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Are there communication strategies that can reduce COVID-19 vaccine-specific hesitancy?
In a between-participants survey study of adult Canadian citizens, individuals who were provided information on the death prevention potential of less-preferred vaccines, such as AstraZeneca and Johnson & Johnson, reported more confidence in their effectiveness and a higher likelihood of taking these vaccines if offered compared with those who did not receive this information. Information on the overall effectiveness of these vaccines at preventing symptomatic COVID-19 showed the opposite result.
These findings suggest that communication strategies that focus on the death prevention potential of less-preferred COVID-19 vaccines have the potential to improve their uptake, whereas focusing on such metrics as their comparatively less impressive overall effectiveness at preventing symptomatic COVID-19 could undermine these efforts.
Ensuring widespread uptake of available COVID-19 vaccinations, each with different safety and efficacy profiles, is essential to combating the unfolding pandemic.
To test communication interventions that may encourage the uptake of less-preferred vaccines.
Design, Setting, and Participants
This online survey was conducted from March 24 to 30, 2021, using a nonprobability convenience sample of Canadian citizens aged 18 years or older, with quota sampling to match 2016 Canadian Census benchmarks on age, gender, region, and language. Respondents completed a 2-by-2-by-2 factorial experiment with random assignment of brand (AstraZeneca or Johnson & Johnson), information about the vaccine’s effectiveness against symptomatic infection (yes or no), and information about the vaccine’s effectiveness at preventing death from COVID-19 (yes or no) before being asked about their willingness to receive their assigned vaccine and their beliefs about its effectiveness.
Respondents were randomly assigned a vaccine brand (AstraZeneca or Johnson & Johnson) and information about the vaccine’s effectiveness against symptomatic COVID-19 infection (yes or no) and at preventing death from COVID-19 (yes or no).
Main Outcomes and Measures
Respondents’ self-reported likelihood of taking their assigned vaccine if offered (response categories: very likely, somewhat likely, not very likely, or not at all likely, scaled 0-1) and their beliefs about their assigned vaccine’s effectiveness (response categories: very effective, somewhat effective, not very effective, or not at all effective, scaled 0-1) were measured.
A total of 2556 Canadian adults responded to the survey (median [IQR] age, 50 [34-63] years; 1339 women [52%]). The self-reported likelihood of taking an assigned AstraZeneca or Johnson & Johnson vaccine was higher for respondents given information about their assigned vaccine’s effectiveness at preventing death from COVID-19 (b, 0.04; 95% CI, 0.01 to 0.06) and lower among those given information about its overall effectiveness at preventing symptomatic transmission (b, −0.03; 95% CI, −0.05 to 0.00), compared with those who were not given the information. Perceived effectiveness was also higher among those given information about their assigned vaccine’s effectiveness at preventing death from COVID-19 (b, 0.03; 95% CI, 0.01 to 0.05) and lower among those given information about their assigned vaccine’s overall efficacy at preventing symptomatic infection (b, −0.05; 95% CI, −0.08 to −0.03), compared with those who were not given this information. The interaction between these treatments was neither substantively nor statistically significant.
Conclusions and Relevance
These findings suggest that providing information on the effectiveness of less-preferred vaccines at preventing death from COVID-19 is associated with more confidence in their effectiveness and less vaccine-specific hesitancy. These results can inform public health communication strategies to reduce hesitancy toward specific COVID-19 vaccines.
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CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.
Accepted for Publication: July 22, 2021.
Published: September 30, 2021. doi:10.1001/jamanetworkopen.2021.26635
Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2021 Merkley E et al. JAMA Network Open.
Corresponding Author: Peter John Loewen, PhD, Munk School of Global Affairs and Public Policy, University of Toronto, One Devonshire Pl, Toronto, ON M5S 3K7, Canada (firstname.lastname@example.org).
Author Contributions: Drs Merkley and Loewen had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.
Concept and design: Merkley.
Acquisition, analysis, or interpretation of data: Both authors.
Drafting of the manuscript: Merkley.
Critical revision of the manuscript for important intellectual content: Both authors.
Statistical analysis: Merkley.
Obtained funding: Loewen.
Administrative, technical, or material support: Loewen.
Conflict of Interest Disclosures: None reported.
Funding/Support: This study was supported by grants from 19toZero, the Department of Canadian Heritage, and the University of Toronto to Drs Merkley and Loewen.
Role of the Funder/Sponsor: The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.
Additional Contributions: Jamie Druckman, PhD (Northwestern University), and members of the Policy, Election, and Representation Lab provided helpful comments on earlier drafts of this manuscript. They were not compensated beyond their normal salaries.
Additional Information: A preanalysis plan for this study was registered on the Open Science Foundation (see https://osf.io/74e2x).
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