key: cord-0890859-lg9zla6h authors: Thaker, Jagadish; Floyd, Brian title: Shifting COVID-19 Vaccine Intentions in New Zealand: Next Steps in the Vaccination Campaign date: 2021-09-17 journal: Lancet Reg Health West Pac DOI: 10.1016/j.lanwpc.2021.100278 sha: 34ed598263e2924f83ada096f0b4850945ba0327 doc_id: 890859 cord_uid: lg9zla6h nan Few studies inform us about the New Zealand public intentions to get a COVID-19 vaccine, even as the vaccine rollout has been slow-a pattern similar to Australia, unlike several other developed countries [1] . Such low vaccination rates pose an increasing threat from the new COVID-19 variants to New Zealand, which has been able to evade the pandemic so far [2] . Given the brittle health care system in New Zealand-with second-fewest intensive care beds per capita among developed countries-health experts say it is important to vaccinate a very large proportion, about 80-90%, of the population to safely open the borders [2] . A recent study by Prickett and colleagues [3] in the Lancet Regional Health -Wester Pacific found that while a majority of New Zealanders (71%) say they are likely to take a COVID-19 vaccine, a significant minority were unsure (15%) or unlikely (14%) to get a vaccine. Young and less educated were more likely to decline a vaccine. Moreover, women were more likely to be unsure than men who were more certain about getting a vaccine or not. However, they did not find ethnicity as significantly associated with COVID-19 vaccine hesitancy in a multivariate model, suggesting that "pub-✩ Funding for the data collection was provided by Massey University. Supplementing their findings, only age and education were significantly associated with COVID-19 vaccine intentions in online national surveys conducted in March 2021 (Wave 1 = 1083) and May 2021 (Wave 2 = 650). Similarly, ethnicity was not significantly associated with vaccine intentions in the presence of other sociodemographic variables; neither was gender or income. In longitudinal online nationally representative surveys conducted between March 1 and May 2021 ( N = 650), there is a sixpercentage point increase among the New Zealand respondents who will 'definitely' take COVID-19 vaccine to protect themselves from 61% in March 2021 to 67% in May 2021 (67%). However, a quarter remained unsure (26%), and another 8% were sceptical. The vaccine uptake is at its highest in over a year across multiple public opinion surveys [ 4 , 5 ] . This finding is consistent with the Ministry of Health surveys that showed an uptick in May [4] . A large majority (92%) of those who had made up their mind to 'definitely' get a vaccine in March continued to do so in May. A small minority became more hesitant (7%), while 1% became more sceptic. The biggest shift was among those who were 'Unsure, but leaning towards YES' in March to 'definitely' in May (42%), even as about half continued to be unsure (47%) and just over 11% became more hesitant or sceptic. The second largest shift was among those who would 'definitely' not get a vaccine in March: while a majority still continued to say so (64%), 21% shifted to 'Unsure, but leaning towards NO,' 4% to 'Unsure, but leaning towards YES', and 11% to 'definitely' getting a vaccine (See Figure 1 ) . The uptick in COVID-19 vaccine intentions, compared to those who did not change their intentions between March and May 2021, was primarily due to uptick among M āori and Asians. M āori respondents were 2 times (Odds Ratio [ were also twice as likely as European New Zealanders to become more motivated to get a COVID-19 vaccine in three months. Gender, age, education, gender, and income were not associated with change in COVID-19 vaccine intentions. In other words, At the same time, there were no significant association between socio-demographic factors and a decline in intentions compared to those who did not change their intention, except for a minor increase in vaccine hesitancy among younger aged groups. Consistent with findings from other Ministry of Health surveys [4] , the COVID-19 vaccination campaign should seek ways to understand and engage the young and less educated groups. The uptick among the ethnic minorities of M āori and Asians is good news. It implies the success of both community-led COVID-19 protective measures as well as government outreach [ 3 , 6 ] . M āori and Pasifika health advocates leading the fight against vaccine misinformation [7] , promoting vaccination through pop-up clinics, and organising vaccination centres at and during community events has helped close the vaccination gap between M āori and non-M āori [8] . Several studies show that ethnic minorities have lower intentions to get a COVID-19 vaccine, in part due to historic inequalities, differential access to health care, among others [9] . Even prior surveys in New Zealand show vaccination intention is generally low among minorities [ 4 , 5 ] , even as their risk of hospitalization and death is higher than others [10] . Continuing the government's focus to engage with at-risk groups will help build trust to resolve other persisting public health issues ( Table 1 ) . It is also important to highlight that there is a vaccination uptake gap among M āori and Pacific people compared to the general population and the gap is slow to narrow down [2] . Understanding the shifting public intentions to get a COVID-19 vaccine will better help increase vaccination uptake, particularly important as almost all COVID-19 deaths are now among the unvaccinated in other countries [11] . On the one hand, health care system should be more embedded with at-risk communities. On the other, we need more participation from local groups-from community and local councils, business groups, unions, and others-encouraging vaccine uptake among their group members. The authors declare no conflict of interest. What's behind NZ's slow vaccine rollout? Newsroom Covid-19: Delta in NZ community would "risk collapsing or compromising our health system Covid-19 vaccine hesitancy and acceptance in a cohort of diverse New Zealanders. The Lancet Regional Health -Western Pacific Ministry of Health New Zealand. 2021 The persistence of vaccine hesitancy: Covid-19 vaccination intention in New Zealand Mahi aroha: M āori work in times of trouble and disaster as an expression of a love for the people. K ōtuitui: New Zealand Journal of Social Sciences Online Advocacy group to tackle vaccination fears among M āori. NZ Herald Gap between M āori and non-M āori vaccination rates closing Lessons about COVID-19 vaccine hesitancy among minority ethnic people in the UK. The Lancet Infectious Diseases Estimated inequities in COVID-19 infection fatality rates by ethnicity for Aotearoa New Zealand Nearly all COVID deaths in US are now among unvaccinated. AP NEWS Table A1 .