From 214 interviews with residents of Austria, Germany, Italy, Portugal and German-speaking Switzerland, we show how vaccination decisions were shaped by the immediate environment (family members, friends, work environment) but also by official measures and public debates. Some people decided to get vaccinated to protect at-risk individuals in their social environment. Others (particularly elderly participants) did not want their relatives to worry about their health without being vaccinated. Moreover, participants expressed fears about long-term health consequences of COVID-19 and the social impact of the pandemic. In some cases, these thoughts overrode the anxiety about complications or adverse effects of the vaccine.
Participants also often referred to the actions of governments as well as recommendations of scientists and other public figures. For example, in Portugal, the national vaccination campaign (including, for example, a written invitation to all citizens) led them to perceive a "social driving force" that encouraged people to vaccinate - what people in other countries perceived as mere government pressure, coercion, and authoritarian action.
In all countries, we found that people's attitudes toward vaccination were not just either anti-vaccination or pro-vaccination, but spanned the entire spectrum. To illustrate this, we elaborated on six idealizing decision types. First, the "Generally Confident" found the decision to vaccinate COVID-19 straightforward; they got vaccinated as soon as a vaccine was available to them and expressed high confidence in science and the authorities. Second, the "Hesitant at First" preferred to wait for further evidence of vaccine safety at the beginning of the vaccination campaign; as soon as vaccinated people around them or public debates confirmed it, they also got vaccinated. Third, the "Uncertain After the Fact" mostly regretted their vaccination because of side effects and discomfort they attributed to vaccination. Also, debates about constantly repeating booster vaccinations made some doubt getting further vaccinated. Fourth, the "Doubtful but Compliant" got vaccinated despite uncertainty about the usefulness and/or safety of COVID-19 vaccination, especially because of social pressure that came from the immediate environment but also via national vaccination campaigns and policies such as 2G regulations. Fifth, the "Hesitant but Considering" had not (yet) been vaccinated but were still considering it for the reasons just mentioned. Some also described great fear of side effects and were constantly in a clinch with themselves about whether vaccination would be safer. Sixth, the "Generally Opposing" out of principle did not want to get vaccinated. Justifications included the refusal to be pressured, a general scepticism towards authorities, science and the pharmaceutical industry, or the belief that getting COVID-19 would be better for their immune system than a vaccination.
Some of these idealized types change their attitudes toward vaccination over time while others hold stable opinions. For policy makers, this means that they should not treat people as being in the pro- or anti-vaccination camp (or yet undecided what camp they belong to). Instead, people’s attitudes to vaccination, and their understandings of them, can change. Moreover, policy making must take into account people’s lived experiences alongside clinical and scientific data. These experiences reveal how individual decision-making is embedded in the respective socio-political contexts and how individual assessments of vaccinations are at once assessments of its governance. Thus, vaccination campaigns should be seen as long-term projects also outside of pandemics, based on regular adjustment and communication.
This study is published in a scientific journal:
Zimmermann, B. M., Paul, K. T., Araújo, E. R., Buyx, A., Ferstl, S., Fiske, A., Kraus, D., Marelli, L., McLennan, S., Porta, V., Prainsack, B., Radhuber, I., Saxinger, G. (2023). The social and socio-political embeddedness of COVID-19 vaccination decision-making: A five-country qualitative interview study from Europe. Vaccine, available online 16 February 2023 https://doi.org/10.1016/j.vaccine.2023.02.012
For media inquiries please contact Katharina Paul (katharina.t.paul@univie.ac.at) or Bettina Zimmermann (bettina.zimmermann@tum.de)
