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Most people in the UK accept the COVID-19 vaccine when it is offered. But some are hesitant. New research has explored whether different versions of written information could change people's views. It found that, among those who were hesitant, stressing the personal benefits of the vaccine was more effective than stressing benefits to the community. This approach did not discourage other groups from accepting the vaccine.

The study was carried out in early 2021, when few people had received vaccines. At the time, almost one in five (17%) people in the UK said they would refuse or delay having the vaccine for as long as possible. Researchers wanted to know the best way to frame information, to find an approach that would encourage more people to get vaccinated. 

Additional information about the personal benefits slightly shifted attitudes among people who intended to refuse vaccination.  Given the large numbers of people needing vaccination, this slight shift in attitude could represent many more people accepting vaccination. 

Further work could explore whether videos or social media campaigns would be a powerful way of reaching this group of people. They need clear information about different COVID vaccines and booster shots.

Further information on booking and managing your COVID-19 vaccination is available on the NHS website

What’s the issue?

The effectiveness of the COVID-19 vaccination programme depends on the numbers who accept the vaccine. The more people vaccinated, the less risk to the population. Clear information about the benefits of the vaccine is therefore vital. 

By October 2021, four in five (79%) over-12s in the UK had received both doses of a COVID-19 vaccine. But some people are not convinced by the information currently available and remain reluctant to accept vaccination.

The researchers wanted to see whether extra pieces of information might address their concerns. They were looking for the information most likely to reduce hesitancy in this group – and to reinforce positive views among others.

What’s new?

The study was carried out in early 2021. It included 18,855 adults who broadly reflected the UK population in terms of their age, gender, income and ethnic group. Two in three (66%) were willing to be vaccinated. But one in six (16%) had some doubts. A similar number (18%) were strongly hesitant and said they would not get vaccinated. 

Hesitancy was more common among some ethnic groups, younger people, and women, plus those with lower income. But it was seen in all groups. People who were hesitant tended to be less aware of the collective benefits of vaccination. For example, that people who are vaccinated are less likely to infect others. 

Everyone in the study received standard information about the vaccine from the NHS website.  They were randomly assigned to one of 10 groups. Nine of the groups received extra short pieces of text. One of these texts covered collective benefits of the vaccine; another covered personal benefits. Other texts addressed the seriousness of the virus and the speed of development of the vaccine.

Various combinations of these texts were sent to the 10 different groups. People then filled in questionnaires about their feelings towards getting vaccinated. 

People who were willing to get vaccinated, or doubtful, did not change their attitudes, regardless of which set of information they received.

But among those who were hesitant, the study found that:

  • the most effective way to reduce hesitancy was extra information about the personal benefits of vaccination (prevention of serious illness or long COVID)
  • information on the safety of the vaccines, addressing concerns about the speed of development, had some, but less, effect on the views of people who were hesitant
  • information about the collective benefit of vaccination was less persuasive  
  • information about personal benefit alone was more effective than a combination of personal and collective benefit.

Why is this important?

High levels of vaccine coverage are important to reduce transmission, hospital admissions and death from COVID-19. At the time of the study, about one in 10 of the UK population was strongly hesitant. This figure is likely to rise if side effects of vaccination are reported in the news.

Persuading people of all ages to have both doses of the vaccine – and a follow-up booster – is a big task. It will be important to understand the views of people who have concerns about its safety or believe it is not necessary. This study shows that stressing the personal benefits is most effective. Stressing the collective benefits to people worried about their personal risk is unlikely to be effective.

Written information is only one way of encouraging people to accept the vaccine. This study found that extra information on the personal benefit of the vaccine had a small effect only. But given the large numbers of people who receive the information, the small effect could mean that many more are vaccinated.

The study also found that this message did no harm. It did not alter positive views of the vaccine. It therefore did not deter the rest of the population from accepting vaccination. 

The researchers stress the importance of successfully communicating to the whole population. Regular vaccination could be necessary for years to come if new variants of COVID-19 arise.

What’s next?

These findings could be used to improve information campaigns, by stressing the personal benefits of vaccination. Healthcare professionals will be able to use a similar approach when discussing people’s concerns about the vaccine. 

A larger study will be needed to show whether men and women react differently to certain pieces of information. People from different ethnic groups might also have differing reactions.

Those who were doubtful (rather than strongly hesitant) did not change their views with any of the information in the study. More work is needed to identify messages to reach this group. 

This study looked at broad themes in the information. The researchers would like to explore in more detail whether particular words and phrases are helpful.

You may be interested to read

This NIHR Alert is based on: Freeman D, and others. Effects of different types of written vaccination information on COVID-19 vaccine hesitancy in the UK (OCEANS-III): a single-blind, parallel-group, randomised controlled trial. Lancet Public Health 2021;6:6 

Other research on vaccine hesitancy, which informed this study: Freeman D, and others. COVID-19 vaccine hesitancy in the UK: The Oxford coronavirus explanations, attitudes, and narratives survey (Oceans) II. Psychological Medicine 2020;1-15: doi:10.1017/S0033291720005188

COVID-19 vaccine hesitancy in the UK: a blog post from the University of Oxford about the study.  

Further research on vaccine hesitancy in a UK healthcare workforce: Martin CA, and others. SARS-CoV-2 vaccine uptake in a multi-ethnic UK healthcare workforce: A cross-sectional study. PLoS Medicine 2021;18:11

Research from the same group on concerns about the speed of COVID-19 vaccine development: Brown P, and others. “It seems impossible that it’s been made so quickly”: a qualitative investigation of concerns about the speed of COVID-19 vaccine development and how these may be overcome. Human Vaccines & Immunotherapeutics 2022;18:1 

Funding: The study was jointly funded by the NIHR Oxford Biomedical Research Centre and the NIHR Oxford Health Biomedical Research Centre.

Conflicts of Interest: One of the authors is Chair of UK Department Health and Social Care’s Joint Committee on Vaccination & Immunisation, but does not participate in discussions on COVID-19 vaccines, and is a member of the WHO’s SAGE.

Disclaimer: NIHR Alerts are not a substitute for professional medical advice. They provide information about research which is funded or supported by the NIHR. Please note that views expressed in NIHR Alerts are those of the author(s) and reviewer(s) and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.

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