Impact of COVID-19 and intensive care unit capacity on vaccination support: Evidence from a two-leg representative survey in the United Kingdom

Abstract

Background: Overcoming coronavirus disease (COVID-19) will likely require mass vaccination. With vaccination scepticism rising in many countries, assessing the willingness to vaccinate against COVID-19 is of crucial global health importance.

Objective: The goal of this study was to examine how personal and family COVID-19 risk and ICU (intensive care unit) availability just before the pandemics influence the acceptance of future COVID-19 vaccines.

Methods: A two-leg survey was carried out for comparing vaccination attitudes pre-and post-COVID-19. UK residents were surveyed in October 2019 about their vaccination attitudes, and again in a follow-up survey in April 2020, containing the previous questions and further ones related to COVID-19 exposure and COVID-19 vaccine attitudes. The study combined survey results with local COVID-19 incidence and pre-COVID-19 measures of ICU capacity and occupancy. Regression analysis of the impact of individual and public health factors on attitudes towards COVID-19 vaccination was performed.

Results: The October 2019 survey included a nationally representative sample of 1653 UK residents. All of them were invited for the follow-up survey in April 2020, and 1194 (72%) participated. The April 2020 sample remained nationally representative. Overall, 85% of respondents (and 55% of vaccine sceptics) would be willing to be vaccinated against COVID-19. Higher personal and family risk for COVID-19 was associated with stronger COVID-19 vaccination willingness, whereas low pre-COVID-19 ICU availability was associated with lower trust in medical experts and lower COVID-19 vaccine support. Further, general vaccination support has risen during the COVID-19 pandemic.

Conclusion: Support for COVID-19 vaccination is high amongst all groups, even vaccine sceptics, boding well for future vaccination take-up rates. Vaccination willingness is correlated with health care availability during the COVID-19 crisis, suggesting a powerful synergy between health care system performance during crisis and the general population's trust in the medical profession - as reflected in vaccination support.

Keywords: COVID-19; Intensive care unit (ICU) capacity; Trust in medical experts; Vaccination hesitancy; Vaccine; Vaccine scepticism.

Fig. 1

COVID-19 vaccine acceptance and general vaccine attitudes. Notes: The figure shows responses to the question: “If a vaccine against COVID-19 became available for everyone tomorrow, do you think you would or would not get vaccinated?” The bar on the left reports the breakdown for all respondents of the April 2020 survey (N = 1194). The other 3 columns report the breakdown for three categories of respondents: “no vax” (N = 148), “hesitants” (N = 431) and “pro vac” (N = 615). We assign respondents to one of these categories using ther answers to the question on general vaccination attitudes. See Section S.2 in the Supplementary Materials for details on the construction of these categories.

Fig. 2

ICU availability, perceived risk and unwillingness to get vaccinated against COVID-19. Notes: Resistance to vaccinate against COVID-19 is from the question: “If a vaccine against COVID-19 became available for everyone tomorrow, do you think you would or would not get vaccinated?” Respondents who would not vaccinate “definitely” and “probably” are coded as resistant. Panel A: unconditional binscatter of February 2020 ICU beds occupancy rate (x-axis) and resistance to COVID-19 vaccine (y-axis). From the full sample of respondents living in England we create 20 bins of roughly equal sample size; the last 2 bins have no variation in occupancy rate (100%) and are combined into a single data point. Panel C: unconditional binscatter of February 2020 ICU beds per 1000 people (x-axis) and resistance to COVID-19 vaccine (y-axis). From the full sample of respondents living in England we create 20 bins of roughly equal sample size; some 30% of respondents live in a local authority without a NHS Trust: these bins are combined into a single data point. Panel E: share of respondents showing resistance to COVID-19 vaccine among those who state that COVID-19 does not poses a major risk to anyone in the household (left bar) and those who state that it does (right bar). The whiskers show the standard errors of the estimates. Panel B, D and F: OLS estimates and 95% confidence intervals from. COVID-19 Vax Resistance_i = β₀ + β₁ OR_i + β₂ ICU_i + β₃ CoV19 Risk_i + β_X X_i + u_i Where COVID-19 Vax Resistance = 1 if respondent states that he would “definitely” or “probably” not vaccinate against COVID-19, and the other variables are defined in the footnote of Table 2. Panel B: estimates of β₁. Panel D: estimates of β₂. Panel F: estimates of β₃. The specification with baseline covariates includes an indicator for whether the respondent knows someone infected with COVID-19. The specification with all covariates includes all explanatory variables in col. 4 of Table 2. “Full sample” includes all respondents living in England. The other three samples report estimates from three regressions estimated on the three samples: “no vax,” “hesitants,” and “pro vac.” Respondents are assigned to one of these categories using their answers to a question on general vaccination attitudes. See Section S.2 in the Supplementary Materials for details on the construction of these categories. Standard errors are clustered at the level of the local authority (269 clusters).