Hesitancy towards COVID-19 vaccination: The role of personality traits, anti-vaccine attitudes and illness perception

Coronavirus disease 2019 (COVID-19) has quickly spread over the world since 2019. There have been over 479 million confirmed cases and an estimation of 6 million deaths as of 27th March 2022 with over 6 million deaths reported globally [1]. With many countries getting their citizens to actively participate in getting vaccinated against COVID-19 infection, Ghana is also pulling its weight with about 5,070,306 representing 16% of the total population being vaccinated as of 21^st March 2022 according to the Ghana Health Service [2]. Little is known about the Ghanaian people’s inclination to get vaccinated. People may decline to be vaccinated for medical, religious, ideological, or situational factors. As vaccine refusal for nonmedical reasons becomes more prevalent in Ghana [3], there is an urgent need to develop motivated reasoning perspectives to overcome vaccination concerns and fallacies, and thus build effective interventions to boost vaccination rates.

Vaccines provide us with protection from diseases, consequently, the COVID-19 vaccines were made to curtail the global transmission of the virus. Nevertheless, the vaccine has been met with reluctance, anxiety, and safety worries along with conspiracy theories against vaccinations, which seriously undermine acceptability and readiness to receive the vaccine. The degree of fear and apprehension expressed by the public concerning vaccine acceptance and uptake is partially due to a lack of adequate information about the concepts behind vaccine development from the various phases of the vaccine trials that consider immunology, toxicity, and effectiveness concerns. Furthermore, the speed with which the COVID-19 vaccines were developed has particularly been identified as a significant contributor to the hesitation associated with vaccination adoption in many regions of the world, including Ghana, giving impetus to this study [4].

With the current data supporting the fact that COVID-19 vaccination does not prevent one from contracting the virus [5] but only suppresses potential symptoms that come with contracting it [6], this has led to many discourses of divergent views and attitudes towards vaccination. The divergent views may have some influence on anti-vaccine attitudes and vaccine hesitancy. Vaccine hesitation has been described as individuals’ general unwillingness to be vaccinated although there is evidence of its safety and efficacy [7].

A study by Huyn et al. [8] showed that individuals who held more liberal political views, expressed higher levels of trust in their primary care provider, perceived stronger social pressure to vaccinate against COVID-19, and those who received a flu shot during the previous flu season had a stronger intention to vaccinate against COVID-19. Some studies [9–11] show a link between personality and political views, as well as the propensity to succumb to pressure and personality, it is worth investigating the role personality plays in decisions to be vaccinated or otherwise.

While prior studies on non-vaccination predictors have concentrated on specific vaccine beliefs [12, 13], the significance of personality factors in predicting vaccine hesitation has received minimum scholarly attention. Personality has been described as an idiosyncratic style of thinking, feeling, and behaving [14]. Personality encompasses sentiments, attitudes, and perspectives, and is most evident in interpersonal interactions. The Big Five personality traits are well-known for encompassing a broader range of personal characteristics and for investigating the individual effects of personality traits on health behaviours [15]. Extraversion (i.e., being energetic, outgoing, and sociable), agreeableness (i.e., being trustworthy, altruistic, and sympathetic), conscientiousness (i.e., being self-disciplined, dutiful, and thoughtful), emotional stability (i.e., being calm, relaxed, and even-tempered), and openness to experience are the five domains in which personality characteristics can be classified [16, 17].

How people perceive a disease is a crucial factor in understanding the uptake of preventative and health-management interventions such as immunization, particularly for COVID-19. Individuals’ cognitive representations or ideas about their condition are referred to as illness perceptions [18]. The self-regulation framework developed by Leventhal and colleagues is the most widely studied conceptual characterization of illness perception [19, 20]. As documented by Broadbent et al. [21], illness perceptions are split into numerous distinct yet interconnected elements. These components have been classified as cognitive or emotional representations of illness [21].

With the onset of the epidemic, several public health promotion goals were critical in the fight against the pandemic [22]. One such strategy was to encourage people to engage in protective behaviours such as hand washing and physical distancing behaviours which are still vital in this presumably post-pandemic era. According to research, illness perceptions may significantly affect the emotional and behavioural responses to a specific illness [23]. As a result, knowledge of COVID-19 illness perceptions may have important implications for achieving these public health goals of vaccination and devising public health strategies, such as health-promoting programs and their context-specific adaptations.

The researchers in this study posited that personality type would greatly influence vaccine hesitancy but per our regression analysis, that was not found. Only extraversion was found to be a significant predictor. This is concordant with a finding by Halstead et al. [29] who also found extraversion as a predictor of vaccine hesitancy. However, the bivariate correlation showed a positive association between conscientiousness and anti-vaccine attitudes. Conscientiousness as a personality type is positively connected with behaviours such as cautiousness, orderliness, and dutifulness [30, 31] which may invariably deter people from receiving the vaccine or have negative attitudes toward it considering the swift rollout of COVID-19 vaccines as compared to other vaccines. Vaccines often take 10–15 years to develop, however, the current COVID-19 vaccine was developed in less than three years [32]. Some vaccines require a single dose, whilst others recommend double doses and still require booster shots. The argument concerning the ability to pass on the virus or suffer mild symptoms even after vaccination has been rife since the vaccines were produced and distributed globally. Conscientiousness is largely associated with engaging in an activity thoroughly and dutifully. The unsteady nature of the number of doses and COVID-19 vaccine efficacy as compared to other vaccines may inform conscientious people in their attitudes towards the COVID-19 vaccines. Other studies have expressed mixed findings regarding the role personality plays in vaccine hesitancy [33, 34] indicating that there are inconsistent findings regarding personality and vaccine acceptance.

In this study, we found out that COVID-19 experience results in a unit increase in vaccine hesitancy. This could be explained by the fact that the vast majority of respondents (85.6%) reported they had never been infected with COVID-19 at the time the study was conducted, and 52.6% also had people close to them who had tested positive for COVID-19. A huge majority of 96.5% of the sample had people close to them who had been vaccinated. Vaccine hesitancy could be a result of the belief in vaccination by proxy. People will potentially be hesitant to get vaccinated if they have never been formally diagnosed as contracting the virus despite other people around them testing positive. Also, considering that almost the entire sample had people close to them who had been vaccinated, this could result in a lax disposition and not create a sense of urgency since they might feel safe and not exposed to any clear and present danger because their close contacts have been vaccinated. The study also found the experience with COVID-19 to moderate the relationship between anti-vaccine attitudes and vaccine hesitancy. As seen from the moderation, as anti-vaccine attitudes increase, people with lower experience still had lower vaccine hesitancy but those with high COVID-19 experience had higher vaccine hesitancy (Fig 1). A reason for this could be that those who may have tested positive for COVID-19 before may perceive themselves to have been naturally inoculated, hence, making them less keen to be vaccinated.

Anti-vaccine attitudes (bar natural immunity) proved to predict vaccine hesitancy and having great concern about the future effects of the vaccine led to more vaccine hesitancy. As one’s trust in the vaccines goes down, vaccine hesitancy increases. This observation is supported by previous research which found that concerns about future unforeseen side effects were the most important determinants of both uncertainty and unwillingness to vaccinate against COVID-19 [35–37].

The study however acknowledges the main limitation of online data collection approaches where only participants who were literate and had access to the internet could participate in the study. Similarly, the majority of participants were female with tertiary-level education and this has also been previously reported as a limitation of online studies [38]. Another limitation was that the potential bias in socio-demographic background places a limit on the generalizability of the study. Again, there is the possibility that knowledge of COVID-19 vaccinations may have led to the provision of socially desirable answers. Despite these limitations, this study’s findings highlight some findings with public health and policy implications. With many countries lifting several restrictions due to the pandemic, it is increasingly becoming necessary to address concerns about hesitancy and improve vaccine uptake since the COVID-19 infection continues to persist.