In light of recent concerns about the Oxford/AstraZeneca vaccine, sustained and clear communication from trusted sources is needed to maintain uptake as the evidence evolves 

Covid-19 has shone a light on deep divisions across the UK in relation to both the government’s handling of the pandemic and the burden on those directly affected by the disease and the measures taken to address it. But the rapid development, approval, and delivery of vaccines may be a unifying factor. Receiving an invitation for a vaccination appointment is something that almost every adult in the UK will experience this year. As vaccination is a key component of our route out of this pandemic, we need people to take up these appointments and to have confidence in the system. But developments this week have raised questions about that confidence. The news that there may be a heightened risk of rare blood clots from the first dose of the vaccine manufactured by Astra Zeneca has prompted many questions from the public. Will these developments increase vaccine hesitancy, and if so how can we address this? 

We start from a position of some strength both in terms of uptake thus far and positive sentiment towards the programme. In England, 94% of eligible residents in older adult care homes have received at least one dose and 92% of those classified as clinically extremely vulnerable. Data from the Office for National Statistics found that up to 20 March 2021, more than 96% of people aged 70 years in the UK had received one or more doses of a covid-19 vaccine. ONS data also illustrate that confidence remains high. In the week up to 28 March, 95% of adults reported that they had either received at least one dose of a vaccine, were waiting for their appointment, or would be likely to have a vaccine if offered. A recent Ipsos Mori survey found people in the UK had the highest levels of confidence in covid-19 vaccines of any of the 15 countries in their poll.

But inequalities remain. We know that ethnic minorities are less likely to have received a vaccine, particularly those living in the most deprived areas. Vaccination rates are also lower among disabled people. There is also concern about whether younger adults, most of whom will not be eligible to be vaccinated until later in the year, will come forward when invited. A recent study led by researchers from the University of Glasgow found 28% of 25-34 year olds were more hesitant about taking up a vaccine compared to just 4% of those aged over 75. 

This week’s developments could increase vaccine hesitancy among younger adults. The UK’s pharmacovigilance system has picked up a cluster of extremely rare adverse events of certain types of blood clots with low levels of platelets among those who have received one dose of the Oxford/Astra Zeneca vaccine. Similar cases have been identified in other countries. The numbers are tiny, with 79 cases reported in the UK (equivalent to 4 people in a million who receive the vaccine) and 19 deaths. Although the cases have been seen in people aged 18-79 years, there were slightly more people in younger age groups who experienced these rare events. On the basis of this, the Joint Committee on Vaccination and Immunisation is advising that people younger than 30 with no underlying health conditions and who have not yet received a first dose should be offered an alternative covid-19 vaccine.

While media coverage of this development has on the whole been measured, there may be a task ahead to maintain trust among younger adults. We know that at least five behavioural factors are related to vaccine uptake. These relate to complacency (perception of risk from covid-19 to the individual); confidence in the efficacy and safety of the vaccine (where questions will continue to need to be addressed, particularly if evidence changes again); convenience (removing physical barriers and prioritising ease of access); sources of information (considering not just official sources, but how accurate information can be disseminated on platforms and via voices that young adults trust); and variation by socio-demographic characteristics within different age groups (e.g. education, ethnicity, religion, past health and vaccination behaviour).  All of these factors will need to be considered in communicating with people of all ages, but particularly the young.

Recent polling after the 7 April 2021 change in official guidance on the Oxford/AstraZeneca vaccine provides some grounds for optimism. In a YouGov survey conducted for The Times, 75% of people considered the Oxford/AstraZeneca vaccine safe, a decline of just 2% since last month, and similar to confidence in the PfizerBioNTech vaccine, which 78% of survey participants considered safe. Confidence among younger adults remained lower than for older age groups, but had not declined since March. There may be further bumps in the road in the roll out of the vaccine programme, and future changes in guidance may be needed as the evidence evolves. But if we can maintain and even increase confidence, while also addressing practical barriers to uptake, we should be in a strong position in the months to come. 

Linda Bauld, Bruce and John Usher Professor of Public Health, Usher Institute, University of Edinburgh.

Competing interests: none declared.