Listening and engaging with the public in building and sustaining vaccine confidence will be crucial, argues Pauline Paterson
It was promising to hear that preliminary results from one of the ongoing covid-19 vaccine trials is suggesting 90% effectiveness.  Further research will tell if there is high effectiveness across age groups, if this vaccine candidate is effective at reducing transmission of disease as well as symptoms of differing severity, and if it is safe. We will hopefully also be receiving more good news in the coming months about the other dozen or so vaccine candidates, also in phase 3 trials.
There have been a number of surveys globally showing differing rates of acceptance for a covid-19 vaccine, ranging from 67 to 90%. [2-6] Given how much everyone’s lives have been disrupted and impacted by the covid-19 pandemic, there is an appetite for this vaccine. However, the public also, understandably, have questions and concerns.
In a recent study we conducted at the Health Protection Research Unit (HPRU) in Immunisation, where we asked parents and guardians of young children if they would be willing to accept a novel covid-19 vaccine when one became available, 90% said yes.  Main reasons for vaccinating were to protect themselves against covid-19, to protect their family, to protect others in their community, to stay safe to look after their children, and to stop the need for social distancing. Reasons given for hesitancy towards a novel covid-19 vaccine were concerns about safety, concerns about this being a new vaccine, concerns about a lack of research evidence, about the research and development of the vaccine being rushed, and concerns about a lack of vaccine effectiveness. Some parents did not see a need to get vaccinated, as they had already had covid-19 or were not in an at risk group. A key finding was that those of Black, Asian, Chinese, Mixed or other Ethnicity (BAME) were 2.7 times less likely to accept a novel covid-19 vaccine than white participants. This is particularly concerning as some of these groups have been shown to be more severely affected by covid-19.
The roll out of a covid-19 vaccine in the UK when available will be in stages, with the Joint Committee on Vaccination and Immunization (JCVI) advice to vaccinate those at highest risk from disease (elderly and those with high risk comorbidities) and health and social care workers initially.  Vaccine hesitancy is very context specific, varying by time, place, and population group, so further research is key and new research is emerging which explores covid-19 vaccine acceptance in these groups. 
Research shows that although people go to the Internet to look for health information, they do not necessarily trust it, however reading negative information around vaccines can influence confidence.  With social media anyone can be an author, anyone can be an expert and with the internet concerns can spread quickly and far. People have a tendency to seek information that reinforces their pre-existing views, entering echo-chambers.  As a society we have not yet learnt to adapt to the fact that in a world where people can self-publish, not all published information has credibility. As a result views online are increasingly polarized and it is more difficult for government and organisations to maintain and build trust. With every outbreak there is a wave of information as well as mis-information. The covid-19 pandemic is no exception. Dr Tedros Adhanom, Director-General of WHO, warned against rumours and misinformation, speaking of an “infodemic” that needs to be fought alongside the pandemic.  With the pandemic there has been misinformation about how the virus spreads, misinformation about how to prevent catching covid-19, and misinformation about covid-19 vaccine research.
Since covid-19 vaccines are being developed and produced much faster than any previous vaccines, it is key that government and public health officials reassure the public that any covid-19 vaccines taken forward have been thoroughly tested for safety and efficacy, and are only taken forward if proved to be safe and effective. These encouraging preliminary findings give significant hope for an effective vaccine against covid-19 in the future, and if and when covid-19 vaccines are available, we will need equitable distribution of vaccines according to need and it is key that low and middle income countries are not forgotten.
It is key to listen and engage with the public, focusing on groups most negatively impacted by covid-19, via a combination of monitoring news and social media, surveys, interviews and focus groups, and engagement events, to explore underlying reasons for acceptance and non-acceptance of covid-19 vaccination, and to address concerns. When a covid-19 vaccine becomes available, public confidence will be key, as a lack of vaccine uptake could greatly compromise the success of the vaccine programmes, and the control of this pandemic.
Pauline Paterson, Assistant Professor and Co-Director of The Vaccine Confidence Project, London School of Hygiene & Tropical Medicine, UK.
Competing interests: PP is funded by NIHR (for HPRU in Immunisation research) and GSK (for research on attitudes towards vaccinating in pregnancy).
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