Planning for a COVID-19 Vaccination Campaign in New Zealand: Trust, Affective and Cognitive Attitudes, and COVID-19 Vaccine Intention

"The central implication of this study is that a key public health investment to reduce public vaccine hesitancy about COVID-19 vaccines is for trusted voices to speak more often as that can boost favourable attitudes towards vaccination, which in turn can improve vaccine uptake."

When faced with a new policy or an unfamiliar technology, individuals use information from trusted sources to form attitudes and decide what actions they may take. Given the changing nature of COVID-19 and the uncertainty related to vaccine development and administration in the face of emerging variants, there is a need to understand factors that shape public intentions to take a COVID-19 vaccine so that public health officials and other stakeholders can provide information that addresses and assuages public concerns. Conducted in New Zealand, this study examines the interplay between attitudes, trust, and vaccine intentions, in line with the theory of planned behaviour.

A nationally representative online sample survey (N = 1,040) of the New Zealand adults was conducted in July 2020, when the COVID-19 vaccine was not yet available. COVID-19 vaccination intention was measured using three items, measured on a 5-point scale from "strongly agree" to "strongly disagree": (i) "I intend to get vaccinated against the coronavirus"; (ii) "I will get vaccinated against the coronavirus even if I must pay for the vaccine"; and (iii) "I am willing to put my name on the list to get vaccinated against the coronavirus." The mean of the three measures was used as an indicator of vaccine intentions. Attitudes (both affective and cognitive dimensions) towards vaccines, previous vaccination refusal, and trust in informational sources were among the other questions measured by the survey.

Findings from this study indicate that trust in informational sources such as mass media (mainstream print and online newspapers, radio, and TV), the Prime Minister Jacinda Ardern, and health experts is associated with affective attitude and cognitive attitude, which, in turn, align with intentions to vaccinate against COVID-19. While this study highlights attitudes as a mediator between trust and intention, the researchers stress that other pathways, such as trust mediating the attitude-behaviour relationship or behaviour as a causal predictor of both trust and attitudes, are equally plausible and should be explored in future research. More specifically:

• Consistent with the theory of planned behaviour and empirical evidence from previous study, favourable attitudes towards vaccines were most strongly associated with vaccine intention, among the factors tested in this study.
• Findings of this study align with the assertion that trust is important in public health campaigns, as individuals pay attention to, and are more likely to follow advice from, trusted sources of information.
• The study suggests that "competency of political leaders - as much as public institutions - plays an important role in how the public responds to a global public health crisis. In contrast to political leaders in other countries, Prime Minister Ardern has been hailed globally as leading the country to contain COVID-19 community transmission through formal press conferences as well as regular social media appearances that likely made her a trustworthy leader (Roy, 2020). Some of the association between trust in the Prime Minister and vaccine intention is explained by attitudes - a large proportion of this mediation can be attributed to affective attitude even though mediation via cognitive attitude remains significant."
• Trust in health experts was associated with both affective and cognitive attitude, which in turn, were associated with vaccine intentions. However, family and friends as a source of trusted information had no significant association with either vaccine attitudes or with COVID-19 vaccination intentions. Together, these findings highlight that on uncertain issues, people have higher trust in relatively unfamiliar health experts than more familiar and socially congruent groups such as their family and friends.
• "As expected, individuals who had previously refused a vaccine were more likely to decline getting a COVID-19 vaccine in univariate analysis. But after accounting for other variables, including vaccine attitudes, it was not significantly associated with vaccine intentions....[I]t is possible that the association between previous behaviour towards vaccine and intentions for a future COVID-19 vaccine are partly or completely mediated through other socio-cognitive factors such as attitudes, norms, and behavioural control..."

In conclusion: "Findings can help inform theory and practice of health campaigns to increase COVID-19 vaccine uptake. Trusted sources communicating information that addresses prevailing vaccine concerns are likely to increase public enthusiasm for COVID-19 vaccination."