COVID vaccines remain the safest way to reduce the chance SARS-CoV-2 can put you in the hospital and are a crucial part of the public health campaign against the pandemic. In the US, however, there has been much controversy and open anger over attempts to expand vaccine use, and a significant portion of the population appears to be avoiding vaccination for political reasons.
The extreme polarization of US politics hasn’t gone away, and the controversy seems fresh in the minds of some politicians, so it’s easy to expect vaccine hesitation not to go away. However, an international survey of attitudes towards COVID vaccines suggests that the US has seen a large increase in COVID vaccine acceptance and now shares attitudes similar to other western-leaning democracies. Elsewhere in the world, the survey reveals clear regional patterns in vaccine uptake, although oddities abound.
become typical
The survey began in 2020 with a series of questions about whether people intended to receive vaccines once they became available. In years past, those who conducted the survey added several nations (now up to 23) and moved the questions to reflect vaccine availability, the addition of booster shots, and the development of treatments for COVID-19. In all 23 countries, the survey included a pool of 1,000 participants who generally reflected the country’s population.
The survey focuses on what she calls vaccine reluctance, which she defines as not having received a dose when it is available or not planning to get one when it is available. Questions about the booster shots took the same form but were specific to those who had already received vaccines.
Overall the news is good. Globally, average vaccine hesitancy has fallen in every survey edition and is now just over 20 percent. That’s exactly where the US is now, with just under 20 percent saying they didn’t get a first chance. (That seems similar to the percentage who had at least one shot, calculated from CDC data.)
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This also makes the US fairly typical of its peer group of Westernized democracies, which tend to be in the 15 to 20 percent vaccine lag range. Spain is on the low side at 10 percent hesitation, but rates are rising as you move east across Europe, with Sweden and Germany above 20 percent. Poland has the highest hesitancy among European democracies at 36 percent, possibly influenced by neighboring Russia, where hesitation is nearly 40 percent. The US now typifies this group, largely due to a roughly 20 percent increase in people who got vaccinated in the last year alone.
There is no clear pattern when it comes to boosters. France, where vaccination skepticism was below 20 percent, recorded a booster inhibition threshold of over 25 percent, and Germany recorded a booster inhibition threshold of just 11 percent. While local factors seem to be most important here, it is clear that we cannot expect a message that has worked for vaccines to automatically translate to boosters.
Span the globe
The rest of the world is sparsely represented in comparison, and the countries included mostly mark the exceptions. For example, South American countries (Brazil, Ecuador, and Peru) tend to have vaccination delays of about 10 percent, while north of that in Mexico, vaccination delays were more than double that, at over 26 percent. Acceptance in East and South Asia was very high (ranging from 11 percent hesitation in South Korea to under 2 percent in India), while it was much lower in African countries, where the best results in Nigeria were nearly 30 percent hesitation.
Remarkably, South Africa saw a 20 per cent drop in vaccination uptake – the largest in the survey – and more than half the population now expresses skepticism about vaccination. South Korea is also unusual in that, despite its high uptake, 27 percent of participants say they are reluctant to give booster shots, second only to Russia.
It is important to note that in many lower GDP countries, people are still answering the question without actually having the opportunity to get vaccinated. Fairer access to vaccines could allow more people in these countries to get vaccinated despite their reluctance. Elsewhere, other research has identified misinformation about vaccines, lower levels of education, and distrust of science and government as factors leading to hesitation.
Medical education appears to be particularly effective at encouraging vaccine acceptance, with just 4.6 per cent of healthcare workers expressing hesitation – a number that is still falling.
Parents’ willingness to have their children vaccinated also increases with familiarity. This has increased slightly worldwide and is now around 70 percent.