Data Synthesis: Public Perceptions of the COVID-19 Vaccinations

"...to inform risk communication and community engagement (RCCE) strategies and policies in relation to COVID-19 vaccination programmes..."

After several COVID-19 vaccines were made available in December 2020, most countries around the world had started vaccination campaigns by early 2021. However, months later, considerable differences in the pace of progress were evident in different parts of the world, with close to 60% of vaccine doses administered in just three countries (United States, China, and India) as of May 2021. In that context, this data synthesis from the Collective Service for Risk Communication and Community Engagement (RCCE CS), the first in a series, shares data (March 2020 to April 2021) on public perceptions of the COVID-19 vaccines. Based on identified knowledge and evidence gaps, the report offers recommendations for RCCE efforts around COVID-19-vaccination and highlights areas for further research investment.

The data synthesis brings together 66 data sources from quantitative surveys conducted across 107 countries and six regions. It also includes findings from 29 qualitative studies and community feedback data from Africa that were collected between March 2020 and April 2021 (click here for more information). Data have been extracted from fieldwork assessments, as well as phone- and/or web-based knowledge, attitude, and practice (KAP) surveys and global opinion polls. In order to measure vaccine acceptance rates, the RCCE CS used a common indicator: "percentage of individuals who would get vaccinated once a vaccine is available and recommended".

Key findings:

• 74.8% (April 2021) of respondents would agree to take a COVID-19 vaccine if it was available and recommended.
• Vaccine acceptance rates are highly variable across different regions and countries. For example, vaccine acceptance rate ranges from as low as 34% in the Democratic Republic of the Congo (DRC) to as high as 93% in Israel and 91% in Mexico. In general, there are lower acceptance rates in low-income countries (58%).
• Looking at rates over time, the data show a substantial decrease (65% in April 2021 compared to 80% in December 2020) in vaccine acceptance rates in Eastern and Southern Africa, and a significant increase in vaccine acceptance in Western Europe (73% in April 2021 compared to 57% in December 2020).
• Global COVID-19 vaccine acceptance rates have steadily increased among health care workers (HCWs): from 40% in March 2020 to 79% in February 2021. However, there are substantial variations across different countries. For example, HCWs in Egypt (44%), France (56%), and Nigeria (58%) seemed to be less inclined to accept a COVID-19 vaccine.
• Low levels of vaccine acceptance appear to be grounded in concerns relating to vaccine safety and efficacy. For example, community feedback data collected across five African countries revealed concerns about the vaccines causing infertility, reducing life expectancy, or even causing death. Data from Jordan indicated that study participants who stated vaccines are generally safe were nine times more willing to receive a COVID-19 vaccine compared to those who expressed concerns about vaccine safety. Several studies have found that many concerns in relation to vaccine safety and efficacy are grounded in a lack of information and knowledge about the vaccine.
• At the global level, the RCCE CS data compilation observed a significant association between levels of trust in public authorities and partners leading the COVID-19 response on an individual's acceptance of COVID-19 vaccination.
• Social norms play a role: COVID-19 vaccine acceptance appears to increase as more people are vaccinated.
• Risk perception does not appear to be a critical driver of vaccine acceptance; however, previous COVID-19 infection can positively affect vaccine acceptance.
• Higher morbidity and mortality rates did not appear to influence vaccine acceptance rates.

Recommendations for those who are engaged in collecting, analysing, and using data for designing and delivering COVID-19 vaccine programmes include:

• Collect data repeatedly and regularly, considering that vaccine decisions are multifactorial, and perceptions change overtime, especially given the dynamic nature of the pandemic, the information relating to it, and the response to it.
• Address the dearth of data and qualitative research on the underlying factors of vaccine acceptance to provide contextual nuances and an in-depth understanding of the socio-behavioural factors influencing vaccine acceptance and uptake across a diverse range of population groups, especially those whose voices and views were not captured by quantitative, remote-based surveys due to limited internet accessibility and/or digital illiteracy.
• Address the significant gaps in relation to data from some population groups, including the most vulnerable and marginalised - factoring in issues related to digital literacy, language, and socio-cultural diversity when standardising data collection processes.
• Increase support for countries in collecting, analysing, and using local-level data.
• Work to understand the country-level interplay between COVID-19 vaccine acceptance and uptake with political attitudes, historical inequalities, and longstanding mistrust in institutions.
• Adapt survey questions that have been framed with hypothetical questions in relation to vaccine acceptance to measure the actual uptake of the COVID-19 vaccines as they are rolled out and reach low- and middle-income countries (LMICs), in particular.

Recommendations for those who are designing and delivering COVID-19 vaccination RCCE interventions include:

• Make timely, accurate, fact-based information about the vaccine and the vaccination process available and accessible to different population groups, and tailor it to their particular needs and knowledge gaps.
• Ensure COVID-19 response decision-makers are informed about the interconnection of access issues with vaccine nationalism and broader geopolitics, which shape local narratives and perceptions around the vaccine (especially in LMICs).
• Work and engage with community-level organisations, as well as HCWs and community volunteers, to increase confidence in the vaccine and plan and deliver the vaccination rollout.
• Assess and address low levels of vaccine acceptance and uptake among HCWs, and understand the socio-behavioural influences among different HCW categories(doctors, nurses, community HCWs), especially in LMICs.
• Take RCCE approaches beyond broad messaging to foster dialogue and strengthen the role of community engagement - for example, by working with trusted community leaders and influencers.
• Reduce structural barriers surrounding overall access to vaccines, registration for COVID-19 vaccination, and/or the location of vaccination sites.
• Continuously assess, analyse, and use people's feedback, questions, and concerns to adapt RCCE strategies.

Click here to access a 1-page summary document of the data synthesis in PDF format.