COVID-19 vaccination: increasing uptake

As the rollout of the COVID-19 vaccine programme continues to accelerate, Dr Michelle Constable, Head of the Behaviour Change Unit at Hertfordshire County Council, outlines their approach to countering vaccine hesitancy.

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The Behavioural Change Unit (BCU) at Hertfordshire County Council was set up in August 2019 to embed behavioural science in workstreams across the council, covering everything from environmental issues to children’s services.

Over the last 9-10 months this skillset has been applied to the COVID-19 response, developing behaviourally informed communications and interventions to support a range of prevention behaviours, including social distancing, wearing face coverings, as well as supporting people’s mental health and resilience.

More recently, the team has been developing a paper specifically on reducing vaccine hesitancy – the delay in acceptance or refusal of vaccines despite their availability - with a focus on communications.

COVID-19 vaccination: reducing vaccine hesitancy

We all understand the important role that the COVID-19 vaccine will play in moving us towards a new normal and ending the pandemic. Whilst developing, testing and producing a vaccine was a huge challenge, reducing vaccine hesitancy and ensuring that vaccine uptake is sufficient for reaching herd immunity will be crucial for success. But it also poses a real challenge - in recent years, vaccination acceptance and uptake has fallen, with significant impacts on public health. The World Health Organization (WHO) has defined three key influences on vaccine hesitancy:

  • Confidence – the level of trust in a vaccine’s safety and/or effectiveness.
  • Complacency – the perception of risk regarding how likely someone is to contract COVID-19 and the severity of the implications it would have upon their health if contracted.
  • Convenience – how easy it is for someone to get the vaccine.

These factors influence individuals and groups to different degrees. So, the approach shouldn’t be one size fits all.

As we continue to gather evidence on the vaccine, Hertfordshire County Council has reviewed research into vaccination uptake for past pandemics and surveys of intentions to have the COVID-19 vaccine, to help identify what influences on uptake might be. Recognising that the influences will be different for different people/groups of people, local consultation with BAME and Gypsy and Traveller communities also fed into the review.  This research has informed a series of recommendations and engagement principles.

These recommendations are outlined below, and can also be found in the full review paper.

Guiding principles

To reduce vaccine hesitancy, effective and targeted communications are essential both for the general public and for groups where uptake is likely to be lower. At the core of the development of any COVID-19 vaccine communications plan is the principle of engagement.

Engage to understand à Engage to empower à Engage to evaluate

  • Engage to understand - Barriers to vaccine uptake vary within and between groups, influencing behaviour to a greater or lesser extent. Engage with local stakeholders to understand their needs, values, and beliefs, and identify trusted sources of information.
  • Engage to empower - Co-produce tailored materials and resources. Apply the insights and emphasise the benefits of having the COVID-19 vaccine. Engage with key influencers to establish routes into the community and gain endorsement and support for messaging. 
  • Engage to evaluate - Assess if materials and resources are having the desired impact. Influences on vaccination intentions fluctuate over time so strategies and communications will need to reflect changes to ensure they remain relevant.


Communications to decrease vaccine hesitancy, and thereby increase the uptake of the COVID-19 vaccine, are more likely to be effective if they achieve the following:

  • Residents believe that there is a risk to them of getting COVID-19 and that this could have severe implications upon their health 

    People are more likely to be vaccinated if they perceive that they are at risk of contracting the virus and that there would be severe implications upon their health if they did. Increasing knowledge of the personal risks associated with not being vaccinated should therefore feature within communication strategies for both the general public and for specific groups.
  • Residents believe that the COVID-19 vaccine is safe and is effective

    People are more likely to have the COVID-19 vaccine if they believe that it is safe and effective, particularly for groups where greater apprehension and fears have been identified. It is important that concerns are addressed in communications and not dismissed or ignored.
  • Being vaccinated is made as easy as possible for residents

    The easier it is for someone to be vaccinated, the more likely they are to have the vaccine. Invitations should provide clear and specific information including where to go and how to get there, and offer a variety of convenient times and locations. Employers should be encouraged to support staff to get the vaccine by ensuring there are no financial or time implications of them attending appointments. Support with planning should also be provided to increase the likelihood of people attending their second vaccination appointment.
  • Residents are motivated to have the COVID-19 vaccine

    People will have multiple motivations to have the vaccine and these will be different for different people e.g. wanting to protect themselves, their friends and family, the NHS or the economy.  Identifying the different motivational levers is key to effective communications.
  • Information gaps are identified and filled, and misinformation is corrected 

    Identify and address any gaps in knowledge regarding COVID-19 and the vaccine and develop resources and communications to address them. Where false information is identified, communicate the correct information as soon as possible to reduce exposure and prevent the spread of misinformation.
  • Engagement crosses multiple communication channels

    Use a range of media channels that are appropriate for the audience. Harnessing social media is essential for engaging a diverse audience as it is the primary source of information for most people. Online campaigns against vaccination, which have the potential to gain rapid exposure, should be counteracted with strategic communications.

For further information on the above recommendations, and examples of how they might be applied within a local authority, please see the full review paper.

COVID Information Champions (CICs)

CICs is a project to complement the current communication campaigns and seeks to engage with all communities through local community champions. The council know it is not reaching everyone, and there are some trust issues in regard to information from government and the public sector for some communities. This type of scheme is happening in other areas of England. Colleagues at Milton Keynes and Newham have been very helpful with sharing their resources and experience.

This project will:

  • Utilise the strong local networks established with the community by the voluntary sector
  • Identify and train CICs and peer educators to share key messaging with friends, families and local communities
  • help embed clear information and behaviours, complementing current communication campaigns

Expected Outcomes:

  • Hertfordshire residents, particularly key target groups, receive regular information updates which are clear and consistent about COVID-19 from Hertfordshire Public Health