Vaccines work, are safe and can save your life
Why not protect yourself against preventable disease?
By Lancet
Edited by Sadie Harley, reviewed by Robert Egan
The study, led by researchers from Imperial College London,
found that of the participants initially hesitant about getting a COVID-19
vaccine, 65% went on to get vaccinated at least once.
The findings offer a novel perspective on the main types of
vaccine hesitancy during the COVID-19 pandemic. Their potential to be reversed
may help inform the targeting and messaging for future roll-outs of novel
vaccines.
While vaccine hesitancy is not a new phenomenon, with WHO naming
vaccine hesitancy as one of the top 10 global health threats in 2019, reduced
uptake of various vaccines, including childhood vaccinations against measles
and pertussis (whooping cough), remains a major public health concern.
COVID-19 vaccination roll-out began in the UK on 8th
December 2020, with a phased strategy that prioritized vaccines on the basis of
age and clinical need.
"We wanted to look at COVID-19 vaccine hesitancy in
more depth to identify groups with more persistent forms of hesitancy and their
main concerns. Understanding these drivers is critical to address vaccine
uptake and better control disease spread," explained lead author Professor
Marc Chadeau-Hyam from Imperial College London, UK.
Researchers analyzed longitudinal survey data from 1.1 million adults (aged 18 and older, 57% female) from the Real-time Assessment of Community Transmission (REACT) Study (at the time of the initial COVID-19 vaccine roll-out between January 2021 and March 2022). They compared vaccine attitudes at enrollment with subsequent vaccination uptake from National Health Service (NHS) vaccination records up to May 7, 2024, to identify categories and drivers of vaccine hesitancy.
During the pandemic, participants were asked whether they
had been or intended to get vaccinated. Those who refused the vaccine, or were
skeptical about vaccination, were asked about their reasons for hesitancy from
a checklist of 23 options as well as a free text option.
Vaccine effectiveness and health effects key reasons for
hesitancy
Overall, 3.3% (37,982 of 1.1 million) of participants
reported some degree of COVID-19 vaccine hesitancy and subsequent vaccination
data were available through NHS records linkage for 24,229 (64%) of them.
Hesitancy rates declined over time from an initial high of
8% of those surveyed in January 2021, to a low of 1.1% at the start of 2022.
There was a small uptick in hesitancy to over 2.2% in February and March 2022
during the omicron wave.
The researchers identified eight categories of vaccine
hesitancy, including concerns about effectiveness and side effects, perception
of low risk from COVID-19 and mistrust of vaccine developers, and fear of
vaccines and reactions.
Among the hesitant who provided a reason for hesitancy, 41%
(12,498 of 30,701) reported concerns around long-term health effects, 39%
(11,953) that they wanted to wait to see whether the vaccine worked, and 37%
(11,287) that they had concerns about side effects.
Reasons for hesitancy varied across demographic groups,
with, for example, men more likely than women to report not feeling COVID-19
was a personal risk (18% vs. 10%); women more likely to be worried about
fertility-related consequences (21% vs. 8%), while those aged 74 years or older
were more likely to be against vaccines in general compared with 18–24 year
olds (12% vs. 2.5%).
The analysis of subsequent vaccination behavior found that
the likelihood of remaining
unvaccinated was higher for older people, women, people of Black
ethnicity, people who were unemployed or living in deprived areas, those with a
history of COVID-19, and people with a lower level of education.
Majority of vaccine-hesitant individuals got vaccinated
People who reported the most common reasons for hesitancy
(i.e., those related to vaccine efficacy or health concerns), were most likely
to change their mind and subsequently get vaccinated against COVID-19.
In contrast, people expressing hesitancy relating to lack
of trust, perception of low personal risk, and general anti-vaccine
sentiment were two to three-times less likely to get vaccinated compared to
those who did not report these reasons.
"We show that certain types of vaccine hesitancy are
more readily addressed than others, for example, concerns relating to pregnancy
or breastfeeding," said co-author Professor Helen Ward from Imperial
College London and the National Institute for Health and Care Research Imperial
Biomedical Research Center, UK.
"Our study suggests that as the vaccine was rolled out,
public confidence increased and the original vaccine skepticism was largely
overcome."
According to co-author Professor Paul Elliott from Imperial
College London, "What we learned from the COVID-19 experience is the
importance of ensuring that people have access to reliable and trusted
information so they can make well-informed decisions about their personal
health choices.
"Reliable, easy-to-understand information, for example,
on vaccine effectiveness and potential risks, is of particular importance in
the case of a public health emergency such as COVID-19, which involved the
rapid deployment at-scale of new vaccine technologies."
The authors acknowledge some limitations of the study,
including that NHS vaccine records and self-reported vaccine status showed some
inconsistencies, likely reflecting both imperfect recall and imperfect coverage
in the NHS data. Additionally, vaccine hesitant respondents were less likely to
consent to NHS record linkage, potentially introducing selection bias, which
may limit the generalizability of the findings.
Writing in a linked Comment, Professor Silvio Tafuri from
the University of Bari Aldo Moro, Bari, Italy (who was not involved with the
study) underscored the "valuable contribution" of the study and
concluded, "whereas these data reflect the extraordinary setting of
SARS-CoV-2 vaccination, it is crucial to ascertain whether similar drivers
of hesitancy affect ordinary (ie, routine or seasonal) vaccinations,
in order to guide context-specific public health interventions at the micro,
meso, and macro levels."
Publication details
Profiling vaccine attitudes and subsequent uptake in 1·1
million people in England: a nationwide cohort study, The Lancet (2026). DOI:
10.1016/S0140-6736(25)01912-9
Journal information: The Lancet
