The development of a safe and effective COVID-19 vaccine is central to overcoming the virus. Experts agree a COVID-19 vaccination could be ready as soon as mid-2021 (Abd El-Aziz, Stockand, 2020). While the discovery of a vaccine will be crucial to protect individuals against COVID-19, achieving widespread vaccination coverage is essential.

Vaccinations trigger an immune response to a pathogen, enabling the body to fight future infections. High vaccination levels are required to suppress disease spread and protect unvaccinated individuals in the population, achieving herd immunity (Gavi, 2020a).

To establish herd immunity for COVID-19, it is estimated that between 55% and 82% of the population will need to be immune (Sanchez et al., 2020). However, ever-rising vaccine hesitancy could hamper these efforts.

Vaccine hesitancy is the reluctance to receive vaccinations despite availability

Vaccine hesitancy is the reluctance to receive vaccinations despite availability and has been identified as one of the top ten threats to global health by the World Health Organisation (WHO, 2019). Studies estimate that between 20% and 30% of the population would refuse a future COVID-19 vaccine (Thunstrom et al., 2020; Pertti-Watel et al., 2020). Furthermore, as certain individuals cannot be vaccinated due to age or health conditions, achieving herd immunity will be challenging. 

The determinants of vaccine hesitancy are numerous and complex; however, the “three Cs” model by the WHO EURO Vaccine Communications Working Group has categorised determinants broadly into three overlapping categories: confidence; complacency; and convenience (Sage Working Group, 2014). This framework can be applied to investigate barriers to future COVID-19 vaccine uptake.

Confidence is the trust in the effectiveness and safety of vaccines, the system delivering vaccines, and the motivations of policy makers (Sage Working Group, 2014). Misinformation concerning the safety of vaccinations and conspiracy theories about COVID-19 are widely circulated online, indicating lack of confidence will be a significant barrier.

Public health educational campaigns will be crucial for boosting confidence in vaccines and warning against complacency toward the virus.

Complacency is the perceived risk of a disease being low (Sage Working Group, 2014). Described as the “biggest threat” in countries recovering from the pandemic, complacency about the risks of COVID-19 could lead to a large proportion of individuals deeming a vaccine unnecessary (WHO, 2020). Public health educational campaigns will be crucial for boosting confidence in vaccines and warning against complacency toward the virus.

Convenience describes the availability, affordability, and physical access to vaccines (Sage Working Group, 2014). Significant challenges lie in the manufacturing of a vaccine at scale, allocating vaccines fairly, and combatting vaccine nationalism, as countries seek to protect their own populations. However, there is promising progress in these areas, including the recent announcement of the COVAX facility (Gavi, 2020b).

The successful uptake of a future COVID-19 vaccination depends on promoting an open and honest dialogue between the public and public health experts. This dialogue must facilitate the spread of accurate information, be appropriately targeted, and correct false claims. To be effective it must begin now.

By Charlotte Bexson

A contributor and member of the Cov360 team

27 July 2020

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