Factors associated with reversals of COVID-19 vaccination willingness: Results from two longitudinal, national surveys in Japan 2021-2022

Cyrus Ghaznavi, Daisuke Yoneoka, Takayuki Kawashima, Akifumi Eguchi, Michio Murakami, Stuart Gilmour, Satoshi Kaneko, Hiroyuki Kunishima, Wataru Naito, Haruka Sakamoto, Keiko Maruyama-Sakurai, Arata Takahashi, Yoshihiro Takayama, Yuta Tanoue, Yoshiko Yamamoto, Tetsuo Yasutaka, Hiroaki Miyata, Shuhei Nomura

Research output: Contribution to journalArticlepeer-review

2 Citations (Scopus)


Background: Research characterizing changes of heart with respect to vaccine intention is scarce, and very little research considers those who were initially vaccine willing but became hesitant. Here, we sought to assess the factors related to reversals of vaccine willingness. Methods: We conducted a longitudinal, national survey on vaccination intention among Japanese adults aged 20 years or older, with the first questionnaire performed in February-March 2021 (N = 30,053) and the follow-up in February 2022 (N = 19,195, response rate 63.9%). The study population comprised those who reported vaccine willingness in the first survey, with the outcome variable being development of vaccine hesitancy at follow-up. We performed a regression analysis of vaccination status using sociodemographic, health-related, psychologic/attitudinal, and information-related variables as predictors. We used the sparse group minimax concave penalty (MCP) to select the optimum group of covariates for the logistic regression. Findings: Of 11,118 (57.9%) respondents who previously expressed interest in vaccination, 10,684 (96.1%) and 434 (3.9%) were in the vaccine willing and hesitant groups, respectively. Several covariates were found to significantly predict vaccine hesitancy, including marital status, influenza vaccine history, COVID-19 infection/testing history, engagement in COVID-19 preventive measures, perceived risks/benefits of the COVID-19 vaccine, and attitudes regarding vaccination policies and norms. The use of certain information sources was also associated with vaccine hesitancy. Interpretation: Sociodemographic, health-related, psychologic/attitudinal, and information-related variables predicted the development of vaccine hesitancy among those with prior willingness. Most of these predictors were also associated with vaccination status. Funding: The present work was supported in part by a grant from the Kanagawa Prefectural Government of Japan and by AIST government subsidies.

Original languageEnglish
Article number100540
JournalThe Lancet Regional Health - Western Pacific
Publication statusPublished - 2022 Oct


  • COVID-19
  • Japan
  • Vaccination
  • Vaccine
  • Vaccine hesitancy

ASJC Scopus subject areas

  • Internal Medicine
  • Pediatrics, Perinatology, and Child Health
  • Health Policy
  • Obstetrics and Gynaecology
  • Public Health, Environmental and Occupational Health
  • Geriatrics and Gerontology
  • Psychiatry and Mental health
  • Infectious Diseases


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