key: cord-0334582-qq5cb45v authors: Savoia, E.; Su, M.; Piltch-Loeb, R.; Testa, M. A. title: Understanding COVID-19 Vaccine Early Skepticism and Misinformation date: 2021-07-22 journal: nan DOI: 10.1101/2021.07.21.21260881 sha: 01103e7bc9402eddac5a47d9ca688fbd8be0167d doc_id: 334582 cord_uid: qq5cb45v Recent polls report that approximately 18% of healthcare workers are still skeptical about getting vaccinated. These professionals play a key role as communicators to their patients and community members. Understanding their concerns and informational needs, as well as those of other essential workers, is important for building an effective communication strategy for the whole population. This study presents the results of a survey of 1,591 hesitant U.S. essential workers, conducted in December 2020, when they were the only group eligible for the vaccine, aiming to describe their concerns regarding the COVID-19 vaccine and related policies. Results show that freedom of choice, concerns about equal access to the vaccine and being able to live a life with no restrictions once vaccinated, were important issues since the early days of the distribution campaign. Vaccine communication campaigns and distribution policies should address both non-medical and medical concerns with the same relevance. A recent analysis of 39 nationally representative polls suggests that approximately 11% of the U.S. public is skeptical about getting the COVID-19 vaccine, and that 22% are definitely not interested in getting it. i At the time of this writing, in July 2021, approximately 67% of the U.S. adult population has received at least one dose of the vaccine. ii If intent, as expressed in the polls, is followed by behavior, it is very possible that we are hitting a plateau in vaccination rates among U.S. adults. This situation may leave us with a fraction of highly vulnerable individuals still at risk of experiencing severe consequences from COVID-19, including individuals working in essential services important for the functioning of our society and maintenance of the health and welfare of our communities. National polls have also highlighted the role that healthcare workers play as trusted messengers in conveying health information in general and specific to the vaccine. Polls' respondents frequently report they trust their doctor and healthcare professionals to share information regarding vaccines safety. Although healthcare workers had access to the vaccine as early as December 2020, recent polls have reported that approximately 18% of them are still skeptical about getting vaccinated. iii It is important to understand the reasons for their skepticism, because these professionals play a key role as communicators to their patients, family and community members. Understanding what type of additional information might reduce their skepticism is important for building an effective communication strategy for the whole population. We surveyed essential workers in the USA in December 2020, 68% of which were working in the healthcare setting, nursing home and public health, and asked them what would be important for them to know to make them more likely to take the COVID-19 vaccine. We believe that, even if demand and supplies have change over the past six months, these data are very informative to the current discourse on vaccine acceptance because people are more likely to remember and believe the first message received, iv therefore what they believed in December 2020 may still be influencing their own and community members' actions today. Our survey asked the essential workers if they needed more information about the safety of the vaccine but also if they had concerns that might have originated from exposure to misinformation, such as the 5G origin of the disease or that you can get COVID-19 from the vaccine. We also asked what they thought about the severity of the pandemic, perceived risks and benefits of the vaccine and opinions about freedom of speech and freedom of health choices in the context of COVID-19 vaccination policies. Finally, we investigated their main sources of information to understand to what extent exposure to social media was influencing their opinions and needs for additional information. We used a cross-sectional online survey study design. The survey was implemented via mobile phones by the use of the survey platform Pollfish, and limited to essential workers aged >18 residing in the USA. Similar to third-party advertising companies, Pollfish pays mobile application developers to display and promote the surveys to their users using crowdsourcing. The survey was implemented between December 13-23, 2020. A screening question was used to identify respondents belonging to one of 19 job categories (essential workers) that were identified as priority groups for vaccine distribution based on national guidance available at the time of the survey. v The study protocol and survey instrument were approved by the Harvard T.H. Chan School of Public Health Institutional Review Board. A copy of the questionnaire and data can be found on GitHub vi . We focused our analysis on individuals that expressed hesitancy about getting the COVID-19 vaccine. We analyzed responses to the following question "What would be important for you to know to make you more likely to take the COVID-19 vaccine?". We computed frequencies for each answerwhich from now on we will refer to as informational needs-and All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted July 22, 2021. ; https://doi.org/10.1101/2021.07.21.21260881 doi: medRxiv preprint Chi-square statistics, followed by trend tests when appropriate, to investigate differences in answers by age, gender, level of education, race and source of COVID-19 vaccine information (social media vs. traditional media). We also computed Chi-square statistics and trend tests to study the association between informational needs and levels of vaccine acceptance. Statistics were computed by the use of the statistical software SAS and significance levels set at alpha<0.05. We gathered responses from 2,650 subjects of which 1,591 (60%) expressed some level of hesitancy about getting the COVID-19 vaccine, the analysis focused on this group of hesitant individuals. Table 1 shows the frequency of type of information that respondents reported as being important to them to increase their acceptance of the vaccine. Table 2 presents the frequencies on vaccine acceptance and sample characteristics. More specifically, when asked if they will get the vaccine in the next two months: 188 (12%) said they were not interested, 339 (21%) said they were unlikely to get it, 153 (10%) somewhat unlikely, 388 (24%) not sure and 523 (33%) somewhat likely. The majority of respondents in our sample were male (55%), in the age group 25-44 (66%), white non-Hispanic (66%), 56% with a college or higher level of education, 68% were either healthcare workers, working in a nursing home or in public health, the rest 32% were working in other essential services such as transportation, pharmacies, vaccine manufacturing etc. and 69% got most information on the vaccine from traditional media compared to social media. All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted July 22, 2021. ; https://doi.org/10.1101/2021.07.21.21260881 doi: medRxiv preprint As shown in Table 1 , freedom of choice, equal access to the vaccine and being able to live a life with no restrictions were the three most important issues to the respondents in relation to their willingness to accept the vaccine. Table 2 displays the differences in informational needs and related concerns about vaccine safety, effectiveness and policies by socio-demographic characteristics and use of social media. Concerns about potential injuries caused by the vaccine and equal access to the vaccine differed by gender (Chi, respectively) . Opinions about freedom of choice and freedom of speech--expressed as the need to know that those with concerns about the vaccine would be able to express themselves--differed by level of education (Chi, p-value= 0.03 and Chi, p-value=0.004, respectively). The need for additional information was associated with vaccine acceptance (Chi, p-value<0.05) for nine out of the fourteen topics investigated. In terms of social media use, those who said to have received most of the information about the vaccine from social media were less likely to report the need for additional information on most of the answer options (Chi, p-value<0.05). Public information and warning is one of the preparedness capabilities, that public health agencies across the country, will need to continue to implement in the months ahead to support the COVID-19 vaccination campaign. vii Despite the fact that the individuals we surveyed belonged to high priority groups for the vaccination at a time when demand for the vaccine was high, our data are consistent with more recent polls stating that approximately 11-20% of the US population is not interested in getting the vaccine or is somewhat hesitant. We believe these data are important because early adopters and rejectors of immunization -in particular if belonging to healthcare professional groups -can have a strong influence on the likelihood that others will accept the vaccine. viii All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. This study focused on understanding specific informational needs that need to be met to enhance vaccine acceptance. It is noteworthy that the top concerns identified in our sample were not related to medical or public health issues such as the safety or effectiveness of the vaccine. And that those who obtained most of the information about the vaccine from social media were less likely to need additional information probably due to a state of overload of information received. Concerns related to freedom of choice, freedom of speech, and freedom of movement were the most important among the hesitant individuals, even at a time when data on safety and effectiveness were limited compared to today. This illustrates that vaccine hesitancy is a complex construct which reflects not just the hesitancy toward a pharmaceutical product but also toward the policies that are developed and used for its distribution. This is clearly a scenario in which ideology influences medical choices with implications for vaccine policy. Mandating vaccination may appear to be an easier strategy to increase vaccine uptake compared to developing better communication efforts. However, it is a strategy with the potential to backfire and further polarize society. Communication efforts should be focused on risks and benefits only because policies that somehow affect the freedom discourse might further alienate the most hesitant individuals. It is impossible to get COVID-19 or any other disease from the vaccine itself or its components 509 32% The fast production of the vaccine did not compromise its safety 492 31% The vaccine cannot cause any immediate or long term injury 488 31% The FDA, CDC and WHO recommend the vaccine and agree it is safe 444 28% Pharmaceutical companies will not make large profits from the vaccine 423 27% Those with concerns about the vaccine have opportunities to share their opinions with the public 405 25% The vaccine works in protecting me from COVID-19 366 23% The vaccine works in stopping the transmission of COVID-19 from one person to another 329 21% There is no other reason why we have so many people sick (i.e. 5G technology or other factors we do not know about) 279 18% Those approving the vaccine are following strict rules 277 17% All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted July 22, 2021. ; https://doi.org/10.1101/2021.07.21.21260881 doi: medRxiv preprint Table 2 What would be important for you to know to make you more likely to take the COVID-19 vaccine? (N=1,591) The fast production of the vaccine did not compromise its safety. Those approving the vaccine are following strict rules. An Uncertain Public -Encouraging Acceptance of Covid-19 DOI: 10.1056/NEJMp2100351. ii CDC COVID Data Tracker. Available at KFF/The Washington Post Frontline Healthcare Workers 19 Vaccination Program Interim Playbook for Jurisdictional Operations. CDC. October 29 2020 version 2.0 Available at -USA vii Public Health Emergency Preparedness and Response Capabilities: National Standards for State, Local, Tribal, and Territorial Public Health Vaccine hesitancy: an overview All rights reserved. No reuse allowed without permission.(which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.