A Proactive Approach for Managing COVID-19: The Importance of Understanding the Motivational Roots of Vaccination Hesitancy for SARS-CoV2

"[I]dentifying motivational factors for vaccination hesitancy and then proactively tailoring public health messaging and incentives to address these factors prior to beginning an immunization program may improve overall vaccine uptake..."

This study assessed a population-representative sample of adults from the United States (US) and Canada in order to identify the prevalence of vaccination hesitancy for a SARS-CoV2 vaccine when one does become available, the motivational roots of this hesitancy, and incentives for increasing vaccination uptake when a vaccine does become available.

Data were collected from May 6-19 2020, from 3,674 adults recruited from communities in the US (n = 1,772) and Canada (n = 1,902) using an internet-based self-report survey.

Many American (25%) and Canadian (20%) respondents said they would not get vaccinated against SARS-CoV2 if a vaccine were available, with significantly more Americans than Canadians saying they would not get vaccinated. Negative attitudes toward a SARS-CoV2 vaccination and vaccinations in general, such as concerns about safety and efficacy, were significantly correlated with the decision to not get vaccinated against SARS-CoV2. Vaccine rejection was most strongly correlated with mistrust of vaccine benefit; it was also correlated with worry about unforeseen future effects, concerns about commercial profiteering from pharmaceutical companies, and preferences for natural immunity.

Consistent with the finding that the strongest correlate of vaccination refusal was concern about the benefit of the vaccine, the most efficacious incentives were found to be those providing evidence that the vaccine was safe and efficacious. On the other hand, the least efficacious incentives involved promotions for vaccine uptake from social media, news media, or community leaders. (For example, the public has been exposed to false hopes about COVID-19 treatments, such as the use of hydroxychloroquine, which the researchers suggest has undermined confidence in the recommendations of political/community leaders.)

In light of research suggesting that greater than 70% of the population will need to be vaccinated against SARS-CoV2 to achieve herd immunity, the findings of this study are cause for concern. The researchers recommend that, in order to maximise vaccine uptake, health authorities should reassure the public that vaccine development has followed pre-established guidelines and that the process of developing a vaccine has not been rushed. Unfortunately, the vaccine production programme by the U.S. Department of Health and Human Services is called "Operation Warp Speed"; the researchers suggest that "[v]accination development and dissemination programs with more reassuring titles would be more likely to engage the public trust (e.g., calling the program 'Operation Due Diligence'...").

Suggestions for future research include:

• Assess possible change in COVID-19-related vaccination attitudes over time, particularly if governments or health authorities launch pro-vaccination public education programmes.
• Investigate whether variables other than those examined in the present study (e.g., health literacy) are associated with vaccination hesitancy.
• Explore whether vaccination attitudes differ across different ethnic or cultural groups and, relatedly, whether the findings of the present study can be generalised across different countries and cultures.