Willingness to be Vaccinated Against SARS-CoV-2 in the German Population During the Second Wave of the Pandemic
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With the increasing number of persons vaccinated against SARS-CoV-2, the willingness of the unvaccinated to be vaccinated is becoming more and more important. The identification of barriers to vaccination is critical to the development of targeted interventions (1). Though up-to-date surveys of unvaccinated persons are desirable, they are hardly achievable at present. However, a population-based survey conducted earlier this year is available and can be used to derive relevant influencing factors. The studied factors influencing the willingness to be vaccinated include sociodemographic characteristics, time of survey, conspiracy-related views, individual exposition to SARS-CoV-2, as well as pre-existing mental and physical conditions. The non-representative studies which have been conducted so far have shown an increased willingness to be vaccinated among women, older persons, persons with higher education (2), persons considering themselves as a risk group, and persons who have experienced infections either themselves or among family and friends (3).
The Gutenberg COVID-19 study investigates 8121 persons from the cohort of the Gutenberg Health Study (GHS—since 2007) as well as 2129 newly included younger persons. The total random sample is stratified by age (25–88 years), gender (m/f) and place of residence (city/county). Given the participation rate of 61%, it cannot be ruled out that persons skeptical of the pandemic did not participate in the survey. The sample will be further evaluated in GHS follow-ups und surveys. Data of the first survey conducted under pandemic conditions were analyzed (October 2020 to April 2021).
The willingness to be vaccinated was indicated for the question “If a vaccine against SARS-CoV-2 would be available for you, would you get vaccinated?“ using a scale ranging from “very unlikely“ = 0 to “highly likely“ = 6. Data on conspiracy-related views were collected using the statements “The real background of the Corona disease will never come to the public light“ and „The Corona crisis was talked up so much so that a few can benefit from it“. Exposure to COVID-19 was recorded dichotomously for behavior (travel, gatherings, testing) and infection (self, environment). Pre-existing mental and physical conditions were identified based on current and previous findings. Taking into account relevant vaccine decisions, four time intervals were defined: prior to vaccine approval (12 October to 20 December 2020), approval of mRNA vaccines (21 December 2020 to 28 January 2021), approval of vector vaccines (29 January to 14 March 2021), suspension of vector vaccines in persons aged under 60 years (15 March to 9 April 2021). Statistical analysis was performed using multiple linear regression analysis in R (version 4.0.5).
Altogether, 9794 persons were included in the analysis. Five persons with missing data and 451 persons (4.4%) who were vaccinated and whose willingness to be vaccinated was not recorded were excluded. The mean age of the participants was 56.4 (standard deviation 15.3) years; 50.2% of the participants were female and 21.5% had a migration background; a SARS-CoV-2 infection was detected in 3.7%. Conspiracy assumptions were held by 7% (“benefit“) and 35.8% (“background of the pandemic“). The willingness to be likely vaccinated was 83.6%, 10.3% were undecided, and 6.1% considered it unlikely. The Figure shows the willingness of men and women to be vaccinated across the four time intervals. The willingness to be vaccinated was higher among men. After the approval of the first mRNA vaccine, the willingness to be vaccinated significantly increased both in men and women and subsequently remained at a high level.
The Table shows the multiple linear regression analysis. The willingness to be vaccinated was higher in men, older persons, persons with high socioeconomic status and persons without migration background. The willingness to be vaccinated was higher during the later time intervals compared to the time interval before vaccine approval. Persons who were more likely to agree with conspiracy views, smokers and persons who had experienced a SARS-CoV-2 infection stated a lower willingness to be vaccinated, while persons with arterial hypertension, cancer or chronic obstructive pulmonary disease (COPD) stated a higher willingness to be vaccinated. The most powerful influencing factors were gender, belief that only a few individuals benefit, time course and socioeconomic status.
The willingness to be vaccinated is influenced by sociodemographic factors, views of the pandemic, time course and medical findings. In contrast to other studies where self-assignment to a risk group was associated with an increased willingness to be vaccinated (for example ), our data of pre-existing conditions identified in the medical history showed an increased willingness to be vaccinated only for patients with cancer, COPD and arterial hypertension. Severe cardiovascular, metabolic, immune, and mental diseases had no impact. Personal risk assessment-related hesitancy (4) means that potentially at-risk groups and those infected with COVID-19 may not seek adequate protection. Especially among these persons, vaccination communication should try to establish trust in the vaccination by providing transparency of the procedure and detailed information (5). In addition, it is necessary to specifically address younger persons, socially disadvantaged persons and persons with a family history of migration. For these person groups, information that is easy to understand and made available in different languages as well as low-threshold vaccination offerings are relevant (1). In order to address persons with a tendency to conspiracy ideas, discussions in social media should be co-created and measures to establish trust in governmental institutions should be developed (4).
The following limitations should be taken into account: The explained variation is 19%, indicating that only some of the influencing factors were covered. Cross-sectional data were collected; the age distribution varies between time intervals; the items for conspiracy-related views were not validated and do not reflect explicit conspiracy narratives. The survey was conducted at a time when vaccine capacities were limited; consequently, the question on willingness to be vaccinated had to be hypothetically answered in most cases.
Nora Hettich, Lina Krakau, Kamiar Rückert, Emar Brähler, Daniela Zahn, Simge Yilmaz, Thomas Münzel, Emilio Gianicolo, Irene Schmidtmann, Andreas Schulz, Philipp S. Wild, Karl J. Lackner, Alexander K. Schuster, Manfred E. Beutel
Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Mainz (Hettich, Krakau, Rückert, Brähler, Beutel) email@example.com
Preventive Cardiology and Medical Prevention, Center for Cardiology (Zahn, Yilmaz, Schulz, Wild)
General Cardiology, Interventional Cardiology, Angiology, and Internal Intensive Care Medicine, Center for Cardiology (Münzel)
Institute of Medical Biostatistics, Epidemiology and Informatics (Gianicolo, Schmidtmann)
Center for Thrombosis and Hemostasis (Wild)
Institute of Clinical Chemistry and Laboratory Medicine (Lackner)
Center for Ophthalmological Epidemiology and Health Services Research, Department of Ophthalmology (Schuster)
Institute of Clinical Physiology, National Research Council, Lecce, Italy (Gianicolo)
We would like to thank all participants in the Gutenberg COVID-19 study and the study staff for their contributions. The study was financially supported by the European Regional Development Fund and the Ministry of Science and Health of Rhineland-Palatinate, the ReALity Initiative of the Life Sciences of the Johannes Gutenberg University Mainz, and the National Research Network of University Medicine.
Conflict of interest statement
Irene Schmidtmann owns shares in Biontech and Curevac.
The remaining authors declare that no conflict of interest exists.
Manuscript received on 5 August 2021, revised version accepted on 29 September 2021.
Translated from the original German by Ralf Thoene, MD.
Cite this as:
Hettich N, Krakau L, Rückert K, Brähler E, Zahn D, Yilmaz S, Münzel T, Gianicolo E, Schmidtmann I, Schulz A, Wild PS, Lackner KJ, Schuster AK, Beutel ME:
Willingness to be vaccinated against SARS-CoV-2 in the German population during the second wave of the pandemic. Dtsch Arztebl Int 2021; 118: 720–1.
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