Who are hesitant to take a COVID-19 vaccine in Ireland?
Since the first case was identified in 2019, the world has come into the midst of the COVID-19 pandemic. The World Health Organization (WHO) suggests that achieving herd immunity through vaccination is critical to ending the COVID-19 pandemic at this stage. The experts estimate that somewhere between 60%-90% of the population needs to be vaccinated to achieve herd immunity. However, a global survey of acceptance of a COVID-19 vaccine shows that only 71.5% of people would like to take a COVID-19 vaccine, remaining 28.5% of people worldwide are hesitant or resistant to taking a COVID-19 vaccine.
As for the situation in Ireland, Ipsos MRBI conducted a survey to measure the potential take-up of a COVID-19 vaccine and tracked it over time for the Irish Pharmaceutical Healthcare Association (IPHA). Their data shows before the vaccination program commenced in Ireland in December 2020, almost half of the people in Ireland were hesitant or resistant to getting the COVID-19 vaccine. However, as time evolved, the percentages of these people dropped down. By the end of November 2021, only 5% of Irish people said they would refuse a COVID-19 vaccine, and only 3% were undecided about whether to get a vaccination or not.
Vaccine hesitancy is defined as “the reluctance or refusal to vaccinate despite the availability of vaccines” and is identified as one of the top ten threats to global health in 2019 by WHO. Achieving herd immunity for COVID-19 depends on a sufficient uptake of COVID-19 vaccines, while vaccine hesitancy influences the acceptance of a COVID-19 vaccine and the rate of uptake severely, which in turn will undermine efforts to end the pandemic. Therefore, identifying who are hesitant towards the COVID-19 vaccination and why they are hesitant is critical to ensure a successful vaccination programme and may help control the spread of COVID-19. Just as WHO stressed, “it’s not vaccines that will stop the pandemic, it’s vaccination”.
Some researchers have identified several sociodemographic features of people who may be less willing to be vaccinated. For example, a large number of studies have found that younger adults express a higher level of vaccine hesitancy than older adults. This feature was also found in Ireland. Based on the data collected from 1600 adults living in Ireland by ESRI, the violin plot shows that the average age of people who said they would definitely or probably not take the COVID-19 vaccine is around 40. While the average age of people who indicated would probably and definitely be vaccinated against COVID-19 is near 50. It also tells that the age of people who are more willing to take the vaccine grouped around 60, while those who are more hesitant and resistant to take the vaccine grouped around 40.
The longitudinal study by Ipsos MRBI also found younger people are less likely to get vaccinated for COVID-19 in Ireland. Their data shows that the age groups of 18 to 44 have consistent high vaccine hesitancy from April to September 2021. In contrast, the over 65 years of age group remained the lowest in vaccine hesitancy during this period.
Such difference of age in willingness to take a COVID-19 vaccine may be explained by omission bias. Studies found that many people perceive the risk of getting a vaccine to be more severe than the risk of omitting vaccination. Specifically for COVID-19, experts have identified that older people, especially those over 70, are more vulnerable to and more at risk of COVID-19. So, when older adults balance the risk of taking a vaccine and the risk of catching COVID-19, they are more likely to take the vaccine. But for young generations, vaccination is the prevention of the risk that may not happen to them, and they may be less at risk of serious illness even if they get COVID-19. Therefore, some of them see a greater risk of the vaccination itself than catching COVID-19.
Studies also found gender might influence the acceptance of the vaccination. However, different research came up with different results. Some studies claimed that women expressed higher vaccine hesitancy than men. While other studies said, women are more likely to get vaccination than men, especially those pregnant women and women of reproductive age. Based on data in Ireland from Ipsos MRBI, women had higher vaccine hesitancy at the initial period when the vaccination program hadn’t started. But the percentage of women with vaccine hesitancy dropped down, and men had slightly higher vaccine hesitancy across time.
A study by Liu and Li gave us some insights to understand such nuanced gender differences in vaccine hesitancy. They noticed that women were hesitant to take a vaccine mainly because of circumspection, and such hesitation would decline quickly according to evolving information over time. But men were showing hesitancy due to confidence and complacency. In addition, men decided whether to get a vaccine more on ideological factors than women. Therefore, vaccine hesitancy from men only had a slight decline and mild fluctuation over time.
Ethnicity is another predictor of vaccine hesitancy. Studies indicated that people from ethnic minority groups have a higher level of vaccine hesitancy, and black has the highest vaccine hesitancy among ethnic minorities. This characteristic also applies to Ireland. Data from ESRI shows that people of minority ethnicities (BAME) were less likely to say they would take the COVID-19 vaccine than white people. Vaccine hesitancy rate was highest among black, followed by mixed, Asian, Hispanic or Latino.
Many studies mentioned that the racial differences in vaccination intentions root in the distrust of government and public health organisations, which is eroded by negative experiences of racism in the medical system. Especially for black populations, previous unethical medical research on black people, such as Tuskegee Syphilis Study, amplify their distrust in doctors and vaccines.
Education may also influence people’s attitudes towards the vaccine and their acceptance of vaccination. Previous studies found that less educated people tend to be unwilling to receive the vaccine. This is consistent with the data in Ireland, which indicates people who have less than junior certificate education level are the most hesitant and resistant to get a COVID-19 vaccine. The potential reasons behind this feature might be that those with lower levels of education do not have sufficient health literacy to understand knowledge about the vaccine. Instead of scientific information, they may be more likely to believe misinformation and COVID-19 vaccine myths.
Although some studies claim that vaccine hesitancy decreased with working status compared to not working, data collected from the Irish population seems not to show this feature. In Ireland, retired people are more willing to be vaccinated. However, this is because people who are retired are typically older in age. Students also have a low level of vaccine hesitancy. Researchers account it for that students are usually more likely to have higher health literacy than others. Unemployed Irish people have a similar level of vaccine hesitancy to self-employed people, and people who are unable to work also have an equivalent level of vaccine acceptance to people who are employed full time. Nevertheless, some studies pointed out people’s occupations have an influence on their vaccine acceptance as well, in light of the differences in medical knowledge among occupations: the clerical, sales and service workers are more reluctant to be vaccinated while people in healthcare-related industries and professions have higher vaccine acceptance.
Previous studies also suggest that people living in rural areas are more unwilling to be vaccinated because rural areas are likely to have poorer public health systems, influencing accessibility to vaccination and vaccine-related information. Besides, the lower education level and incomes in rural communities may lead to lower health literacy than urban areas. But in Ireland, people have a similar level of hesitancy and acceptance of vaccines no matter they live in rural areas or urban areas. In spite of this, data from Ipsos MRBI shows people living in Munster have a relatively lower level of COVID-19 vaccine hesitancy than people living in other regions, although such differences are not significant.
To sum everything that’s been staged so far, young adults, people from ethnic minority groups, and those with lower education levels are more hesitant and resistant to take vaccination against COVID-19 in Ireland. The influence of gender, employment status, and places of residence on people’s vaccination intentions and vaccine hesitancy seems insignificant.
