Exploratory study of the global intent to accept COVID-19 vaccinations

Abstract

Background: As the world begins the rollout of multiple COVID-19 vaccines, pandemic exit strategies hinge on widespread acceptance of these vaccines. In this study, we perform a large-scale global exploratory study to examine the levels of COVID-19 vaccine acceptance and explore sociodemographic determinants of acceptance.

Methods: Between October 31, 2020 and December 15, 2020, 26,759 individuals were surveyed across 32 countries via nationally representative survey designs. Bayesian methods are used to estimate COVID-19 vaccination acceptance and explore the sociodemographic determinants of uptake, as well as the link between self-reported health and faith in the government's handling of the pandemic and acceptance.

Results: Here we show that intent to accept a COVID-19 vaccine is low in Lebanon, France, Croatia, and Serbia and there is population-level polarisation in acceptance in Poland and Pakistan. Averaged across all countries, being male, over 65, having a high level of education, and believing that the government is handling the pandemic well are associated with increased stated acceptance, but there are country-specific deviations. A belief that the government is handling the pandemic well in Brazil and the United States is associated with lower vaccination intent. In the United Kingdom, we find that approval of the first COVID-19 vaccine in December 2020 did not appear to have an impact on the UK's vaccine acceptance, though as rollout has continued into 2021, the UK's uptake exceeds stated intent in large-scale surveys conducted before rollout.

Conclusions: Identifying factors that may modulate uptake of novel COVID-19 vaccines can inform effective immunisation programmes and policies. Differential stated intent to accept vaccines between socio-demographic groups may yield insights into the specific causes of low confidence and may suggest and inform targeted communication policies to boost confidence.

Keywords: Epidemiology; Infectious diseases.

Fig. 1. Global trends in intent to accept a COVID-19 vaccine.

A Ranking of countries by intent to accept a COVID-19 vaccine, with both positive responses (“definitely will get vaccinated” and “unsure, but probably will get vaccinated”) grouped. Error bars denote posterior 95% highest posterior-density intervals. B Ranking of countries by the percentage of respondents reporting that they will “definitely” not accept a COVID-19 vaccine, with all survey-response possibilities shown. C For each country, the percentage of respondents who would “definitely” vaccinate is shown against the percentage who would “definitely not” vaccinate, thus revealing countries that are polarised in their acceptance of a COVID-19 vaccine. (The diagonal line is y = x and thus shows the line on which as many respondents would definitely accept the vaccine as would not.) Please see supplementary data 1 for all raw counts to vaccination intent.

Fig. 2. Determinants of intent to accept a COVID-19 vaccine.

A The fixed-effect parameters (coloured: reds denote a negative log odds ratio, while blues denote a positive log odds ratio) with 95% highest posterior-density intervals (HPDI; black horizontal bars) from the intercepts-as-outcomes model (see Methods), which represents an “average” of the effects across all 32 countries (greyed). For each parameter, odds ratios and 95% HPDIs are shown (right panel). The left panel denotes the covariate group with the baseline group shown in parentheses. B Random-effect parameters (coloured: reds denote a negative log odds ratio, while blues denote a positive log odds ratio) from the intercepts-as-outcomes model. Only parameters whose 95% HPDIs exclude zero are shown (these points are therefore a subset of the greyed points in A). (The left panel again shows the covariate group with the baseline in parentheses. Note that not all covariates from (A) are shown as some do not contain random-effect parameters for which the 95% HPDI excludes zero.) Countries are labelled with a two-letter abbreviation. Due to crowding of labels, not all data points have labels: the reader should consult supplementary data 1 and 2 for all model parameters.

Fig. 3. Comparison of intent to accept a COVID-19 vaccine in this study to previous global and national surveys.

A A comparison between overall intent to accept a COVID-19 vaccine in this study (“probably or definitely”) versus agreement to “you would accept a [COVID-19] vaccine if it were recommended by your employer and was approved safe and effective by the government” (see Methods for further details). B A comparison between intent to accept a COVID-19 vaccine in the United Kingdom before (Lazarus; de Figueiredo) and after (this study) both emergency use authorisation by the UK Medicines and Healthcare Products Regulatory Agency on 2 December 2020 and the first vaccination on 8 December 2020 (error bars denote 95% highest posterior-density intervals).