The reluctance of the COVID-19 vaccine within the UK varies considerably between inhabitants subgroups

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Researchers examining attitudes towards vaccination against the severe coronavirus 2 (SARS-CoV-2) acute respiratory syndrome in the UK population found that most people overall were willing to accept a vaccine.

The SARS-CoV-2 virus is the causative agent of the current 2019 coronavirus disease (COVID-19) pandemic, which continues to pose a significant threat to global public health and the global economy.

The study also found that certain subsets of the population are unlikely to accept a vaccine (vaccine reluctance), which has important implications for public health policy, the team said.

Analysis of the nationally representative survey data found that 82% of participants are likely to accept a vaccine. However, women, younger people, and those with a lower level of education were more likely to be hesitant about vaccines.

Certain ethnic groups, particularly blacks, Pakistani and Bangladeshis, were also more reluctant to vaccinate.

The team – from the University of Glasgow, the University of Essex, Public Health Scotland and Ipsos MORI UK Ltd – say the main reason the vaccine was hesitant was concerns about unknown future effects.

Given the UK is currently rolling out a vaccination program, these results have important implications for the steps that need to be taken to increase intake, say the researchers.

"Herd immunity can be achieved through vaccination in the UK, but a focus on specific ethnic minorities and socio-economic groups is required to ensure an equitable vaccination program," writes Michaela Benzeval (University of Essex) and colleagues.

A pre-print version of the paper is available on the medRxiv * server while the article is being peer-reviewed.

Having a safe and effective vaccine is critical to controlling COVID-19

Widespread delivery of an effective and safe vaccine against SARS-COV-2 is critical to bringing the COVID-19 pandemic under control, but vaccine hesitation could undermine such efforts.

Ideally, the proportion of the vaccinated population would be large enough that those who do not remain vaccinated can also be protected (known as herd immunity).

Understanding whether some subgroups are more likely to accept or reject a vaccine is critical to developing successful vaccination strategies to achieve herd immunity.

Reasons for vaccine hesitation, willingness to vaccinate and factors that would induce people to take a vaccine (weighted proportions with 95% CI bars)

Reasons for vaccine hesitation, willingness to vaccinate and factors that would induce people to take a vaccine (weighted proportions with 95% CI bars)

What did the researchers do?

From November 24 to December 1, 2020, nationally representative data were collected for 12,035 people who participated in wave 6 of the COVID-19 web survey “Understanding Society”.

Participants were asked how likely or unlikely they were to receive a vaccine and why.

"The four countries in the UK are currently running a vaccination program starting with those most at risk of COVID-19," the team writes. "The results reported here provide evidence of the groups that need to be targeted and arguments that might be most compelling to them."

The hesitation varied significantly between the subgroups

Overall, the intention to be vaccinated was high. 82% of respondents said they were likely (28.5%) or very likely (53.5%) to receive a vaccine. However, 18% said they were unlikely or very unlikely to receive the vaccine.

The intentions to be vaccinated varied greatly between population subgroups.

A higher proportion of women reported vaccination delay than men at 21.0% versus 14.7%, and a higher proportion of younger age groups reported vaccination reluctance compared to older age groups.

For 16- to 24-year-olds and 25-24 year olds, vaccine reluctance was 26.5% and 28.3%, respectively. This compared with 14.3% in the 55 to 64 year olds, 8.1% in the 65 to 74 year olds and only 4.5% in the 75 year olds or older.

"Older age and masculinity are the top drivers of risk of death from COVID-19. They are less likely to be reluctant to vaccinate, suggesting that the UK vaccination program could bring great health benefits," said Benzeval and the team.

Reluctance to vaccinate also varied widely by ethnicity, with Black (71.8%) and Pakistan / Bangladesh (42.3%) being the most reluctant, followed by mixed ethnicity (32.4%) and non-British / Irish whites (26.4%). .

People with lower levels of education were also more likely to be hesitant about vaccines. Of the graduates, 13.2% said they were vaccine reluctant, compared with 24.6% of those with GCSE and 18% of those with no qualifications.

Overall, the main reason for hesitation was concerns about unknown future side effects of a vaccine, with 42.7% citing this as the reason.

The main reasons for willingness to get vaccinated were not to get infected with the virus or to get very sick (54.6%) and to get social and family life back to normal (12.5%).

The study also found that knowing that a vaccine was effective and safe were the main factors that would encourage vaccine uptake.

What are the effects of the study?

"Our study has important practical implications for health policy," the team writes.

The risk of vaccine reluctance varies significantly between ethnic minorities in the UK, with Black, Pakistani and Bangladeshi groups being particularly likely to be vaccine reluctant, the researchers say.

"People with lower levels of education were also more likely to be hesitant about vaccines," they add.

Benzeval and colleagues say vaccine hesitation is a complex problem and that a number of practical steps need to be taken to increase intake.

"The sub-groups we have identified as vaccine reluctant should be included in the planning and development of engagement programs," they conclude.

* Important NOTE

medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be considered conclusive, guide clinical practice / health-related behavior, or treated as established information.