocol] [Moderna protocol]. Immunosuppressed patients also worry about possible inefficiency of the vaccines for them. 
=> We should be transparent about the reactogenicity of the vaccines so that people are not surprised by transient (but discomforting) side-effects like fever, muscle pain and rushes [DOI: 10.1126/science.370.6520.1022] (Link to wiki: Potential side-effects of COVID-19 vaccines). This is especially important for people who have rationally-driven safety concerns and are open to getting the vaccine if they are reassured about the potential side-effects. It also needs to be clearly stated that this is standard practice in vaccine clinical trials and that the COVID-19 vaccine is not an exception [REF:].


•	Ethnic minorities, immigrants, LGBTQ individuals, homeless and/or low-income people, incarcerated individuals, people with disabilities and other marginalized populations traditionally face obstacles and inequalities in healthcare and this situation has only been accentuated due to the COVID-19 pandemic [APA - Building Vaccine Confidence]. Research indicates that many of the groups that face these health inequalities have a larger degree of hesitancy towards vaccines. For instance, people from ethnic minorities, such as Black or Asian British were three times more hesitant than White British towards COVID-19 vaccine for their children and themselves [DOI: 10.1016/j.vaccine.2020.10.027], 37% of low-income individual, 22% of elderly, 36% of young women in France would not get the vaccine if it was available compared to 26% in the overall sample [DOI: 10.1016/S1473-3099(20)30426-6]. A similar, but less bleak, pattern was observed in Australia [DOI: 10.1016/S1473-3099(20)30724-6] [DOI: 10.1016/s1473-3099(20)30559-4], and similar division were also found in the US: while almost a third of Americans do not intend to be vaccinated, this percentage was greater for Black Americans (+40% relative increase) and women (+72%) [DOI: 10.2139/ssrn.3667971] [DOI: 10.1097/JAC.0000000000000360].

<!-- MJ: not sure about the term "coloured parent" in the above paragraphso I have edited it a little-->
<!-- Also, should we speculate on why this might be the case? In our data, we found that people from ethnic minorities intend less to be vaccinated
and trust the government less - data from [doi: 10.2139/ssrn.3667971]  also showed that more Black Americans (compared to White) believed the vaccine to be less safe, less effective, - and they are also less likely to have helath insurance [US context]--> 
<!-- a note of caution for the French data - not sure we should go into the detail about young women for example as this is certainly the result of a small group
of people (e.g., maybe a hundred? - as the total sample was 1000, 50% men and distributed across a number of age groups) because of the crossing of gender and age - the other groups are larger and are more valid I think --> 
<!--possibly w eshould devote a separate paragraph to gender differences? the men-women difference does not quite fit well in the paragraph above -->


=> Factors like price of vaccine, access to medical care, location of vaccination, possibility of unpaid leave to get vaccinated etc. need to be taken into account in order to facilitate access and avoid community mistrust [APA - Building Community Trust]. These obstacles have to be overcome through careful, fair and transparent organization of the vaccine allocation, as these groups have already suffered disproportionately from COVID-19. [NASEM Framework] [Priority groups for coronavirus (COVID-19) vaccination] (Link to wiki: Equitable allocation of COVID-19 vaccine)
•	Related to the previous point, a lot of people who are generally hesitant towards vaccines might not be conscious hardcore deniers but instead be confused due to low education, health risks illiteracy or relying on misinformation. [REF] For example, ethnic minorities and conservatives are also more likely to believe in conspiracy theory type of misinformation than the White majority or people who vote for other parties [DOI: 10.1002/acp.3442] . <!--we found this trend as well in [REF: Juanchich2020] in our UK data across two studies but we did not focus on the ethnic differences in the analyses we report in the ms, so not sure we can cite oit here -  we share the data on the OSF so we could refer to taht if people would be interested in exploring this further--> 


=> This can be tackled by building trust via transparent reporting of vaccine resuts and development process and with the use of appropriate materials that facilitate comprehension of statistics [Fischhoff, Brewer, & Downs, 2011; Gigerenzer, 2015]. Research has shown for example that many people misinterpret the meaning of being at higher risk from COVID-19 [REF: Liu-Holford, 2020] or how to interpret the infamous epidemic curve of daily cases compared to the cumulative trends [REF]. The COVID-19 Health Literacy Project is a US based group of experts that shares information on how to improve people's understanding  of COVID-19 statisticcs, see here: [REF: https://covid19healthliteracyproject.com/]  <!-- interesting: A US-based national coalition of medical and health students, called the COVID-19 Health Literacy Project [42], was recently launched in response to citizen and patient needs for reliable and easy-to-understand information.-->


•	Some people (usually young, healthy individuals) believe they are not really in danger of COVID-19. 
=> This belief can be answered by explaining the long-term neurological effects that have been observed in young and otherwise healthy people [DOI: 10.1016/S1474-4422(20)30272-6][DOI: 10.2139/ssrn.3589350] (Link to wiki: I am not in danger of COVID-19, or am I?). 
Secondly, the altruistic nature of vaccination should be highlighted: even if someone is not in danger of getting sick, they could get others sick. We should get the vaccine in order to protect our loved ones who may belong to high-risk groups [REF: ]. The strategy has proved effective in promoting social distancing for example and altrusim was related to greater adherence to restrictions [REF:]  <!-- ‘Our’ vs. ‘Your’: Subtle Variations in Pronoun Usage Can Influence the Effectiveness of Social Distancing Messages during the COVID-19 Pandemic" this paper is about to be published but is not yet - I reviewed it --> 

•	Some countries have witnessed sham vaccination campaigns run by the CIA, contributing to political instability [@Reardon11; @Lenzer11 ].
For each person / group / community, one or more of these factors may be leading them to hesitancy. This means that we should tailor the message for each recipient / audience accordingly [APA welcomes].

Another important note is that vaccine hesitancy does not necessarily lead to rejection of vaccine uptake [DOI: 10.4161/hv.24657], as a lot of individuals may still remain skeptic about a vaccine even after having it.





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