A disturbing new study by researchers at the Australian National University details an increase in vaccine hesitancy among many Australians over the period of August 2020 to January 2021. This may have serious implications for the country’s ability to achieve universal immunization.
*Important notice: medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information.
The research team has released its findings on the medRxiv* preprint server.
COVID-19 in Australia
The rate of COVID-19 in Australia is extremely low compared to most other countries. This has been attributed to tight travel restrictions, including for Australian nationals returning home, who are having to wait for a limited number of slots on international flights to avoid importing infection.
This was coupled with a mandatory quarantine on all travelers to Australia, except for those coming from New Zealand. Lockdowns were also implemented at various points of time following reports of local outbreaks.
A relaxation of these restrictions will require the vaccination of enough Australians, as well as vaccination certification of travelers arriving from other parts of the world, in most cases.
Several vaccines have now been rolled out that claim to be both safe and effective. Certainly, few serious adverse effects have been reported so far, after millions of vaccinations in many countries. For instance, for every hundred individuals, Israel has administered 72 vaccine doses, Dubai about 50, and the UK about 21.
In Australia, the Pfizer vaccine was approved for use in people aged 16 years or more by the Australian Therapeutic Goods Administration (TGA). Vaccination is now underway, but the question is, are enough people willing to be vaccinated?
Study aims
The current study aimed at answering the question as to what proportion of the population is willing to be vaccinated and how this proportion varies between population subgroups, as well as contributing factors.
The researchers aimed to follow-up with the same respondents involved in their earlier survey in August 2020. The study comes from the ANU Centre for Social Research and Methods ANU COVID-19 Impact Monitoring Survey Program.
By January 2021, vaccine roll-out had already begun in many countries, and therefore the respondents were also asked about their confidence in the vaccine development process.
Vaccine hesitance at the international level
Early evidence indicated that vaccine hesitancy fell during the early months of the pandemic but then rose throughout the world. This is despite the experienced effects of lockdowns and other restrictions on social and economic activity.
While France and the US showed a large rise in vaccine hesitancy, the tide may be turning in the latter. A recent report shows that 10% more of Americans were willing to get a vaccine in November 2020, compared to 50% in September.
The public perception that the vaccine development process was being hurried through, perhaps at the expense of safety checks, may have fueled the lack of willingness. Other factors may be the feeling that governments did a poor job of pandemic control and social relief, or are not practicing transparency, or that the vaccine may not be effective.
The lack of trust in the intentions of Big Pharma in promoting vaccines may also be a factor.
Australian attitudes to the vaccine
In August 2020, just over 5% of respondents (adult Australians) said they were unwilling to get the vaccine, while 7% were hesitant. 29% and 59% were ‘probably’ and ‘definitely’ going to be vaccinated.
When the same respondents were contacted in January 2020, over 8% were now unwilling and 13% hesitant. About 35% said they would ‘probably’ get it. Only 44% said they would ‘definitely’ get it.
Only a quarter of Australians said they were very confident in the vaccine development process, with half the survey population saying they had ‘a fair amount’ of confidence. About 19% and 7% had little to no confidence.
Individual trends towards and away from willingness
While 32% of Australians moved from more to less willing, at an individual level, 10% became more willing. About 19% became marginally less willing, from ‘definitely’ to ‘probably’ getting a vaccine.
One of the biggest concerns from a herd immunity perspective between mid-2020 and early 2021 is the very large increase in vaccine uncertainty.”
Overall trends in vaccine hesitancy
The analysis shows that vaccine hesitancy is closely related to non-confidence in the vaccine development process. Females are less willing to get a vaccine, with about 77% of females indicating willingness or probability of getting it, compared to 80% of males.
Younger Australians were also less willing, in the 18-24-year age group, compared to those aged 55 or more, at 86% and 91% saying they were definitely or probably going to get the vaccine, respectively. Among those aged 25 to 34 years, only 70% were willing.
Those who speak non-English languages at home were less willing, which indicates a gap in public health education. And finally, those who completed year 12, and especially those with a degree or higher education, were more willing.
Of those without a degree, 76% were willing, compared to 85% and 87% of those with a bachelor’s degree and post-graduate degree, respectively.
Those living in and outside a capital city also showed a higher and lower willingness, at 79% and 76%, respectively. While this may also be traceable to lower infection trends outside cities, the risk of infection remains real and is likely to increase as travel restrictions are eased.
Reasons for vaccine unwillingness overall
The researchers found that having been tested for COVID-19, as well as those who were significantly anxious or worried about the infection, were much more likely to be willing, indicating the role of subjective experience in this decision-making process.
The association between confidence in the healthcare system, other public health authorities, and the Federal government, and vaccine willingness is strong.
Financial stress is also a driver of vaccine willingness, as are those who believe the government has a right to mandate policies for the good of citizens, and those who have a positive view of the future.
Changes from August 2020 individually
Reasons for individual changes in vaccine intentions included thinking COVID-19 risk is being magnified, financial stress, confidence in the government and healthcare systems, and an optimistic viewpoint regarding the future. Age and education were also positively associated with willingness. The strength of these associations declined from those observed in the larger sample.
A decrease in willingness on an individual basis is mainly observed to occur in those who thought the pandemic was being exaggerated. The opposite change in willingness was seen in those who believe in the healthcare system and in the government, and believe the future will get better.
Those who speak non-English languages at home, indigenous Australians, and those educated to below year 12, became less willing over time.
Those who newly became unwilling or hesitant over this period were those experiencing significant financial stress, between 45-54 years, and with Year 12 to Associate Degree levels of education. They had less confidence in government and healthcare systems and were more pessimistic about the next 12 months.
What are the implications?
Despite being ranked 8th globally for COVID-19 policies, Australia continues to require immunization to achieve herd immunity and return to some semblance of pre-pandemic life in the near future.
The public health response has been fast and effective, though costly in terms of social and economic disruptions. However, Australians generally feel satisfied with their lives now, compared to the pre-pandemic period, and economic improvement is also visible.
However, challenges to universal immunization continue to present themselves, with increasing rates of vaccine hesitancy and unwillingness. The time required to extend vaccine reach to all Australians is also time that can be used to spread false information, fueling distrust of the vaccines now available.
Since the current survey was carried out in English, the chances are high that it does not represent those families and groups who do not speak English at all. Non-urbanized areas also need to be targeted to increase vaccine compliance.
Public health messages need to be conveyed in a way that people without advanced education can understand them, with relevant and reassuring information. Languages other than English need to be covered to get the information to such groups.
The risk of making light of COVID-19 should be countered by presenting detailed and complete information to specific target groups, to remind them of the potential severity of the infection and its long-term effects, even if currently Australia is at a low level of infections. The potential for a better future as early as next year should also be conveyed with realistic and reassuring data.
*Important notice: medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information.
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