Trends, patterns and psychological influences on COVID-19 vaccination intention: findings from a large prospective community cohort study in England and Wales (Virus Watch)

Byrne, Thomas; Patel, Parth; Shrotri, Madhumita; Beale, Sarah; Michie, Susan; Butt, Jabeer; Hawkins, Nicky; Hardelid, Pia; Rodger, Alison; Aryee, Anna; Braithwaite, Isobel; Lam Erica Fong, Wing; Fragaszy, Ellen; Geismar, Cyril; Kovar, Jana; Navaratnam, Annalan MD; Nguyen, Vincent; Hayward, Andrew; Aldridge, Robert W; Wijlaar, Linda; Nastouli, Eleni; Spyer, Moira; Killingley, Ben; Cox, Ingemar; Lampos, Vasileios; McKendry, Rachel A; Cheng, Tao; Liu, Yunzhe; Johnson, Anne M; Gibbs, Jo; Gilson, Richard

Background Vaccination intention is vital to the success of any vaccination programme, alongside vaccine availability and access. Public intention to take a COVID-19 vaccine if offered is high in the UK, but evidence of disparities between ethnic, social and age groups has led to concern. Methods Online survey of prospective household community cohort study participants across England and Wales (Virus Watch). Vaccination intention was measured by individual participant responses to ‘Would you accept a COVID-19 vaccine if offered?’, collected in December 2020 and February 2021. Responses to a 13-item questionnaire collected in January 2021 were analysed using factor analysis to investigate psychological influences on vaccination intention. Results Survey response rate was 56% (20,785/36,998) in December 2020 and 53% (20,590/38,727) in February 2021, with 14880 adults reporting across both time points. Of participants reporting across both timepoints, 13,411 (90%) answered ‘Yes’ and 1,469 (10%) responded ‘No’ or ‘Unsure’ in December 2020. Of those answering ‘No’ or ‘Unsure’ in December 2020, 1,266 (86%) subsequently answered ‘Yes’ or ‘Already had a COVID-19 vaccine’ in February 2021. Vaccination intention increased across all ethnic groups and levels of social deprivation. Age was most strongly associated with vaccination intention, with 16–24-year-olds more likely to respond “Unsure” or “No” versus “Yes” than 65-74-year-olds in December 2020 (OR: 4.63, 95%CI: 3.42, 6.27 & OR 7.17 95%CI: 4.26, 12.07 respectively) and February 2021 (OR: 27.92 95%CI: 13.79, 56.51 & OR 17.16 95%CI: 4.12, 71.55). The association between ethnicity and vaccination intention has weakened, but not disappeared, over time. Both vaccine- and illness-related psychological factors were shown to influence vaccination intention. Conclusions Four in five adults (86%) who were reluctant or intending to refuse a COVID-19 vaccine in December 2020 had changed their mind in February 2021 and planned to accept, or had already accepted, a vaccine.