A Global Survey of Potential Acceptance of a COVID-19 Vaccine

"Unless and until the origins of...wide variation in willingness to accept a COVID-19 vaccine is better understood and addressed, differences in vaccine coverage between countries could potentially delay global control of the pandemic and the ensuing societal and economic recovery."

In many countries, vaccine hesitancy and misinformation present obstacles to achieving coverage and community immunity. According to the authors of this article, governments, public health officials, and advocacy groups must be prepared to address hesitancy and build vaccine literacy so that the public will accept immunisation when a COVID-19 vaccine becomes available. To assist in that effort, the article presents findings from a survey of the likelihood of vaccine acceptance from a global survey of potential acceptance of a COVID-19 vaccine.

From June 16-20 2020, the researchers surveyed 13,426 people in 19 countries that comprise around 55% of the global population. Of these, 71.5% of participants reported they would be very or somewhat likely to take a COVID-19 vaccine; differences in acceptance rates ranged from almost 90% (in China) to less than 55% (in Russia). When asked whether a participant would accept a vaccine if it were recommended by his or her employer and was approved safe and effective by the government, 61.4% said they would do so; China again had the highest proportion of positive responses, and Russia had the highest proportion of negative responses. Respondents reporting higher levels of trust in information from government sources were more likely to accept a vaccine and take their employer's advice to do so.

Countries where acceptance exceeded 80% tended to be Asian nations with strong trust in central governments (China, South Korea, and Singapore). The researchers also observed variation with age, income, and education level, with acceptance higher among older people and those with higher earnings and education levels. Perhaps surprisingly, those who were had fallen ill with COVID-19 or knew someone close to them who had were less likely to give a positive response.

Reflecting on the findings, the researchers suggest:

• Future vaccine communication strategies should consider the level of health, scientific, and general literacy in subpopulations, identify locally trusted sources of information, and go beyond simply pronouncing that vaccines are safe and effective.
• Strategies to build vaccine literacy and acceptance should directly address community-specific concerns or misconceptions, address historic issues breeding distrust, and be sensitive to religious or philosophical beliefs.
• In translating evidence about approaches for building confidence and reducing vaccine hesitancy in different contexts into large-scale vaccination campaigns, practitioners need to cultivate awareness of and attention to existing public perceptions and felt needs; engaging formal and informal opinion leaders within these communities will be key.
• Due to the crucial role that clear, credible, consistent, and culturally relevant communication by governmental officials plays in building public confidence in vaccine programmes, it is advisable to prepare spokespeople, such as the public and leaders of civic, religious, and fraternal organisations that are respected within various sectors of society and local communities, as well as the private sector, to play an active role in local engagement, accurate information, and technological support.
• In light of the fact that all respondents, regardless of nationality, reported they would be less likely to accept a COVID-19 vaccine if it were mandated by employers, the latter should focus on promoting voluntary acceptance.
• Relatedly, to avoid any suggestion of coercion, respected community-based groups and non-governmental organisations (NGOs) that are considered impartial, such as the Red Cross, could be galvanised to help build trust in a future COVID-19 vaccine. ("However, addressing vaccine hesitancy requires more than building trust. It is a multifactorial, complex and context-dependent endeavor that must be addressed simultaneously at global, national and sub-national levels.")

The researchers note that events which have occurred since the survey was conducted, such as pauses in COVID-19 vaccine trials and reports of political pressure for a COVID-19 vaccine approval, might have led to even higher levels of vaccine hesitancy. For example, subsequent national surveys in the United States (US) and elsewhere about vaccine acceptance have suggested an intensification of the vaccine communications challenges discussed in this article.

In conclusion: "The ongoing pandemic provides the public health community with an important opportunity to build vaccine literacy and confidence to support the uptake of a potential COVID-19 vaccine, as well as to bolster overall immunization programs for all vaccine-preventable diseases."