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Cited by 2,904Vaccine Coverage and HesitancySARS-CoV-2 and COVID-19 ResearchRisk Perception and Management

A global survey of potential acceptance of a COVID-19 vaccine

Open access
Lazarus, Jeffrey V., Ratzan, Scott C., Palayew, Adam, Gostin, Lawrence O., Larson, Heidi J., Rabin, Kenneth, Kimball, Spencer, El-Mohandes, Ayman·2021·Nature Medicine
DOI 10.1038/s41591-020-1124-9PMC PMC7573523
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Abstract

Several coronavirus disease 2019 (COVID-19) vaccines are currently in human trials. In June 2020, we surveyed 13,426 people in 19 countries to determine potential acceptance rates and factors influencing acceptance of a COVID-19 vaccine. Of these, 71.5% of participants reported that they would be very or somewhat likely to take a COVID-19 vaccine, and 48.1% reported that they would accept their employer’s recommendation to do so. Differences in acceptance rates ranged from almost 90% (in China) to less than 55% (in Russia). Respondents reporting higher levels of trust in information from government sources were more likely to accept a vaccine and take their employer’s advice to do so. Survey data from across 19 countries reveal heterogeneity in attitudes toward acceptance of a COVID-19 vaccine and suggest that trust in government is associated with vaccine confidence.

AI snapshot

Written from the paper’s full text.

TL;DR

In June 2020, a 19-country survey of 13,426 adults found that 71.5% would be very or somewhat likely to take a COVID-19 vaccine, but only 48.1% would accept their employer’s recommendation to do so. Acceptance varied widely by country and was strongly associated with trust in government.

Key findings

  • Overall, 71.5% reported they would take a proven safe and effective COVID-19 vaccine, and 48.1% said they would accept an employer recommendation to get vaccinated.
  • Country variation was large: China had the highest positive response for the general vaccine question (631/712, 88.6%) and Russia the lowest (373/680, 54.9%); Poland had the highest negative response (182/666, 27.3%). For employer recommendation, China had 83.7% positive responses (596/712), while Russia had the lowest willingness (184/680, 27.1%) and highest negative response (278/680, 40.9%).
  • Trust in government was associated with acceptance: OR = 1.67 (95% CI 1.54, 1.80) for the general vaccine question and OR = 4.35 (95% CI 4.01, 4.72) for the employer-recommendation question.
  • Older age and higher income/education were positively associated with acceptance. For example, respondents aged 65+ vs 18–24 had OR = 1.73 (95% CI 1.48, 2.02) for the general question, and those earning >$32/day vs <$2/day had OR = 2.18 (95% CI 1.79, 2.64). Men were slightly less likely than women to respond positively (OR = 0.84; 95% CI 0.78, 0.91), and self/family COVID-19 sickness was not associated with acceptance (OR = 0.97; 95% CI 0.87, 1.08).

Methods

  • The study analyzed two vaccine-acceptance questions from the COVID-SCORE online survey, collected June 16–20, 2020, from 13,426 respondents aged 18+ in 19 countries, with 619–773 participants per country.
  • Participants were recruited through multiple international online panel providers; sampling was random and described elsewhere.
  • Responses used a five-point Likert scale. Logistic regressions coded “completely agree” or “somewhat agree” as 1 and all other responses as 0, with univariate models against age, gender, income, education, COVID-19 sickness in self/family, country cases and mortality per million, and trust in government.

Limitations

  • The paper states that public surveys are snapshots at a point in time, the survey occurred in a highly dynamic COVID-19 landscape, and reported willingness may not predict actual acceptance. It also notes that events after the survey may have increased hesitancy, and that employment status was not investigated for the age/employer-recommendation finding.
  • The text makes evident that the regressions are univariate rather than multivariable-adjusted, so associations may not be independent.
  • The online panel design may limit representativeness despite random sampling, and the outcomes are self-reported intentions rather than observed vaccination behavior.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1038/s41591-020-1124-9

Cites

19 of 19 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 11 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    Respondents who trusted their government were more likely to accept a vaccine than those who did not (OR = 1.67; 95% CI 1.54, 1.80).

    “Respondents who said that they trusted their government were more likely to accept a vaccine than those who said that they did not (OR = 1.67; 95% CI (1.54, 1.80)).”
    Quote in the paperSubstantial claim
  • Findingown data

    Men were slightly less likely than women to respond positively to the general vaccine question, OR = 0.84 (95% CI 0.78, 0.91).

    “Gender differences were small, but the univariate association for both questions suggested that men were slightly less likely to respond positively than women, with an OR of 0.84 (95% CI (0.78, 0.91)) of men responding positively relative to women for the general question”
    Quote in the paperNot a substantial claim
  • Findingown data

    Acceptance rates varied by country, ranging from almost 90% in China to less than 55% in Russia.

    “Differences in acceptance rates ranged from almost 90% (in China) to less than 55% (in Russia).”
    Quote in the paperSubstantial claim
  • Findingown data

    The difference in acceptance was strongest when the oldest age cohort (65+) was compared with the youngest (18-24), OR = 1.73 (95% CI 1.48, 2.02).

    “This difference was strongest (odds ratio (OR) = 1.73; 95% confidence interval (CI) (1.48, 2.02)) when responses from the oldest age cohort and those from the youngest age cohort were compared (Table 2).”
    Quote in the paperNot a substantial claim
  • Findingown data

    Poland reported the highest proportion of negative responses (27.3%, 182/666) to the proven safe and effective vaccine question.

    “Respondents from Poland reported the highest proportion of negative responses (182 of 666, 27.3%)”
    Quote in the paperNot a substantial claim
  • May combine two claims. 7
  • The quote only partly states this claim. 1
  • Classified as probably not a substantial claim. 11

  • May combine two claims.

    Findingown data

    For the employer recommendation question, 14.0% completely agreed and 25.9% somewhat or completely disagreed.

    “When asked whether “You would accept a vaccine if it were recommended by your employer and was approved safe and effective by the government,” 14.0% (1,881 of 13,426) completely agreed, whereas 25.9% (3,478 of 13,426) somewhat or completely disagreed (Table 1).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    China had the highest proportion of positive responses (88.6%, 631/712) and the lowest proportion of negative responses (0.7%, 5/712) when asked if they would take a proven, safe and effective vaccine.

    “Respondents from China gave the highest proportion of positive responses (631 of 712 respondants, 88.6%) and the lowest proportion of negative responses (5 of 712, 0.7%) when asked if they would take a ‘proven, safe and effective vaccine’.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    For employer recommendation, the age trend was similar except that responses from the oldest age cohort were similar to the youngest age cohort.

    “A similar trend was observed in regard to acceptance of the vaccine if one’s employer required it, except that responses from the oldest age cohort were similar to the youngest age cohort.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Russia had the highest proportion of negative responses (40.9%, 278/680) and the lowest proportion willing to accept their employer's recommendation (27.1%, 184/680).

    “Russia had the highest proportion of negative responses (278 of 680, 40.9%) and the lowest proportion of respondents (184 of 680, 27.1%) willing to accept their employer’s recommendation (Supplementary Table 1).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    China had the highest proportion of positive responses (83.7%, 596/712) and the lowest proportion of negative responses (3.7%, 26/712) to the employer recommendation question.

    “There was considerable variation by country, with China again having the highest proportion of positive responses (596 of 712, 83.7%) and the lowest proportion of negative responses (26 of 712, 3.7%).”
    Quote in the paperNot a substantial claim

  • The quote only partly states this claim.

    Findingown data

    In June 2020, 71.5% of 13,426 surveyed participants in 19 countries reported they would be very or somewhat likely to take a COVID-19 vaccine if it were proven safe and effective and available.

    “Of these, 71.5% of participants reported that they would be very or somewhat likely to take a COVID-19 vaccine”
    • Also stated in: § Discussion · plain
      “Of these, 71.5% responded that they would take a vaccine if it were proven safe and effective”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    No personally identifiable information was collected or stored.

    “No personally identifiable information was collected or stored.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Misinformation spread through multiple channels could have a considerable effect on the acceptance of a COVID-19 vaccine.

    “Misinformation spread through multiple channels could have a considerable effect on the acceptance of a COVID-19 vaccine8.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [8] Cornwall, W. Officials gird for a war on vaccine misinformation. Science 369, 14–19 (2020). source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Anti-vaccination activists are already campaigning in multiple countries against the need for a vaccine, with some denying the existence of COVID-19 altogether.

    “Anti-vaccination activists are already campaigning in multiple countries against the need for a vaccine, with some denying the existence of COVID-19 altogether7.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [7] Enserink, M. & Cohen, J. Fact-checking Judy Mikovits, the controversial virologist attacking Anthony Fauci in a viral conspiracy video. Science https://www.sciencemag.org/news/2020/05/fact-checking-judy-mikovits-controversial-virologist-attacking-anthony-fauci-viral (2020). source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Respondents' identities were verified using IP addresses and mobile phone numbers to ensure each participant was real and unique upon initial registration.

    “Respondents’ identities were verified using IP addresses and mobile phone numbers to ensure that each participant was real and unique upon initial registration.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    The study was approved by Emerson College institutional review board (protocol no. 20-023-F-E-6/12).

    “This study was approved by Emerson College, USA (institutional review board protocol no. 20–023-F-E-6/12), with an expiration date of June 11, 2021.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    This particular survey was conducted in a highly dynamic and changing landscape, with daily variations in perceived disease threat and COVID-19 vaccine development itself.

    “This particular survey was conducted in the context of a highly dynamic and changing landscape, with daily variations in perceived disease threat and COVID-19 vaccine development itself.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing), S4 (based).

    Interpretationreasoning

    Reporting one's willingness to get vaccinated might not be a good predictor of acceptance, as vaccine decisions are multifactorial and can change over time.

    “Furthermore, reporting one’s willingness to get vaccinated might not be necessarily a good predictor of acceptance, as vaccine decisions are multifactorial and can change over time.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    The accelerated pace of vaccine development has heightened public anxieties and could compromise acceptance.

    “The accelerated pace of vaccine development has further heightened public anxieties and could compromise acceptance9.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [9] Fadda, M., Albanese, E. & Suggs, L. S. When a COVID-19 vaccine is ready, will we all be ready for it? Int. J. Public Health 65, 711–712 (2020). source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Lessons learned from previous infectious disease outbreaks and public health emergencies, including HIV, H1N1, SARS, MERS and Ebola, indicate that trusted sources of information and guidance are fundamental to disease control.

    “Lessons learned from previous infectious disease outbreaks and public health emergencies, including HIV, H1N1, SARS, MERS and Ebola, remind us that trusted sources of information and guidance are fundamental to disease control16.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [16] Siegrist, M. & Zingg, A. The role of public trust during pandemics: implications for crisis communication. Eur. Psychol. 19, 23–32 (2014). source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Researchers have identified promising interventions for building confidence and reducing vaccine hesitancy in different contexts.

    “Researchers have identified promising interventions for building confidence and reducing vaccine hesitancy in different contexts12,13”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [12] Thomson, A., Vallée-Tourangeau, G. & Suggs, L. S. Strategies to increase vaccine acceptance and uptake: from behavioral insights to context-specific, culturally-appropriate, evidence-based communications and interventions. Vaccine 36, 6457–6458 (2018). source

      Not checked in the free run.

    • cites [13] European Centre for Disease Prevention and Control. Catalogue of interventions addressing vaccine hesitancy. https://www.ecdc.europa.eu/sites/portal/files/documents/Catalogue-interventions-vaccine-hesitancy.pdf (2017).

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Study design and conductnone given

    All public surveys of the type reported here are snapshots taken at a point in time.

    “It must be kept in mind that all public surveys of the type reported here are snapshots taken at a point in time.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Written informed consent was obtained from respondents.

    “The online questionnaire was administered by Emerson College to gather information from respondents after obtaining their written, informed consent about the survey and this project.”
    Quote in the paperNot a substantial claim
18 of 18

  • The paper relies on this without support.

    The level of vaccine acceptance required for community immunity is higher than the levels of willingness observed in most of the 19 countries.

    “In most of the 19 countries surveyed in our study, current levels of willingness to accept a COVID-19 vaccine are insufficient to meet the requirements for community immunity.”
1 of 1

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • The heterogeneity analysis reported in Fig. 5 was not pre-specified and followed heterogeneity tests common in the vaccine literature.

    “The heterogeneity analysis reported in Fig. 5, in which we analysed whether vaccination rates differ by age, sex, schooling and wealth variables, was not pre-specified and followed heterogeneity tests that are common in the vaccine literature54.”

    From Last-mile delivery increases vaccine uptake in Sierra Leone (2024) · cites this paper as [54]

  • Information from employers and government sources has been shown to improve COVID-19 vaccine acceptance rates.

    “For COVID-19, information from employers and government sources has been shown to improve vaccine acceptance rates, which range from 55% to 90% around the world244.”

    From mRNA vaccines for infectious diseases: principles, delivery and clinical translation (2021) · cites this paper as [244]

  • COVID-19 vaccine acceptance rates range from 55% to 90% around the world.

    “For COVID-19, information from employers and government sources has been shown to improve vaccine acceptance rates, which range from 55% to 90% around the world244.”

    From mRNA vaccines for infectious diseases: principles, delivery and clinical translation (2021) · cites this paper as [244]

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Authors
Lazarus, J. V., Ratzan, S. C., Palayew, A., Gostin, L. O., Larson, H. J., Rabin, K., Kimball, S., & El-Mohandes, A.
Affiliations
  • Barcelona Institute for Global Health (ES)
  • City University of New York (US)
  • Georgetown University (US)
  • London School of Hygiene & Tropical Medicine (GB)
  • Emerson College (US)
Corresponding author
Lazarus, Jeffrey V.
ORCID
Venue
Nature Medicine
Publisher
Springer Science and Business Media LLC
Published
2020-10-20
Volume
27
Issue
2
Pages
225-228
ISSN
  • 1078-8956 (ISSN-L)
  • 1546-170X
DOI
10.1038/s41591-020-1124-9
PMC
PMC7573523
OpenAlex
W3093974194
Semantic Scholar
abe8c2a1c2a072c6c0f729204a329d82fffad38c
Cited by
2,904
References
19
Citations by year
2026: 91 · 2025: 109 · 2024: 276 · 2023: 541 · 2022: 950 · 2021: 901 · 2020: 32 · 2018: 1
FWCI
335.12
Type
journal article
Language
en
Update notices
correction (2021-01-11)
Open access
Licence
Locations
  • Nature Medicine (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
  • Scholarship - GEORGETOWN LAW (Georgetown University) (submittedVersion)
  • SSRN Electronic Journal (submittedVersion)
Funders
  • City University of New York
  • Ministerio de Ciencia, Innovación y Universidades (CEX 2018-000806-S)
  • Centres de Recerca de Catalunya (CEX2018-000806-S)
  • Generalitat de Catalunya (CEX2018-000806-S)
  • Università Bocconi
Topics
  • Social Sciences › Health › Vaccine Coverage and Hesitancy
  • Health Sciences › Medicine › Infectious Diseases › SARS-CoV-2 and COVID-19 Research
  • Social Sciences › Sociology and Political Science › Risk Perception and Management
Keywords
COVID-19 vaccines, vaccine acceptance, vaccine hesitancy, vaccine confidence, public trust in government, cross-national comparison, vaccine attitudes
MeSH terms
COVID-19, SARS-CoV-2, COVID-19 Vaccines, Adolescent, Adult, Aged, Female, Humans, Male, Middle Aged, Patient Acceptance of Health Care, Surveys and Questionnaires, Regression Analysis, Internationality, Young Adult

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