Coronavirus (COVID-19) vaccine barriers and incentives to uptake: literature review

Convenience

Convenience pertains to vaccine accessibility, not only in physical terms (e.g. access to vaccination clinics), but also in relation to actual availability of doses (including different kinds of vaccines) and ability to understand information and/or engage with digital booking systems.

Accessibility barriers can be very practical, such as inconvenience of appointments (e.g. location or time) or scarce access to and costs of public/private transport. However, social or psychological barriers also play a role (e.g. anxiety caused by unfamiliar surroundings and people). Research from Voluntary Health Scotland, for example, has shown how people who were shielding, voluntarily or otherwise, were worried about leaving home and attending mass vaccination centres, including the potential of having to take public transport^[70]. Communication barriers due to poor health literacy or digital exclusion, and logistical barriers in locating or travelling to the vaccination venues have also been identified in some studies on minority ethnic groups^[71]. Together with that, lack of or limited access to health care (e.g. due to residential segregation or lack of understanding of the functioning of the medical system) represent an additional obstacle to vaccine uptake and a cause for increasing inequalities^{[72] [73]}.

However, broadly, mentions of concerns relating to convenience are relatively scarce in the literature at an overall UK level and refer mostly to the first phases of the vaccination campaign. Scholars have attributed the success of the vaccination programme in the UK to its capability to guarantee accessibility: a sufficient number of doses from three different types of vaccines have been made available in a number of venues (both on a drop-in or appointment basis) or have travelled to specific locations through mobile units such as buses and taxis, at no cost to the public, with the provision of information in more than 30 languages and formats such as Easy Read and British Sign Language, great flexibility in terms of time slots and the possibility of rescheduling appointments via phone or the internet^[74]. Results from the Perceptions of the Pandemic project which took place in England in July/August 2021 and involved members of the public from ethnic minorities also confirmed this, with the majority of participants rating the rollout plan, speed, communications and booking system of the vaccination programme as good or very good^[75].

In Scotland, efforts to guarantee accessibility have seen health boards and local authorities working in partnership with a number of organisations supporting groups such as the homeless or asylum seekers, and co-producing outreach approaches and communication^[76]. Targeted communications addressing different communities, making use of several languages, platforms and formats have been developed in collaboration with the Scottish Government^[77]. Vaccines have also been delivered at religious sites, pharmacies, food banks, schools and workplaces in order to facilitate uptake. Furthermore, the Scottish Ambulance Service (SAS) has adopted an agile model using mobile units to reach rural and remote areas, while also providing pop-up services in locations such as shopping centres and football stadiums. Finally, some health boards have implemented person-centred strategies contributing to the vaccination of Gypsy/Travellers, seasonal workers, refugees and those living in emergency accommodation who admitted they would not have attended other vaccination services^{[78 79 80]}.

Most of the recommendations in the literature have already been implemented (with the exception of including the use of door-to-door administration^[81]). As early as December 2020 the UK Government set the objective of ensuring that everyone was given the capability and the opportunity to get vaccinated. The use of workplaces, community centres and places of worship was then suggested as a means to target those individuals who are not registered with primary care services or may have less trust in political and medical institutions. Knowledge of local communities and ability to reach them were indicated as important reasons to rely on health boards and local authorities for the selection of venues and approaches^[82]. Indeed, the existence in local areas of several alternative venues does not only solve logistical issues, but can be seen as a way to minimise the financial impact on the public, such as loss of earnings deriving from taking time off work or expenses due to travel to vaccination sites^{[83] [84]}. UK research also mentions the importance of developing messaging by means of proactive engagement and co-production with relevant communities, as simply translating one language into another is not always enough and information needs to be provided in a way that is understandable to people with different concepts of health and disease^{[85 86 87 88 89 90]}.