Coronavirus (COVID-19) and flu vaccination programme: user journeys and experiences

6. Future considerations

Key points

• In considering whether to have future Covid-19 vaccinations, automatic motivations, often driven by fear and urgency earlier in the pandemic, had been largely replaced by more reflective motivations, with participants weighing up the risks and benefits.
• Views towards future Covid-19 vaccinations varied. Among those who would not hesitate to take up further vaccinations, personal health risk was a key factor.
• Among other participants, views ranged from being likely to take up a future vaccine, albeit with careful consideration, to being certain not to. Barriers to future take up included:
  • perceived (low) health risk
  • vaccine fatigue
  • views on vaccine efficacy
  • concern about side effects
  • original reason for vaccination no longer valid (e.g., Covid Status Certification travel requirements removed for certain countries)
• Changes to (or new evidence on) the above factors may change participants' minds about receiving future vaccinations.
• Overall, participants who had engaged with the Covid-19 and flu vaccination programmes felt they had been well organised.
• Participants suggested minor improvements to future Covid-19 and flu vaccinations programmes. Several themes cut across these suggestions for improvements, a vaccination programme that is: inclusive; transparent; flexible to users' needs, friendly and welcoming.

This section examines how likely participants thought they were to engage in future Covid-19 and flu vaccination programmes. This is followed by participants' suggestions for improvement to future vaccination programmes.

Likelihood to engage in future offers of the Covid-19 vaccination

Wider contextual shifts

From March to May 2022, when the research took place, few pandemic-related restrictions remained and Covid-19 had become less prominent in people's thoughts than was the case in the earlier stages of the pandemic. Reflecting this wider context, barriers and motivations for receiving future Covid-19 vaccinations had shifted somewhat from those that had driven initial vaccination decisions. In particular, the more automatic motivations, often driven by fear and urgency earlier in the pandemic, had been largely replaced by more reflective motivations, with participants weighing up the risks and benefits.

"I would need more information before I just suddenly agree and launch myself into it [another Covid-19 vaccination]. It flings up quite a few questions. The way the first one was promoted, all these deaths worldwide, people were dropping like flies. [I got it] more [because of] the scare factor, 'oh there's a vaccine I'll take it'. We weren't told we might need a booster."

Participant, white Scottish, man, 40+ carer, SIMD2, 2 Covid-19 vaccinations

A further shift noted was the lessening influence of social factors. While both pressure from family and friends and a wider sense of duty influenced initial vaccination decisions, there was very little discussion of these factors in relation to future vaccination decisions.

Motivations and barriers for engaging with future Covid-19 vaccinations

Among those who had received three Covid-19 vaccinations, views towards receiving further vaccinations varied. One view was that they would not hesitate to accept any Covid-19 vaccine offered to them in future. This view was held by both those who had been willing to receive all of their Covid-19 vaccines and those who were initially more reluctant. Having had a positive experience of the Covid-19 vaccination (for example not experiencing any side effects and attributing not having caught Covid-19, or experiencing it mildly, to being vaccinated) contributed to this view. Those with health conditions were particularly likely to be in this group, with personal health risk being an important motivator.

There were other triple-vaccinated participants, though, who were more reluctant to have future vaccinations. Views ranged from those who felt they were likely to but noted they would need to give it careful consideration to those who felt almost certain not to. The factors influencing these decisions are discussed below, together with the views of participants who had received two or fewer Covid-19 vaccinations (although drivers and motivations to engagement with the current vaccination programme are discussed in chapters 2 and 3 above, these participants were also asked about whether they would engage in future vaccination programmes and their views on engagement with the current and future programmes did not always correspond).

There were notable subgroup differences in views towards future Covid-19 vaccination with Pakistani and Black African participants less receptive to future vaccinations. The exception to this is those with a health condition they felt affected their personal health risk.

Key barriers to take-up of future Covid-19 vaccinations included:

• perceived health risk – a feeling of having sufficient immunity from vaccines already received; comparisons with the flu vaccination only being needed for more vulnerable individuals; the perceived risk from Omicron being lower than for previous strains; having had Covid-19 mildly.
• vaccine fatigue – apprehension around having several vaccines in a short space of time and/or around the idea of having to have them frequently in future
• views on efficacy – the fact that the current vaccine does not stop transmission of the virus; perception that the current vaccines are only effective against previous strains of the virus and that the virus will continue to mutate, making it difficult for vaccines to keep up; linked to vaccine fatigue, reduced faith in the effectiveness of the vaccine the more doses are required
• side effects – having experienced side effects after previous vaccines; concern about the longer-term build-up from having numerous vaccines in their system
• that their original reasons for receiving, or considering receiving, vaccination, such as to travel to a particular country or attend events, no longer apply

"Is it necessary? I don't think it is necessary, because you know now they have lifted off everything, so it is not necessary, they have lifted it [restrictions] off, they have stopped the whole vaccine travel thing."

Participant, health condition or disability, White Polish, woman, under 40, SIMD2, parent, 3+ Covid-19 vaccinations

In terms of what would need to be different for them to take up future Covid-19 vaccinations, participants typically cited any changes in circumstances linked to the barriers described above. These included: a perceived increase in their personal health risk due to a change in their health or the emergence of a more virulent variant; the development of a vaccine which is more effective at preventing transmission (and seeing first-hand evidence of this happening); further information on the safety of the vaccine and evidence of side effects waning (for example menstrual periods returning to normal); and whether they wanted to travel abroad (and Covid Certification was required for that country) or if domestic Covid Certification Status was reintroduced.

"I'm reluctant. I would only take it again if I needed to, and by that I mean if I can't attend something or travel abroad".

Participant, Pakistani, man, under 40, SIMD1, 3+ Covid-19 vaccinations

Likelihood to engage in future offers of the flu vaccination

Likelihood to get a future flu vaccination was closely aligned with general views on the vaccine and was not typically something that had recently changed. In terms of what would have to change for those eligible for the flu vaccination but not planning to take-up future offers, a change in personal health risk was a key factor.

As touched on in Chapter 4, however, in a small number of cases, Covid-19 had influenced decisions on flu vaccinations, acting as both a motivating factor and a barrier. For these participants, decisions on future flu vaccinations would depend on the Covid-19 context at the time.

Suggested improvements for a future vaccination programme

Overall, participants who had engaged with the Covid-19 and flu vaccination programmes felt they had been well organised. In relation to Covid-19 specifically, there was a sense that the vaccination programme had been particularly impressive given the circumstances, timeframe and scale of the programme.

"I couldn't fault it, I was really impressed with all vaccination programme and all information available, really truly impressed."

Participant, White Polish, woman, 40+, rural, 3+ Covid-19 vaccinations

Participants were asked what a future Covid-19 and flu vaccination programme which was both trusted and well-designed would look like. There were views at both ends of the spectrum, from those who felt it worked very well as it was to those who felt very disengaged from the vaccination programme and did not feel anything could make them trust it. However, among the remaining participants, suggestions for improvement were provided. These covered all aspects of the programme and, on the whole, were for minor improvements rather than fundamental changes. Suggestions were informed by challenges participants had personally experienced and by thinking about others in different circumstances

Several themes cut across suggestions for improvements. Participants wanted any future vaccination programme to be: inclusive; accessible; transparent; flexible to users' needs; friendly and welcoming.

It should be noted that participants tended to focus more on Covid-19 than flu when considering a future programme, reflecting the Covid-19 vaccination's higher profile and the fact that not all participants had experience of the flu vaccination.

Information provision

There was a strong desire for more information as part of a future vaccination programme. While participants had typically used multiple information sources to help inform their vaccination decisions, as described in Chapter 2, these did not always give them all the information they sought. Transparency, in particular, was a key theme in the discussion of information, which was strongly linked to trust in the vaccine. Topics on which there was a desire for more transparent information included:

• timescales for development of vaccines – how was it possible to develop them so quickly, when vaccine development usually takes a lot longer?
• ingredients and manufacturing processes – detailed information on these
• safety – how can they be sure that it is safe? how was it tested? access to trial data
• side effects – data on the likelihood of different side effects and among different groups in the population
• effectiveness – how does it work? how do we know that it is working? what evidence is there? why it is necessary?
• rationale behind the prioritisation of different groups (i.e. age groups and health conditions) for vaccines.

The tone of information was also considered important. One viewpoint was that information should be presented in a more factual manner, covering both pros and cons, to allow people to make their own decisions, rather than presented in a 'scaremongering' way, using fear as a motivator.

"If there was a bit less pressuring people to get it and just more of the facts, because obviously there is people that do get side effects from it and I think it is a bit more common than what has been let on.[…] If you speak about that more widely, rather than trying to kind of brush it under the carpet, I feel there is going to be less scepticism towards it and a bit more people maybe accepting it or having a bit more discussion about it […] Just being a bit more honest and saying, 'right, okay, there are some side effects, but you could have side effects if you take paracetamol', or just being aware what are the risks with this."

Participant, white Scottish, woman, under 40, no Covid-19 vaccinations

Suggestions were also made in relation to information sources and channels, largely reflecting those used to date:

• continued communication and information sharing via the NHS (e.g. leaflets, online, billboards) – considered particularly important due to the NHS being trusted
• further promotion of the vaccine by scientists and doctors
• news and media – a range to maximise reach (television, radio, social media (links to official sites such as NHS/Government websites)).

Ensuring information was accessible to all was also a valued aspect of a future vaccination programme, for example the provision of easy read versions of material.

Appointment scheduling

Typically, participants had been invited for a Covid-19 vaccination via letter. Opinion was divided on whether this was the best way to organise appointments in future. On the one hand, it was seen as preferable due to its formality and ability to reach those not online. However, there were reports of people not having received letters and concerns about the environmental impact were also mentioned. Accessibility barriers were also raised, with one blind participant noting that letters are not accessible to visually impaired individuals.

Being invited via text, email, by GP practice or being able to go online to book an appointment, without waiting to receive an invitation, were suggested as alternatives.

It was suggested that the information at the appointment stage could be more personalised. In particular, participants who had a strong preference for one vaccine over another suggested that it would be preferable to know at the appointment stage which vaccine brand they would receive.

Flexibility was viewed as a positive feature of the current programme and, while participants had their own preferences, they supported retaining the options of booking appointments as well as having drop-in vaccine centres. Being able to attend during evenings and weekends was valued.

There was a suggestion that the booking systems could be upgraded to improve user experiences, for example having a map displaying different vaccination venues, sharing live waiting times or having an app to cover all aspects of the vaccination programme (e.g., appointments, vaccine certification) in a single place.

Venues and vaccination experience

As discussed in Chapter 3, participants' practical experiences of being vaccinated were positive. In line with this, they did not tend to feel that the current system required significant change. However, considerations were raised in relation to the following key features of vaccination venues: proximity to home/ease of getting to the venue; type of setting; Covid-19 safety; and vaccination staff.

Ensuring that people could get to a vaccination centre on foot was the ideal scenario. While participants had typically not had to travel far to be vaccinated, they noted that the journeys could be difficult when people were unable to travel by car. In some cases, this had led to participants having to incur expense by travelling by taxi. These issues of access were more pronounced in rural areas.

Several ways in which people could be vaccinated closer to home or in more convenient locations were suggested:

• vaccinations being delivered in GP surgeries, pharmacies and local health centres
• mobile vaccination venues in rural areas
• greater choice of venues so individuals can select the one most convenient for them.

Among those who had a preference for being vaccinated in their GP surgery or local pharmacy, trust and familiarity with the settings as vaccination venues also played a role. However, there was some acknowledgement that these professionals may be too busy to deliver the vaccination programme.

Ensuring that venues were 'Covid-safe' was a further factor considered important in an ideal scenario, particularly for vulnerable groups. In real terms, this meant ensuring that there were enough venues to prevent them being crowded (there were those who had experience of long queues, particularly at booster vaccination centres with increased risk of catching Covid-19) and that they are clean.

While not a widespread issue, a desire for greater privacy while being vaccinated was also requested by a small number of participants.

Reflecting typical experiences of the current vaccination programme, participants stressed the importance of staff being friendly and welcoming, recognising that people can feel nervous.

Ensuring that staff have the training and skills to support those with additional support needs (for example, autism) to have a positive vaccination experience was also important.

Finally, although this method of administration is not currently available, there was a desire for a nasal spray Covid-19 vaccine to be made available for children, those with needle phobias and those with certain additional needs.