Vaccine hesitancy, defined as a delay in acceptance or refusal of safe vaccines, is recognized by WHO as a major global health threat, particularly regarding COVID-19 vaccination. Factors contributing to vaccine hesitancy include concerns about safety, effectiveness, and personal health risks, with disparities observed among ethnic groups and socioeconomic statuses. Addressing hesitancy requires tailored communication, community engagement, and systemic health interventions, emphasizing the need for trust and knowledge in promoting vaccine uptake.

1. Addressing Hesitancy to
Covid-19 Vaccination
Professor Azeem Majeed
Imperial College London
NIHR ARC NW London

2. Vaccine hesitancy
“A delay in acceptance or refusal of safe vaccines despite availability of vaccine services.” World
Health Organization (WHO)
WHO has named vaccine hesitancy as one of the top 10 threats to global health
“Vaccines only work if people receive them”

3. Levels of vaccine hesitancy
ACCEPT
ALL
ACCEPT SOME,
DELAY AND
REFUSE SOME
ACCEPT
BUT
UNSURE
REFUSE
ALL
REFUSE
BUT
UNSURE

4. Proportion of UK adults likely to have a Covid-19 vaccine

5. Attitudes to vaccination by ethnic group in UK

6. Vaccine hesitancy by clinical status

7. Vaccine hesitancy by income level

8. Top reasons for vaccine hesitancy
I am worried about the side effects 44%
I am worried about the long term effects on my health 43%
I would wait to see how well the vaccine works 40%
I do not think it will be safe 24%
I do not feel COVID-19 is a personal risk 17%
I do not think it will work 12%
I am worried about the effect on an existing health condition 11%
I am against vaccines in general 8%
I am pregnant or trying to get pregnant and afraid of the effects on my baby 6%
I do not think I need the vaccine as I have tested positive for COVID-19 5%
I am worried it might be painful 3%
I am worried the vaccine will give me COVID-19 3%

9. Factors in vaccine hesitancy: The five Cs
• Confidence & Trust
• Communication: misinformation and public health messaging
• Context: sociodemographic factors, ethnicity, religion,
education
• Convenience
• Complacency

10. Take-up of Covid-19 vaccination lower in ethnic
minority groups

11. Vaccine hesitancy is declining in many countries

12. Concerns about safety can undermine vaccine
confidence and increase vaccine hesitancy

14. Factors in vaccine hesitancy in minority groups

16. What can be done to address vaccine hesitancy?
• Tailored communication from trusted sources (eg, healthcare
providers, community representatives)
• Access to community groups and local NHS Services – primary
and community-led vaccination
• Engagement by community champions, faith leaders, youth
ambassadors, healthcare workers
• Communication training and education of those involved with
engagement activities at a local level
• Listen, respect, address information needs

17. Some additional tips
• Remember to acknowledge any concerns
• Try to remain non-judgemental
• Be knowledgeable about vaccines
• Provide evidence-based information
• Discuss the risks and benefits of vaccination
• Vaccines are extensively studied before being licensed
• Vaccine safety monitoring continues after they enter use

18. Health system and provider level interventions also essential
• Call-Recall Systems (computer, not paper-based)
• Reminders – Text message, letter, email, telephone
• Financial reimbursement and incentives for providers
• Feedback of data on provider performance
• Mass media campaigns
• Endorsements by local and national figures

20. Issues to be addressed
• How long does immunity last after vaccination?
• How effective are current vaccines against new variants?
• Will booster doses be needed and, if so, how frequently?
• How will the NHS implement vaccination programmes if
booster doses are needed?

21. Conclusions
• Vaccines offer the best method for controlling the global
Covid-19 pandemic
• Vaccines only work if people are prepared to receive them
• Vaccine hesitancy is a key issue globally, particularly among
marginalised groups, minorities and the poor
• Addressing vaccine hesitancy requires both individual and
population-based approaches
• Healthcare professionals and occupational health specialists
have a key role to play in promoting vaccination

22. Acknowledgements
• UK Office for National Statistics
• World Health Organization
• Our World in Data
• Dr Mohammad Razai
• Dr Tatiana Christmas
• Dr Tasnime Osama
• Twitter @Azeem_Majeed