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The most comprehensive study of COVID-19 vaccine hesitancy to date shows a majority willing to be vaccinated, but a substantial minority concerned. Researchers from the University of Oxford surveyed a representative group of 5,114 UK adults about an approved COVID-19 vaccine for the NHS.

A bottle of COVID-19 vaccine held by a health professional

The results are published today in the journal Psychological Medicine. Analysis of the survey items indicated that 72% are willing to be vaccinated, 16% are very unsure, and 12% are strongly hesitant.

Vaccine hesitancy was found to occur when the person: cannot see any collective benefit; the person doesn’t see themselves at risk; the vaccine effectiveness is in doubt; there is concern about side effects; or there is a fear that the speed of development has compromised safety.  These beliefs explained almost all of vaccine hesitancy. Rooted in longer-standing issues of mistrust, higher levels of hesitancy were associated with negative views of doctors, poorer NHS experiences, concerns about the financial motivations of vaccine developers, discontent with institutions, coronavirus conspiracy concerns, and vaccination conspiracy ideas. 

Professor Daniel Freeman, study lead, Department of Psychiatry, University of Oxford, said,


“Vaccine hesitancy is mistrust of a vaccine: that it is not needed, it will not work, or it will not be safe. Strikingly, those who are hesitant are not bringing to mind the benefit to everyone of taking a COVID-19 vaccine. There are also suspicions that the virus is no worse than the flu and that vaccine side effects won’t be known until later. It is often rooted in deeper mistrust, including negative views of doctors, anger at our institutions, and sometimes even outright conspiracy beliefs. People will avoid getting vaccinated rather than feel like a guinea pig, experimented on by those they view as not caring about them.

“We need strong messaging that taking a vaccination is actually a duty we need to do for the benefit of everyone. Most people can see vaccination as the light at the end of the tunnel, but they are also looking for detailed information on the topic that they can trust. They want reassurance that the speed of development has not compromised safety. They want thorough information on effectiveness, safety, and how long protection will last.”

Approximately a quarter of the population are entertaining the idea that the virus is a hoax. Around one in five people think vaccine data may be fabricated, with another one in four people unsure whether such data are made-up. Similar proportions of the population think that there is a cover-up of a link between autism and vaccines.

Professor Freeman continues,

The fear is that we are approaching a tipping point, when suspicion of vaccination becomes mainstream. We've seen conspiracy ideas emerge from the fringes during the pandemic, and the concern is that vaccine hesitancy follow in their wake. Vaccine suspicion is another marker, exposed by the pandemic, of a crisis in trust.

Dr Sinéad Lambe, study team member, argues that:

It is a mistake to dismiss vaccine hesitancy as unconsidered. Even when sceptical, people have weighed up a number of issues in their decision-making. Understanding their concerns is essential if we are going to provide the right information and necessary assurances to increase public confidence in the new vaccines. 

Professor of Vaccinology, Helen McShane, University of Oxford and study team member, said,


“Ensuring high levels of vaccine uptake is critical for the real world effectiveness of any vaccine. Now that we have effective vaccines against SARS CoV2, it is essential we do everything we can to maximise uptake. This timely study on vaccine hesitancy addresses the underlying reasons for a mistrust in vaccines. It is only by addressing these underlying thoughts and assumptions that we can develop strategies to minimise them, and ensure we maximise the public health benefits of the available vaccines. This is true for all our licensed vaccines but is of immediate relevance to the impending rollout of the SARS CoV2 vaccines.”

Professor Stephan Lewandowsky, Chair in Cognitive Psychology at the University of Bristol, and co-author on the study, said,

“The study confirms that the vast majority of the public recognises the importance and benefits from the vaccine, and its importance to our common future welfare. The results suggest we must explain to the public that the COVID vaccine is the ticket to freedom for all of us.”

Vaccine hesitancy was higher in younger people, females, and those on lower incomes, but these were only very small associations, indicating hesitancy is evenly spread across the population. The Oxford Coronavirus Explanations, Attitudes, and Narratives Survey (OCEANS II) was conducted between 24 September and 17 October 2020 with 5,114 UK adults, quota sampled to match the population for age, gender, ethnicity, income, and region.

It was funded by a grant from the University of Oxford COVID-19 Research Response Fund. It was also supported by the National Institute of Health Research (NIHR) invention for innovation (i4i) programme and the NIHR Oxford Health Biomedical Research Centre.

To read the full paper, COVID-19 Vaccine Hesitancy in the UK: The Oxford Coronavirus Explanations, Attitudes, and Narratives Survey (OCEANS) II