COVID-19 Vaccine Hesitancy Explained: Key Insights to Improve Future Vaccine Rollouts
New research has found that early hesitation around COVID-19 vaccines was largely driven by concerns that could be addressed over time.
As part of the major REACT study conducted by Imperial College London and involving more than one million people, researchers found that nearly two-thirds (65%) of those who were initially hesitant about getting the COVID-19 vaccine eventually went on to receive at least one dose.
The findings, published today in The Lancet, show that the most common reasons for vaccine hesitancy during the pandemic were concerns about the effectiveness of COVID-19 vaccines and their potential side effects. People who cited these concerns were more likely to change their minds later and get vaccinated.
However, those who expressed general anti-vaccine sentiments, distrust in vaccine manufacturers, or felt they were at low personal risk from COVID-19 were more likely to remain hesitant about vaccination.
These findings offer fresh insights into the main types of vaccine hesitancy seen in the UK during the COVID-19 pandemic and help identify potential barriers to vaccination in the future. The authors stress that public health officials and policymakers need to recognise that some forms of hesitancy are easier to address, while others are more resistant to change.
Professor Paul Elliott from Imperial’s School of Public Health, co-senior author of the paper and Director of the REACT Community Surveillance Study, said:
“The COVID-19 experience has shown us how crucial it is to ensure people have access to trusted and reliable information so they can make informed decisions about their personal health. Clear, trustworthy, and easy-to-understand information—especially about vaccine effectiveness and possible risks—is particularly important during public health emergencies like COVID-19, where new vaccine technologies are rolled out rapidly on a large scale.”
COVID-19 Vaccine Rollout
In this study, researchers from Imperial’s School of Public Health analysed longitudinal survey data from 1.1 million adults collected as part of the Real-time Assessment of Community Transmission (REACT) study, which focused on the early COVID-19 vaccine rollout between January 2021 and March 2022. Participants’ responses at the time of enrolment were later compared with National Health Service (NHS) vaccination records up to May 2024 to identify different types of vaccine hesitancy and their underlying reasons.
During the pandemic, participants were asked whether they had been vaccinated or intended to get vaccinated. Those who said they were unwilling or hesitant were asked to explain their reasons using a checklist of 23 options, along with a free-text response option.
The analysis found that overall, 3.3% of participants (37,982 people) showed some level of COVID-19 vaccine hesitancy. For 24,229 of these individuals (64%), later vaccination data was available through NHS record linkage. Hesitancy rates generally declined over time—from a high of 8% among those surveyed in January 2021 to just 1.1% by early 2022. During February and March 2022, coinciding with the Omicron wave, hesitancy rose slightly to just over 2.2%.
Researchers identified eight categories of vaccine hesitancy, including concerns about effectiveness and side effects, perceived low risk from COVID-19, distrust of vaccine manufacturers, and fear of vaccines and adverse reactions. Among the 30,701 participants who provided reasons for hesitancy, 41% (12,498) were worried about long-term health effects, 39% (11,953) wanted to wait and see whether the vaccine worked, and 37% (11,287) were concerned about side effects.
Reasons for hesitancy varied across different demographic groups. For example, men were more likely than women to say they felt no personal risk from COVID-19 (18% vs 10%). Women were more likely to express concerns about fertility-related outcomes (21% vs 8%). People aged 74 and above were more likely to hold generally anti-vaccine views compared to those aged 18–24 (12% vs 2.5%).
An analysis of later vaccination behaviour found that people who were less likely to eventually get vaccinated included older adults, women, people from Black ethnic backgrounds, those who were unemployed or living in poverty, individuals with a history of COVID-19 infection, and those with lower levels of education.
Professor Mark Chadeau-Hyam from Imperial’s School of Public Health, co-senior author of the paper, said:
“The COVID-19 pandemic gave us a unique opportunity to observe attitudes toward vaccination during a health emergency. There was a great deal of uncertainty at the time, as we were dealing with a new disease and a new vaccine platform. In our study, we wanted to take a deeper look at vaccine hesitancy to understand which groups were most hesitant and what their main concerns were. Understanding these reasons is essential for improving vaccination uptake and better controlling the spread of disease in the future.”
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