In the absence of effective treatment and the arrival of new variants, preventive measures and vaccination remain the key pillars in the fight against covid-19. Studying the social perception, knowledge and attitudes of the population in relation to the pandemic helps us to know their needs, understand their motivations and identify barriers and facilitators of behaviour.

In October, the COSMO-Spain team, coordinated by the Instituto de Salud Carlos III (ISCIII), launched a survey to find out the reasons why people have not yet been vaccinated and to identify possible factors associated with refusal to vaccinate. This was carried out through an online questionnaire via social networks and WhatsApp, the results of which were released last week.

A total of 2 312 people responded to the survey, of whom 97% said they had not received any doses of the vaccine and 3% said they had received one dose but did not plan to receive a second dose. The main reason for not having completed the vaccination schedule was having had too many adverse effects with the first dose (44%).

Fears and doubts

Also, the main reason for not getting vaccinated (given by 71.9% of respondents) was having doubts about the safety of vaccines due to the perception that they have been developed too quickly. The second most cited reason by respondents is again fear of side effects and possible health risk, with 50% (note that several reasons were allowed to be chosen). Other reasons mentioned relate to a low perception of risk ("I am healthy and do not need to be vaccinated") and doubts about the effectiveness of vaccines ("covid-19 vaccines do not work"), with percentages of 41% for both reasons.

Only 12% of respondents are totally negative and indicate that they have not been vaccinated because they believe that the coronavirus does not exist or because they think that vaccines are a hoax

Only 12% of respondents are total naysayers and indicate that they have not been vaccinated because they believe that the coronavirus does not exist or because they think that vaccines are a hoax. Six percent do not believe in vaccines in general. In contrast, 9% report not having been vaccinated because they have had the disease and therefore feel they are immunised, and 8% say they have not been vaccinated because of health problems or medical advice.

The study also shows that unvaccinated people also have a lower perception of the seriousness of the disease (only 9 % believe that they could have a serious case of covid-19), less adherence to preventive behaviour and a lower degree of health literacy. That is, less perceived ease in finding, understanding, evaluating and applying coronavirus-related information than the general population.

In addition, 60% of respondents indicated that they never or rarely consult coronavirus information and, in general, confidence in coronavirus information sources is low.

Up-to-date communication with scientific evidence

Despite the fact that the study covers all types of doubts about vaccines, the results on the health literacy of respondents suggest that we are dealing with a population group that has difficulties in accessing reliable information based on scientific evidence about the pandemic, which leads to sometimes biased knowledge and attitudes.

For all these reasons, it is important to remember that both messages and the media must be up to date and respond to the population's doubts only with scientific evidence. For example, we must wait for science before assessing the effects of new variants of vaccines.

We are faced with a population group that has difficulties in accessing reliable, evidence-based information about the pandemic, leading to sometimes biased knowledge and attitudes

In addition, between unvaccinated people and vaccinated people or people who have had the disease but have not been immunised, there are still around ten million people in Spain who could be infected by the coronavirus, so, in addition to vaccination, it is essential to maintain all other preventive measures at all times.

It is also important to highlight that after one year of vaccination there is clear evidence that the vaccines are safe and protect against covid-19, thanks to the pharmacovigilance studies carried out by regulatory agencies such as the European Medicines Agency, which continue to collect data on the efficacy of these vaccines and their side effects, as is done with any other medicine.

In addition, the Ministry of Health reports every week on the incidence of the disease among vaccinated and unvaccinated people and so far both the incidence, hospitalisation and deaths in fully vaccinated people is much lower than that observed in unvaccinated people.

The vast majority are not anti-vaccine

In relation to the fear of side effects reported by both those who have only had one dose and those who have not had any, passing covid-19 can be much more serious and dangerous than the side effects of vaccines. The Spanish Agency for Medicines and Health Products (AEMPS) collects information on these effects and describes them as "mild, of short duration and not all people suffer from them". The most frequent side effects are: pain at the injection site, fever, tiredness, dizziness and headache, with a maximum duration of three days, while unvaccinated people run the risk of having severe covid-19, being admitted to an ICU and suffering from what has been called "persistent covid", whose symptoms are long-lasting and can cause disability.

This study shows that Spain is not an anti-vaccine country and that not all people who have not yet been vaccinated deny the existence of the virus or believe that it is all a conspiracy

In short, this study on unvaccinated people shows us that Spain is not an anti-vaccine country and that by no means all the people who have not yet been vaccinated deny the existence of the virus or believe that it is all a conspiracy.

It is essential to address the doubts and concerns expressed by the majority of unvaccinated people, to fight disinformation and hoaxes with scientific evidence. This is the only way to facilitate a correct interpretation of the data.