COVID-19 vaccine hesitancy in a representative working-age population in France: a survey experiment based on vaccine characteristics

Abstract

Background Opinion polls on vaccination intentions suggest that COVID-19 vaccine hesitancy is increasing worldwide; however, the usefulness of opinion polls to prepare mass vaccination campaigns for specific new vaccines and to estimate acceptance in a country's population is limited. We therefore aimed to assess the effects of vaccine characteristics, information on herd immunity, and general practitioner (GP) recommendation on vaccine hesitancy in a representative working-age population in France. MethodsIn this survey experiment, adults aged 18-64 years residing in France, with no history of SARS-CoV-2 infection, were randomly selected from an online survey research panel in July, 2020, stratified by gender, age, education, household size, and region and area of residence to be representative of the French population. Participants completed an online questionnaire on their background and vaccination behaviour-related variables (including past vaccine compliance, risk factors for severe COVID-19, and COVID-19 perceptions and experience), and were then randomly assigned according to a full factorial design to one of three groups to receive differing information on herd immunity (>50% of adults aged 18-64 years must be immunised [either by vaccination or infection]; >50% of adults must be immunised [either by vaccination or infection]; or no information on herd immunity) and to one of two groups regarding GP recommendation of vaccination (GP recommends vaccination or expresses no opinion). Participants then completed a series of eight discrete choice tasks designed to assess vaccine acceptance or refusal based on hypothetical vaccine characteristics (efficacy [50%, 80%, 90%, or 100%], risk of serious side-effects [1 in 10 000 or 1 in 100 000], location of manufacture [EU, USA, or China], and place of administration [GP practice, local pharmacy, or mass vaccination centre]). Responses were analysed with a two-part model to disentangle outright vaccine refusal (irrespective of vaccine characteristics, defined as opting for no vaccination in all eight tasks) from vaccine hesitancy (acceptance depending on vaccine characteristics). Findings Survey responses were collected from 1942 working-age adults, of whom 560 (28•8%) opted for no vaccination in all eight tasks (outright vaccine refusal) and 1382 (71•2%) did not. In our model, outright vaccine refusal and vaccine hesitancy were both significantly associated with female gender, age (with an inverted U-shaped relationship), lower educational level, poor compliance with recommended vaccinations in the past, and no report of specified chronic conditions (ie, no hypertension [ for vaccine hesitancy] or no chronic conditions other than hypertension [ for outright vaccine refusal]). Outright vaccine refusal was also associated with a lower perceived severity of COVID-19, whereas vaccine hesitancy was lower when herd immunity benefits were communicated and in working versus nonworking individuals, and those with experience of COVID-19 (had symptoms or knew someone with CO...

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“…Since the DHPSP account exclusively posts science-based content, it is reasonable to assume that it attracted followers with interests in science. This assumption is in line with a recent study by Schwarzinger et al [38], which revealed that COVID-19 vaccination hesitancy was highly prevalent among people with low educational levels in the French population. These findings are in line with other, more recent studies that were conducted in France, the United States of America, and Australia [39][40][41].…”

Are Epidemiological Indicators Misleading under Uncertainty? An Evaluation and a Remedy from An Economic Perspective

“…an der Heiden and Hamouda 2020). But how many people an infected individual will indeed contaminate will depend, for example, on the number of people an infected person is exposed to on each of those days, on the probability of each exposure becoming an infection, on the duration of infectiousness including periods of asymptomatic infectiousness, and other individual characteristics such as age and obesity (Edwards et al 2021, Pandit 2020). Hence the reproduction number is an average number that assumes away a number of supposedly important, and possibly time-varying, characteristics that may affect the "reproduction" of the virus depending on who, when and where one is infected.…”

“…Even if a vaccination campaign is under way, testing will continue to be important as long as herd immunity will not be attained. Given virus mutations and vaccine hesitancy, there may still a long shot to go until worldwide immunity will be obtained (Schwarzinger et al 2021). Massive and continuous low-threshold testing (in addition to other policies such as respecting social distancing rules or face masks for example) provides the possibility for an open society.…”

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“…In countries with a similarly rapid and successful vaccination campaign as the UK's (eg, the USA and Israel, in which 46% and 63% of the general population, respectively, had received at least one COVID-19 vaccine dose by May 9, 2021), 5 COVID-19 vaccination is becoming the social norm, and a large proportion of strongly hesitant people who have postponed their decision might be further convinced by a positive reinforcement from official communication about vaccination. In countries with early reluctance about COVID-19 vaccination, 8 distrust in information from official sources, 9 and slow growth of vaccination coverage (eg, only 26% of the French population had received a vaccine dose by May 8, 2021), 5 a large proportion of strongly hesitant people might be anti-vaxxers and reinforcing the official communication about vaccination might not only be ineffective but even counterproductive. 10 Additional input from social sciences are urgently needed in these country settings if the ultimate goal is to reach herd immunity by mass vaccination.…”