A research team from the City University of New York Graduate School of Public Health and Health Policy (CUNY SPH), the Barcelona Institute for Global Health (ISGlobal), the Vaccine Confidence Project at the London School of Hygiene and Tropical Medicine (LSHTM), and Georgetown University Law School announced today that Nature Medicine has published their research revealing potential global hesitancy to accept a COVID-19 vaccine. Based on data collected with the previously validated COVID-SCORE survey of a sample of over 13,400 individuals from 19 countries that have been hard-hit by the virus, the investigators found that 72 % of participants would likely take the vaccine. Of the remaining 28 %, 14% would refuse, while 14% would hesitate, which translates into tens of millions of potential vaccine avoiders.
To date, more than 90 COVID-19 vaccines are in development, half of which are in human trials. In addition to addressing the formidable challenges of developing a safe and effective vaccine, producing it on a large scale, and distributing it equitably, health authorities worldwide must now consider the added obstacle of vaccine hesitancy.
"We found that the problem of vaccine hesitancy is strongly related with a lack of trust in government. Vaccine confidence was invariably higher in countries where trust was higher", said Jeffrey V. Lazarus, ISGlobal researcher and study coordinator.
"We need to increase vaccine confidence, and we need to improve the public's understanding of how they can help control the spread of COVID-19 in their families and their communities," adds Ayman El-Mohandes, Dean of CUNY SPH, and co-coordinator of the study.
The country with the highest score of positive responses to "taking a proven, safe and effective vaccine" was China (87%), which also had the lowest percentage of negative responses (0.7%). On the other end, Poland had the highest number of negative responses (27 %), while the Russian respondents gave the lowest number of positive responses (55%). In the U.S., 76% of respondents answered positively, 11 % were negative, and 13% had no opinion.
When asked if "you would accept a vaccine if it were recommended by your employer and was approved safe and effective by the government," 32% of respondents completely agreed, while 18% somewhat or completely disagreed. Again, a great variation between countries was observed - China again had the highest percentage of positive responses (84%) and the lowest percentage of negative responses (4%). Russia had the highest percentage of negative responses (41%) and the lowest percentage of respondents (27%) who were likely to accept their employer's recommendation. In the U.S., 52% had confidence in an employer's recommendation, and 25% did not.
Vaccine acceptance also varied with age (with higher acceptance among older people as compared to those aged under 22), income (higher among people earning more than 32 dollars per day, as compared to those earning under two dollars per day), or education level. Curiously, people who had fallen sick with COVID-19, or whose relatives had fallen sick, were not more likely to respond positively.
"It will be tragic if we develop safe and effective vaccines and people refuse to take them. We need to develop a robust and sustained effort to address vaccine hesitancy and rebuild public confidence in the personal, family and community benefits of immunizations," warns Scott C. Ratzan, study co-author and Distinguished Lecturer at CUNY SPH. "Our findings are consistent with recent surveys in the US, which show diminished public trust in a COVID-19 vaccine," he concludes.
Heidi J. Larson, study co-author and Professor and Director of the Vaccine Confidence Project at LSHTM says, "These findings should be a call to action for the international health community. If we do not start building vaccine literacy and restoring public trust in science today, we cannot hope to contain this pandemic."
The authors also point out that people's decisions about vaccination depend on many factors and can change with time. In fact, since this survey was conducted in late June 2020, vaccine-related issues have become increasingly politicized and the antivaccine movement has become more aggressive, which suggests that vaccine hesitancy may be a greater threat today.
Lazarus, J.V., Ratzan, S.C., Palayew, A. et al. A global survey of potential acceptance of a COVID-19 vaccine. Nat Med (2020). https://doi.org/10.1038/s41591-020-1124-9
Funding was provided by the City University of New York Graduate School of Public Health and Health Policy Foundation, Bocconi University, J. Fielding, the United States Council for International Business Foundation and K. Rabin. Consensus Strategies was the funding recipient. J.V.L. acknowledges support to ISGlobal from the Spanish Ministry of Science, Innovation and Universities through the 'Centro de Excelencia Severo Ochoa 2019-2023' Programme (CEX2018-000806-S) and from the Government of Catalonia through the CERCA Programme.
The CUNY Graduate School of Public Health and Health Policy is committed to teaching, research, and service that creates a healthier New York City and helps promote equitable, efficient, and evidence-based solutions to pressing health problems facing cities around the world. For more information, visit sph.cuny.edu. Follow us on Twitter: @CUNYSPH.