Public decisions about COVID-19 vaccines: A UK-based qualitative study

PLOS ONE RESEARCH ARTICLE Public decisions about COVID-19 vaccines: A UK-based qualitative study Simon N. Williams ID1,2*, Christopher J. Armitage3,4,5, Kimberly Dienes1,3, John Drury6, Tova Tampe7 a1111111111 a1111111111 a1111111111 a1111111111 a1111111111 1 School of Psychology, Swansea University, Swansea, Wales, United Kingdom, 2 Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America, 3 Manchester Centre for Health Psychology, University of Manchester, Manchester, United Kingdom, 4 Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom, 5 NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester, United Kingdom, 6 University of Sussex, School of Psychology, Falmer, United Kingdom, 7 Independent Researcher, Kassel, Germany * Abstract OPEN ACCESS Objective Citation: Williams SN, Armitage CJ, Dienes K, Drury J, Tampe T (2023) Public decisions about COVID-19 vaccines: A UK-based qualitative study. PLoS ONE 18(3): e0277360. https://doi.org/ 10.1371/journal.pone.0277360 To explore UK public decisions around whether or not to get COVID-19 vaccines, and the facilitators and barriers behind participants’ decisions. Editor: Mohamed F. Jalloh, Centers for Disease Control and Prevention, UNITED STATES This qualitative study consisted of six online focus groups conducted between 15th March and 22nd April 2021. Data were analysed using a framework approach. Design Received: March 22, 2022 Accepted: October 26, 2022 Setting Published: March 6, 2023 Focus groups took place via online videoconferencing (Zoom). Peer Review History: PLOS recognizes the benefits of transparency in the peer review process; therefore, we enable the publication of all of the content of peer review and author responses alongside final, published articles. The editorial history of this article is available here: https://doi.org/10.1371/journal.pone.0277360 Copyright: © 2023 Williams et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability Statement: Ethics was approved by Swansea University’s Department of Psychology Ethics Committee. As part of the ethics review process, participant confidentiality restrictions prohibit the authors from making the Participants Participants (n = 29) were a diverse group (by ethnicity, age and gender) UK residents aged 18 years and older. Results We used the World Health Organization’s vaccine hesitancy continuum model to look for, and explore, three main types of decisions related to COVID-19 vaccines: vaccine acceptance, vaccine refusal and vaccine hesitancy (or vaccine delay). Two reasons for vaccine delay were identified: delay due to a perceived need for more information and delay until vaccine was “required” in the future. Nine themes were identified: three main facilitators (Vaccination as a social norm; Vaccination as a necessity; Trust in science) and six main barriers (Preference for “natural immunity”; Concerns over possible side effects; Perceived lack of information; Distrust in government;; Conspiracy theories; “Covid echo chambers”) to vaccine uptake. PLOS ONE | https://doi.org/10.1371/journal.pone.0277360 March 6, 2023 1 / 20 PLOS ONE data set publicly available. During the consent process, participants were explicitly guaranteed that the data would only be seen my members of the study team. For any discussions about the data set please contact Swansea University’s Research Governance: . Funding: This research was supported by the Manchester Centre for Health Psychology based at the University of Manchester (£2000) and Swansea University’s ‘Greatest Need Fund’ (£3000). This research was supported by the Manchester Centre for Health Psychology based at the University of Manchester (£2000) and Swansea University’s ‘Greatest Need Fund’ (£3000). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Competing interests: CJA is supported by NIHR Manchester Biomedical Research Centre and NIHR Greater Manchester Patient Safety Translational Research Centre. This does not alter our adherence to PLOS ONE policies on sharing data and materials. JD sits on SAGE SPI-B subgroup, and Independent Sage. TT currently works for the World Health Organization, but contributed to this paper as an independent researcher. This does not alter our adherence to PLOS ONE policies on sharing data and materials.” (as detailed online in our guide for authors http://journals.plos.org/ plosone/s/competing-interests The authors have no other relationships or activities that could appear to have influenced the submitted work. Public decisions about COVID-19 vaccines Conclusion In order to address vaccine uptake and vaccine hesitancy, it is useful to understand the reasons behind people’s decisions to accept or refuse an offer of a vaccine, and to listen to them and engage with, rather than dismiss, these reasons. Those working in public health or health communication around vaccines, including COVID-19 vaccines, in and beyond the UK, might benefit from incorporating the facilitators and barriers found in this study. Introduction Vaccine hesitancy is a complex and multifaceted problem, and one that is influenced by a range of contextual (e.g. historical, institutional, political) factors, as well as individual-level and vaccine specific factors (e.g. costs or design of a given vaccination program) [1]. Individual-level factors, include health-system and providers, knowledge and beliefs about health and prevention, personal perceptions about risk versus benefit and personal and family experiences with vaccination (including pain and side effects from past vaccines) [1, 2]. Although they are shaped by contextual factors, this research is primarily interested in individual perceptions of UK residents around the decision to get vaccinated against COVID-19. Vaccine hesitancy can be defined as “the delay in acceptance or refusal of vaccination despite availability of vaccination services” [2]. In this paper, we draw on The World Health Organization’s (WHO) SAGE Working Group on Vaccine Hesitancy’s ‘continuum of vaccine hesitancy’ model, which sees vaccine views to be set on a continuum between full acceptance of vaccines with no doubts, through to complete refusal with no doubts [1, 2]. Vaccine hesitancy is seen as a heterogenous group in-between these diametric positions, including those who “delay” acceptance (i.e. do not get it when first offered or according to schedule). Although the WHO continuum of vaccine hesitancy is a simple and useful heuristic to categorise individuals, especially in relation to individu (...truncated)