Despite most of adults in the UK undertaking a full COVID-19 vaccination programme, including the booster jab (Office for National Statistics (ONS), 2022a), there remains a significant number who continue to eschew the various opportunities to be vaccinated. As a consequence, a further 3.5 million doses of the COVID-19 vaccine may be destroyed as they reach their expiration date, adding to the 4.7 million doses already wasted (National Audit Office, 2022). Having an unvaccinated population is a serious issue for any society, as there is an increased transmission risk of COVID-19 due to the higher viral load of infected, unvaccinated adults. The assumption that having widely available COVID-19 vaccination opportunities will result in a largely vaccinated population grossly underestimates the various potential barriers to uptake. Vaccination uptake is the result of a complex and highly personal decision-making process, which is influenced by many factors, some of which are context-specific and vary across time, place and different vaccines (While, 2021a).
Despite a sustained effort to increase COVID-19 vaccination uptake, the ONS (2022a) has reported that the ethnic groups with the lowest uptake of a full three-jab vaccination programme were black Caribbean (33.9%), Pakistani (37.8%) and black African (37.9%), after adjusting for differences in age, with those identifying as Muslim (40.2%) having the lowest uptake. This lower uptake is also found among those in less advantaged socioeconomic groups, including those living in more deprived areas, those who have never worked or are long-term unemployed, those with no qualifications and those living in rented accommodation (ONS, 2022a). Individuals working in healthcare have high rates of vaccine uptake, although there remains a small minority (4 to 5%) who are unvaccinated, including doctors, nurses and allied healthcare professionals (ONS, 2022a), fuelled by misinformation about the safety and effectiveness of the vaccines (Manby et al, 2022).
‘Emphasising the social benefits of vaccination may reduce COVID-19 vaccine hesitancy, perhaps because it shifts attention away from the individual and to the collective good’
It has become apparent that sources of information and opinion that are anti-vaccination may reinforce areas of personal doubt. The ONS (2022b) has reported that the main reasons behind non-uptake of the COVID-19 vaccination during the period of 7–16 September 2021 were: anxiety regarding side effects (58%), concerns that the vaccine has been developed too quickly (55%), and fear about the long-term impact on health (54%). Other significant reasons included ‘waiting to see how well the vaccine works’ (45%), ‘distrust in advice from the Government about COVID-19 vaccines’ (41%), and ‘insufficient information about what is in the vaccines’ (41%) (ONS, 2022b). Most survey participants did not indicate what would motivate them to take a vaccine, although 19% of those remaining unvaccinated reported that wanting to protect others or themselves would motivate them to get a vaccination (ONS, 2022b). This echoes the findings of Liao et al (2022), who reported that emphasising the social benefits of vaccination reduced COVID-19 vaccine hesitancy, perhaps because it shifted attention away from the individual and to the collective good.
As we progress to and through the reality of living with COVID-19, achieving full population vaccination coverage becomes ever more important as SARS-CoV-2 variants challenge the current vaccines' efficacy in sustaining sufficient herd immunity (While, 2021b). Lessons learnt in promoting and enabling COVID-19 vaccination uptake should not be forgotten in terms of understanding individual information needs and the context of the vaccination offering (While, 2021b). Not only can these lessons be redeployed during the next round of COVID-19 vaccination delivery, but they can help improve the uptake of the annual seasonal influenza vaccination, as well as the pneumococcal and shingles vaccinations to clients aged 65 or 70 years, respectively.