Among those who said they wouldn’t get vaccinated in a future pandemic, a third said they did get a COVID-19 vaccine. The study by eight University of Tokyo researchers was published last week on the medRxiv preprint server. The researchers said they wanted to shed light on the factors contributing to “vaccine hesitancy.”
Nearly half of the people who responded to a nationwide Japanese survey said they would not get vaccinated in a future pandemic, even if faced with a fatality rate similar to that of the COVID-19 pandemic.
Among those who said they wouldn’t get vaccinated in a future pandemic, a third said they did get a COVID-19 vaccine.
The study by eight University of Tokyo researchers was published last week on the medRxiv preprint server. A total of 28,000 participants ages 15-84 took part in the survey, conducted between December 2024 and January 2025.
The researchers said they wanted to shed light on the factors contributing to “vaccine hesitancy.”
“Vaccine hesitancy emerged as a major challenge during the COVID-19 pandemic and has persisted beyond it, raising concerns about public readiness for vaccination in future pandemics,” the researchers wrote.
The survey’s results showed that 53.1% of respondents said they would be willing to get vaccinated in a future pandemic with a similar case fatality rate to that of COVID-19. Only 14.9% of those who said they did not receive a COVID-19 vaccine said they would be willing to get vaccinated in the next pandemic.
The survey identified eight subgroups with distinct attitudes toward vaccination. It found that the groups least willing to get vaccinated were females and younger adults (aged 20-40), people with “lower income or education” and “those endorsing misinformation or conspiracy beliefs.”
Respondents from higher-income brackets who engaged in “active information seeking” behavior, or who exhibited “greater fear of COVID-19” and infectious diseases, were more willing to get vaccinated.
Growing distrust in vaccines ‘began decades before the COVID pandemic’
The high rate of respondents who said they wouldn’t get vaccinated in a future pandemic represents “a marked decline from observed COVID-19 vaccination coverage,” the researchers wrote.
Nearly 77.5% of the Japanese population got the initial two-dose COVID-19 vaccine series as of Feb. 27, 2023, according to Statista.
In the U.S., 69.4% of the population had received the two-dose series as of 2023, according to Statista. According to the World Health Organization (WHO), the global COVID-19 vaccination rate as of Dec. 31, 2023, was 67%.
The researchers said their findings highlight populations that public health officials could target during a future pandemic and underscore “the need to develop effective risk communication strategies tailored to target populations.”
But according to TrialSite News, the study’s findings “highlight a significant preparedness gap and suggest that vaccine acceptance is now more conditional, fragmented, and sensitive to trust, risk perception, and vaccine characteristics.”
Barbara Loe Fisher, co-founder and president of the National Vaccine Information Center, said the growing distrust in what public health officials have been saying about vaccine safety and effectiveness “began decades before the COVID pandemic, and that is especially true for educated populations in developed countries like Japan and the U.S.”
Raw data suggest ‘vaccine hesitancy’ is higher than researchers stated
According to Karl Jablonowski, Ph.D., senior research scientist for Children’s Health Defense, the raw data from the Japanese survey indicate that the rate of “vaccine hesitancy” was even higher than what the authors stated.
Jablonowski said the researchers suggested that vaccine injuries didn’t significantly affect people’s willingness to get vaccinated during a future pandemic. However, the raw data showed a high level of vaccine-related adverse reactions. He said:
“Of the 19,027 vaccinated individuals, 11,308 responded to the adverse reaction question. Merely 7.5% of respondents recorded no adverse reaction, with 69.3% having a mild reaction and 23.2% having a strong reaction. This is an astounding level of self-reported adverse reactions.
“Even if all of those who did not respond to the specific question were negative for an adverse reaction, the adverse reaction rate for the COVID-19 vaccine is 55.0%, with 13.8% recorded as ‘strong reaction.’”
According to the study’s supplementary text, respondents who said they believed vaccine safety data are “often fabricated,” that Big Pharma hides the dangers of vaccines or that the public is being deceived about vaccines’ safety and effectiveness, were classified as believers of “vaccine-related misinformation.”
Jablonowski said the survey data, which indicate a high degree of vaccine-related adverse events, “stands as a testament” to this set of beliefs.
Higher exposure to mainstream fear narratives increased vaccine acceptance
The survey results also indicated that increased exposure to government and mainstream media messaging helped increase respondents’ willingness to get vaccinated during a future pandemic.
“Respondents who reported actively seeking COVID-19-related information generally showed higher vaccination intention,” the researchers wrote. “Among the information sources, the government, healthcare professionals, medical experts, television, and newspapers were particularly effective in promoting vaccine acceptance.”
The researchers highlighted the role of fear in shaping attitudes toward vaccination.
“Analysis of psychological factors showed that individuals who reported lower levels of general anxiety tended to exhibit stronger vaccine hesitancy. A similar pattern was observed for fear of COVID-19: those who experienced little fear were more likely to be hesitant,” the researchers stated.
Jablonowski suggested that such findings may lead authorities to focus on more fear-based messaging during a future public health emergency.
“This paper may lead some to an obvious course of action when tailoring strategies and risk communication,” Jablonowski said. He noted that, in the study, the “easiest modifiable factor with the largest difference in the willingness to be vaccinated is the psychological variable ‘fear of COVID-19 very low.’”
Jablonowski and Fisher suggested those strategies may be ineffective on people who are already skeptical of vaccine safety.
“For many vaccine refusers, it’s with certainty and conviction that the risks outweigh the benefits, and not an unsure stuttering of a perceived ‘right-action.’ Vaccine ‘hesitancy’ is often better characterized as ‘vaccine risk-aware,’” Jablonowski said.
“Until the pharmaceutical industry and governments do the scientifically sound studies to prove that the many vaccines people are being told to use are protecting health rather than harming health, ‘vaccine hesitancy’ will only continue to grow in every country,” Fisher said.
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