Major study suggests transparent communication is key to vaccine uptake
A Lancet study of 1.1 million people suggests that most COVID-19 vaccine hesitancy reflected concrete concerns that faded over time, underscoring the importance of good information and transparent communication.
- 25 February 2026
- 4 min read
- by Priya Joi
At a glance
- A new Lancet study tracked people’s vaccine attitudes and whether they ultimately got vaccinated.
- Hesitancy during COVID-19 was often linked to concerns about novelty, safety and effectiveness. As evidence became available, many hesitant individuals chose vaccination.
- Researchers say timely, clear and transparent communication is key to future vaccine campaigns.
Delivering clear, timely and transparent information is crucial if populations are to embrace vaccination campaigns, according to new research published in The Lancet examining COVID-19 vaccine hesitancy.
The study followed people over time, tracking not only their stated reasons for hesitancy but whether they ultimately went on to be vaccinated. The authors say this is the first time this through-line has been drawn to their knowledge.
Co-author Prof Marc Chadeau-Hyam, School of Public Health, Imperial College London, London, told VaccinesWork that this approach offered insight into the reasons for hesitancy and the ability to identify concerns.
Pandemic roll-out
The research team analysed survey data from the Real-time Assessment of Community Transmission (REACT) studies, which monitored the prevalence of SARS-CoV-2 in England during the COVID-19 pandemic. Just over 1.1 million people’s data was analysed.
In total, 37,982 (3.3%) participants reported vaccine hesitancy. Hesitancy rates peaked at 8.0% in early 2021 at the start of vaccine roll-out, and this dropped to 1.1% at the start of 2022. Hesitancy rose again slightly to 2.2% in early 2022, just after an Omicron surge.
The research indicated at that point, “There was an increase in the proportion of people reporting their reasons for hesitancy as feeling that the impact of COVID-19 was being exaggerated, not needing the vaccine as they had already had COVID-19, or not feeling that COVID-19 was a personal risk.”
Strikingly, a majority of hesitant people went on to get vaccinated: of the 24,229 participants who indicated hesitancy and consented to data linkage, 15,744 (65.0%) went on to receive one or more vaccinations.
Many of the vaccine concerns people had at the start of pandemic were context-specific, says Chadeau-Hyam. “It was a new, unseen disease and the response required as-yet undeployed technologies in the form of mRNA vaccines.”
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Early in the roll-out, many concerns were tied to novelty. The researchers identified clusters of hesitancy related to vaccine effectiveness, potential side-effects and specific issues such as fertility and breastfeeding. But the study showed that these concerns reduced during the roll out, potentially related to evidence accumulating.
“There was a drop in hesitancy in the first few months of the pandemic,” he says, “which may be related to the emergence of reassuring information on the vaccine technology and effectiveness during the roll-out.”
From doubt to action
Crucially, the study was able to link attitudes to outcomes, which showed that hesitancy doesn’t always lead to a refusal of the vaccine – there were participants who initially described themselves as hesitant but later chose vaccination (with what Chadeau-Hyam describes as “a more flexible attitude”) as well as those who “didn’t convert” and remained unvaccinated.
The authors’ analysis of subsequent vaccination behaviour showed that some factors linked to hesitancy – including previous COVID-19 infection, lower levels of education and deprivation – were also associated with remaining unvaccinated among those who initially expressed doubt.
However, some patterns reversed over time. Older adults were less likely to report hesitancy at first, but if they did, they were more likely to remain unvaccinated, possibly because their concerns – such as previous bad reactions to vaccines or underlying health conditions – were more persistent.
Women, by contrast, were more likely than men to initially express hesitancy, yet less likely to remain unvaccinated, which may, among other things, reflect time-limited concerns such as pregnancy or breastfeeding.
This suggests that vaccine sentiment can shift over time, and that targeted outreach and improved communication may help address concerns, particularly in communities at higher risk.
Future pandemics
For future pandemics, the lesson is clear. “It’s clear that if anything deserves serious investment, it’s making communication transparent and informative,” Chadeau-Hyam says.
“Our study suggests that the delivery of timely information is crucial if you want the population to adhere to a vaccine campaign. And if you want the roll-out to be as large as possible and non-selective, then you need to produce that evidence and information in the clearest, fastest way possible.”
The findings also underline that hesitancy is not monolithic and that different populations behave differently. “Our results only apply to the population of England, and one may anticipate heterogeneities across countries, so there’s no universal approach,” he says.
And despite the turbulence of the COVID-19 era, Chadeau-Hyam remains cautiously optimistic: “In general, people are now more aware of what epidemiology is about… So I’m quite hopeful that if information is provided carefully, then it will be received and interpreted in a reasonable way.”
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