Attitudes to COVID-19 Vaccines Among Australians During the Delta Variant Wave: A Qualitative Interview Study

Abstract

Since the outbreak of COVID-19 globally, a range of vaccines has been developed and delivered to reduce viral transmission and prevent COVID cases. This article reports findings from a qualitative research project involving telephone interviews with a diverse group of 40 adult Australians about their experiences of the COVID crisis. Interviews were conducted in late 2021 when Australians were dealing with the Delta variant outbreak and following a major effort on the part of government authorities to improve COVID-19 vaccination supplies and take-up. Responses to a question about COVID vaccines revealed that attitudes to and acceptance of COVID vaccines among this group were overwhelmingly positive. All participants had received at least one vaccine dose and the majority expressed views in support of mass vaccination against COVID. People who were hesitant or cautious about accepting COVID vaccination referred to the vaccines’ novelty and potential side effects. While many people were aware of debates about vaccine safety in the news media, trust in science and medical advice about COVID vaccines was strong. Participants wanted to protect themselves and others by accepting the recommended doses. Participants’ locale was a major factor in shaping experiences and stances on vaccines. The setting of government targets and mandates for vaccination was a key motivating factor. The goal of ‘getting back to normal’ was expressed as another reason for accepting vaccination, particularly for those living in areas that had been badly affected by high COVID cases and prolonged lockdowns.

Lay Summary

Attitudes to COVID-19 vaccines have changed over time, as different variants have emerged, and new vaccines have become available. Identification of the geographical, socioeconomic and political contextual aspects of why people may accept, reject or feel hesitant about COVID vaccines is important. This Australian-based study shows that government road maps and targets can play a key role in encouraging people to accept COVID vaccines. Trust in science and medical advice is an important factor in accepting COVID vaccines in the context in which they have been fast-tracked and side effects have been publicized. Socio-spatial dimensions play a major role in shaping experiences and attitudes towards COVID vaccines.

COVID-19, Australia, vaccines, attitudes, behaviours, social research

INTRODUCTION

Since the advent of the COVID-19 crisis, a number of vaccines have been rapidly developed, approved and administered to populations across the world: albeit with a continuing major disparity between low- and high-income countries (Basak et al., 2022). Together with government messaging and health agency campaigns urging people to accept the recommended doses of COVID vaccines, news media reporting and social media platforms have given a high level of attention to COVID vaccines. Debates about COVID vaccines have taken place in an intense global media-rich and online environment. In the context of a 24/7 news cycle, COVID information and advice have been constantly updated in real-time and misinformation or conspiracy theories continually aired alongside the advice of medical and scientific authorities. Public commentary on the various COVID vaccines available has compared their efficacy, noted side effects and discussed the number of vaccine doses required to deal with new COVID variants, as well as offering forums for anti-vaccination sentiment (Orso et al., 2020; Atehortua and Patino, 2021; de Albuquerque Veloso Machado et al., 2021).

There is a large literature, based mostly on medicine, public health and health psychology, that has addressed the issue of vaccine acceptance or hesitancy during pandemics across world regions (Truong et al., 2022). In response to the COVID pandemic, a growing number of new studies have focused on attitudes to the vaccines developed to reduce transmission of SARS-CoV-2 and prevent severe COVID and deaths from the disease (Sallam, 2021; Majid et al., 2022; Rodrigues et al., 2022). However, a recent Nature commentary by experts in vaccination attitudes and beliefs (Attwell et al., 2022) pointed out that the socioeconomic and political contextual aspects of why people may accept, reject or feel hesitant about such vaccines have rarely been addressed in detail in the COVID vaccines literature. The authors argued that further in-depth social research that can elucidate the socioeconomic and political dimensions of how people think and feel about vaccines and make decisions about vaccination for themselves or their family members is required. A comprehensive scoping review of the global literature specifically on COVID vaccines demonstrated that factors such as trust in government systems, risk perceptions, exposure to misinformation, previous experience with other vaccines, concerns about the side effects of COVID vaccines, feelings of social solidarity and political ideology have contributed to either willingness to accept COVID vaccines or hesitancy/rejection of them (Majid et al., 2022). Most of the research included in this review adopted quantitative methods and was conducted in the early stages of the pandemic. The review was therefore not able to delve into the details of more recent developments in attitudes to and experiences of COVID vaccines.

The present article goes some way to providing such insights in relation to the Australian context, drawing on findings from a broader social research project entitled ‘Australians’ Experiences of COVID-19’. This qualitative project’s primary objective was to explore how adult Australians across the nation have experienced the COVID crisis over time. Thus far, the project has included three stages across 2020–22, each involving semi-structured telephone interviews with 40 Australian adults. The Stage 1 interviews were held in mid-2020, while the Stage 2 interviews were conducted over a year later, in late 2021: a time during which vaccines against COVID had become widely available in Australia following a series of controversies and delays (Australian National Audit Office, 2022). Stage 3 interviews were conducted in September 2022.

This article focuses on the discussions with Stage 2 interviewees generated by new questions added to the initial interview schedule about vaccines. In what follows, an overview of how the COVID crisis has unfolded in Australia, the bumpy COVID vaccination rollout and previous research on Australians’ responses to COVID vaccination is first outlined, so as to provide the social and political contexts. Details of the ‘Australians’ Experiences of COVID’ project are then laid out. The results section outlines a thematic analysis of Phase 2 participants’ discussions of COVID vaccines, with a focus on their accounts of their understandings and experiences. The Conclusions section summarizes the key findings.

The COVID-19 crisis in Australia

Australia has experienced several peaks and troughs in COVID case numbers and deaths, with four distinct waves of the SARS-CoV-2 and its variants. Six different phases in the Australian response and management of the COVID crisis to the end of 2021 have been identified: (i) ‘A Distant Threat’, January to February 2020; (ii) ‘The National Lockdown’, March to May 2020; (iii) ‘COVID Zero’, June 2020 to January 2021; (iv) ‘Vaccine Dilemmas’, February to May 2021; (v) ‘Delta Response’, June to September 2021 and (vi) ‘Living with COVID’ (which included the impacts of Omicron variant), from October 2021 onwards (Lupton, 2021).

The Australian federal and state/territory governments began to implement strong COVID control measures early in the pandemic. From March 2020, Australia’s international borders were closed to incoming travellers, with only small numbers of people with special exemptions allowed into the country. These restrictions only began to be lifted from November 2021 (Andrews, 2021). As a result of this prolonged international border closure and other restrictions such as lockdowns and internal border closures, together with a strong test-and-trace system, compared with other wealthy countries such as the UK, USA and Canada, Australia reported far fewer deaths and cases per head of population in 2020–21 (Australian Institute of Health and Welfare, 2022). However, the situation changed rapidly in 2022. After prolonged periods of containment and low rates of community viral transmission following the first peak in March 2020 and subsequent peaks in August 2020 and September/October 2021, the sharpest rise in cases and deaths occurred when the Omicron variant of the novel coronavirus reached Australia and began to spread rapidly from mid-December 2021, reaching extremely high numbers of cases in January 2022 (Australian Government Department of Health, 2022).

During the Delta phase, Australian government federal and state/territory health agencies strove to buy time to maximize COVID vaccination rates after major delays in securing adequate supply for large-scale mass immunization (Australian National Audit Office, 2022). The two most populous Australian states (New South Wales and Victoria) and one territory (the Australian Capital Territory [ACT]) and particularly their three major cities (Sydney, Melbourne and Canberra, respectively), were badly affected by outbreaks of the Delta variant. Strict and prolonged lockdowns were endured by residents of these two states and territory, which together account for more than half of the entire Australian population (Lupton, 2021). The other Australian states (Queensland, Tasmania, South Australia and Western Australia) and territory (the Northern Territory) had few COVID restrictions in place during this time. These states/territory governments had closed their borders to the affected states and territories, with quarantine orders in place for those people who were granted exemptions to be allowed in (Duckett, 2022). These regions therefore effectively kept out the Delta variant, with little to no instances of community transmission (Australian Institute of Health and Welfare, 2022).

The COVID vaccine rollout in Australia began in late February 2021, but due to supply constraints, vaccines were initially limited to priority target groups deemed most at risk from severe COVID. In the early months of 2021, the locally manufactured AstraZeneca (Vaxzevria) vaccine was the most readily available in Australia. The Pfizer vaccine, which had to be sourced overseas, became more widely available in Australia from mid-2021 (Australian National Audit Office, 2022). During the ‘Vaccine Dilemmas’ phase, Australian government health authorities were struggling with improving problems with COVID vaccine supplies and distribution infrastructure (Lupton, 2021). This was a time in which a high level of negative publicity was given in global mainstream news reporting about rare but serious side effects of the Oxford AstraZeneca vaccine (blood clots) and the subsequent suspension by several European countries of its use for a time from March 2021 (Carlson et al., 2022). COVID vaccine refusal, uncertainty and hesitancy were becoming significant problems in some countries as a result of people’s concerns about these side effects (de Albuquerque Veloso Machado et al., 2021).

Australian-based research on COVID vaccination intentions and practices has identified major changes over time related to such contextual factors as geographical location, prevalence of COVID in the state or territory in which people lived, socioeconomic attributes and experience with other preventive measures. Australians’ willingness to accept a potential COVID vaccine during the early months of the pandemic was high (Dodd et al., 2020; Edwards et al., 2021; Kaufman et al., 2022). However, this level of acceptance had diminished by the early months of 2021, when COVID was well controlled across Australia. A combination of inadequate COVID vaccine supplies, complacency about the risk of contracting COVID while international borders remained closed and community transmission was low, changes to government policy about the use of AstraZeneca and hesitancy about vaccine safety on the part of those members of groups deemed eligible for vaccination (Carlson et al., 2022), meant that COVID vaccine take-up was initially extremely low. According to the Our World in Data website (2021), by 1 June 2021, only 2% of the entire Australian population had received the two recommended COVID vaccine doses: a much lower proportion compared with other high-income countries at that time.

By mid-2021, there was evidence of increased confusion, hesitation and uncertainty: particularly among Australians from rural or socioeconomically disadvantaged backgrounds (Wang et al., 2021; Carter et al., 2022). Low levels of vaccination, together with the effects wrought by the Delta variant outbreak, inspired an intense effort on the part of federal and state government health agencies to secure and distribute supplies, promote vaccination and establish a mass vaccination infrastructure (Australian National Audit Office, 2022). The National Cabinet at the end of July 2021 set vaccine targets as an incentive, based on a national ‘roadmap’ for easing restrictions and exiting lockdowns. Australians were promised that once 70% of people aged 16 years and over had received both vaccine doses available to them at that time (third doses were not yet offered), there would be some easing of the severe COVID restrictions that had been in place for months. Further ‘opening up’ was scheduled for when the target of 80% for both doses in this age group had been reached (Riga, 2021). Australia’s vaccination rate subsequently climbed remarkably rapidly: particularly in the regions affected by high COVID cases and extended lockdowns. By 1 November 2021, the proportion of all Australians who had been double vaccinated according to the recommendations at that time had risen to 65% (Our World in Data, 2021).

In what follows, I build on these previous findings on Australians’ initial responses concerning their willingness to accept COVID vaccines and large-scale data about dramatic changes in the uptake of the vaccines during the Delta phase. Adopting an in-depth approach that is able to surface the social, policy and geographical contexts of the participants’ vaccine decisions, further details are provided that explain Australians’ rapid acceptance of COVID vaccines once they became widely available.

MATERIALS AND METHODS

Study design

The ‘Australians’ Experiences of COVID-19’ project began in May 2020 after approval from the University of New South Wales (UNSW) Human Research Ethics Committee had been received. This project was designed to generate in-depth insights from a participant group purposively recruited to maximize heterogeneity rather than to generate generalizable findings. Semi-structured interviews were conducted for all stages by telephone/video call, which allowed for ready inclusion of participants from all over Australia as well as ensuring COVID-safe participation.

The Phase 2 interviews were conducted in a two-week period between late September and early October 2021. This was a time when it appeared that the effects of the Delta variant were receding due to the rapid uptake of COVID vaccination in the two states (New South Wales and Victoria) and territory (ACT) that had been affected by lockdowns (Lupton, 2021). The original interview schedule, formulated before vaccines against COVID had been developed, approved and released, included questions about how participants first learned about COVID, how it had changed their lives, what were the most challenging aspects of the pandemic and how they coped with these, what participants thought of their government responses to COVID management and how they imagined life once the pandemic was over. Most questions were repeated across the project’s stages, but several from the first stage were removed to make room for new questions that better reflected new issues and challenges at the time the Stage 2 interviews were conducted: including asking participants about their understandings and experiences related to COVID vaccines, which by that time were available in Australia. Participants were asked if they had had any COVID vaccines, which brand they had had and how they felt about the vaccines, with follow-up questions asking them to explain their answers.

Participants

The participant groups were different for each stage of interviews. All three stages involved a total of 40 adult Australians (for a total across the project of 120 participants). A research company that has been used by the author many times for previous interview-based research was engaged to recruit and interview volunteers from their research panel members to participate in the Stage 2 round of interviews. The same interviewer from the company conducted all the interviews under briefing by the author and using the interview guide formulated by the author. Potential participants were told that the interviews would be about their experiences with the COVID pandemic. All participants gave their written consent for participation before the interview was conducted.

Recruitment was structured for each stage by the same sub-quotas to ensure a diversity of sociodemographic attributes and geographical locations. The 40 Stage 2 participants resided in every state and territory of Australia. Sub-quotas were set so that a mix of rural (14 participants) and metropolitan areas (26 participants) were included. Sub-quotas were also set for gender to ensure equal participation of women and men and for age (10 participants were recruited from each of the age groups 18–29 years, 30–49 years, 50–69 years and 70 years and over). Half of the participants reported university-level education, with the remainder having completed high school or trade qualification. All participants were given pseudonyms to protect their anonymity when reporting findings. Participants were provided with an AUD$50 gift card as compensation for their time.

Analysis

All interviews were audio-recorded and fully transcribed by a professional transcription service. The interview transcripts were analysed using an iterative inductive thematic approach (Thorne, 2014; Fugard and Potts, 2020) conducted solely by the author. This approach to analysis is well-established and common in sociological and applied health qualitative research. It does not attempt to mimic the scientistic approach of quantitative research, but rather relies on the skill of the analyst in interpretation (Thorne, 2014). Themes are viewed as patterns of shared meaning that are identified via careful reading across the research texts (in this case, interview transcripts). This analytical approach recognizes that all research design and analysis approaches (qualitative or quantitative) are undertaken from the situated perspective of the researchers. It sees the in-depth interview as a form of shared storytelling, in which participants recount narratives in response to interview questions and researchers formulate their accounts into narratives (Denzin, 2019).

Themes were inductively identified by engaging in an iterative interpretation of the participants’ words. No data management software was used. The author repeatedly read through the electronic transcript files, looking for concepts and rationales under which the interviewees’ accounts of their experiences, knowledges, practices and beliefs could be organized in relation to the main topic on which this article focuses: COVID-19 vaccines. Themes were developed by noting overarching patterns in the participants’ narratives through this iterative process, with exemplary quotations from the set of interviews cut and pasted under themes as the process continued. Excerpts from the interview transcripts are provided in the participants’ own words to illustrate the themes and show how they were derived.

RESULTS

Overview

Attitudes to COVID vaccines among this group of 40 adult Australians were overwhelmingly positive, with just a few exceptions. All participants had received at least one vaccine dose and the majority expressed views in support of mass vaccination against COVID. When discussing why they supported COVID mass vaccination programs and had themselves accepted vaccination, the rationales of ‘protecting oneself’, ‘protecting others’, ‘necessary to get back to normal’ and ‘meeting vaccine targets’ were most commonly expressed. The small number of people who outlined major misgivings, criticism or hesitation about vaccination centred their arguments around ‘uncertainties about vaccine risks’ or ‘vaccines are not failsafe’. The theme of ‘trust in science’, however, was dominant across participants’ accounts.

Protecting oneself

A major theme across participants’ accounts was the belief that COVID vaccines provide strong protection against severe COVID. This belief meant that many participants had sought vaccination as soon as it was available to them and were feeling gratitude and relief that they were finally protected. At the time of interview, Josh, aged 26 (Sydney, New South Wales), had received both doses of Pfizer. He noted that: ‘I feel good about it. I think I definitely want to protect myself from serious health consequences because of COVID, so I’m happy to do whatever it takes’. For her part, Joanna, aged 53, who lives in a regional town in the state of Victoria, had received two doses of Pfizer vaccine. She expressed her sheer relief that she and her family members had been able to receive COVID vaccinations.

It’s just fantastic. I just—I still can’t believe that we’ve got [COVID vaccines] and that we have a solution, because for the first year we couldn’t see an end to it. And the day when the kids had their first one, I just I felt really just so happy, so relieved, so I just think it’s brilliant.

Older people and those with chronic health conditions were particularly grateful to have had access to COVID vaccination sooner rather than later. Dave, aged 75, lives in rural New South Wales. He was double vaccinated with AstraZeneca at the time of interview: due to their age, both he and his wife had been among the early recipients. Like Joanna, Dave expressed his faith in the protective properties of the COVID vaccines, noting that he felt much less at risk from COVID now that he was double vaccinated: ‘I feel if I did get [COVID], that I wouldn’t have it as bad... If they ask us to have a third booster jab, we’ll probably be happy to have that too’. As both a cancer patient and older person, 71-year-old Keith (rural Victoria) was highly aware of how vulnerable he is to COVID and was feeling fortunate to have been able to have received double doses of COVID vaccines early on, even if the vaccines seemed to have been approved rather quickly: ‘I’d rather get them than not have them’. Similarly, 44-year-old Phil (rural Tasmania) has Type 1 diabetes and noted ‘I was lucky enough to get [both doses] done pretty early. Yeah, I’m all for it’.

Among the small number of participants who reported that they usually avoided vaccination for themselves or their children, most had accepted the need for COVID vaccination. One example is 54-year-old Kylie, who lives in Sydney. She noted that: ‘It was a big decision because I’m very much pro-choice when it comes to vaccines—and I haven’t vaccinated for anything else’. Kylie went on to say that she gave the COVID vaccine and COVID risk ‘quite a bit of thought. because I thought it hasn’t been well tested’. It was noticing the effects of the Delta variant and its rapid community spread that had changed Kylie’s mind, so she decided that ‘it’s a no-brainer’ to accept vaccination for herself and to encourage her teenage children to follow suit.

Protecting others

It was not just individual protection that people focused on when explaining their rationales for accepting COVID vaccination. Many people pointed out the benefits to their local community if as many people as possible were fully vaccinated. One example is 49-year-old Stuart (Adelaide, South Australia), who drew attention to the need for everyone to get vaccinated to protect vulnerable members of the community or family members:

It’s for the greater good. And the last thing I want to do is get my elderly parents or my wife’s mother infected—pass on something as nasty as COVID to them, or even anyone else’s grandmother for that matter.

Marie, aged 64 (Hobart, Tasmania), said that she worked with children and young people who were not yet able to receive vaccines and therefore were still exposed to COVID. She stated vehemently that: ‘Everyone should jolly well go and have one!’. She argued that: ‘We’ve got to learn to live with it and the only way we’re going to manage it as a society is if we get vaccinated’. Participants who were living in areas of Australia that had not yet experienced many COVID cases were also highly supportive of the community benefits of vaccines. Danielle, aged 45 (Perth, Western Australia), was equally as forthright about the need for people to vaccinate to protect others. She stated her opinion of people refusing vaccines in the following terms:

There’s so much riding on the fact that if we all get vaccinated—I think it’s very selfish. If somebody gave it to my mum and dad, I would be ropable [extremely angry] and I think they’re just thinking of themselves. They might not like things in their body, but I don’t particularly want that person to sit on the bus next to my mum and give it to my mum.

Georgia, aged 26 (Canberra, ACT), explained that for her, while getting vaccinated was ‘the first step’ in protecting her health during COVID, it was also important to continue to engage in practices such as mask wearing and staying away from people when in public places. But even these individual practices were not enough, because she and others in her community would not be fully protected from COVID until vaccination levels were high enough, and this was not something she could control herself: ‘It’s safety measures for the community, which includes mass vaccination for the whole community and restrictions for the whole community, until there’s minimal COVID around’.

Other people mentioned the impact on the healthcare system of COVID cases requiring hospital treatment. Lisa, aged 32, lives in Darwin in the Northern Territory (NT). She pointed to the serious deficiencies of the health service in her area as another major incentive for her to seek COVID vaccination. ‘Our healthcare system in the NT is not good... We have got that many shortages and lack of beds in intensive care for COVID patients’. Lisa said that she wanted to help protect the healthcare system from becoming overwhelmed with COVID patients by receiving both vaccine doses as soon as she could.

Necessary to get back to normal

During the ‘Delta Phase’, Australian federal and state governments emphasized to citizens that reaching high levels of full COVID vaccination levels would be the key to ‘returning to normal’—particularly for people in the areas that were experiencing high COVID cases numbers and subsequent lockdowns. This message was echoed across the interviews, with people often making reference to the need for themselves and others in their locale to accept both COVID vaccine doses when they were available to them so that they can exit or avoid further lockdowns and other restrictions, cross state or national borders and see family and friends from whom they had been separated for months or in some cases, years. For example, Keeley, aged 27, lives in Canberra, ACT, and had experienced an extended lockdown. She said that she had had both Pfizer doses and saw double-vaccination as ‘great, it’s a necessary step in order to be able to get back to doing the things that I want to do’.

Zara, aged 24, resides in Perth, Western Australia. At the time of interview, few cases of COVID were in the community in her state and Zara consequently did not feel at risk from COVID or that she personally needed vaccination: ‘I’m just much more likely to get a lot of other things well and truly that will kill me before I get COVID’. However, Zara had gone ahead and received her first recommended dose of Pfizer and was planning on following up with her second dose when it became due. She understood that the Western Australian borders would not be re-opened to other Australians or international visitors until high enough levels of vaccination were reached: ‘we do want to open back up, so I understand that that’s why we get vaccinated’. Nathan, aged 31 (Canberra), referred to the importance of avoiding the kinds of regular or extended lockdowns he had witnessed in other states as a reason for everyone to receive their vaccinations: ‘looking at other states, you’re like, I do not want to be in lockdown for three-plus months. So if that’s what I need to do then I’m definitely going to get [vaccination] done’.

Many participants mentioned their desire to be able to travel again to see family members or go on holiday—either interstate or overseas—as the primary motivating force. One example is Kate, aged 45. She lives in Hobart, Tasmania, where there had been few COVID cases or restrictions. She said that she had overcome her reservations about vaccine safety because she wanted to visit her family in New South Wales—particularly her elderly mother. She knew that she would be unable to enter that state unless she was fully vaccinated, due to that state’s government rules. For his part, Stuart expressed his desire to be able to go on a family holiday to New Zealand as the reason for ensuring he and his family were fully vaccinated: ‘We all decided very early on that the only way we were ever going to get there was that we were going to have to be fully vaccinated’.

Meeting vaccine targets

Several people made specific reference to the vaccination target percentages that had been set by governments as a way to motivate people to receive both vaccine doses. For example, Dave noted that: ‘I’m just waiting for the 70% to turn up and then the 80%, when hopefully things will come back to more of a normal way of life for us’. Lisa referred to the ‘magic numbers’ that communities were urged to reach by their state/territory governments. She said that seeking vaccination to achieve this target was important to her, as it would lead to Australia’s international borders being opened again, allowing her to travel overseas to see family members after waiting for two years.

I think the reason I got the vaccine—only a small portion of it was to protect myself. The narrative coming from government at that time, was that this magical 80% [target]: this is what we have to do. And for me, if I want to see my family again, I’ve got to get vaccinated. It was really straightforward.

Lisa observed that having this percentage set by her territory government as a goal to work towards helped her to feel some hope that conditions would improve, and some sense of certainty would return:

That’s why I really appreciated this benchmark being set at 80%: because it’s quantifiable. Every state has released vaccine rates. You can clearly see where we’re at. I think the lack of certainty around those things have been difficult as well. But I feel like we’re out the other side now, hopefully.

Uncertainties about vaccine risks

While nearly all the participants were positive in their views of the importance of COVID vaccines and willing to accept them for themselves, there was also evidence of some uncertainty and concerns. Kate, who was double dosed, was one participant who said that she had some concerns about the safety of the COVID vaccines because they were so new and approved so fast.

I feel like the whole thing is a bit of an experiment knowing how COVID affects people, what to do to manage it, how to stop it from spreading, vaccines. So, I guess there’s a part of me that was, there was a bit of trepidation mainly because most people felt that the vaccine came out quite quickly.

Due to the news publicity given to the blood clots side effects of AstraZeneca, several people made mention of their concerns about having this vaccine: particularly those who were the recipients of what Richard, aged 66 (Canberra), referred to as ‘the blood clot one’. Jason, aged 51 (Hobart, Tasmania), who has several major chronic health conditions, admitted that at first, he had felt highly worried about the potentially serious side effects of the AstraZeneca vaccine: ‘I was petrified because of all my health problems, about the blood clots and stuff’. At the time, AstraZeneca was the only vaccine available to him. However, he had overcome his fears about listening to his doctor’s advice:

at the last minute, I said to my doctor, ‘Just give me the jab.’ You see, my doctor said if I don’t get this vaccination, if I pick up the virus, she said, you’re just going to end up on life support, and it would kill me because of my health.

Some people expressed uncertainty about the risks of vaccines not about themselves, but on behalf of others. For example, Lisa’s perspective on COVID vaccines was inflected by her experiences of pregnancy and miscarriage. In her interview, she explained that she has had two doses of the Pfizer vaccine. She had delayed vaccination because of her initial hesitancy while she was pregnant, as she was unsure of the risks to her foetus. She lost the pregnancy, however, and this changed her attitudes towards vaccination, because at that point she then only had to consider the risks to herself:

While I was pregnant, I said, ‘I’m really not sure about this vaccine thing.’ But when that passed, and we got past [the miscarriage], I think I just saw the risk of a vaccine was only to me, and it wasn’t going to damage anyone else. So that was when my decision was made to, let’s do it.

Montanna, aged 28, lives in Melbourne in the state of Victoria, expressed the most hesitant stance towards COVID vaccination of all the Stage 2 participants. She said that she had felt ‘forced’ by government policy to accept vaccination:

I just didn’t want to get it yet—just wanted a bit more testing and stuff. So I sort of felt like I was forced to. I just wanted, yeah, a bit more research to be done and to see, yeah, exactly what the effects are... And I think, at the moment, most of us are getting vaccinated so we have taken that step at least, but I just don’t think it should be forced. I think it should be an option, and if you choose not to, you run that risk, but at the end of the day, it’s your choice, or should be your choice.

Montanna was at pains to emphasize that ‘I’m not an anti-vaxxer or anything like that’. She said that rather than being against COVID vaccination, she was simply concerned that the vaccines had not yet been adequately tested for safety or harmful side effects, and that people like her had felt that she did not have a choice. She noted that it was only her desire to be able to leave lockdown conditions and engage in social activities again that motivated her to receive both vaccine doses.

Vaccines aren’t failsafe

While they supported mass vaccination, some people expressed their awareness that COVID vaccines are not fully effective in preventing SARS-CoV-2 transmission, illness or hospitalizations. For example, Zara observed that mass vaccination ‘did not seem to be working’ in other countries, such as Israel: ‘now they’re up to their third shot and it doesn’t sound like it does much. People are still getting sick, people still going to hospital’. Dinesh, aged 44 (Darwin, NT) works as a first responder in disaster situations, sometimes deployed overseas. He has received many vaccinations as protection in his public-facing role and is highly in favour of them: ‘Any vaccine that is available, I’ve had or have’. He commented, however, that with COVID vaccines, there is still uncertainty about how long they are protective, and they are less effective against transmission:

No one knows how long the vaccines are effective for. And the vaccines, they reduce the effects, they don’t stop the effects; it doesn’t stop you being a carrier so that’s always going to be an issue.

Margaret, aged 77 (Perth, Western Australia), noted that she hoped that being double-vaccinated would greatly reduce her risk from COVID: ‘hopefully it would not be so severe. I hope. I still think it’s an unknown; I’ve heard of people who are double vaxxed who have died’. Similarly, Keith mentioned that he had heard of people he knew personally who had developed COVID symptoms despite having had two doses of the vaccine. For Keith recovering from cancer meant that even though he was doubled-dosed he had become far more cautious about exposing himself to risk of infection: ‘it’s obviously, even though you’ve had the jabs, it’s not an absolute guarantee that you can’t get it. So hence I’m still playing it very, very safe indeed’.

Trusting the science

In the face of vaccine controversies receiving news media attention, participants went on to argue that they had a strong belief in the power and safety of vaccines and the science involved in developing and testing them. An attitude of caution and wanting to spend some time considering and weighing up relative risks and comparing different vaccines was evident in several people’s responses.

Part of adopting this considered approach was ensuring that the information sources people sought out were reliable and valid. Andy, aged 37 (Adelaide, South Australia), noted that ‘I do believe in vaccines and they’re there for a reason’. He said that he had not simply accepted that there would be no risk involved in having a COVID vaccine. He spent some time considering the side effects and the ‘science behind the vaccines’ to decide which COVID vaccine was the safest and most effective: ‘just to understand if there were any other long-term side effects or anything like that’. Similarly, Sam, aged 25 (Brisbane, Queensland), said that he had had one Pfizer dose and will have the second when he is eligible. He said that when he was thinking about vaccination, he was not against the idea but wanted to make sure that he received the safest and most effective vaccine. He was willing to ‘trust the science over other, I don’t know, scaremongering... so, yeah, it’s more about finding the information sources that are actually reliable at the moment’.

Several people who had received their vaccinations with few qualms referred to other Australians—either people they knew in person or views they had seen expressed in the news or social media—who were opposed to COVID vaccination. For these participants, it was difficult to fathom why such individuals would be hesitant or reject vaccination outright. For example, Dave expressed his concern and surprise that friends of his had downright rejected the vaccines. He said that they had believed misinformation they had read online rather than trusted scientific or medical advice.

I’m personally concerned that so many people are against having the vaccine. People that we know as well, they’re very adamant that they don’t want it and we can’t imagine why. They’ve said that we’ve read this on the internet, or we read this on Facebook.

Another example is Jim, aged 75 (Adelaide, South Australia), who said that he had two doses of the AstraZeneca vaccine: or as he put it, ‘the one everyone was complaining about’. Jim described the level of debate concerning this brand of vaccine that he had noticed in the news media, noting that ‘it was being talked about everywhere’. Jim said that this news coverage about risk did not overly concern him, however:

I thought there was a little bit of over-reaction to it. I guess at the time when there was more controversy about it, I probably preferred to get Pfizer, but I was fine with the AstraZeneca, but you know, it didn’t worry me that much.

DISCUSSION

The findings of this study build on previous research on Australians’ attitudes to COVID vaccines by adopting a qualitative approach that allows for in-depth insights and including participants from around Australia, thereby focusing on the diverse social contexts and locations in which people express their understandings and experiences. Further, this study was conducted during a crucial phase in the COVID crisis in Australia (the ‘Delta Response’) that hitherto has not received close attention. The findings also build on previous research that has identified the socio-spatial and policy specificities of global responses to COVID vaccines (Majid et al., 2022).

As is common in many other countries worldwide, the Australian government and health agencies have emphasized personal responsibility for protecting against SARS-CoV-2 infection throughout the pandemic (Cardona, 2020), This discourse was reflected in the participants’ attitudes to vaccines. Participants wanted to protect themselves and others by accepting the recommended doses. The findings also provide some insights into the minority of people who felt hesitant about becoming vaccinated against COVID themselves. People who were hesitant or cautious about accepting COVID vaccination referred to the vaccines’ novelty and potential side effects. While many people expressed their awareness of news media coverage concerning the possible risks or side effects of these new vaccines, across the participant group, strong trust in science, medical and government advice on COVID vaccines was evident. A clear rationale for these people was that of uncertainty about risk, which related to the apparent speed by which the vaccines had been formulated and approved. They wanted more time to consider whether vaccination was safe for them. None of these more hesitant people, however, rejected the scientific knowledge and expertise behind the COVID vaccine development and testing or expressed anti-vaccination views.

The place-based nature of people’s COVID risk assessments was particularly notable across their responses, intertwining with people’s embodied experiences. When discussing COVID vaccines, the participants made reference to the numbers of COVID cases in their region, their own vaccination status, the level of vaccination uptake in their region, their own general health status, their assessment of how serious COVID was as a disease and the state of the healthcare services for COVID patients in their state/territory. They often compared their own state/territory’s situation with that of others. Participants drew attention in their accounts to their state/territory leaders’ announcements and health authorities’ actions and policies for COVID vaccine distribution, frequently mentioning the vaccine targets set by governments as part of ‘road maps’ out of lockdowns, restrictions and border closures. They noted that due to border restrictions and travel rules, to see close family members in other Australian states or overseas, they need to be vaccinated.

This focus on state-based locale is not surprising. As noted in the Introduction, at the time the Stage 2 interviews were conducted, the numbers of COVID cases and the state-level responses of governments had differed significantly across Australia; and this in turn has influenced people’s experiences of the crisis. Most COVID management and control strategies had been implemented by state/territory governments rather than the federal government (Goldfinch et al., 2021; Duckett, 2022). The advice of state-based Chief Health Officers has received unprecedented levels of media attention throughout the COVID crisis (MacAulay et al., 2022). People living in the state of Victoria had experienced numerous harsh lockdowns and other COVID-related restrictions, while those in New South Wales (particularly those living in Sydney), and the ACT had also been through both the first national lockdown in 2020 as well as an extended second lockdown in mid-to-late 2021. Residents of these states and territories were living with daily government press conferences where the most recent COVID cases, hospitalizations, deaths and vaccination uptake statistics were reported and where the news media and government authorities continually warned people to avoid exposure to COVID, check-in to every public place they visited (using a QR code app), wear masks in public places, physically distance from others and receive both doses of the recommended COVID vaccine as soon as they could. Meanwhile, other states were able to live relatively ‘normally’ during this time because of low COVID case numbers, with less incentive to seek vaccination. Further, internal state/territory border closures had been a feature of COVID management throughout the pandemic in Australia, contributing to a mentality of state-based COVID response (Duckett, 2022).

CONCLUSIONS

This study has demonstrated the importance of socio-spatial and policy dimensions of people’s responses to and experiences of COVID vaccines in the context of their assessment of personal risk of severe COVID. These dimensions include people’s age and stage of life (older people compared with young adults, for example), their trust in science, the policy settings and case numbers in the state or territory in which they resided and in which their close family lived, and their general state of health (whether they had existing illnesses or chronic health conditions). Significant changes in COVID conditions over time are continuing to occur, as new variants emerge and spread and new policy settings are established, and old ones abandoned. It is notable that Australians’ uptake of COVID vaccines slowed dramatically in 2022, even while case numbers remained high (Australian National Audit Office, 2022). Health and economic policies, treatments and preventive actions, including vaccine development, scheduling and distribution, must be responsive and mindful of the often extremely localized and contextual experiences of people living through outbreaks, as well as the ways that the news media report vaccine risks or successes. Research that continues to investigate such situated understandings and experiences is required for a richer understanding of vaccine attitudes and practices as the world moves into the next stages of the pandemic.