Assessing COVID-19 Vaccine Hesitancy, Confidence, and Public Engagement: A Global Social Listening Study

"As governments are preparing to introduce COVID-19 vaccines and initiate postpandemic recovery, the need to develop an effective vaccine campaign for the rollout that boosts public confidence and addresses hesitancy is urgent."

When vaccine confidence breaks down, hesitancy can cause delays, refusals, and disruptions to research and delivery (R&D) programmes, and sometimes leads to the resurgence of disease outbreaks Thus, monitoring public confidence and hesitancy is crucial for the COVID-19 vaccine rollout. Individuals are increasingly using social media to communicate with each other, including about vaccines. Social media listening (infoveillance) can not only monitor public attitudes on COVID-19 vaccines but also assess the dissemination of and public engagement with these opinions.

The researchers collected 7,032 social media posts mentioning the COVID-19 vaccine between June 13 and July 31 2020, when five COVID-19 vaccines started their Phase III clinical trials worldwide, from five global metropolises with high COVID-19 burdens. They manually double-coded these posts on Twitter [from New York (United States), London (United Kingdom), Mumbai (India), and Sao Paulo (Brazil)] and Sina Weibo [from Beijing (China)] using a coding framework developed according to the World Health Organization (WHO)'s Confidence, Complacency, and Convenience (3Cs) model of vaccine hesitancy and then conducted engagement analysis to investigate public communication about COVID-19 vaccines on social media.

Among social media users, 36.4% (571/1,568) in New York and 51.3% (738/1,440) in London reported willingness to accept COVID-19 vaccines, much lower than observed in metropolises in lower- and middle-income countries (LMICs), such as 69.8% (726/1,040) in Mumbai, 67.3% (144/214) in Sao Paulo, and 76.8% (2128/2,770) in Beijing. With a high perceived risk of getting COVID-19, more tweeters in New York and London expressed a lack of confidence in vaccine safety, distrust in governments and experts, and widespread misinformation or rumours. Tweeters from Mumbai, Sao Paulo, and Beijing worried more about vaccine production and supply, whereas tweeters from New York and London had more concerns about vaccine distribution and inequity. Negative tweets expressing lack of vaccine confidence and misinformation or rumours had more followers and attracted more online public engagement.

Reflecting on the results, the authors cite previous scholarship indicating that confidence in vaccines and governments was strongly associated with vaccine acceptance and uptake. However, the present study showed lack of confidence in vaccine safety, distrust in governments and experts, and widespread misinformation or rumours, especially in high-income countries (HICs). Public confidence in the safety and effectiveness of COVID-19 vaccines was far lower than the confidence level in general vaccines.

In light of these findings, the researchers suggest that "effective communication campaigns should be designed to explain the safety of COVID-19 vaccines to the public and clarify misinformation or rumors, especially in HICs. Communication campaigns should be supported by the scientific community to address public concerns in COVID-19 vaccines. Through creating a space for a collaborative dialogue between the scientific community and the public, these campaigns would aim to not only provide the public with the latest information but also build public confidence in vaccine programs." Furthermore, "more efforts are needed to build a more proactive public health presence on social media, and health systems should listen to tweets from the public to help inform policies related to public health response."