What are the causes of covid-19 vaccine hesitancy?
Confidence in the importance of vaccines has the strongest association with vaccine uptake; however, confidence in the importance (necessity and value), safety, and effectiveness of vaccines fell in many countries between 2015 and 2019.21 WHO listed vaccine hesitancy among the top 10 global threats to health in 2019.22 Drivers of low confidence in covid-19 vaccination are listed in box 1. The ‘Understanding Society’ UK Household Longitudinal survey highlighted that the main reason for hesitancy was concerns about future unknown effects, with 42.7% of respondents specifying this.14 Less common reasons included those under the bracket of “other” (12.2%), worries about side effects (11.4%), concern that others are in more urgent need of the vaccine (7.7%), and lack of trust in vaccines (7.6%).14 However, the survey found that people of Black ethnicities were more likely to state that they “don’t trust vaccines” compared with White people (29.2% v 5.7%), and people of Pakistani and Bangladeshi ethnicities often cited concerns about vaccine side effects (35.4% v 8.6%).14 Some reports indicate a rise in vaccine hesitancy following the AstraZeneca vaccine safety scare across Europe and Africa.2425 Historical precedents show that widely publicised safety scares can have profound and long-lasting effects on vaccine confidence.26

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