Vaccine refusal during the COVID-19 pandemic: A qualitative study

As in other countries, France has implemented unprecedented measures to restrict freedoms to control the COVID-19 pandemic. The rapid development and widespread availability of new vaccines in early 2021 have undoubtedly saved many lives. However, despite the implementation and maintenance of a strong incentive policy over several months, more than 6.5% of the French population eligible for vaccination had not been vaccinated in August 2022, OBJECTIVES: The aim of this study was to explore the mechanisms and dynamics of vaccine refusal among individuals more than one year after they became eligible for COVID-19 vaccination.

A qualitative grounded theory-based survey was conducted between April 2022 and June 2023. Participants were recruited from various French regions to maximize sample diversity, excluding anti-vaccine activists, until sufficient data were collected. Coding and analysis were triangulated according to the COREQ criteria.

Ten in-depth interviews with a mean duration of 57 min (median: 54 min) were conducted. None of the participants reported refusing all vaccines. However, most had been scarred by past vaccine controversies in France. Common features of vaccine hesitancy were observed, including concerns about COVID-19 vaccine safety and a lack of perceived severity of personal infection. However, resistance to social norms and a strong emphasis on individual freedoms were particularly reported. Being labeled as unvaccinated, combined with the questioning of fundamental values, contributed to participants maintaining their position.

Although vaccination was crucial for controlling the pandemic, this study highlighted the need to implement careful, targeted communication strategies to prevent long-term negative effects of the growing number of vaccine-reluctant individuals on community health.