Opposition to voluntary and mandated COVID-19 vaccination as a dynamic process: Evidence and policy implications of changing beliefs.

COVID-19 vaccination rates slowed in many countries during the second half of 2021, along with the emergence of vocal opposition, particularly to mandated vaccinations. Who are those resisting vaccination? Under what conditions do they change their minds? Our three-wave representative panel survey from Germany allows us to estimate the dynamics of vaccine opposition, providing the following answers. Without mandates, it may be difficult to reach and to sustain the near-universal level of repeated vaccinations apparently required to contain the Delta, Omicron, and likely subsequent variants. But mandates substantially increase opposition to vaccination. We find that few were opposed to voluntary vaccination in all three waves of the survey. They are just 3.3% of our panel, a number that we demonstrate is unlikely to be the result of response error. In contrast, the fraction consistently opposed to enforced vaccinations is 16.5%. Under both policies, those consistently opposed and those switching from opposition to supporting vaccination are sociodemographically virtually indistinguishable from other Germans. Thus, the mechanisms accounting for the dynamics of vaccine attitudes may apply generally across societal groups. What differentiates them from others are their beliefs about vaccination effectiveness, their trust in public institutions, and whether they perceive enforced vaccination as a restriction on their freedom. We find that changing these beliefs is both possible and necessary to increase vaccine willingness, even in the case of mandates. An inference is that well-designed policies of persuasion and enforcement will be complementary, not alternatives. [ABSTRACT FROM AUTHOR]