key: cord-0909267-xh5adkog
authors: Seale, H.; Heywood, A. E.; Leask, J.; Sheel, M.; Durrheim, D. N.; Bolsewicz, K.; Kaur, R.
title: Examining Australian public perceptions and behaviors towards a future COVID-19 vaccine
date: 2020-09-30
journal: nan
DOI: 10.1101/2020.09.29.20204396
sha: 47fb132a28d1896af3a9b55e00777a51ce136672
doc_id: 909267
cord_uid: xh5adkog

Background: There is an indication that vaccine(s) for COVID-19 could be available by early 2021. As immunisation program launches have previously demonstrated, it is essential that careful planning occurs now to ensure the readiness of the public for a COVID-19 vaccine. As part of that process, this study aimed to understand the public perceptions regarding a future COVID-19 vaccine in Australia. Methods: A national cross-sectional online survey of 1420 Australian adults (18 years and older) was undertaken between 18 and 24 March 2020. The statistical analysis of the data included univariate and multivariate logistic regression analysis. Results: Participants generally held positive views towards vaccination. Eighty percent (n=1143) agreed with the statement that getting myself vaccinated for COVID-19 would be a good way to protect myself against infection. Females (614, 83%) were more likely to agree with the statement than males (529, 78%) (aOR=1.4 (95% CI: 1.1-1.8); P=0.029), while 90.9% aged 70 and above agreed compared to 76.6% aged 18-29 year old (aOR=2.3 (95% CI:1.2-4.1); 0.008). Agreement was also higher for those with a self-reported chronic disease (aOR=1.4 (95% CI: 1.1-2.0); P=0.043) and among those who held private health insurance (aOR=1.7 (95% CI: 1.3-2.3); P<0.001). Beyond individual perceptions, 78% stated that their decision to vaccinate would be supported by family and friends Conclusion: This study presents an early indication of public perceptions towards a future COVID-19 vaccine and represents a starting point for mapping vaccine perceptions. To support an effective launch of these new vaccines, governments need to use this time to understand the communities concerns and to identify the strategies that will support engagement.

BACKGROUND 56 Finding safe and effective vaccine candidates to control the spread of SARS-CoV-2 (COVID-57 19) is an urgent public health priority. There are an unprecedented number of agencies 58 (including biotechnology companies, universities, military researchers, and pharmaceutical 59 companies) aiming to identify and develop a vaccine candidate at a speed and scale not 60 previously seen [1, 2] . While a smaller number of entities have already launched clinical 61 trials, it is suggested that a COVID-19 vaccine will take 12 to 18 months to develop and 62 manufacture at scale, and may be ready by early 2021 [3] . 63 To ensure community readiness, it is essential that governments determine levels of demand 64 and acceptance of the COVID-19 vaccine to ensure the readiness of both the public and poor, very poor). Due to the uncertainty around vaccine development at the time of the survey, participants were not directly asked whether they would receive a vaccine but rather 104 whether they thought a COVID-19 vaccine would be a good way to protect against infection. 105 Descriptive statistical statistics were reported for sample demographics. Mean scores and 106 standard deviations of the risk perception score and the vaccine acceptance response were 107 calculated by demographic characteristic. Univariate associations were ascertained with each 108 demographic variable and the outcome variable, vaccine acceptance. The risk perception 109 score of those who would accept the vaccine was compared to those who would not using an 

The demographic characteristics of the 1420 respondents by their risk perception and stated 117 vaccine acceptance are presented in Table 1 . In summary, 681 (48%) were male, 829 (58%) 118 were in some form of employment, 363 (25%) had a chronic health condition, while 830 119 (58%) had private health insurance. Participants generally held positive views towards 120 vaccination, with 1188 (83%) agreeing with the statement that 'vaccines are effective at 121 preventing diseases', while 305 (21%) indicated that 'diseases provide better immunity than 122 vaccines do'. Among all respondents, 88% (n=1252) had heard that a COVID-19 vaccine was 123 being developed. Of those who were not aware, 129/168 (76%) were aged under 50 years 124 (lowest awareness levels were in the youngest age group i.e. 18-29 years (n=62/168, 36.9%)). is the author/funder, who has granted medRxiv a license to display the preprint in (which was not certified by peer review) preprint

The copyright holder for this this version posted September 30, 2020 . . https://doi.org/10.1101 /2020 Eighty percent (n=1143) agreed with the statement that getting myself vaccinated for COVID-128 19 would be a good way to protect myself against infection, while a further 194 (13%) were 129 uncertain, leaving 83 (5.8%) to disagree with the sentiment ( is the author/funder, who has granted medRxiv a license to display the preprint in (which was not certified by peer review) preprint

The copyright holder for this this version posted September 30, 2020 . . https://doi.org/10.1101 /2020 private health insurance (P=0.01) and those with chronic health conditions (P=?) perceived 152 their mean risk score higher than those without.

There was variation in the proportion of people who agreed that getting vaccinated against 154 COVID-19 would be a good way to protect myself against infection by demographic 155 characteristics. These differences were significant for gender, Indigenous status, educational 156 attainment, private health insurance, international travel in 2020 and self-reported chronic 157 health condition (Table 3) . Overall, 83% of females agreed with the statement compared to 158 78% of males (aOR=1.4 (95% CI: 1.1-1.8); P=0.029. Those above 70 years of age (90.9%) 159 compared to those between 18-29 years of age (76.6%) reported higher level of agreement 160 (aOR=2.3 (95% CI 1.2-4.1); P=0.008) Agreement was also higher for those who self-reported 161 having a chronic disease (aOR=1.4 (95% CI: 1.1-2.0); P=0.043) and who had private health 162 insurance (aOR=1.7 (95% CI: 1.3-2.3); P<0.001) ( Table 3) .

The survey was conducted in March 2020, at a time when the first wave of COVID-19 cases 165 was increasing in Australia, there was intense media coverage and community members were 166 being encouraged to adopt hygiene and physical distancing strategies. At that point, there was 167 no lockdown enforced in Australia. From our survey, we found that 80% agreed that is the author/funder, who has granted medRxiv a license to display the preprint in (which was not certified by peer review) preprint

The copyright holder for this this version posted September 30, 2020. . https://doi.org/10.1101/2020.09.29.20204396 doi: medRxiv preprint UK) [12] . The difference in acceptance rate documented in this study may be due to a single or combination of factor(s) including: (1) the variation in the wording of the question; (2) 177 high level of confidence and trust in the Australian government [6] or (3) due to concerns 178 about increasing local transmission which were high at the time. However, our results align 179 with other Australian studies, which have reported willingness levels between 76% to 86% 180 [13, 14] . Both studies collected the data in April 2020.

It has been well documented that the same psychological factors that influence acceptance of is the author/funder, who has granted medRxiv a license to display the preprint in (which was not certified by peer review) preprint

The copyright holder for this this version posted September 30, 2020. . https://doi.org/10.1101/2020.09.29.20204396 doi: medRxiv preprint encourages vaccination; and (2) anticipated regret of not getting the COVID-19 vaccine, as a 201 person is unable to travel abroad to visit friends and relatives (hypothetical situation of 202 COVID-19 vaccination operating in the same manner as yellow fever vaccination), which 203 encourage vaccination.

To translate early willingness into actual vaccine receipt, we will need to draw on key 205 behavioural insights from past studies. For example, a recommendation from a healthcare 206 provider is a key driver of routine immunisation uptake [23] [24] [25] [26] . Amongst our participants, 207 the majority agreed that they follow the advice of their healthcare professionals. To support 208 this action, there is a need to equip healthcare professionals with the understanding about the 209 COVID-19 vaccine (including how it was developed, safety profiles), the skills to take a 210 presumptive approach to recommending the vaccine and the confidence to answer questions.

For example, there may be a need to support peoples understanding around the rational for 212 receiving the COVID-19 vaccine, especially amongst those who believe that they may have 213 been already infected during the pandemic. Around a quarter of our participants agreed with 214 the statement that 'diseases provide better immunity than vaccines do', while a further 40% 215 were neutral about the statement. Health professionals will have a strong impact on uptake 216 since they both recommend, and in this case, are likely to be the first eligible for the vaccine. is the author/funder, who has granted medRxiv a license to display the preprint in (which was not certified by peer review) preprint

The copyright holder for this this version posted September 30, 2020. is the author/funder, who has granted medRxiv a license to display the preprint in (which was not certified by peer review) preprint

The copyright holder for this this version posted September 30, 2020. is the author/funder, who has granted medRxiv a license to display the preprint in (which was not certified by peer review) preprint

The copyright holder for this this version posted September 30, 2020 . . https://doi.org/10.1101 /2020 The strengths of our study include a large, representative cross-section of the adult Australian 275 population. However, the work is subject to several limitations including that we recruited a 276 convenience sample of participants. People who could not communicate in English were 277 excluded from the sample, which may have affected representation of ethnic minorities. We is the author/funder, who has granted medRxiv a license to display the preprint in (which was not certified by peer review) preprint

The copyright holder for this this version posted September 30, 2020. is the author/funder, who has granted medRxiv a license to display the preprint in (which was not certified by peer review) preprint

The copyright holder for this this version posted September 30, 2020 . . https://doi.org/10.1101 /2020 is the author/funder, who has granted medRxiv a license to display the preprint in (which was not certified by peer review) preprint

The copyright holder for this this version posted September 30, 2020. . is the author/funder, who has granted medRxiv a license to display the preprint in (which was not certified by peer review) preprint

The copyright holder for this this version posted September 30, 2020. . is the author/funder, who has granted medRxiv a license to display the preprint in (which was not certified by peer review) preprint

The copyright holder for this this version posted September 30, 2020. . is the author/funder, who has granted medRxiv a license to display the preprint in (which was not certified by peer review) preprint

The copyright holder for this this version posted September 30, 2020. . CC-BY-NC-ND 4.0 International license It is made available under a perpetuity.

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The copyright holder for this this version posted September 30, 2020. . https://doi.org/10. 1101 /2020 

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