|
 
 |
| SHORT COMMUNICATION |
|
| Year : 2021 | Volume
: 4
| Issue : 2 | Page : 81-83 |
|
Willingness to vaccinate against COVID-19 might be systematically underestimated
Marc Oliver Rieger
Department IV, University of Trier, Trier, Germany
| Date of Submission | 26-Jan-2021 |
| Date of Decision | 30-Mar-2021 |
| Date of Acceptance | 10-Apr-2021 |
| Date of Web Publication | 28-May-2021 |
Correspondence Address:
Marc Oliver Rieger
Department of IV, University of Trier, Trier
Germany
 Source of Support: None, Conflict of Interest: None  | 18 |
DOI: 10.4103/shb.shb_7_21
Estimations of the willingness to vaccinate against COVID-19 are important to plan the vaccination process and also to coordinate efforts to reach herd immunity.Aims and Objectives: In this article, we test standard measures of vaccination willingness against systematic biases caused by misunderstandings and lack of information. We use a survey among 730 persons living in Germany at the start of the official vaccination program. We elicit willingness to vaccinate first in a standard form, and then again after clarifications and after providing additional information. We find that a substantial number of persons who state initially that they do not want to get vaccinated does so simply because they want to let people with higher risk be vaccinated first. Appropriately rephrasing the question increases the willingness by around 5 percentage points. Information about herd immunity increases the willingness by additional 7%, confirming previous findings. Standard survey-based estimates of vaccination willingness might underestimate the real number of persons who want to get a vaccination. This number can be increased even further by simply providing appropriate information on herd immunity. In our sample this increased vaccination willingness from 71.4% to 83.6%.
Keywords: COVID-19, herd immunity, vaccination, willingness to vaccinate
How to cite this article:
Rieger MO. Willingness to vaccinate against COVID-19 might be systematically underestimated. Asian J Soc Health Behav 2021;4:81-3 |
| Introduction | |  |
To achieve herd immunity against COVID-19, a fairly large share of the population has to be immune which implies that a large proportion of the population needs to be vaccinated.[1] Willingness to get vaccinated are, however, not as high, as results from surveys in France,[2] Europe,[3] Australia,[4] and the U. S.[5] show. But will it really be as low? Or may misunderstandings or lack of basic information lead to (seemingly) low willingness for vaccinations that in reality will be larger?
In this article, we study this question which of course is important for policy decisions on vaccination campaigns as well as estimating the amount of vaccine needed.
| Methods | | |
We conducted an online survey among 730 persons living in Germany on December 21–28, 2020, just at the start of the official vaccination program in Germany, as part of a larger survey on COVID-19, previously documented in some studies.[6] The survey was advertised at several German universities, mostly using e-mail announcements (as part of regular university newsletters or separately) and e-mail invitations to participants of previous experiments. Given that most members of universities are students, they were a large group of the participants (82.7%), but the survey covered also nonstudents. About 54.4% of the participants were female. Participants were aged between 18 years and 99 years where the average age was 25.9 years. While the composition of the survey sample was not representative of the German population, it had enough variability to determine at least whether the results are dependent on age, gender, and education.
The survey was incentivized with a prize of 50€ for one randomly chosen participant. It was implemented in Enterprise Feedback Suite Questback (Unipark). The research protocol is approved by Ethics Committee at Trier University according to §7.5 of the statutes of the ethic committee.
| Results | | |
In the first key question, we asked participants: “If a vaccine against COVID-19 becomes available, would you get vaccinated? (Assuming that the cost is covered by health insurance).” (Potential answers were: Definitely yes, rather yes, rather no, definitely no). The results are shown in [Table 1]: 71.4% chose ”rather yes” or “definitely yes.” We then asked those participants who had chosen “rather no” or “definitely no” the same question, but they added the following clarifying statement: “Let us now assume that all high-risk patients, medical staff, caregivers, etc., have already been vaccinated.” About 27.3% changed their mind. This suggests that the original question was misinterpreted by a substantial number of participants: A “no” to a question about vaccination might simply be an altruistic consideration. In our survey, the number of respondents choosing “rather yes” or “definitely yes” increased in this way by 5% to 76.4%. | Table 1: Willingness to get vaccinated against COVID-19: initial responses, responses after clarification about the priority of risk groups, and responses after information on protective effects for others
Click here to view |
We then presented to those still choosing “rather no” or “definitely no” the following text:
“Vaccinations do not work for everyone. For some people, e.g., the immune system does not respond enough to a vaccination. These people can then still get sick or even die. But if many people get vaccinated, they are unlikely to be infected by them. This provides an indirect protection. So, if you get vaccinated, you may save someone's life! If you take that into account, would you get vaccinated?”
This text has been used in the previous research,[7] and this fairly simple intervention increased the total percentage of respondents choosing “rather yes” or “;definitely yes” to 83.6%, similar to in previous experiments.[7],[8] Both increases in vaccination willingness were statistically highly significant (P < 0.001).
We also elicited basic demographic information, in particular gender, age, and occupation. We converted the information on occupation into two dummy variables, one denoting whether a person was a university student (dummy variable student) and another one whether a person was either self-employed or employee (dummy variable working). As a proxy for education, we also elicited whether respondents had a university degree. We did not find significant effects of gender, age, student, working, and education on the final vaccination willingness [Figure 1]. These demographic factors do not lead to strong differences which suggest that our results likely also hold for the general population. Initial willingness to vaccinate, however, was slightly lower for females (P < 0.05). | Figure 1: Stated reasons against a vaccination and time respondents would wait until considering the vaccination safe
Click here to view |
In addition, we elicited potential reasons why people might not want a vaccination [Table 2]. The most frequently selected reasons were “The vaccine has not been tested long enough.” (Stated by 87.2% of those who did not want a vaccination 77.3%) and “I am worried about possible side effects.”; Other reasons (not belonging to a risk group, belief in low harm of COVID-19, general opposition to vaccinations, and others) played a much smaller role. | Table 2: Demographic characteristics and total willingness to obtain a COVID-19 vaccination (after survey treatment)
Click here to view |
We then asked those who worried about the too short test period when in future they would deem the vaccination to be safe. The answers varied widely with a median value of around 3 years.
| Conclusion | | |
In summary, the results give the reason for optimism: The number of people willing to get vaccinated might be higher than previous studies suggested. Indeed, a simple misunderstanding of the intent of standard formulations leads to an underreporting of around 5% for the percentage of people who definitely or probably want a vaccination.
Moreover, after providing information on indirect protecting effects of a vaccination through herd immunity, even more people were willing to get vaccinated. This shows that this (previously known[7],[8]) effect is separate from the aforementioned increase. Both effects combined increased the willingness in our sample by more than 12 percentage points – a substantial amount. Given the insignificant dependence of our results on age, gender, and education, a quantitatively similar effect can be expected for the general population.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
| 1. | Randolph H, Barreiro L. Herd immunity: Understanding COVID-19. Immunity 2020;52:737-41.  |
| 2. | The COCONEL Group. A future vaccination campaign against COVID-19 at risk of vaccine hesitancy and politicisation. Lancet Infect Dis 2020;20:769-70. |
| 3. | Neumann-Böhme S, Varghese NE, Sabat I, Barros PP, Brouwer W, van Exel J, et al. Once we have it, will we use it? A European survey on willingness to be vaccinated against COVID-19. Eur J Health Econ 2020;21:977-82. |
| 4. | Thunstrom L, Ashworth M, Finnoff DC, Newbold SC. Hesitancy Towards a COVID-19 Vaccine and Prospects for Herd Immunity. SSRN Working paper 2020. doi: 10.2139/ssrn.3593098. |
| 5. | Dodd RH, Cvejic E, Bonner C, Pickles K, McCaffery KJ, Sydney Health Literacy Lab COVID-19 group. Willingness to vaccinate against COVID-19 in Australia. Lancet Infect Dis 2020. doi: 10.1016/s1473-3099(20)30559-4. |
| 6. | Rieger MO, He-Ulbricht Y. German and Chinese dataset on attitudes regarding COVID-19 policies, perception of the crisis, and belief in conspiracy theories. Data Brief 2020;33:106384. |
| 7. | Rieger MO. Triggering altruism increases the willingness to get vaccinated against COVID-19. Soc Health Behav 2020;3:78. [Full text] |
| 8. | Pfattheicher S, Petersen M B, Böhm R. Information About Herd Immunity and Empathy Promote COVID-19 Vaccination Intentions. Working Paper; 2020. Available from: https://Psyarxiv.com. [Last accessed on 2021 Feb 17]. |
[Figure 1]
[Table 1], [Table 2]
| This article has been cited by | | 1 |
Worldwide Estimation of Parental Acceptance of COVID-19 Vaccine for Their Children: A Systematic Review and Meta-Analysis |
|
| Zainab Alimoradi, Chung-Ying Lin, Amir H. Pakpour | | Vaccines. 2023; 11(3): 533 | | [Pubmed] | [DOI] | | | 2 |
The Content of COVID-19 Information Searches and Vaccination Intention: An Implication for Risk Communication |
|
| Ayokunle A. Olagoke, Brenikki Floyd, Comfort T. Adebayo, Ayomide Owoyemi, Ashley M. Hughes | | Disaster Medicine and Public Health Preparedness. 2022; : 1 | | [Pubmed] | [DOI] | | | 3 |
The general public’s intent to receive a COVID-19 vaccine in Saudi Arabia |
|
| Fatmah Almoayad, Lujain Abdullah Bin-Amer, Nujud Talea Althubyani, Sarah Mohammed Alajmi, Aljoharah Abdullah Alshammari, Reema Abdulrhman Alsuwayal | | International Journal of Health Promotion and Education. 2022; : 1 | | [Pubmed] | [DOI] | | | 4 |
General vaccination knowledge influences nurses’ and midwives’ COVID-19 vaccination intention in Cyprus: a nationwide cross-sectional study |
|
| Georgia Fakonti, Maria Kyprianidou, Stelios Iordanou, Giannos Toumbis, Konstantinos Giannakou | | Human Vaccines & Immunotherapeutics. 2022; : 1 | | [Pubmed] | [DOI] | | | 5 |
Associations between vaccination and quality of life among Taiwan general population: A comparison between COVID-19 vaccines and flu vaccines |
|
| Chung-Ying Lin, Chia-Wei Fan, Daniel Kwasi Ahorsu, Yu Ching Lin, Hui-Ching Weng, Mark D. Griffiths | | Human Vaccines & Immunotherapeutics. 2022; | | [Pubmed] | [DOI] | | | 6 |
Conspiracy beliefs and vaccination intent for COVID-19 in an infodemic |
|
| Ali Ghaddar, Sanaa Khandaqji, Zeinab Awad, Rawad Kansoun, Amir H. Pakpour | | PLOS ONE. 2022; 17(1): e0261559 | | [Pubmed] | [DOI] | | | 7 |
Assessment of attitude towards COVID-19 vaccine and associated factors among clinical practitioners in Ethiopia: A cross-sectional study |
|
| Eleleta Surafel Abay, Mezmur Dawit Belew, Beza Seleshi Ketsela, Enderas Eneyew Mengistu, Liya Sisay Getachew, Yonas Ademe Teferi, Abebe Bekele Zerihun, Amir H. Pakpour | | PLOS ONE. 2022; 17(6): e0269923 | | [Pubmed] | [DOI] | | | 8 |
Beliefs, barriers and hesitancy towards the COVID-19 vaccine among Bangladeshi residents: Findings from a cross-sectional study |
|
| Md. Sharif Hossain, Md. Saiful Islam, Shahina Pardhan, Rajon Banik, Ayesha Ahmed, Md. Zohurul Islam, Md. Saif Mahabub, Md. Tajuddin Sikder, Amir H. Pakpour | | PLOS ONE. 2022; 17(8): e0269944 | | [Pubmed] | [DOI] | | | 9 |
Parents’ Knowledge, Attitude, and Practice on Childhood Vaccination During the COVID-19 Pandemic in Indonesia |
|
| Rano K Sinuraya, Arif SW Kusuma, Zinzi E Pardoel, Maarten J Postma, Auliya A Suwantika | | Patient Preference and Adherence. 2022; Volume 16: 105 | | [Pubmed] | [DOI] | | | 10 |
Willingness to receive the COVID-19 vaccine and associated factors among residents of Southwestern Ethiopia: A cross-sectional study |
|
| Dabala Jabessa, Firomsa Bekele | | Patient Preference and Adherence. 2022; Volume 16: 1177 | | [Pubmed] | [DOI] | | | 11 |
The Motors of COVID-19 Vaccination Acceptance Scale (MoVac-COVID19S): Measurement Invariant Evidence for Its Nine-Item Version in Taiwan, Indonesia, and Malaysia |
|
| Iqbal Pramukti, Carol Strong, I-Hua Chen, Cheng-Fang Yen, Ahmad Rifai, Kusman Ibrahim, Moses Glorino Rumambo Pandin, Hema Subramaniam, Mark D Griffiths, Chung-Ying Lin, Nai-Ying Ko | | Psychology Research and Behavior Management. 2022; Volume 15: 1617 | | [Pubmed] | [DOI] | | | 12 |
Motors of COVID-19 Vaccination Acceptance Scale (MoVac-COVID19S): Evidence of Measurement Invariance Across Five Countries |
|
| I-Hua Chen, Pei-Ling Wu, Cheng-Fang Yen, Irfan Ullah, Sheikh Shoib, Shafi Ullah Zahid, Aadil Bashir, Naved Iqbal, Frimpong-Manso Addo, Emma Sethina Adjaottor, Gifty Boakye Amankwaah, Daniel Kwasi Ahorsu, Mark D Griffiths, Chung-Ying Lin, Amir H Pakpour | | Risk Management and Healthcare Policy. 2022; Volume 15: 435 | | [Pubmed] | [DOI] | | | 13 |
Cognitive Barriers to COVID-19 Vaccine Uptake Among Older Adults |
|
| Jonathan L. Chia, Andree Hartanto | | Frontiers in Medicine. 2021; 8 | | [Pubmed] | [DOI] | | | 14 |
To vaccinate or not to vaccinate!? Predictors of willingness to receive Covid-19 vaccination in Europe, the U.S., and China |
|
| Julia Brailovskaia, Silvia Schneider, Jürgen Margraf, Chung-Ying Lin | | PLOS ONE. 2021; 16(12): e0260230 | | [Pubmed] | [DOI] | | | 15 |
Early COVID-19 Vaccination of Romanian Medical and Social Personnel |
|
| Loredana Sabina Cornelia Manolescu,Corneliu Nicolae Zaharia,Anca Irina Dumitrescu,Irina Prasacu,Mihaela Corina Radu,Adrian Calin Boeru,Liliana Boidache,Irina Nita,Andrei Necsulescu,Razvan Daniel Chivu | | Vaccines. 2021; 9(10): 1127 | | [Pubmed] | [DOI] | | | 16 |
Factors affecting Pakistani young adults’ intentions to uptake COVID-19 vaccination: An extension of the theory of planned behavior |
|
| Irfan Ullah,Chung-Ying Lin,Najma Iqbal Malik,Tzu-Yi Wu,Marzieh Araban,Mark D. Griffiths,Amir H. Pakpour | | Brain and Behavior. 2021; | | [Pubmed] | [DOI] | | | 17 |
A population-based dataset concerning predictors of willingness to get a COVID-19 vaccine in Iran |
|
| Amir H. Pakpour,Rafat Yahaghi,Safie Ahmadizade,Razie Fotuhi,Elham Taherkhani,Mehdi Ranjbaran,Zeinab Buchali,Chung-Ying Lin,Mark D. Griffiths,Anders Broström | | Data in Brief. 2021; 39: 107459 | | [Pubmed] | [DOI] | |
|
 |
|
|
|
Search Pubmed for