What are the reasons for refusing a COVID-19 vaccine? A qualitative analysis of social media in Germany – BMC Public Health – BMC Public Health

Our analysis revealed six main categories of reasons for refusing a COVID-19 vaccination. Reasons include low perceived benefits of getting vaccinated, a low subjective risk, concerns of potential adverse effects from the vaccine, poor health literacy, mistrust and spiritual and religious beliefs (see Table 1).

Several posts show that social media users did not trust the newly developed mRNA-based vaccines or had some reservations about gene-based vaccines in general. According to these posts, users thought that vaccination with mRNA-vaccines had not yet been sufficiently investigated or that they were not as effective as attenuated or inactivated vaccines, which is why they did not consider vaccination with the existing vaccines to be necessary or sensible.

"Pfizer's vaccines and other vaccines against COVID-19 are experiments, not vaccines. These are novel genetic technologies that have never been used on humans before. An mRNA molecule can never stimulate the immune system the way a vaccination can." [User 33]

Furthermore, the analysis shows that users viewed their personal risk of getting infected with COVID-19, suffering from a severe course of the disease and developing serious complications from an infection as low. Therefore, vaccination was not regarded necessary. Mild symptoms, a young age and a good subjective health status were reported as relevant factors leading to that evaluation.

"I already had Corona, I only had a slight cough for two days, it didn't bother me at all. I'd rather get Corona than have anything injected into my blood. Everyone as they like." [User 140]

In addition, some users emphasized that their own immune system was strong enough to deal with a possible infection and therefore they did not need vaccination. According to their own statements, some of the users relied on preventive and supportive measures like a balanced diet or taking supplemental vitamins to bolster up their immune system, rendering vaccination, in their opinion, unnecessary.

"I am asthmatic, but I would never be vaccinated against Corona. I don't have to weigh that. We have an immune system. I live a healthy life with lots of vitamins. I don't deny Corona, but I'm not afraid of it." [User 47]

Moreover, some users on social media stated that prior infections with COVID-19 made them immune to reinfection, including immunity to mutations of the virus, and therefore a vaccination was not necessary. In line with that, some users believed that a prior infection offered more natural protection than the vaccines.

"No one needs this vaccination, because once you have Corona you are immune." [User 4]

Another reason to refuse vaccination were users' concerns about various potential side effects and possible vaccine-related damage. Some users justified rejecting vaccination citing the lack of long-term studies and insufficient reliable information about side effects and consequential damages. Among others, these fears were related to the risk of getting cancer, changes and damages to their genetic makeup, infertility and death. These concerns were often associated with past vaccine and drug scandals.

"I don't get vaccinated, I'm afraid of side effects. Thalidomide, for example, should not be ignored either. There are no long-term studies, but everyone should do what they want." [User 121]

Users emphasized their objection especially regarding the possible approval of vaccine use for women during pregnancy. This was based on the lack of data supporting safe use in these cases and concerns about the effects of vaccination on the unborn child.

"Who does that?! I'm sorry, that's irresponsible. No one knows what happens to the unborn child, no one can take that responsibility on themselves! It's a pure human experiment." [User 296]

Our analysis also showed that vaccination was refused due to other pre-existing health conditions and allergies, as only little information was available on possible interactions between existing health impairments and COVID-19 vaccines. Personal experiences with physical reactions or vaccine damages from past vaccinations were further reported reasons that led to rejection of the vaccines.

"I am chronically ill and take a lot of medication, I have very great respect for vaccination. There is no data on the side effects and interactions in connection with the medication. That is too meagre for me." [User 160]

Another reason for users refusing vaccination was that some did not feel sufficiently informed about the vaccination and that the available information was perceived as incomprehensible.

No, I don't feel informed enough because the text is too difficult to understand." [User 124]

This lack of transparent and user-oriented information in some cases resulted in the spread of misinformation and conspiracy theories. The lack of knowledge led to a general mistrust and a negative attitude towards information on the disease itself and vaccines among some of the users. These beliefs, which were mostly based on misinformation or conspiracy theories, led to strong downplaying or denial of COVID-19 among users and a subsequent lack of willingness to get vaccinated.

"Corona vaccination is seen as protection. However, these vaccinations have the opposite effect. They are killings with the intention of reducing the world's population. Survive or die together? Which would also be romantic." [User 261]

Mistrust in authorities, political stakeholders or in representatives of the pharmaceutical industry also played an important role. There weredoubts about the reliability and integrity of information and the intentions of certain groups, organizations or institutions in promoting vaccination, which users attributed to previous misconduct. For example, users were convinced that the pharmaceutical industry had a mere financial interest in promoting vaccination against COVID-19.

"Unfortunately, I cannot trust the pharmaceutical industry, as much as I would like to. I would get vaccinated, but my mistrust is far too great. I have also not yet received anything that would build my trust. In the past, the pharmaceutical industry has acted unethically and immorally and knowingly harmed people. They have put their sales first, for example with the Duogynon scandal. [...]" [User 140]

Furthermore, the rapid development and approval of the vaccines compared to previous vaccines against other diseases was another reason given by users for refusing vaccination. They expressed concern that the vaccines were not sufficiently tested and that long-term negative physical consequences could not be ruled out. The partial emergency approval of the vaccines also led to concerns.

"I'm not going to have it injected. Normally a vaccine is researched for years. And now I'm supposed to get injected with something that was mixed together in a very short time?" [User 186]

In addition, vaccines from specific manufacturers were sometimes rejected. Users justified this with differences in perceived effectiveness and suspected side effects of vaccines from certain manufacturers. The respective country of development or production also played a role in rejecting these vaccines.

"I'd rather die before I get vaccinated with the Russian or Chinese vaccine." [User 70].

Spiritual or religious beliefs, such as the protection by God or the protective effect of precious stones, also led to a refusal of vaccination against COVID-19 by some users.

"I don't believe in this vaccination and this vaccination will not help us, I believe in God, in Jesus Christ and only he can help us, save us and protect us from this virus." [User 219]

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What are the reasons for refusing a COVID-19 vaccine? A qualitative analysis of social media in Germany - BMC Public Health - BMC Public Health