COVID-19 Vaccination Intent and Belief that Vaccination Will End the Pandemic

Marion de Vries; Liesbeth Claassen; Mattijs Lambooij; Ka Yin Leung; Kees Boersma; Aura Timen


Emerging Infectious Diseases. 2022;28(8):1642-1649. 

In This Article

Abstract and Introduction


High vaccination coverage is considered to be key in dealing with the coronavirus disease (COVID-19) pandemic. However, vaccine hesitancy can limit uptake. We examined the specific coronavirus beliefs that persons have regarding COVID-19 and COVID-19 vaccines and to what extent these beliefs explain COVID-19 vaccination intentions. We conducted a survey among 4,033 residents of the Netherlands that examined COVID-19 vaccination intentions and various beliefs. Random forest regression analysis explained 76% of the variance in vaccination intentions. The strongest determinant in the model was the belief the COVID-19 crisis will only end if many persons get vaccinated. Other strong determinants were beliefs about safety of vaccines, specifically in relation to vaccine development and approval process; (social) benefits of vaccination; social norms regarding vaccination behavior; and effectiveness of vaccines. We propose to address these specific beliefs in communications about COVID-19 vaccinations to stimulate vaccine uptake.


The COVID-19 pandemic has profoundly affected global health and well-being. Since 2020, countries worldwide have experienced high rates of illness and death caused by COVID-19, and many societies have dealt with often stringent outbreak control measures. The successful development of effective vaccines has provided a much-wanted major step toward controlling the pandemic. However, for the vaccines to be successful during outbreak control, a high and equally distributed vaccine uptake is essential. Next to possible barriers of limited COVID-19 vaccine availability and accessibility, vaccine hesitancy can also form a considerable barrier to reaching a high vaccine uptake.

The public acceptance of vaccines has been a global concern for decades. Before the COVID-19 crisis, in 2019, the World Health Organization declared vaccine hesitancy as one of the top 10 global public health threats.[1] Vaccine hesitancy has been defined as a broad range of vaccine-related attitudes and behavior, from having some doubts and delaying vaccinations up to complete refusal of vaccines.[2] Various studies have provided insights into beliefs underlying vaccination hesitancy and vaccination intentions for childhood vaccinations;[3–5] influenza vaccinations,[5,6] including pandemic influenza A(H1N1) vaccination;[5–7] and COVID-19 vaccinations.[8–12] Personal beliefs that are known to have a major role in vaccination decision-making are beliefs about the need for, safety of, and effectiveness of vaccines.

Many studies that examine determinants of vaccination hesitancy, intentions, or behavior (e.g., studies applying the health belief model)[9–13] explore beliefs in relatively general terms. For example, surveys may simply ask respondents whether they have concerns about the safety of vaccines. It is useful to have more detailed knowledge of these beliefs for 3 reasons. First, in-depth insights into beliefs can provide more concrete input toward developing well-adapted communication.[14] For example, concerns about safety of vaccines might be related to beliefs about the vaccine production process, long-term side-effects, and composition of vaccines. Such specific beliefs should be addressed in communications. Second, COVID-19 vaccination intentions are likely to be associated with specific beliefs that differ from those found in research during other vaccination campaigns. This reaction might be the case for beliefs about the rapid vaccine development process, the new technologies used (mRNA), and the personal freedom associated with vaccination (through vaccination entry passes). Third, there might be major differences in (the influence of certain) beliefs underlying vaccination decisions between countries or communities[15] (e.g., due to differences in experiences with the COVID-19 pandemic, information streams, and vaccination campaign history).

Consistent with earlier research on vaccination decisions,[16] we adopted a mental models perspective in studying beliefs underlying COVID-19 vaccination intentions among persons in the Netherlands.[14] This perspective entails a detailed study of interrelated beliefs of a subject, in this case COVID-19 and the COVID-19 vaccinations. These beliefs form a mental model underlying decisions of persons regarding COVID-19 vaccination. By gaining in-depth insights into these various beliefs, we can identify knowledge gaps and misbeliefs that need to be addressed in communications. In addition, by studying which beliefs are useful determinants of vaccination intentions, we aimed to identify beliefs that should be addressed and prioritized in communications to optimize vaccine acceptability and uptake.