Insights into COVID Vaccine Hesitancy

In a related commentary, Lilia Cervantes, MD, of the University of Colorado, adds, “The focus group study by Carson et al highlights the need for well-planned and funded health policies at the federal, state, and local levels that will not only improve COVID-19 vaccine equity but also improve investment in social resources for racial and ethnic minority groups.

“To build trust, we must engage racial and ethnic minority–serving community organizations and invite them to sit at the head of the table as we partner on strategies that will close the gaps on COVID-19 vaccine disparities.”

Death Prevention May Be Key
In the second study, which was based on an online survey from Mar 24 to 30, Canadians were randomized to answer questions about either the AstraZeneca or Johnson & Johnson vaccine. Some received no other information, some received information about vaccine effectiveness (VE) against COVID-19 symptomatic infection, some received information about VE against COVID-related death, and some received information on both statistics.

At the time, Canada had four COVID-19 vaccines authorized for emergency use—Moderna, Pfizer, AstraZeneca, and Johnson & Johnson—although each had different eligibility profiles. As an example, AstraZeneca was recommended only for adults 50 to 55 years old at first but eventually expanded to those 30 to 55.

Almost 2,560 Canadian adults responded to the survey, of whom 52% were women. The median age was 50 years.

The self-reported likelihood of receiving their assigned vaccine was higher for those who were given information about its effectiveness against COVID-related death compared with those who received no information at all (b, 0.04; 95% confidence interval [CI], 0.01 to 0.06). Receiving information about the VE against symptomatic infection, however, was linked with lower likelihood (b, -0.03; 95% CI, -0.05 to 0.00). Perceived effectiveness followed these same trends.

“Unfortunately, information about the impressive record of AstraZeneca and Johnson & Johnson at death prevention did not appear [to] counteract the negative association between providing information on their overall efficacy and perceived effectiveness or intention to vaccinate,” the researchers write.

“Both pieces of information simply canceled each other out. This suggests that there is a need to focus communication strategies on this metric of performance rather than the arguably less important indicator of overall effectiveness at preventing symptomatic COVID-19.”

The researchers noted that gender and age also appeared to influence the connection between death prevention and vaccine intention. Women and those who were 35 to 54 years old scored 7% and 8% higher, respectively, in their likelihood of vaccination after receiving death prevention information compared with those of other age-groups (95% CIs, 0.04 to 0.11, P < 0.001; 0.04 to 0.12, P < 0.001, respectively).

When stratifying data by vaccine brand, age—but not gender—was significant for those evaluating AstraZeneca, the researchers note. No other subgroup differences were found when analyzing the relationship between receiving all possible VE information and vaccination likelihood.

“These results can inform public health communication strategies to reduce hesitancy toward specific COVID-19 vaccines,” write the researchers. “Considering the importance of the Johnson & Johnson and AstraZeneca COVID-19 vaccines to global supply, identifying ways to mitigate hesitancy toward these specific vaccines is vitally important.”

Lianna Matt McLernon is editor/writr at CIDRAP. This article is published courtesy of the University of Minnesota’s Center for Infectious Diseases Research and Policy (CIDRAP).