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Virtual reality reduces COVID-19 vaccine hesitancy in the wild: A randomized trial


Abstract and Figures

Vaccine hesitancy poses one of the largest threats to global health. Informing people about the collective benefit of vaccination has great potential in increasing vaccination intentions. This research investigates the potential for engaging experiences in immersive virtual reality (VR) to strengthen participants’ understanding of community immunity, and therefore, their intention to get vaccinated. In a pre-registered lab-in-the-field intervention study, participants were recruited in a public park (tested: n = 232, analyzed: n = 222). They were randomly assigned to experience the collective benefit of community immunity in a gamified immersive virtual reality environment (2/3 of sample), or to receive the same information via text and images (1/3 of sample). Before and after the intervention, participants indicated their intention to take up a hypothetical vaccine for a new COVID-19 strain (0–100 scale) and belief in vaccination as a collective responsibility (1–7 scale). The study employs a crossover design (participants later received a second treatment), but the primary outcome is the effect of the first treatment on vaccination intention. After the VR treatment, for participants with less-than-maximal vaccination intention, intention increases by 9.3 points (95% CI: 7.0 to 11.5, p < 0.001). The text-and- image treatment raises vaccination intention by 3.3 points (difference in effects: 5.8, 95% CI: 2.0 to 9.5, p = 0.003). The VR treatment also increases collective responsibility by 0.82 points (95% CI: 0.37 to 1.27, p < 0.001). The results suggest that VR interventions are an effective tool for boosting vaccination intention, and that they can be applied “in the wild”—providing a complementary method for vaccine advocacy.
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Scientic Reports | (2022) 12:4593 |
Virtual reality reduces COVID‑19
vaccine hesitancy in the wild:
a randomized trial
Clara Vandeweerdt1,2*, Tiany Luong3, Michael Atchapero1, Aske Mottelson4,
Christian Holz3, Guido Makransky1 & Robert Böhm1,5,6
Vaccine hesitancy poses one of the largest threats to global health. Informing people about the
collective benet of vaccination has great potential in increasing vaccination intentions. This research
investigates the potential for engaging experiences in immersive virtual reality (VR) to strengthen
participants’ understanding of community immunity, and therefore, their intention to get vaccinated.
In a pre‑registered lab‑in‑the‑eld intervention study, participants were recruited in a public park
, analyzed:
). They were randomly assigned to experience the collective
benet of community immunity in a gamied immersive virtual reality environment (
of sample), or
to receive the same information via text and images (
of sample). Before and after the intervention,
participants indicated their intention to take up a hypothetical vaccine for a new COVID‑19 strain
(0–100 scale) and belief in vaccination as a collective responsibility (1–7 scale). The study employs
a crossover design (participants later received a second treatment), but the primary outcome is
the eect of the rst treatment on vaccination intention. After the VR treatment, for participants
with less‑than‑maximal vaccination intention, intention increases by 9.3 points (95% CI: 7.0 to
). The text‑and‑image treatment raises vaccination intention by 3.3 points (dierence
in eects: 5.8, 95% CI: 2.0 to
). The VR treatment also increases collective responsibility
by 0.82 points (95% CI: 0.37 to
). The results suggest that VR interventions are an
eective tool for boosting vaccination intention, and that they can be applied “in the wild”—providing
a complementary method for vaccine advocacy.
Vaccination against most infectious diseases is an individual decision with positive externalities. at is, when
individuals get vaccinated, they not only protect themselves, but typically also limit the probability that they will
transmit the disease to others1. As such, even unvaccinated citizens can be indirectly protected from infection,
known as community immunity or herd immunity1. With regard to the COVID-19 pandemic, it has been esti-
mated that 60–90% of the population needs to be vaccinated (depending, for instance, on the vaccine’s ecacy)
to stop the spread of SARS-CoV-22,3. erefore, vaccine hesitancy—dened as “the delay in acceptance or refusal
of vaccination despite availability of vaccination services”4—is a key obstacle to ending the COVID-19 pandemic.
Vaccine hesitancy is complex and may be aected by several factors5,6: lack of condence (i.e., the tendency
to trust in the safety and eectiveness of vaccines and to trust health authorities and experts who develop,
license, and recommend vaccines), complacency (i.e., low perceived risk of infectious diseases), constraints
(i.e., structural or psychological barriers in daily life that make vaccination dicult or costly), calculation (i.e.,
the degree to which personal costs and benets of vaccination are weighted), lack of collective responsibility
(i.e., the willingness to protect others and eliminate infectious diseases), lack of compliance (i.e., the support for
societal monitoring and sanctioning of people who are not vaccinated), and conspiracy (i.e., conspiracy thinking
and belief in fake news related to vaccination). Accordingly, fully informed vaccination decisions require that
people know and understand the individual costs and benets of a vaccination, as well as its collective benet.
In line with the assumption that people care not only about their own but also about others’ welfare, inform-
ing them about community immunity has sometimes (e.g.,7) but not always (e.g.,8) been shown to increase
vaccination intentions (for a review, see9). Interactive simulations have been particularly eective in increasing
1Department of Psychology, University of Copenhagen, Copenhagen, Denmark. 2Department of Political Science,
University of Copenhagen, Copenhagen, Denmark. 3Department of Computer Science, ETH Zürich, Zurich,
Switzerland. 4IT University of Copenhagen, Copenhagen, Denmark. 5Faculty of Psychology, University of Vienna,
Vienna, Austria. 6Copenhagen Center for Social Data Science (SODAS), University of Copenhagen, Copenhagen,
Denmark. *email:
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vaccine intentions1012, potentially because they are more engaging13 and, therefore, increase people’s learning
motivation10,14. In other words, using novel technologies that help people to better understand the collective
benet of vaccination-and the impact that their own vaccination may have on (vulnerable) others—may be a
promising strategy to increase collective responsibility and, in turn, decrease vaccine hesitancy15.
Building on these ndings, in this study we investigate whether vaccination intention is increased by a gami-
ed immersive VR experience showing how community immunity works. Immersive VR is a promising medium
for health communication (cf.16), because compared to other media it facilitates a high level of presence (the
feeling of being in the virtual environment)17 and agency (the psychological experience of controlling one’s own
actions)18, which results in higher levels of enjoyment and engagement19,20. Still, it has only just started to be
tested as a tool for vaccine advocacy, with one study showing no signicant impact on vaccination intentions21,
and a second study nding a noticeable eect22.
In our VR simulation, participants must either try not to infect other non-player characters in a virtual scene,
or try not to get infected by them. All participants play two scenarios—starting with an environment in which
few characters are vaccinated, followed by an environment where many characters are vaccinated. e simulation
thus allows participants to experience community immunity from a rst-person perspective, learning how much
more slowly infection spreads when vaccination rates are high versus low. Moreover, by using gamication in
an immersive VR simulation, participants are likely to be motivated and engaged with the learning content18,23.
We compare the eectiveness of this simulation against a typical information treatment using text and images.
We hypothesized that:
H1. Vaccination intention increases aer the VR treatment.
H2. Vaccination intention increases more aer the VR treatment than aer the text-and-image treatment.
H3. Collective responsibility increases aer the VR treatment.
H4. Collective responsibility increases more aer the VR than than aer the text-and-image treatment.
e design and analysis plan of this randomized control trial was preregistered on 03/06/2021, prior to access-
ing any data. See https:// osf. io/ cjgfe/? view_ only= ac57e a9f e54ed 8bcd9 d3bee 16cc8 a4 for the anonmyized plan.
Registration DOI is https:// doi. o r g/ 10. 17605/ OS F. IO/ WUFXK. Unless otherwise noted, all steps below follow the
pre-registration plan. e full study procedure was approved by the Institutional Review Board at the Psychol-
ogy Department, University of Copenhagen. e study was performed in accordance with the ethical standards
of the Declaration of Helsinki (1964) and its subsequent amendments. Informed consent was obtained from all
Recruitment. Participants (tested:
, analyzed:
) were 207 passersby recruited in a public
park in Copenhagen during the rst weekend in June 2021, plus 15 passersby recruited one week earlier on
campus at the University of Copenhagen. All adults with basic understanding of English were eligible. e
sample size was determined by the number of passersby who agreed to participate during the pre-registered
study period. Respondents (aged 18 to 63) participated in exchange for drinks and snacks. Table1 contains key
descriptive statistics.
Design. Aer lling out a pre-treatment questionnaire,
of the participants were randomly assigned to the
VR treatment. e other
were randomly assigned to read a text and see images explaining community immu-
nity. All participants then lled out a post-treatment questionnaire. Finally, all participants also received the
treatment they had not been assigned to initially (VR or text-and-image), and lled out a second post-treatment
questionnaire (crossover design). Figure1 shows the trial prole.
Below, we detail the content of both treatments: the VR simulation and the text-and-image treatment.
Table 1. Characteristics of the analyzed study sample (
). Continuous variables are summarized as
mean (standard deviation). Last two rows are % of respondents who had maximum values on the outcome
measures before receiving any treatment.
Sample characteristic Result
Age 29.0 (9.1)
% Female 39%
% Vaccinated 16%
Previous VR experience (median) 1–3 times
Pre-treatment vaccination intention 65.8 (25.6)
Pre-treatment collective responsibility 6.0 (1.5)
% Max pre-treatment vaccination intention 12%
% Max pre-treatment collective responsibility 53%
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VR. In the VR treatment, participants wore an Oculus Quest headset for a 5–10 min simulation developed at
SIPLAB (ETH Zurich). ey were embodied as an older character matching their gender. ey were told that
their character is vulnerable to COVID-19.
Participants were randomly assigned to one of two versions of the VR simulation. In the avoid spreading
version, the player character (“avatar”) is already infected and the player must try not to infect others. In the
avoid infecting version, the player character is uninfected and the player must try not to be exposed to infected
In a rst step, a tutorial showed the mechanics of the game. ere were healthy-and-unvaccinated, infected
(red clothing) and healthy-and-vaccinated (blue clothing) characters in the environment. Infected characters
could spread the disease when coming too close to a healthy-and-unvaccinated character. Close contact was
dened as a 2m radius around the character.
In a second step, participants were tasked with crossing a busy square to reach a marked destination, while
avoiding contact with the other 130 characters in the square. In the rst scenario, they did so in an environment
where 20% of the virtual characters were vaccinated. In the second scenario, they crossed the busy square again,
but with 70% of the characters being vaccinated. Instructions claried that the dierence between the two sce-
narios was the avatars’ vaccination rate.
When participants came into close contact with a character (infecting them or being exposed to their infec-
tion), they were made aware through graphics and haptic feedback (vibrating controllers). A small graph also
helped them see how the disease spread between characters in the square, increasing the count of infected char-
acters as they moved through the scenario. Figure2 shows the square scene and spreading graph.
Text‑and‑image. e alternative treatment, using text and images, displayed the denition of community
immunity by the US Centers for Disease Control and Prevention24, followed by two pictures (adapted from10)
238 participants started
232 randomised
78 assigned
to text-and-image
154 assigned to
VR first
145 included in
main analyses
4 dropped out
1 VR sickness
3 unknown
150 completed
3 under 18 years old
3 dropped out
1 did not speak English
1 no informed consent
5 not analyzed
3answered w/o completing VR
1 did not speak English
1 under influence of alcohol
78 completed
77 included in
main analyses
1 not analyzed, under
influence of alcohol
2 dropped out, unknown
143 completed
second post-
4dropped out, unknown
143 included in
73 completed
second post-
70 included in
3 answered w/o
completing VR
Figure1. Trial prole showing ow of participants into treatment arms and analyses. Because participants
largely self-administered the questionnaires and treatments, needing assistance only to start up the VR
simulation, dropout reasons are sometimes unknown.
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with captions. e pictures represented communities where few or many people are vaccinated. Captions
explained that in a low-vaccination community, many healthy but unvaccinated people are at risk of infection.
In a high-vaccination community, few are at risk.
Both the VR and text-and-image treatment ended with a brief summary, highlighting the takeaway message
(“As you can see, when many people are vaccinated the virus does not spread as fast and it creates a world that is
safer for everyone. You can see the dierence in [...] the low and high vaccination scenarios”). A more detailed
description of both treatments, including video, can be found in the study repository (https:// osf. io/ wufxk/?
view_ only= 56e83 d061c 6d469 637 8d29c 2940a 4a).
Randomization and masking. Simple randomization between treatment orderings (VR rst or text rst)
happened within the Qualtrics survey soware. Random assignment to a version of the VR simulation (avoid
spreading or avoid infection) was tied to participants’ ID numbers (even or uneven), which were allocated con-
secutively to both VR-rst and text-rst participants. Experimenters only assisted participants in starting up
the VR simulation. ey were blind to both the treatment ordering and the VR simulation version that each
participant was assigned to.
Outcome measures. Two key measurements were taken before and aer participants’ rst treatment, as
well as aer their second treatment: First, vaccination intention for a hypothetical new COVID-19 strain was
assessed (0–100 scale; adapted from10). is primary outcome measure was pretested in a pilot study available
in the supplemental material. Second, seeing COVID-19 vaccination as a collective responsibility was assessed
(1–7 scale)5. e supplemental material details the wording of these two items, and all other measures collected
in the study.
All preregistered hypotheses are about the eect of the participants’ rst treatment on the two outcome meas-
ures, either the VR treatment or the text-and-image treatment. e supplemental material section describes the
models used to test these hypotheses; they are simple regressions of rst dierences in the outcome measures
on medium of rst treatment (VR or text).
Figure3 (le panel) illustrates the eect of each treatment on vaccination intention as the dierence between
measurements before and aer the rst treatment. e supplemental material presents the full distribution of
individual treatment eects, as well as analyses that do not exclude maximum-score participants.
Comparing vaccination intention between the pre-treatment and rst post-treatment measure, for partici-
pants who did not already have maximally positive vaccination intention (n = 195), we nd that the VR treat-
ment increased vaccination intention by 9.3 points (95% CI: 7.0 to
11.5, p
). e VR treatment is more
eective than the text-and-image treatment, which only increases vaccination intention by 3.3 points (dierence
in eects: 5.8, 95% CI: 2.0 to
9.5, p
Comparing collective responsibility pre- and post-treatment, for participants who did not already score the
maximum on collective responsibility (n = 104), we nd that the VR treatment increases collective responsi-
bility by 0.82 points (95% CI: 0.37 to
1.27, p
). e VR treatment is once again more eective than a
text-and-image treatment, which increases collective responsibility by just 0.43 points, though the dierence is
not signicant (dierence in eects: 0.39, 95% CI: 0.36 to
1.14, p
). e power to detect signicant treat-
ment dierences is lower here, due to the smaller number of “moveable” participants with less-than-maximum
perceptions of collective responsibility.
Figure2. e busy square scene in VR, with feedback graph showing the number of infected, healthy and
vaccinated characters.
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Further, we conducted an exploratory analysis on whether the VR treatment further increases vaccination
intentions aer a text-and-image treatment. Indeed, as shown in the right panel of Fig.3, we nd that for par-
ticipants who experienced the text-and-image treatment rst and did not have maximum pre-treatment vac-
cination intention, the subsequent VR treatment further increased vaccination intention by 6.3 points (95% CI:
4.2 to
8.3, p
). In contrast, for those who received the text-and-image treatment aer the VR treatment,
there was no signicant further increase in vaccination intention (eect: 0.8, 95% CI:
2.3, p
We also explored any potential dierence between the eectiveness of the two versions of the VR treat-
ment: the one where participants avoided spreading COVID-19 and the one where they avoided infection with
COVID-19. ere is no dierence in the eect of these two versions on either vaccination intention (dierence
in eects: 0.2, 95% CI:
47, p
) or collective responsibility (dierence in eects:
, 95% CI:
0.45, p
Finally, we asked all participants who completed the full study (n = 208) whether learning about community
immunity via VR and text/pictures was fun, and whether they would like to receive more health communica-
tions via VR and text/pictures (1–5 scale). Compared to their ratings of text, participants rated VR as more fun
(dierence in means: 0.23, 95% CI: 0.11 to
0.35, p
). ere was no dierence on how much participants
wanted to receive future health communications via the two media (dierence in means:
, 95% CI:
0.05, p
We provide seminal evidence that a rst-person experience of vaccinations’ collective benets in immersive VR
can increase vaccination intentions. Further, the VR treatment is nearly three times more eective than com-
municating the same content via text and images. As the intended eect of both treatments is quite clear, the
VR treatment’s greater eectiveness shows that its impact cannot be reduced to demand characteristics. is
is further supported by the nding that adding the VR treatment aer the text-and-image treatment further
increased vaccination intention, whereas adding the text-and-image treatment aer the VR treatment did not
provide any further benet.
Our results suggest that, due to the unique type of content it allows for, a VR intervention communicating
about the collective benet of vaccination can go beyond merely providing information. e results t into a
growing literature on the eectiveness of communicating about community immunity on vaccination intentions
(see9 for a review) and builds on the nding that such interventions appear more eective when they are more
engaging, such as via interactive simulations1012, and when they elicit emotions, such as empathy7. As we dem-
onstrate here, immersive VR is an eective alternative communication medium that can convey the collective
benet of vaccination in a highly engaging and emotional way.
ere are several potential mechanisms for why the VR treatment leads to changes in behavioral intentions
that deserve further investigation in future research. Our participants reported greater fun with the VR treatment
than with the text-and-image treatment. Previous research has shown that immersive VR increases participants’
interest in the content domain25 and enjoyment26, which can increase attention and eort18 to understand a
Figure3. Average eect on vaccination intention of rst treatment (n = 195, le panel) and second treatment
(n = 189, right panel), leaving out participants with maximum pre-treatment vaccination intention. Error bars
are 95% CIs.
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Scientic Reports | (2022) 12:4593 |
topic. Immersive simulations also induce a sense of presence17 and agency, which are essential for experiencing
embodiment (the feeling of being in and controlling a virtual body)27. is can cause participants to associate
negative and positive emotions with low and high vaccination rates, respectively. All of these features make it
possible to create intense experiences of scenarios from another person’s perspective—increasing empathy with
vulnerable others by allowing users to share their emotional processes28. Such eects are likely to further increase
when elements of gamication are used23, as in the present study. Taken together, there are both cognitive and
emotional features of the VR treatment that are likely inuence behavioral intentions.
e current research has some limitations. Firstly, because is dicult to dierentiate between mechanisms,
it is currently unclear which aspects of the intervention may be modied by practitioners, and which ones must
be kept. In future work, we will further investigate the mechanisms behind the eect of this intervention type,
by developing more versions of the simulation, and measuring more intermediate variables (e.g., empathy).
Secondly, our outcome measures were vaccination intention and collective responsibility. We used established
measures for these constructs and both have been linked to self-reported vaccine uptake6,29. Nevertheless, future
research should investigate the eects on actual vaccination behaviour.
irdly, in contexts with limited funds and technological know-how, VR interventions are less feasible. Still,
headsets have fallen dramatically in price, and they have become easier and more versatile in use—a trend that
is expected to continue, making VR a more accessible option in the future.
Finally, since our sample was composed of passersby in a public park, people who had greater interest in VR
may have been more likely to participate. Further, despite the fact that the study was advertised as a “VR experi-
ment on COVID-19”, with no mention of vaccines or advocacy, it is possible that participants anticipated our
objectives. is means that individuals with strong (anti-)vaccine beliefs may have declined to take part. Indeed,
the strength of our invention lies in motivating the vaccine-hesitant to engage with vaccine-related content, rather
than in persuading strong vaccine deniers.
Despite these limitations of the sample, showing the eectiveness of VR in increasing vaccination intentions
“in the wild” indicates the generalizability of our ndings to non-research settings. Moreover, the fact that VR
attracts a specic audience may be benecial. In fact, most volunteers in our study were younger adults—an age
group that currently has lower COVID-19 vaccine uptake, including in countries where the vaccine is widely
Although we found a substantial change in vaccination intentions, future research could develop an even
more eective VR treatment. For example, subsequent versions may improve the experience’s narrative, or create
more empathy with a main character who is especially vulnerable to the target disease. And while the present
study focused on COVID-19 vaccination intentions, the VR treatment can also easily be adapted to, and tested
for, dierent infectious diseases.
Our research contributes to a potential paradigm shi in health communication generally, and vaccine advo-
cacy in particular. Finding novel methods to reduce vaccine hesitancy is critical4,32,33. Immersive, gamied VR
provides a exible tool to create more engaging and interactive learning experiences—alongside other media
and technology, such as gamied apps and augmented reality. For vaccine and community immunity informa-
tion in particular, it is crucial to reach and engage healthy members of the population (including young adults).
Immersive VR has strong potential to complement more traditional communication channels and, therefore,
contribute to decreasing the threat from infectious diseases.
Data availability
Anonymous individual participant data, plus analysis les a data dictionary with variable descriptions, are avail-
able to anyone from the study repository (https:// osf. io/ wufxk/? view_ only= 56e83 d061c 6d469 637 8d29c 2940a
4a). e repository also includes the study protocol, pre-analysis plan and informed consent form.
Received: 18 August 2021; Accepted: 23 February 2022
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is research was funded by the European Institute of Innovation and Technology (EIT Health, Grant No.
210836). Registered at Open Science Foundation, https:// doi. org/ 10. 17605/ OSF. IO/ WUFXK.
Author contributions
All authors were involved in conceiving the study idea and design. C.V. led the study design and implementation,
processed and analyzed data, and draed the paper. T.L. created the Virtual Reality application and processed
data. M.A., A.M., G.M. and R.B. were involved in study implementation. C.V., T.L., M.A., A.M., C.H., G.M. and
R.B. revised the paper.
e funder of the study (EIT Health) had no role in study design, data collection, data analysis, data interpreta-
tion, or writing of the report.
Competing interests
e authors declare no competing interests.
Additional information
Correspondence and requests for materials should be addressed to C.V.
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... XR teknolojileri insanlara ilk yardımın nasıl yapılacağını öğretebilir, felç, kalp krizi ve alerjik reaksiyonlar için acil bakımın nasıl yapılacağını öğretmek için halk sağlığı kampanyalarını kolaylaştırmaya yardımcı olabilir ve halka meme kanseri gibi hastalıklar için kendilerini doğru bir şekilde nasıl tarayacaklarını öğretmeye yardımcı olabilir (10thdegree, n.d.). Sanal gerçekliğin COVID-19 aşısı tereddütünü azalttığını (Vandeweerdt et al., 2022), sigara bırakmada etkili olduğunu (Sandra et al., 2021) ifade eden çalışmalar da bulunmaktadır. ...
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Değerli okuyucularımız; Sağlık bilimleri alanında özveri ile çalışan akademisyenlerimizin büyük emekleri ile hazırladığımız kitabımız, geniş kapsamlı bir yaklaşım ile bizlere güncel bilgiler sunmaktadır. Tıpta temel bilimler ile klinik bilimler birlikte çalışarak sürekli önemli gelişmeler kaydetmektedir. Konular üzerinde araştırma yaparken ona birçok bakış açısı ile bakarak yaklaşmamız, ayrıntıları fark etmemize, yeni fikirler ve çözümler üretmemize katkı sağlamaktadır. Kitabın zengin içeriği ve perspektifi ile yazarlarımızın bilim dünyasına katkı sunan yorumlarının, bilime gönül veren insanlar için yararlı olacağını umut etmekteyim. Hastalıkların önlenmesi, erken tanısı ve etkin tedavisi için bilimsel alanlarda sabırla çalışan yol arkadaşlarımın çalışmalarına yeni ufuklar açmasını dilerim. Kitabımıza destek veren yazar kadromuz ve her seferinde aynı heyecan ile hazırladığımız yeni eserlerde büyük çabalarından dolayı yayın ekibimize teşekkür ederim. Prof. Dr. Hülya Çiçek
... Virtual reality has been shown to have a stronger persuasive power as compared to traditional, less immersive media regarding increasing intentions to act more prosocially (Fonseca and Kraus, 2016;Plechatá, Thomas Morton, FJA Perez-Cueto and Makransky, 2022;Vandeweerdt et al., 2022), but the impact of VR in terms of affecting real-life behavior is not very clear (Fonseca and Kraus, 2016;Meijers, Torfadóttir, et al., 2022;Soliman et al., 2017). Therefore, in this pre-registered study, we investigated whether experiencing different climate change scenarios in VR while having the chance to change the future by altering food preferences would influence food behavior in terms of real-world food choice and consumption. ...
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To reach necessary greenhouse gas (GHG) emissions targets, behavioral change is necessary at the consumer level. Nevertheless, behavioral interventions have only a limited impact on habitual behaviors such as beef consumption, which significantly contributes to the GHGs released. Immersive virtual reality (VR) in the metaverse can transform the current information-based environmental communication into more experience-based communication. To study how such a shift might change its effectiveness, we randomly assigned N = 167 participants to a VR experience (experiencing and influencing climate change based on food choices) or a VR information condition (receiving the same information from a virtual human). The VR experience led to higher intentions to reduce meat consumption and more pro-environmental behavior in VR and real life than the information condition. Mediation analyses confirm that experiential VR environmental communication can increase people’s efficacy beliefs, which increase their intentions and, consequently, lead to a reduction in beef consumption.
... VR interventions for college students date back more than 10 years to explorations with influences on alcohol behavior [57,58], physical activity [59][60][61] and healthy eating [62,63], and mental health [64][65][66]. Recently published research has shown VR and augmented reality interventions to be appropriate for building confidence in vaccinations and promoting adherence to vaccination recommendations [67][68][69][70][71]. Real et al. assessed the impact of VR on HPV vaccination in a pilot trial with physicians to include simulations to practice counseling avatars who demonstrated hesitancy [67]. ...
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Human papillomavirus (HPV) vaccination protects against six types of cancer—cervical, anal, oropharyngeal, penile, vulvar, and vaginal. In the United States (U.S.), HPV vaccination coverage in college students remains low, especially in the Mid-South region, despite the highest risk of HPV infections and disease burden. However, few studies have assessed HPV vaccination among college students here. This study examined factors associated with HPV vaccination among college students in the Mid-South and explored preferred strategies for promoting vaccination. A mixed-methods design comprising a cross-sectional, self-report online survey and dyadic virtual interviews was conducted. Simple random sampling was performed to recruit a total of 417 undergraduate students aged 18–26 from March to May 2021; convenience sampling was performed to recruit three sex-matched dyads of a total of six (four female and two male) undergraduates from survey respondents who had not completed the HPV vaccine series in May 2021. Binary logistic regression analyses showed HPV vaccine knowledge and perceived barriers to vaccination were factors contributing to coverage for both female and male students, while perceived risks of HPV and vaccine hesitancy were factors only among female students. Findings from the qualitative content analysis identified college students’ perceived barriers to the vaccination at multiple levels and preferred strategies for vaccination promotion, corroborating the findings from the survey study. The findings provide implications that benefit the development of tailored interventions aimed at facilitating catch-up vaccination among college students in the Mid-South region. There is an urgent need for further research and the implementation of effective strategies that address the identified barriers and improve HPV vaccine uptake in this population.
... Nevertheless, there have been conflicting data available on whether educational interventions reduce vaccine hesitancy. [31][32][33] Our study limited the number of participants in webinars to 40, and questions were asked anonymously. Providing a small, interactive and possibly anonymous webinar where individuals can discuss their concerns directly with professionals might be an effective strategy for increasing vaccine confidence, which could in turn decrease vaccine hesitancy. ...
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Introduction We investigated the effect of social media-based interventions on COVID-19 vaccine intention (VI) and confidence in Japan. Methods We conducted a three-arm randomised controlled trial between 5 November 2021 and 9 January 2022 during a low incidence (<1000/day) of COVID-19 in Japan in the midst of the second and the third waves. Japanese citizens aged ≥20 who had not received any COVID-19 vaccine and did not intend to be vaccinated were randomly assigned to one of the following three groups: (1) a control group, (2) a group using a mobile app chatbot providing information on COVID-19 vaccines and (3) a group using interactive webinars with health professionals. VI and predefined Vaccine Confidence Index (VCI) measuring confidence in the importance, safety and effectiveness were compared before and after the interventions under intention-to-treat principle. Logistic regression models were used to investigate the effect of each intervention on postintervention VI and changes of VCI compared with control. Results Among 386 participants in each group, 359 (93.0%), 231 (59.8%) and 207 (53.6%) completed the postsurvey for the control, chatbot and webinar groups, respectively. The average duration between the intervention and the postsurvey was 32 days in chatbot group and 27 days in webinar group. VI increased from 0% to 18.5% (95% CI 14.5%, 22.5%) in control group, 15.4% (95% CI 10.8%, 20.1%) in chatbot group and 19.7% (95% CI 14.5%, 24.9%) in webinar group without significant difference (OR for improvement=0.8 (95% CI 0.5, 1.3), p=0.33 between chatbot and control, OR=1.1 (95% CI 0.7, 1.6), p=0.73 between webinar and control). VCI change tended to be larger in chatbot group compared with control group without significant difference (3.3% vs −2.5% in importance, OR for improvement=1.3 (95% CI 0.9, 2.0), p=0.18; 2.5% vs 1.9% in safety, OR=1.1 (95% CI 0.7, 1.9), p=0.62; −2.4% vs −7.6% in effectiveness, OR=1.4 (95% CI 0.9, 2.1), p=0.09). Improvement in VCI was larger in webinar group compared with control group for importance (7.8% vs −2.5%, OR=1.8 (95% CI 1.2, 2.8), p<0.01), effectiveness (6.4% vs −7.6%, OR=2.2 (95% CI 1.4, 3.4), p<0.01) and safety (6.0% vs 1.9%, OR=1.6 (95% CI 1.0, 2.6), p=0.08). Conclusion This study demonstrated that neither the chatbot nor the webinar changed VI importantly compared with control. Interactive webinars could be an effective tool to change vaccine confidence. Further study is needed to identify risk factors associated with decreased vaccine confidence and investigate what intervention can increase VI and vaccine confidence for COVID-19 vaccines. Trial registration number UMIN000045747.
... Lastly, reliance on selfassessment questionnaires may lead participants to overestimate their level of vaccine acceptance, in order to convey a socially desirable impression to others and themselves (Khubchandani et al., 2021). The use of virtual reality scenarios to investigate vaccine hesitancy (as in Vandeweerdt et al., 2022) will contribute to avoid this limitation. By providing a first-person experience, these new approaches offer an ecological way to measure the collective benefits of vaccination, with the aim of increasing public consensus. ...
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In previous studies, anti-vaccination attitudes have been attributed either to far-right voters or to both far-left and far-right voters. The present study investigated the associations of political orientation with vaccine hesitancy and intention to be vaccinated against COVID-19, and the potential mediating roles of trust in science and belief in misinformation. A total of 750 Italian respondents completed an online questionnaire in the period between the second and the third wave of COVID-19 (from 9th March to 9th May 2021). The results showed that political orientation had both direct and indirect associations with vaccine hesitancy and vaccine intention, mediated by trust in science and belief in misinformation. Specifically, right-wing adherents were less trustful of scientists and believed in COVID-19-related misinformation more than left-wing adherents, and these two factors accounted for their higher vaccine hesitancy and reduced willingness to receive an anti-COVID-19 vaccination. Our findings are in line with the predictions of the mindsponge theory and suggest that communicative campaigns aimed at improving the rates of vaccine acceptance in right-wing adherents should be specifically focused on enhancing trust in science and reducing belief in misinformation.
... Similarly, a reduction in age bias has been reported following the embodiment of an old avatar [7]. In recent health research, the embodiment of an old avatar was also shown to be effective in an intervention designed to increase intentions to vaccinate [122,179]. Virtual embodiment is also an emerging technology to support motor learning and rehabilitation [54,62,177]. Moreover, a large randomized controlled trial showed that BOIs are effective in the treatment of fear of heights [40]. ...
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Body ownership illusions (BOIs) occur when participants experience that their actual body is replaced by a body shown in virtual reality (VR). Based on a systematic review of the cumulative evidence on BOIs from 111 research papers published in 2010 to 2021, this article summarizes the findings of empirical studies of BOIs. Following the PRISMA guidelines, the review points to diverse experimental practices for inducing and measuring body ownership. The two major components of embodiment measurement, body ownership and agency, are examined. The embodiment of virtual avatars generally leads to modest body ownership and slightly higher agency. We also find that BOI research lacks statistical power and standardization across tasks, measurement instruments, and analysis approaches. Furthermore, the reviewed studies showed a lack of clarity in fundamental terminology, constructs, and theoretical underpinnings. These issues restrict scientific advances on the major components of BOIs, and together impede scientific rigor and theory-building.
Technology holds great potential to address many vaccine hesitancy determinants and support vaccine uptake given its ability to amplify positive messages, support knowledge, and enhance providers' recommendations. Modalities previously implemented with variable success have included automated reminder systems, decision support for clinicians, online education programs, social media campaigns, and virtual reality curricula. Further research is needed to identify the optimal uses of technology at the patient/parent and provider levels to overcome vaccine hesitancy. The most effective interventions will likely be multipronged providing patients, parents, and providers with information related to vaccine status.
Objectives To identify technologies used in vaccine safety communication and evaluate their impact on vaccination intention, uptake, knowledge, attitude, and perceptions of consumers. Methods We searched 6 electronic databases to identify randomised controlled trials assessing the impact of using technology in vaccine safety communication. The Cochrane Collaboration’s tool for assessing risk of bias was used to evaluate each study. Results We included 22 studies involving 27,109 participants from 8 countries; 15 studies assessed the use of videos and 7 examined innovative technologies. Using videos significantly improved knowledge (n = 3) and participant engagement (n = 2) compared to printed material. Among the innovative technologies, the use of virtual reality, and smartphone applications incorporating social networking or gamification significantly increased vaccination knowledge, confidence, and engagement. The studies showed that narrative messaging increased perceived disease severity (n = 2) and vaccination intention (n = 2). Conclusions While the use of innovative technologies is increasing, videos currently remain the most popular technology for vaccine safety communication. Communication technology, particularly with narrative messaging, improves patient engagement and comprehension. Practice implications Health authorities should increase focus on using videos and smartphone applications for vaccine safety communication. Collaboration among stakeholders is essential to develop guidelines on effective message content to complement the technology.
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Understanding individuals' preferences for antibiotics can help mitigate the acceleration of antibiotic resistance. Similar to the climate crisis, individuals "today" need to appropriately use antibiotics to reduce the negative consequences of antibiotic resistance for individuals "tomorrow." We use an established-yet novel in this research field-behavioral game approach to investigate individuals' preferences for antibiotics in the face of a between-generations conflict. In an online study, we investigated whether a between-generations (vs within-generations) conflict in antibiotic intake leads to larger overuse and how to promote appropriate use of antibiotics. Results indicate that overuse in the face of a between-generations (vs within-generations) conflict increased. Eliciting empathy toward future generations in the case of a between-generations conflict decreased overuse. Findings suggest that different representations of this social dilemma can influence people's preferences for antibiotics, and that empathy-based interventions might promote appropriate antibiotic use.
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Effective interventions for increasing people’s intention to get vaccinated are crucial for global health, especially considering COVID-19. We devised a novel intervention using virtual reality (VR) consisting of a consultation with a general practitioner for communicating the benefits of COVID-19 vaccination and, in turn, increasing the intention to get vaccinated against COVID-19. We conducted a preregistered online experiment with a 2×2 between-participant design. People with eligible VR headsets were invited to install our experimental application and complete the ten minute virtual consultation study at their own discretion. Participants were randomly assigned across two age conditions (young or old self-body) and two communication conditions (with provision of personal benefit of vaccination only, or collective and personal benefit). The primary outcome was vaccination intention (score range 1–100) measured three times: immediately before and after the study, as well as one week later. Five-hundred-and-seven adults not vaccinated against COVID-19 were recruited. Among the 282 participants with imperfect vaccination intentions (<100), the VR intervention increased pre-to-post vaccination intentions across intervention conditions (mean difference 8.6, 95% CI 6.1 to 11.1,p<0.0001). The pre-to-post difference significantly correlated with the vaccination intention one week later, ρ=0.20,p<0.0001. The VR intervention was effective in increasing COVID-19 vaccination intentions both when only personal benefits and personal and collective benefits of vaccination were communicated, with significant retention one week after the intervention. Utilizing recent evidence from health psychology and embodiment research to develop immersive environments with customized and salient communication efforts could therefore be an effective tool to complement public health campaigns.
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Objective: An effective vaccine against COVID-19 is a desired solution to curb the spread of the disease. However, vaccine hesitancy might hinder high uptake rates and thus undermine efforts to eliminate COVID-19 once an effective vaccine became available. The present contribution addresses this issue by examining two ways of increasing the intention to get vaccinated against COVID-19. Method: Two preregistered online studies were conducted (N = 2,315 participants from the United Kingdom) in which knowledge about and beliefs in herd immunity through vaccination, as well as empathy for those most vulnerable to the virus, were either measured (Study 1) or manipulated (Study 2). As a dependent variable, individuals' self-reported vaccination intention once a vaccine against COVID-19 became available was assessed. Results: In Study 1 (N = 310), the intention to get vaccinated against COVID-19 was correlated with knowledge about and belief in herd immunity through vaccination (r = .58, p < .001), as well as with empathy for those most vulnerable to the virus (r = .26, p < .001). In Study 2 (N = 2,005), information about herd immunity through vaccination (Cohen's d = .13, p = .003) and empathy (Cohen's d = .22, p < .001) independently promoted vaccination intention. Conclusions: The motivation to get vaccinated against COVID-19 was related to and could be causally promoted by both mere information about herd immunity through vaccination and by empathy. As such, the present research provides a better understanding of the intention to get vaccinated against COVID-19. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Most vaccines not only directly protect vaccinated individuals but also provide a social benefit through community protection. Therefore, vaccination can be considered a prosocial act to protect others. We review the recent empirical evidence on (i) how prosocial concerns relate to vaccination intentions and (ii) promoting prosocial vaccination through explaining community protection or inducing concern for vulnerable others. The available evidence suggests that promoting the prosocial aspect of vaccinations could be a vaccination communication strategy to improve vaccine uptake. We point to several areas in which future research can test the boundary conditions of this approach and increase its effectiveness.
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Virtual Reality (VR) has been touted as an effective empathy intervention, with its most ardent supporters claiming it is "the ultimate empathy machine." We aimed to determine whether VR deserves this reputation, using a random-effects meta-analysis of all known studies that examined the effect of virtual reality experiences on users' empathy (k = 43 studies, with 5,644 participants). The results indicated that many different kinds of VR experiences can increase empathy, however, there are important boundary conditions to this effect. Subgroup analyses revealed that VR improved emotional empathy, but not cognitive empathy. In other words, VR can arouse compassionate feelings but does not appear to encourage users to imagine other peoples' perspectives. Further subgroup analyses revealed that VR was no more effective at increasing empathy than less technologically advanced empathy interventions such as reading about others and imagining their experiences. Finally, more immersive and interactive VR experiences were no more effective at arousing empathy than less expensive VR experiences such as cardboard headsets. Our results converge with existing research suggesting that different mechanisms underlie cognitive versus emotional empathy. It appears that emotional empathy can be aroused automatically when witnessing evocative stimuli in VR, but cognitive empathy may require more effortful engagement, such as using one's own imagination to construct others' experiences. Our results have important practical implications for nonprofits, policymakers, and practitioners who are considering using VR for prosocial purposes. In addition, we recommend that VR designers develop experiences that challenge people to engage in empathic effort.
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Influenza, pneumococcal disease, and shingles (herpes zoster) are more prevalent in older people. These illnesses are preventable via vaccination, but uptake is low and decreasing. Little research has focused on understanding the psychosocial reasons behind older adults’ hesitancy towards different vaccines. A cross-sectional survey with 372 UK-based adults aged 65-92 years (M = 70.5) assessed awareness and uptake of the influenza, pneumococcal, and shingles vaccines. Participants provided health and socio-demographic data and completed two scales measuring the psychosocial factors associated with vaccination behaviour. Self-reported daily functioning, cognitive difficulties, and social support were also assessed. Participants were additionally given the opportunity to provide free text responses outlining up to three main reasons for their vaccination decisions. We found that considerably more participants had received the influenza vaccine in the last 12 months (83.6%), relative to having ever received the pneumococcal (60.2%) and shingles vaccines (58.9%). Participants were more aware of their eligibility for the influenza vaccine, and were more likely to have been offered it. Multivariate logistic regression analyses showed that a lower sense of collective responsibility independently predicted lack of uptake of all three vaccines. Greater calculation of disease and vaccination risk, and preference for natural immunity, also predicted not getting the influenza vaccine. For both the pneumococcal and shingles vaccines, concerns about profiteering further predicted lack of uptake. Analysis of the qualitative responses highlighted that participants vaccinated to protect their own health and that of others. Our findings suggest that interventions targeted towards older adults would benefit from being vaccine-specific and that they should emphasise disease risks and vaccine benefits for the individual, as well as the benefits of vaccination for the wider community. These findings can help inform intervention development aimed at increasing vaccination uptake in future.
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Although vaccines are among the most effective interventions used in fighting diseases, vaccination readiness varies substantially among individuals. Vaccination readiness is defined as a set of components that increase or decrease the individual’s likelihood of getting vaccinated. Building on earlier work that distinguished five components of vaccination readiness (i.e., confidence, complacency, constraints, calculation, and collective responsibility), we revised the questionnaire used to measure these components to improve its psychometric properties, specifically criterion validity. In doing so, we also developed two new components of vaccination readiness: compliance and conspiracy. Compliance is the tendency to support monitoring to control adherence to regulations; conspiracy is the tendency to endorse conspiratorial beliefs about vaccination. The 7C scale was initially piloted in a cascade of serial cross-sectional studies and then validated with N = 681 participants from the COVID-19 Snapshot Monitoring in Denmark. We report a bifactor measurement model, convergent validity with other questionnaires, and explanation of 85% variance in the willingness to vaccinate against COVID-19. We also presented a 7-item short version of the scale. The instrument is publicly available in several languages (, and we seek collaboration to provide translations of our instrument into other languages.
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There has been a surge in interest and implementation of Immersive Virtual Reality (IVR) based lessons in education and training recently, which has resulted in many studies on the topic. There are recent reviews which summarize this research, but little work has been done that synthesizes the existing findings into a theoretical framework. The Cognitive Affective Model of Immersive Learning (CAMIL) synthesizes existing immersive educational research to describe the process of learning in IVR. The general theoretical framework of the model suggests that instructional methods which are based on evidence from research with less immersive media generalize to learning in IVR. However, the CAMIL builds on evidence that media interacts with method. That is, certain methods which facilitate the affordances of IVR are specifically relevant in this medium. The CAMIL identifies presence and agency as the general psychological affordances of learning in IVR, and describes how immersion, control factors, and representational fidelity facilitate these affordances. The model describes six affective and cognitive factors that can lead to IVR based learning outcomes including interest, motivation, self-efficacy, embodiment, cognitive load, and self-regulation. The model also describes how these factors lead to factual, conceptual, and procedural knowledge acquisition and knowledge transfer. Implications for future research and instructional design are proposed.
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Mass vaccination to create herd immunity to Covid-19 (SARS-CoV-2)
Even though learning refers to both a process and a product, the former tends to be overlooked in educational virtual reality (VR) research. This study examines the process of learning with VR technology using the Cognitive Affective Model of Immersive Learning (CAMIL) as its framework. The CAMIL theorizes that two technological features of VR, interactivity and immersion, influence a number of cognitive and affective variables that may facilitate or hinder learning. In addition, VR studies often involve media comparisons that make it difficult to disentangle the relative effects of technological features on learning. Therefore, this study also aims to provide insights concerning the unique and combined effects of interactivity and immersion on the cognitive and affective variables specified by CAMIL. We employed a 2 × 2 between-subjects design (N = 153) and manipulated the degree of interactivity and immersion during a virtual lesson on the topic of viral diseases. Analyses of variance (ANOVAs) were used to examine the effects of interactivity and immersion on our variables of interest, and structural equation modeling (SEM) was used to assess the process of learning as predicted by the CAMIL. The results indicated that the process of learning involves situational interest and embodied learning. Main effects of interactivity and/or immersion on cognitive load, situational interest, and physical presence are also reported in addition to interaction effects between immersion and interactivity on agency and embodied learning. The findings provide evidence for the CAMIL and suggest important additions to the model. These findings can be used to provide a better understanding of the process of learning in immersive VR and guide future immersive learning research.
Background: Following the emergency use authorisation of the Pfizer-BioNTech mRNA COVID-19 vaccine BNT162b2 (international non-proprietary name tozinameran) in Israel, the Ministry of Health (MoH) launched a campaign to immunise the 6·5 million residents of Israel aged 16 years and older. We estimated the real-world effectiveness of two doses of BNT162b2 against a range of SARS-CoV-2 outcomes and to evaluate the nationwide public-health impact following the widespread introduction of the vaccine. Methods: We used national surveillance data from the first 4 months of the nationwide vaccination campaign to ascertain incident cases of laboratory-confirmed SARS-CoV-2 infections and outcomes, as well as vaccine uptake in residents of Israel aged 16 years and older. Vaccine effectiveness against SARS-CoV-2 outcomes (asymptomatic infection, symptomatic infection, and COVID-19-related hospitalisation, severe or critical hospitalisation, and death) was calculated on the basis of incidence rates in fully vaccinated individuals (defined as those for whom 7 days had passed since receiving the second dose of vaccine) compared with rates in unvaccinated individuals (who had not received any doses of the vaccine), with use of a negative binomial regression model adjusted for age group (16-24, 25-34, 35-44, 45-54, 55-64, 65-74, 75-84, and ≥85 years), sex, and calendar week. The proportion of spike gene target failures on PCR test among a nationwide convenience-sample of SARS-CoV-2-positive specimens was used to estimate the prevelance of the B.1.1.7 variant. Findings: During the analysis period (Jan 24 to April 3, 2021), there were 232 268 SARS-CoV-2 infections, 7694 COVID-19 hospitalisations, 4481 severe or critical COVID-19 hospitalisations, and 1113 COVID-19 deaths in people aged 16 years or older. By April 3, 2021, 4 714 932 (72·1%) of 6 538 911 people aged 16 years and older were fully vaccinated with two doses of BNT162b2. Adjusted estimates of vaccine effectiveness at 7 days or longer after the second dose were 95·3% (95% CI 94·9-95·7; incidence rate 91·5 per 100 000 person-days in unvaccinated vs 3·1 per 100 000 person-days in fully vaccinated individuals) against SARS-CoV-2 infection, 91·5% (90·7-92·2; 40·9 vs 1·8 per 100 000 person-days) against asymptomatic SARS-CoV-2 infection, 97·0% (96·7-97·2; 32·5 vs 0·8 per 100 000 person-days) against symptomatic COVID-19, 97·2% (96·8-97·5; 4·6 vs 0·3 per 100 000 person-days) against COVID-19-related hospitalisation, 97·5% (97·1-97·8; 2·7 vs 0·2 per 100 000 person-days) against severe or critical COVID-19-related hospitalisation, and 96·7% (96·0-97·3; 0·6 vs 0·1 per 100 000 person-days) against COVID-19-related death. In all age groups, as vaccine coverage increased, the incidence of SARS-CoV-2 outcomes declined. 8006 of 8472 samples tested showed a spike gene target failure, giving an estimated prevalence of the B.1.1.7 variant of 94·5% among SARS-CoV-2 infections. Interpretation: Two doses of BNT162b2 are highly effective across all age groups (≥16 years, including older adults aged ≥85 years) in preventing symptomatic and asymptomatic SARS-CoV-2 infections and COVID-19-related hospitalisations, severe disease, and death, including those caused by the B.1.1.7 SARS-CoV-2 variant. There were marked and sustained declines in SARS-CoV-2 incidence corresponding to increasing vaccine coverage. These findings suggest that COVID-19 vaccination can help to control the pandemic. Funding: None.