Public acceptance of COVID-19 vaccines: cross-national evidence on levels and individual-level predictors using observational data

Abstract

Objectives: The management of the COVID-19 pandemic hinges on the approval of safe and effective vaccines but, equally importantly, on high vaccine acceptance among people. To facilitate vaccine acceptance via effective health communication, it is key to understand levels of vaccine scepticism and the demographic, psychological and political predictors. To this end, we examine the levels and predictors of acceptance of an approved COVID-19 vaccine.

Design, setting and participants: We examine the levels and predictors of acceptance of an approved COVID-19 vaccine in large online surveys from eight Western democracies that differ in terms of the severity of the pandemic and their response: Denmark, France, Germany, Hungary, Sweden, Italy, UK and USA (total N=18 231). Survey respondents were quota sampled to match the population margins on age, gender and geographical location for each country. The study was conducted from September 2020 to February 2021, allowing us to assess changes in acceptance and predictors as COVID-19 vaccine programmes were rolled out.

Outcome measure: The outcome of the study is self-reported acceptance of a COVID-19 vaccine approved and recommended by health authorities.

Results: The data reveal large variations in vaccine acceptance that ranges from 83% in Denmark to 47% in France and Hungary. Lack of vaccine acceptance is associated with lack of trust in authorities and scientists, conspiratorial thinking and a lack of concern about COVID-19.

Conclusion: Most national levels of vaccine acceptance fall below estimates of the required threshold for herd immunity. The results emphasise the long-term importance of building trust in preparations for health emergencies such as the current pandemic. For health communication, the results emphasise the importance of focusing on personal consequences of infections and debunking of myths to guide communication strategies.

Keywords: COVID-19; epidemiology; public health.

Figure 1

Development in vaccine acceptance for an approved COVID-19 vaccine. Note: N=18 231. The figure illustrates the development in vaccine acceptance across countries. Vaccine acceptance is defined here as the proportion who answers ‘somewhat agree’ or ‘completely agree’ to the question ‘If the health authorities advise people like me to get an approved vaccine against the coronavirus, I will follow their advice’.

Figure 2

Individual-level correlations of vaccine acceptance. N=18 231. Black circles are the estimated correlations based on models I and II in online supplemental appendix table A4. Model II (the full model) includes control for country dummies. Horizontal bars are the associated 95% CIs.

Figure 3

Macro-level correlations of vaccine acceptance. The figure plots country averages for vaccine acceptance and country averages for four measures: trust in health authorities, egotropic concern related to COVID-19, endorsement of COVID-19 conspiracy beliefs and the degree of changed behaviour to avoid spreading infections during the COVID-19 pandemic. Reported correlations are Pearson’s r.