Anti-vaccine attitudes and risk factors for not agreeing to vaccination against COVID-19 amongst 32,361 UK adults: Implications for public health communications

BackgroundNegative attitudes towards vaccines and an uncertainty or unwillingness to receive vaccinations are major barriers to managing the COVID-19 pandemic in the long-term. We estimate predictors of four domains of negative attitudes towards vaccines and identify groups most at risk of uncertainty and unwillingness to receive a COVID-19 vaccine in a large sample of UK adults. MethodsData were from 32,361 adults in the UCL COVID-19 Social Study. Ordinary least squares regression analyses examined the impact of socio-demographic and COVID-19 related factors on four types of negative vaccine attitudes: mistrust of vaccine benefit, worries about unforeseen effects, concerns about commercial profiteering, and preference for natural immunity. Multinomial logistic regression examined the impact of socio-demographic and COVID-19 related factors, negative vaccine attitudes, and prior vaccine behaviour on uncertainty and unwillingness to be vaccinated for COVID-19. Findings16% of respondents displayed high levels of mistrust or misinformation about vaccines across one or more domains. Distrustful attitudes towards vaccination were higher amongst individuals from ethnic minority backgrounds, with lower levels of education, lower annual income, poor knowledge of COVID-19, and poor compliance with government COVID-19 guidelines. Overall, 14% of respondents reported unwillingness to receive a vaccine for COVID-19, whilst 22% were unsure. The largest predictors of both COVID-19 vaccine uncertainty and refusal were low income (< {pound}30,000 a year), having not received a flu vaccine last year, poor adherence to COVID-19 government guidelines, female gender, and living with children. Amongst vaccine attitudes, intermediate to high levels of vaccine benefit mistrust and concerns about future unforeseen side effects were the most important determinants of both uncertainty and unwillingness to vaccinate against COVID-19. InterpretationNegative attitudes towards vaccines are major public health concerns in the UK. General mistrust in vaccines and concerns about future side effects in particular will be barriers to achieving population immunity to COVID-19 through vaccination. Public health messaging should be tailored to address these concerns. FundingThe Nuffield Foundation [WEL/FR-000022583], the MARCH Mental Health Network funded by the Cross-Disciplinary Mental Health Network Plus initiative supported by UK Research and Innovation [ES/S002588/1], and the Wellcome Trust [221400/Z/20/Z and 205407/Z/16/Z]. O_TEXTBOXEvidence before this studyWe searched PubMed for articles published in English from 1 January 2020 to 20 September 2020 with the following keywords: ("COVID19 vaccine" OR "coronavirus vaccine") and ("intent*" OR "refusal"). Our search found 639 titles. Several previous studies have examined predictors of intent to vaccinate for COVID-19 when it becomes available. Reasons for unwillingness to receive the COVID-19 vaccination when it becomes available centred on concerns about its newness, safety, and potential side effects. However, estimates and predictors of negative vaccine attitudes in general and how these attitudes predict uncertainty and unwillingness to vaccinate in the context of COVID-19 are unavailable. Added value of this studyThe attitudinal and behavioural barriers to being unsure about receiving a COVID-19 vaccine and not intending to receive one were largely overlapping; 1) didnt get a flu vaccine last year, 2) poor adherence to government guidelines, 3) concerns about the unforeseen future effects of vaccines, and 4) and general mistrust in the benefits of vaccines. Implications of all of the available evidenceMistrust towards vaccines represent a significant challenge in achieving the vaccination coverage required for population immunity. Taken together, there is evidence that groups most vulnerable to falling ill and dying of COVID-19 (e.g. those from ethnic minority backgrounds and who have lower incomes) have more negative attitudes towards vaccines and are less willing to vaccinate against COVID-19. Not everyone who intends to receive a COVID-19 vaccination will be able to do so because of practical barriers such as lack of accessibility and government decisions on the availability of the vaccine, underscoring the importance of improving vaccine attitudes in the general population to improve vaccine uptake amongst those who are offered a vaccine and prevent widening socio-economic health inequalities. Vaccine safety communication to increase public trust by the time a COVID-19 vaccine is available should begin now. C_TEXTBOX