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FEARING the DISEASE OR the VACCINE 1 1 This Manuscript Has Been Accepted for Publication in Personality and Individual Differenc FEARING THE DISEASE OR THE VACCINE 1 1 2 This manuscript has been accepted for publication in Personality and Individual Differences 3 (https://doi.org/10.1016/j.paid.2020.110590) 4 5 Fearing the Disease or the Vaccine: The Case of COVID-19 6 7 Linda C. Karlsson1*, Anna Soveri2, Stephan Lewandowsky3, Linnea Karlsson4, Hasse 8 Karlsson5, Saara Nolvi6, Max Karukivi7, Mikael Lindfelt8, and Jan Antfolk9 9 10 1Department of Psychology, Åbo Akademi University, Finland; [email protected] 11 2FinnBrain Birth Cohort Study, Institute of Clinical Medicine, University of Turku, Finland; 12 [email protected] 13 3School of Psychological Science, University of Bristol, United Kingdom; and School of 14 Psychological Science, University of Western Australia, Australia; 15 [email protected] 16 4FinnBrain Birth Cohort Study, Institute of Clinical Medicine, University of Turku, Finland; 17 the Centre for Population Health Research, University of Turku and Turku University 18 Hospital, Finland; and Department of Child Psychiatry, Turku University Hospital and 19 University of Turku, Finland; [email protected] 20 5FinnBrain Birth Cohort Study, Institute of Clinical Medicine, University of Turku, Finland; 21 and Centre for Population Health Research, University of Turku and Turku University 22 Hospital, Finland; and Department of Psychiatry, Turku University Hospital and University 23 of Turku, Finland; [email protected] 24 6FinnBrain Birth Cohort Study, Institute of Clinical Medicine, University of Turku, Finland; 25 Turku Institute for Advanced Studies, Department of Psychology and Speech-Language FEARING THE DISEASE OR THE VACCINE 2 1 Pathology, University of Turku, Finland; and Department of Medical Psychology, Charité 2 Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt- 3 Universität zu Berlin, Germany; [email protected] 4 7FinnBrain Birth Cohort Study, Institute of Clinical Medicine, University of Turku, Finland; 5 and Department of Psychiatry, Turku University Hospital and University of Turku, Finland; 6 [email protected] 7 8Department of Theological Ethics, Åbo Akademi University, Finland; 8 [email protected] 9 9Department of Psychology, Åbo Akademi Univerity, Finland; [email protected] 10 11 Declarations of interest: none 12 13 14 15 *Address correspondence to Linda C. Karlsson, Department of Psychology, Åbo Akademi 16 University, Tehtaankatu 2, 20500, Turku, Finland, e-mail: [email protected], phone 17 number: +358 40 8244119 18 19 Funding: LCK was funded by the doctoral network of Minority Research 20 (www.abo.fi/en/minority-research/) at Åbo Akademi University. AS was funded by the 21 Academy of Finland (grant number: 316004; www.aka.fi/en/). ML was funded by the 22 Academy of Finland (grant number: 316726; www.aka.fi/en/) and the Polin Institute (www. 23 polininstitutet.fi/en/polin-institute/). 24 25 © 2020. This manuscript version is made available under the CC-BY-NC-ND 4.0 license 26 http://creativecommons.org/licenses/by-nc-nd/4.0/ 27 FEARING THE DISEASE OR THE VACCINE 3 1 Abstract 2 As studies indicate that people perceive COVID-19 as a threatening disease, the 3 demand for a vaccine against the disease could be expected to be high. Vaccine safety 4 concerns might nevertheless outweigh the perceived disease risks when an individual decides 5 whether or not to accept the vaccine. We investigated the role of perceived risk of COVID-19 6 (i.e., perceived likelihood of infection, perceived disease severity, and disease-related worry) 7 and perceived safety of a prospective vaccine against COVID-19 in predicting intentions to 8 accept a COVID-19 vaccine. Three Finnish samples were surveyed: 825 parents of small 9 children, 205 individuals living in an area with suboptimal vaccination coverage, and 1,325 10 Facebook users nationwide. As points of reference, we compared the perceptions of COVID- 11 19 to those of influenza and measles. COVID-19 was perceived as a threatening disease— 12 more so than influenza and measles. The strongest predictor of COVID-19 vaccination 13 intentions was trusting the safety of the potential vaccine. Those perceiving COVID-19 as a 14 severe disease were also slightly more intent on taking a COVID-19 vaccine. Informing the 15 public about the safety of a forthcoming COVID-19 vaccine should be the focus for health 16 authorities aiming to achieve a high vaccine uptake. 17 Keywords: COVID-19; coronavirus; vaccination intentions; vaccine hesitancy; 18 perceived risk; perceived vaccine safety 19 FEARING THE DISEASE OR THE VACCINE 4 1 1 INTRODUCTION 2 Due to the COVID-19 pandemic, the world faces a novel infectious disease, for 3 which there currently is no treatment or herd immunity. The pandemic poses a serious threat 4 to our health and well-being (WHO, 2020a) and researchers are racing to develop and test 5 vaccines against COVID-19 (Callaway, 2020). When vaccines become available, the success 6 of the vaccination program will depend on the public’s acceptance of the vaccines. Recent 7 studies have indicated that whereas the majority report they would accept a future vaccine 8 against COVID-19 (Blanchard-Rohner, Caprettini, Rohner, & Voth, 2020 [pre-print]; Detoc 9 et al., 2020; Dodd, Cvejic, Bonner, Pickles, & McCaffery, 2020; Faasse & Newby, 2020; 10 Malik, McFadden, Elharake, & Omer, 2020; Murphy et al., 2020 [pre-print]; Neumann- 11 Böhme et al., 2020), 6–25% report they would not (Detoc et al., 2020; Faasse & Newby, 12 2020; Murphy et al., 2020 [pre-print]; Neumann-Böhme et al., 2020; The COCONEL Group, 13 2020; Ward, Alleaume, Peretti-watel, & the COCONEL Group, 2020). Understanding why 14 people feel hesitant towards a vaccine against COVID-19 is of paramount importance, as this 15 can help health authorities boost vaccine acceptance to limit the spread of the disease. 16 Research shows that vaccine acceptance is a complex decision-making process influenced by 17 a wide range of factors (for reviews, see e.g., Betsch et al., 2018; Brewer et al., 2017; Larson 18 et al., 2014; Thomson et al., 2016). The present study will explore the role of two of these 19 key factors—the perceived risk of the disease the vaccine protects against and the perceived 20 safety of the vaccine—in people’s acceptance of a vaccine against COVID-19. 21 1.1 Perceived Risk of Disease 22 A key determinant in people’s vaccination decisions is the risk they associate with the 23 disease the vaccine protects against (Betsch et al., 2018; Thomson et al., 2016). These risk 24 perceptions are often measured as the perceived likelihood of contracting the disease and the 25 perceived severity of the symptoms (Brewer et al., 2007). Risk perceptions are also generally FEARING THE DISEASE OR THE VACCINE 5 1 considered to have an emotional dimension, including fear and worry (Loewenstein, Weber, 2 Hsee, & Welch, 2001; Slovic, Finucane, Peters, & MacGregor, 2004). Research shows that 3 individuals who perceive the risk of contracting a vaccine-preventable disease as low, 4 consider the symptoms of the disease as mild, and worry little about the disease, report less 5 intent to take the vaccines and more often remain unvaccinated (Betsch et al., 2018; Bish, 6 Yardley, Nicoll, & Michie, 2011; Brewer et al., 2007; Schmid, Rauber, Betsch, Lidolt, & 7 Denker, 2017; Thomson et al., 2016). 8 The risks related to the novel corona virus SARS-CoV-2, which causes COVID-19, 9 have been given considerable attention. On March 11th 2020, the World Health Organization 10 (WHO) declared the outbreak of COVID-19 a pandemic, calling for nations to take “urgent 11 and aggressive” action (WHO, 2020a). The pandemic is a global health crisis that has been 12 covered extensively by the media, and governments and health authorities have taken 13 extensive measures to control the spread of the disease. Therefore it is not surprising that 14 recent studies show that people experience COVID-19 as a threatening disease (Dryhurst et 15 al., 2020; Faasse & Newby, 2020; Glöckner, Dorrough, Wingen, & Dohle, 2020 [pre-print]; 16 Kwok et al., 2020; Park, Ju, Ohs, & Hinsley, 2020; Wise, Zbozinek, Michelini, Hagan, & 17 Mobbs, 2020). 18 Looking at different aspects of perceived risk, studies have generally found that 19 individuals who perceive COVID-19 to pose a greater risk engage more readily in preventive 20 efforts, such as handwashing and social distancing (Dryhurst et al., 2020; Faasse & Newby, 21 2020; Harper, Satchell, Fido, & Latzman, 2020; Wise et al., 2020). Investigating the 22 relationship between risk perceptions and willingness to take a prospective vaccine against 23 COVID-19, Malik et al. (2020) found that US respondents who rated the disease higher on a 24 risk perception index (consisting of several risk measures) more often reported that they 25 would accept a vaccine against COVID-19. Glöckner et al. (2020 [pre-print]) found that in a FEARING THE DISEASE OR THE VACCINE 6 1 German sample, those who perceived their likelihood of becoming infected with COVID-19 2 as high and the health consequences of the disease as severe had higher vaccination 3 intentions. By contrast, at an early stage of the pandemic, Faasse and Newby (2020) found in 4 an Australian sample that perceived infection risk and perceived disease severity were not 5 meaningful predictors of COVID-19 vaccination intentions. Instead, the more the 6 respondents worried about a widespread outbreak of COVID-19 in Australia, the higher their 7 intentions were to take a COVID-19 vaccine. Also in a French sample, respondents who were 8 very worried about contracting COVID-19 were more likely to agree to take a hypothetical 9 COVID-19 vaccine (Ward et al., 2020). Taken together, the available research indicates that 10 individuals who perceive the risk of COVID-19 as higher, report more willingness to take a 11 prospective vaccine against the disease.
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