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Once we have it, will we use it? A European survey on willingness to be vaccinated against COVID-19

While the focus of attention currently is on developing a vaccine against the Coronavirus SARS-CoV-2 to protect against the disease COVID-19, policymakers should prepare for the next challenge: uptake of the vaccine among the public. In this editorial, we provide some first insights into this willingness to be vaccinated. This project has received funding from the European Union’s Horizon 2020 research and innovation programme under the Marie Skłodowska-Curie Grant Agreement No 721402.

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On April 26, the WHO counted seven COVID-19 candidate vaccines in the clinical evaluation phase and 82 more in the preclinical evaluation phase. This underlines the unprecedented current efforts worldwide to find an effective vaccine against the Coronavirus SARS-CoV-2. Some expect that first vaccines may become available under emergency use protocols as soon as early 2021, given the speed and scale of research and development efforts globally, while others argue it will take longer. In both cases, the development phase should be followed by large-scale vaccination programmes to attain herd immunity. That way, we can protect the lives of the most vulnerable people and reduce the social and economic burden of the current crisis. At present, it is unclear whether a sufficient proportion of the population would decide to get vaccinated when a vaccine becomes available. In the EU, vaccine delays and refusals are contributing to declining immunisation rates in several countries and lead to increases in disease outbreaks. Hence, the question is whether enough Europeans trust the effectiveness and safety of vaccines and the healthcare system that delivers them. To shed more light on the issue of willingness to be vaccinated, we investigated people’s attitudes about vaccination against COVID-19 in an online survey among representative samples of the population (in terms of region, gender, age group and education) in seven European countries (N = 7.662). In total, 73.9% of the 7664 participants from Denmark, France, Germany, Italy, Portugal, the Netherlands, and the UK stated that they would be willing to get vaccinated against COVID-19 if a vaccine would be available. A further 18.9% of respondents stated that they were not sure, and 7.2% stated that they do not want to get vaccinated. The largest proportions of the population opposed to a COVID-19 vaccination were observed in Germany (10%) and France (10%), while France also has the largest group of people who were unsure about getting vaccinated (28%). We asked respondents who were unsure about being vaccinated about their main reasons. More than half (55%) said they were concerned about potential side effects of a vaccine, although this concern was more frequent among women (36%) than men (19%). Around 15% of respondents stated that a vaccine might not be safe, with no notable differences between genders. This finding highlights that while the current focus seems to be on developing a vaccine about ten times faster than usual, the public should also be reassured that any vaccine which becomes available that quickly is safe and effective. Understanding which groups in the population are not willing to be vaccinated and why remains vital for the design of policy responses to vaccination hesitancy. One of the avenues to explore could be to emphasise the social benefits of vaccination more strongly so that they weigh the public health dimension more heavily in their decision whether to vaccinate. Our findings highlight that considerable policy effort may be required to come from having a vaccine to adequate vaccination rates, especially in some countries. Targeting those in the population who are currently hesitant seems most promising and cost-effective, but this requires convincing evidence and clear communication on the safety and effectiveness of the vaccine. This may be at odds with the current push for having a vaccine available as soon as possible. A campaign emphasising the social benefits of vaccination could increase the willingness to be vaccinated among those amenable to such pro-social motives. Finally, a sizeable proportion of the population indicates not to be open to vaccination. Concluding, improving our understanding of vaccination hesitancy in the context of COVID-19, as well as finding and using policies to overcome it, may be as important as discovering a safe and effective vaccine.


health, COVID-19, vaccine