COVID-19 vaccine intentions in Australia.

Prior to the availability of a COVID-19 vaccine and when case numbers were low, our longitudinal survey with Australian adults showed that 85·8% (3741 of 4362) were willing to be vaccinated in April, 2020, and 89·8% (1144 of 1274) in July, 2020.1, 2 Younger adults perceived themselves to be at less risk of infection and were less willing to receive a vaccine.

Since then, Australia's vaccine rollout has gained rapid momentum in some states, due in part to an outbreak of the highly contagious delta (B.1.617.2) variant. In July–August, 2021, we did a nationally representative survey of 2050 adults aged 18–49 years (appendix p 1) to understand barriers to vaccine uptake in a group underrepresented in current research and with lower vaccine uptake. Participants indicated their intentions on a six-point scale. We found that 871 (42·5%) intended to get a COVID-19 vaccine as soon as possible, 467 (22·8%) would get it when they had time, 177 (8·6%) would delay being vaccinated, 223 (10·9%) planned to avoid getting it for as long as possible, 121 (5·9%) said that they would never get a COVID-19 vaccine, and 191 (9·3%) were unsure.

In adjusted analyses, higher perceived threat of COVID-19 (adjusted odds ratio 0·92 [95% CI 0·88–0·97]), increased concern about getting COVID-19 (0·24 [0·16–0·37] for very concerned vs not at all concerned), greater confidence in the government (0·54 [0·49–0·60]), and higher trust in institutions (0·58 [0·52–0·63]) were associated with increased intention to vaccinate (appendix pp 1–2). Participants with the lowest level of education had lower intentions to vaccinate (1·33 [1·03–1·72] for high-school or less vs university educated).

The top three reasons for lower intention to vaccinate were not knowing enough about how safe a COVID-19 vaccine would be (60·6%; 458 of 756), concern about blood-clotting risk (27·5%; 151 of 1500), and worry about long-term side-effects (26·3%; 185 of 704), supporting previous findings.

At the time of the survey, two vaccines were approved in Australia: Pfizer-BioNTech (Comirnaty) and Oxford-AstraZeneca (Vaxzevria). Among our sample, 63·3% (1297 of 2050) preferred the Pfizer-BioNTech vaccine, whereas 4% (81) preferred the Oxford-AstraZeneca vaccine. Pfizer-BioNTech was consistently perceived as being more effective than Oxford-AstraZeneca (appendix p 2).

Separate to issues affecting vaccination intention, our findings also reflect access barriers. When asked what makes it hard to get a COVID-19 vaccine, 908 (44·3%) of 2050 reported lack of vaccine supply and 668 (32·6%) said that the waiting time is too long. Further barriers included the vaccination site being too far away (8·9%, 182), inconvenient opening times (7·8%, 160), being unable to leave work (6·3%, 129), or caring duties (4·8%, 98). 462 (22·5%) stated that they would feel “not at all” comfortable going to a mass vaccination clinic to receive a vaccine. 420 (20·5%) did not know how to book an appointment and 318 (17%) had been unable to book an appointment.

These findings highlight key areas that need immediate attention to ensure the long-term success of vaccine programmes globally. Public health messaging needs to continue targeting groups with lower education and trust to address motivational barriers to vaccination and explicitly acknowledge and alleviate the vaccine safety concerns of this younger cohort. This survey identified small but critical practical barriers to vaccine uptake which must be urgently managed by authorities for populations to reach vaccination targets.

HS reports funding from Sanofi Pasteur and Seqirus and honoraria from Sanofi Pasteur and Smartling. MSS reports funding to their organisation from NSW Health. GM-K is a volunteer committee member of the Australian Skeptics Society. KM receives funding from the National Health and Medical Research Council. All other authors declare no competing interests.