key: cord-0804517-q2t9z0h5
authors: Kessels, Roselinde; Luyten, Jeroen; Tubeuf, Sandy
title: Willingness to get vaccinated against Covid-19 and attitudes towards vaccination in general
date: 2021-05-26
journal: Vaccine
DOI: 10.1016/j.vaccine.2021.05.069
sha: 91ec5316d6a31b45d383fa8c83eac82deadf0c50
doc_id: 804517
cord_uid: q2t9z0h5

BACKGROUND: High uptake of Covid-19 vaccination is required to reach herd immunity. METHODS: A representative sample of 2,060 Belgians were surveyed in October 2020. Regression analyses identified the predictors associated with willingness to get vaccinated against Covid-19, and attitudes toward vaccination in general. RESULTS: 34% of the participants reported that they will definitely get vaccinated against Covid-19 and 39% that they would “probably”. Intended uptake was strongly associated with age, opinion on the government’s dealing with the Covid-19 pandemic, medical risk, spoken language, gender, and to a lesser extent with having known someone who was hospitalised because of Covid-19. Similar predictors were identified for attitudes to vaccination in general. Covid-19 vaccine hesitancy was more marked in age groups below 54 years old. We further analysed a sample of 17% (N=349) found favourable to vaccination in general but not willing to vaccinate against Covid-19. They were mainly female, young, French speaking, slightly less educated, working, and did not belong to a Covid-19 risk group. They were very dissatisfied with the government’s dealing with the pandemic, and did not know someone who was hospitalised because of Covid-19. CONCLUSIONS: Vaccine hesitancy is higher for Covid-19 vaccines than for other vaccines. The part of the population being convinced of the utility of vaccination in general but hesitant about the Covid-19 vaccine is a primary interest group for tailored communication campaigns in order to reach the vaccine coverage needed for herd immunity.

vaccine is a primary interest group for tailored communication campaigns in order to reach the vaccine 2 coverage needed for herd immunity. After months of a global public health crisis that has paralyzed our societies, safe and effective 10 vaccines that protect against Covid-19 are becoming available (1, 2). The next crucial challenge will 11 be to deploy these vaccines with sufficiently high vaccination coverage rates in the population so that 12 thresholds required for herd immunity can be reached. For vaccine efficacies of approximately 80%, it 13 has been estimated that herd immunity requires that minimally 60% but possibly up to 90% of the 14 population become vaccinated (3, 4). Herd immunity will not just be a bonus that comes on top of 15 individual vaccine protection; it will be an essential layer of Covid-19 prevention on which many 16 people will depend as it remains to be seen whether Covid-19 vaccines will be equally effective in all 17 individuals and whether some population subgroups won't be able to receive vaccination for medical 18 reasons.

To rapidly achieve herd immunity, mass vaccination will be required. However, apart from the logistic Health Organization (WHO) labelled vaccine hesitancy one of the top ten threats to global health in 2 2019, next to e.g. antimicrobial resistance or air pollution and climate change (9). In the context of the unreasonably fast (below a third of the median time to completion). This left us with a sample of 2,060 ** Our survey was carried out almost one month before the press release from Pfizer-BioNTech successfully completing their phase III trials for a Covid-19 vaccine (November 9 2020). † † The research company has a pool of 252,597 volunteers, from which it selected a standard panel of 5,500 individuals who resemble the Belgian population as well as possible. The company evaluates their pool of participants continuously, systematically eliminates low-quality responders and participation is rewarded with bonus points that lead to vouchers to buy certain products or make donations. Online panels are second-best in comparison with population surveys with randomly drawn participants from a census. However, we checked how our survey sample compared to national Belgium data (see Appendix A) and found that our sample was representative of Belgians for most comparable characteristics but higher educated respondents were overrepresented.

1 responses, which fulfilled pre-determined Belgium quota for age, gender and province (Appendix A).

The main objective of the survey was to carry out an experiment to elicit individual preferences on 3 who should get vaccinated first in the population; the results of the experiment are reported elsewhere 4 (15). In this paper we focus on two specific questions about attitudes toward vaccination. Before 5 participants took the experiment, we asked them to answer the question "Would you say that 6 vaccination for infectious disease is… very useful, rather useful, rather useless, very useless". Then, at 7 the end of the experiment, we asked the question "Once there is a safe and effective Covid-19 vaccine, 8 will you get vaccinated?" and the four responses items were "definitely", "probably", "probably not",

"definitely not". The survey started by asking respondents for a range of sociodemographic 10 characteristics along with their attitudes toward the government's dealing with the corona crisis,

whether they had had Covid-19, whether someone they knew had had it, was hospitalised because of it 12 and had died because of it. Respondents were also asked whether their profession was among the 13 "essential professions" (i.e., those that were obliged to keep working during the first "lockdown" in

March/April 2020) and whether they considered themselves to be part of a risk group for Covid-19

15 and if so, which group they belonged to (old age, chronic illness, obesity, or other). Finally,

respondents were asked about whom should decide who gets the Covid-19 vaccine first (government,

scientists or the population) and whether they would choose to be vaccinated themselves once a 18 vaccine becomes available.

19 20

We considered willingness to get Covid-19 vaccinated as a binary variable grouping the answers

"definitely" against "probably", "probably not" and "definitely not". We determined the factors 23 significantly associated to this response using a multivariate logistic regression model with as 24 dependent variable whether an individual intends to become vaccinated or still doubts or refuses to 25 become vaccinated. We estimated adjusted and unadjusted odds ratios of willingness to be Covid-19

26 vaccinated using all the variables that showed significance (p<0.05) in a univariate analysis. We 1 repeated the same analysis for attitudes toward infectious disease vaccination grouping "very useful" 2 against "rather useful", "rather useless" and "very useless".

We then studied the sub-sample of people who exhibited a seemingly inconsistent opinion of being 4 pro vaccination in general but being unwilling to take the Covid-19 vaccine once available. We used 5 basic descriptive statistics and frequencies to describe all variables, comparing the full sample of 6 survey data with the smaller sample of inconsistent individuals. We used chi-square tests to indicate 7 significant differences in proportions between the two samples. We performed all analyses using the 8 JMP Pro 16 statistical software.

A total of N=2,060 surveys were completed and checked for quality based on respondents' answers to 12 several comment boxes. None were excluded. Overall, 34% (N=651) indicated that they would 13 "definitely" become vaccinated with a Covid-19 vaccine and 39% (N=742) stated that they would 14 "probably" become vaccinated with a Covid-19 vaccine, 18% (N=346) said "probably not" and 9%

(N=165) said "definitely not". The numbers of sceptical answers to Covid-19 vaccination were 16 substantially higher than the sceptical answers to the usefulness of vaccination in general. Whereas 17 73% stated to be willing to become vaccinated with the Covid-19 vaccine, 90% stated to think that 18 vaccination is useful to protect against infectious diseases. 49% (N=1002) stated that vaccination is 19 "very useful" and 41% (N=848) stated it to be "rather useful". 7% (N=153) said "rather useless" and 20 3% (N=57) said "very useless".

When carrying out univariate analyses, we found larger discrepancies in different age groups' 

While there were fewer Covid-19 vaccine sceptics in the older age groups (20% in 55-64 and 13.3% in 1 people above 65), these shares were still larger than the shares of people reporting vaccination in 2 general to be useless across any age groups.

3

The multivariate logistic regression analyses ( 

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