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Protective Behaviors Against COVID-19 by Individual Vaccination Status in 12 Countries During the Pandemic

Educational Objective
To identify the key insights or developments described in this article
1 Credit CME

The eagerly awaited onset of vaccination programs against COVID-19, along with people’s urge to return to “normal life,” has prompted concerns that individuals who were vaccinated would reduce their protective behaviors faster than recommended.1,2 Whereas worries about risk compensation3 have proven unfounded in some preventive medicine contexts (eg, human papillomavirus vaccination4), signs of riskier conduct among the treated have appeared in others (eg, individuals who use HIV preexposure prophylaxis5). Based on representative samples of 12 countries in various stages of immunization programs, this study compared the self-reported protective behaviors of individuals who had received 0, 1, or 2 COVID-19 vaccine doses. We assessed the period February 23 to June 1, 2021, when, barring anecdotal exceptions,6 governments had yet to exempt individuals who had been vaccinated from COVID-19 protective-behavior policies.

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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.

Article Information

Accepted for Publication: August 23, 2021.

Published: October 26, 2021. doi:10.1001/jamanetworkopen.2021.31137

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2021 Goldszmidt R et al. JAMA Network Open.

Corresponding Author: Rafael Goldszmidt, PhD, Brazilian School of Public and Business Administration, Fundação Getulio Vargas, Rua Jornalista Orlando Dantas 30, Rio de Janeiro, RJ, CEP 22231-010, Brazil (rafael.goldszmidt@fgv.br).

Author Contributions: Dr Goldszmidt had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Drs Goldszmidt and Petherick are co–first authors.

Concept and design: Goldszmidt, Petherick, Andrade, Phillips, Jones.

Acquisition, analysis, or interpretation of data: Goldszmidt, Petherick, Hale, Furst.

Drafting of the manuscript: Goldszmidt, Petherick, Andrade, Jones.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Goldszmidt, Petherick, Furst.

Administrative, technical, or material support: Hale.

Supervision: Goldszmidt, Andrade.

Conflict of Interest Disclosures: Mr Furst reported receiving grants from Coordenação de Aperfeiçoamento de Pessoal de Nível Superior during the conduct of the study. No other disclosures were reported.

Additional Contributions: Helen Tatlow, MPH, Laura Hallas, MSc, and Jessica Anania, DPhil (Oxford University) provided their research into vaccine-conditional protective-behavior policies. They were not compensated outside of their salaries.

References
1.
Mantzari  E , Rubin  GJ , Marteau  TM .  Is risk compensation threatening public health in the COVID-19 pandemic?   BMJ. 2020;370:m2913. doi:10.1136/bmj.m2913PubMedGoogle Scholar
2.
Wright  L., , Steptoe  A., , Mak  H. W., , & Fancourt  D.,   Do people reduce compliance with COVID-19 guidelines following vaccination: a longitudinal analysis of matched UK adults.   medRxiv. Preprint posted online April 28, 2021. doi:10.1101/2021.04.13.21255328Google Scholar
3.
Brewer  NT , Cuite  CL , Herrington  JE , Weinstein  ND .  Risk compensation and vaccination: can getting vaccinated cause people to engage in risky behaviors?   Ann Behav Med. 2007;34(1):95-99. doi:10.1007/BF02879925PubMedGoogle ScholarCrossref
4.
Kasting  ML , Shapiro  GK , Rosberger  Z , Kahn  JA , Zimet  GD .  Tempest in a teapot: a systematic review of HPV vaccination and risk compensation research.   Hum Vaccin Immunother. 2016;12(6):1435-1450. doi:10.1080/21645515.2016.1141158PubMedGoogle ScholarCrossref
5.
Traeger  MW , Schroeder  SE , Wright  EJ ,  et al.  Effects of pre-exposure prophylaxis for the prevention of human immunodeficiency virus infection on sexual risk behavior in men who have sex with men: a systematic review and meta-analysis.   Clin Infect Dis. 2018;67(5):676-686. doi:10.1093/cid/ciy182PubMedGoogle ScholarCrossref
6.
Hale  T , Angrist  N , Goldszmidt  R ,  et al.  A global panel database of pandemic policies (Oxford COVID-19 Government Response Tracker).   Nat Hum Behav. 2021;5(4):529-538. doi:10.1038/s41562-021-01079-8PubMedGoogle ScholarCrossref
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