Optimising General Public Uptake of a Covid-19 Vaccine: A Mixed Methods Study (OPTIMUM)

Lead Research Organisation: University of Stirling
Department Name: School of Health Sciences

Abstract

The Covid-19 pandemic of 2020 has disrupted people's daily lives in many parts of the world, including in the UK, and it has caused many people to become ill and even die. Scientists, policy makers and the general public hope that a Covid-19 vaccine will developed soon, to help to prevent the spread of Covid-19 in future.

As with any vaccination, it is very important that the public are confident in the vaccine so that most people will want to choose to have the vaccine. A high uptake of the vaccine is needed to protect as many individuals from becoming ill as possible, and to stop the spread of the virus. Recent studies suggest most people want a vaccine, but a minority of people are uncertain about whether they would want to be vaccinated against Covid-19. This seems to be because some people are worried about the safety of a new vaccine or do not have trust in the benefits of vaccination more generally.

We want to understand more about what people see as the upsides and downsides of a new Covid-19 vaccine. This information will help to design a vaccination campaign that is trusted by people because it tells them what they want to - or need to - know before making a decision about having the vaccination. A good vaccination campaign would help to increase vaccine uptake, and help people separate facts about the vaccine from misinformed stories.

To understand what hopes and worries people have about a Covid-19 vaccine, we plan to do a study on people's attitudes towards a new Covid-19 vaccine. The study will have four parts.

In the first part, we will interview 12-15 key people involved in vaccine policy and in providing vaccines in different parts of the UK. The interviews will ask about: plans for vaccine roll-out; expected barriers and facilitators to vaccine uptake; communication challenges; key messages, channels and target groups, including professional and public; and any helfpul learning from other countries and other campaigns.

In the second part, we will ask a sample of around 2,250 adults in the general population across Great Britain to take part in a survey about Covid-19 and a vaccine to prevent it. The people we ask will be a random sample of people who have taken part in the British Social Attitudes Survey in the past. The survey will include questions in five key ares: (1) typical behaviour in the past for other vaccines (e.g. annual flu vaccination, childhood vaccination); (2) general attitudes to vaccination; (3) experience of Covid-19 infection and whether people feel they are likely to get Covid-19 in the future (e.g. tested positive, suspected infection, contact with people with Covid-19 through their work, being in some of the groups that were asked to 'shield'); (4) attitudes and beliefs towards a new Covid-19 vaccine (e.g. safety, effectiveness, accessibility, necessity, trust, sources of information about vaccination, responsibility to others); and (5) people's intentions (e.g. whether they think they would agree to be vaccinated). Participants will also be asked about views and use of the NHS Tracking App.

In the third part, will will invite a smaller sample of about 30 people, including some people at higher risk of Covid-19, to take part in more in-depth interviews so that we can understand their hopes and concerns about the development and roll-out of a Covid-19 vaccine in much more detail.

In the last part of the study, we will go back to key people involved in vaccine policy and in providing vaccines in different parts of the UK and invite them to workshops so that they can hear about the study findings and use these to shape their information and plans to support high uptake of the vaccine.
 
Description Our survey of almost 5,000 adults in the UK explored Covid vaccine intentions and the implications for communications and targeted support. We found that vaccine hesitancy was a particular issue in non-white British ethnic groups, in younger adults, and among those with lower education, greater financial hardship and those who believe that they have already had the virus. Targeted engagement is required to address vaccine hesitancy in non-white British ethnic groups, in younger adults, and among those with lower education, greater financial hardship and unconfirmed past infection. The top three trusted information sources were the NHS; doctors, nurses, and other healthcare professionals; and scientific and medical advisers. Just 44% trusted the UK Government 'completely / a great deal', with the three least trusted sources reported as celebrities and social media influencers; social media; and faith or community leaders. Healthcare professionals and scientific advisors should play a central role in communications and tailored messaging is needed for hesitant groups. Ongoing analysis of the survey data is examining the role of attitudes and proximity to Covid in predicting vaccine acceptance.

Our qualitative interviews explored a wide range of themes, including public acceptability of vaccine mandates. Six themes were identified in participants' narratives concerning mandates: (i) mandates are a necessary and proportionate response for some occupations to protect the vulnerable and facilitate the resumption of free movement; (ii) mandates undermine autonomy and choice; (iii) mandates represent an over-reach of state power; (iv) mandates are could potentially create 'vaccine apartheid'; (v) the importance of context and framing; and (vi) mandates present considerable feasibility challenges. Those refusing vaccination tended to argue strongly against mandates. However, those in favour of vaccination also expressed concerns about freedom of choice, state coercion and social divisiveness. Our data suggest that debate around mandates can arouse strong concerns and could entrench scepticism, therefore policymakers should proceed with caution.

Our qualitative interviews also explored why some people who were previously hesitant about vaccination moved towards acceptance. We found that for some, acceptance of the vaccination was temporary and context-dependant (for example, influenced by the perceived severity of the winter 2020/21 wave, by social norms, and by a desire to 'get back to normal'). This suggests that uptake of Covid vaccination among those who were hesitant was in part driven by external factors, and does not necessarily suggest an increase in vaccine confidence; it cannot be assumed that uptake of future vaccination will be as high as in the first wave of Covid vaccination.

We have built relationships with key vaccination campaign planners, and have responded throughout the project to requests for information and advice based on our findings.
We have been invited to present our findings to the Joint Biosecurity Centre and to c.360 government researchers and policymakers. As outlined in other sections of the submission, our findings have informed ministerial briefings and vaccination delivery planning in Scotland and Wales. We have also engaged with the media, and contributed to a piece on national news on vaccination uptake. Behavioural science insights from the study are informing our current collaborative work with the Roslin Institute, which is modelling realtime vaccination uptake and virus transmission and reporting regularly to SAGE.
Exploitation Route Our findings are useful to governments in Scotland, Wales and England in charge of future Covid vaccination campaigns, communications and services. We outline in other sections of the submission how we have fed back findings in a timely way to inform ministerial briefings and vaccination delivery planning and have been invited to present our findings to the Joint Biosecurity Centre and to government researchers and policymakers. We have built relationships with key vaccination campaign planners, and have responded throughout the project to requests for information and advice based on our findings. Behavioural science insights from the study are informing our current collaborative work with the Roslin Institute, which is modelling realtime vaccination uptake and virus transmission. In terms of future developments: (1) Our large sample means that our BAME population was larger than in some national surveys, and these data could be of particular interest to those studying vaccine acceptance in BAME populations. (2) We are working on preparing the survey data for submission to a UK data archive which will make it accessible to other researchers wishing to conduct further analysis of predictors of vaccination acceptance. In methodological terms, our approach supports the value of recruiting qualitative respondents based on responses to surveys, as this enables targeted recruitment (in our case, we recruited those who had indicated refusal or hesitancy in their survey responses).
Sectors Communities and Social Services/Policy,Healthcare

 
Description 2020: We were asked by Public Health Scotland to share our survey questionnaire and the interview guide for our qualitative interviews to help inform their own evaluation plans for examining Covid vaccine delivery in Scotland. We were invited to take part in an evaluation collaborative with governmental, academic and public health experts across Scotland to share findings and identify research gaps in relation to evaluation of Covid vaccine delivery. In response to PHS' need for more insight into vaccine hesitancy in Scotland, we were provided with additional funding to boost the sample of the main study to include 20 further interviews in Scotland. 2021: We were invited to a meeting with four staff from the Joint Biosecurity Centre to discuss how the study findings could help address JBC's future data needs. Following this meeting, we were invited to present emerging findings from the survey to the wider JBC group, which included UK Behavioural Insights Team, PHE, NHS England, Scottish Govt, Welsh Govt, Public Health Northern Ireland. Findings from the qualitative interviews (including the additional 20 interviews in Scotland) were presented to around 50 members of Scottish Govt and Public Health Scotland, and incorporated in slidepack briefings to ministers. We responded to an email query from Public Health Scotland on public willingness to have the second dose of Covid vaccination, which fed into a briefing to the First Minister, and to a further query for additional information to be shared with national colleagues planning the Autumn vaccination booster campaign. Building on the relationship we had already established with Welsh stakeholders through the earlier JBC meeting, we were invited to meet with senior staff from Public Health Wales and Welsh Government to share our findings on public acceptability of vaccine mandates, with this information being fed into a briefing to the Welsh CMO that same day. We were invited to present at one of the UKRI Actionable Insights Seminars, to an audience of around 360 government researchers and policymakers. Finally, we generated considerable media coverage from our first article, on Covid vaccine acceptance, and did an interview with national news in Scotland as part of a package on rising Covid infection rates and the importance of coming forward to be vaccinated.
First Year Of Impact 2020
Sector Healthcare
Impact Types Policy & public services

 
Description Information to Public Health Scotland to inform Covid vaccination delivery planning
Geographic Reach National 
Policy Influence Type Implementation circular/rapid advice/letter to e.g. Ministry of Health
 
Description Information to Welsh Government on public acceptability of vaccine mandates
Geographic Reach National 
Policy Influence Type Implementation circular/rapid advice/letter to e.g. Ministry of Health
 
Description OPTIMUM study Scottish Boost
Amount £28,000 (GBP)
Organisation NHS Health Scotland 
Sector Public
Country United Kingdom
Start 02/2021 
End 08/2021
 
Description Collaboration with Roslin Institute, University of Edinburgh 
Organisation University of Edinburgh
Department The Roslin Institute
Country United Kingdom 
Sector Academic/University 
PI Contribution Two investigators on the OPTIMUM study (Anne Marie MacKintosh and myself) were invited to be co-investigators on an ESRC bid (subsequently funded) led by Prof Rowland Kao at Roslin Institute (Real-time Monitoring and Predictive Modelling of the Impact of Human Behaviour and Vaccine Characteristics on Covid-19 Vaccination in Scotland). We contributed behavioural science expertise, drawing on our OPTIMUM data to help explain the trends in vaccination uptake, virus transmission and testing behaviours analysed by Prof Kao's team.
Collaborator Contribution Participation in Prof Kao's weekly team meetings enabled us to keep up to date with current trends in actual Covid vaccination uptake and transmission. This helped us to assess the usefulness of our own model of predicted vaccination uptake (based on sociodemographic, attitudinal and other variables). It also kept us in touch with topical policymaker concerns.
Impact Outputs will be recorded by Professor Kao and colleagues
Start Year 2021
 
Description Invited interview with Campaign for Social Science 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Policymakers/politicians
Results and Impact The study PI, Martine Stead, was invited to take part in an interview for the Campaign for Social Science/King's College London Policy Institute, about the study and the contribution of social science to tackling the harms associated with Covid-19. I have made a guess as to likely reach.
Year(s) Of Engagement Activity 2021
URL https://www.youtube.com/playlist?list=PLQLDRODSYL6CcpfdpPk5BR53j_jPft7OY
 
Description Media interview for national news 
Form Of Engagement Activity A press release, press conference or response to a media enquiry/interview
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Media (as a channel to the public)
Results and Impact I was invited to participate in an interview for national news (STV) following the press release which accompanied publication of our article on acceptance of Covid vaccination and implications for messaging. The interview was featured as part of a package (second item on the main news bulletin) on rising infection rates and the importance of vaccination. I also responded to queries from journalists at the Times and China Daily. The press release generated coverage in around 200 titles (international, national and local).
Year(s) Of Engagement Activity 2021
 
Description Meeting with Scottish Govt 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Policymakers/politicians
Results and Impact We were invited to attend a meeting with Scottish Govt to share insights from our data on public attitudes towards vaccine certification and wider findings from the study. The findings helped inform Scottish Govt's approach to vaccine mandates.
Year(s) Of Engagement Activity 2021
 
Description Presentation to Public Health Scotland 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Policymakers/politicians
Results and Impact Presentation of findings from the 'Scottish Boost' (additional qualitative interviews conducted in Scotland, drawn from the same sample as the main OPTIMUM study) and comparison with the main OPTIMUM study findings. The findings addressed all the topics covered in the qualitative interviews, with particular focus on experiences of vaccination services and views on vaccine mandates.
Year(s) Of Engagement Activity 2021
 
Description Presentation to UK Joint Biosecurity Centre 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Policymakers/politicians
Results and Impact Following on from an initial meeting with four members of the JBC in Feb 2021, we were invited to present emerging findings from the study to a wider group comprising the UK Behavioural Insights Team, Public Health England, NHS England, Public Health Northern Ireland, Welsh Govt, Scottish Govt, Safefood Ireland and the NI Civil Service. We presented our survey findings on vaccine acceptance, socio-demographic characteristics associated with acceptance, acceptance among BAME populations, the relationship between vaccine acceptance and experience of Covid, and trust in different information sources.
Year(s) Of Engagement Activity 2021
 
Description Stakeholder Briefing document 
Form Of Engagement Activity A magazine, newsletter or online publication
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Policymakers/politicians
Results and Impact We produced a first Briefing document (two page accessible newsletter format) from the study in November 2020. This outlined key findings from the stakeholder interviews and our plans for the survey. We sent the Briefing to all stakeholder interviewees plus around 80 other stakeholders from UK, Scottish and Welsh governments and public health, Royal Colleges, NHS, media experts and others.
Year(s) Of Engagement Activity 2020
 
Description UKRI Actionable Insights Seminar 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Policymakers/politicians
Results and Impact Invited presentation at a UKRI Actionable Insights seminar showcasing behavioural and social science Covid research. Presented a 10-minute talk followed by participation in verbal panel debate and online chat questions. The presentation focused on the lessons from our findings for future messaging around Covid vaccination and the implications for uptake of boosters. An audience of around 360 government social science researchers and policymakers participated. The seminar was subsequently featured in a publication for civil servants: https://library.myebook.com/csw/civil-service-world-312-december-2021/3797/#page/16
Year(s) Of Engagement Activity 2021
URL https://library.myebook.com/csw/civil-service-world-312-december-2021/3797/#page/16