Coronavirus (COVID-19) vaccine barriers and incentives to uptake: literature review

Key findings

Vaccine hesitancy is complex and varies by population group. It affects uptake of a number of routine vaccinations in the UK (e.g. MMR) with consequences such as outbreaks of preventable diseases and the loss of the country's measles-free status^[21].

In the past few years, research has identified some of the common factors impacting vaccine acceptance. These range from access barriers to trust in the system that delivers it, perception of being at low risk and cultural beliefs.

This knowledge has helped to predict uptake of Covid-19 vaccines and contributed to developing the 3Cs model. While supported by this in the design and roll-out of one of the most effective vaccination campaigns in UK history, policy makers have faced new challenges. Covid-19 vaccines present a degree of uniqueness due to the speed at which they have been developed and the intense efforts that have been put to their promotion.

A number of studies have investigated how this may have affected the intention to get a Covid-19 vaccine and have shown a percentage of hesitancy oscillating between 12 and 36%^{[22 23 24 25 26 27 28 29 30 31 32 33 34]}. This is in line not only with statistics from other Western countries, but also with statistics on resistance to vaccines targeting other infectious diseases^{[35 36 37 38 39]}. Overall, research indicates that certain groups are more likely than others to be hesitant. These groups are: minority ethnic communities, pregnant women or women of fertile age, those living in poverty, people with lower levels of education, younger people, parents and those who haven't engaged with other vaccination campaigns.

Intention to get vaccinated has mostly matched actual uptake of first and second doses, including the expectation of higher acceptance in Scotland compared to the other UK nations and lower acceptance in London^[40]. Over time, there has been continuous progress in vaccine uptake, even more evident as the gap between minority ethnic groups has kept reducing^[41]. Yet, whenever case rates were lower or Covid-19 restrictions were eased, vaccine hesitancy started to rise again^[42].

The variety of factors determining vaccine hesitancy will be analysed in the following sections by means of the SAGE 3Cs model. This will be used as a reference to report key findings on barriers and possible incentives to uptake.