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Social media have played an important role in shaping COVID-19 vaccine choices during the pandemic. Understanding people’s attitudes toward the vaccine as expressed on social media can help address the concerns of vaccine-hesitant individuals.
The aim of this study was to understand the attitudes of Swedish-speaking Twitter users toward COVID-19 vaccines.
This was an exploratory qualitative study that used a social media–listening approach. Between January and March 2022, a total of 2877 publicly available tweets in Swedish were systematically extracted from Twitter. A deductive thematic analysis was conducted using the World Health Organization’s 3C model (
Swedish-speaking Twitter users in this study had negative attitudes toward COVID-19 vaccines, particularly booster vaccines. We identified attitudes toward vaccines and misinformation, indicating that social media monitoring can help policy makers respond by developing proactive health communication interventions.
Sweden was seriously affected by the pandemic compared with some European countries. In relation to neighboring Nordic countries, Sweden has had the highest number of infected and terminally ill patients, with 2,500,000 positive cases and >16,000 deaths as of February 2022 [
The Public Health Agency of Sweden implemented various interventions and strategies to speed up COVID-19 vaccine uptake, including media campaigns to promote vaccination and facilitate vaccination accessibility across the Stockholm region through mobile vaccination buses [
Globally, skepticism about vaccine effectiveness and safety has been a consistent challenge, and the rise in vaccine hesitancy has become an urgent concern and one of the top 10 threats to global health in 2019, according to the World Health Organization (WHO) [
Since the beginning of the COVID-19 pandemic, myths and rumors have circulated on social media regarding the virus’s origin, spread, symptoms, severity, treatments, and the safety and effectiveness of its vaccines [
The WHO defines false information that systematically spreads in time of disease outbreaks as
The European Center for Disease Prevention and Control published a report in June 2021 that encouraged member states to gain a better understanding of the misinformation landscape on social media [
This was an exploratory qualitative study that used a social media–listening approach. Data from Twitter were gathered using Netlytic, a wrapper for the Twitter application programming interface (API; version 1), and Boolean operator search queries. Qualitative deductive thematic data analysis was guided by the WHO’s 3C model: confidence, complacency, and convenience. The WHO’s 3C model classifies the factors influencing vaccine hesitancy in individuals or groups into 3 main categories: confidence, complacency, and convenience [
Twitter was selected as the main data source because it is an important social media platform for disseminating information and sharing opinions [
The study analyzed public attitudes by reviewing tweets posted in Swedish. This was accomplished through “Netlytic,” a web-based service that allows for real-time data scraping from various social media platforms that publish publicly available posts [
Boolean search queries were set based on the most-used hashtags and terms in Sweden regarding COVID-19 according to Google Trends, Statista, and Twitter [
To reduce duplicates, Netlytic was set to exclude retweets while importing data. The study did not filter according to geographical location, as many users chose to hide their location for privacy concerns. Data scraping was scheduled to run the search queries weekly to match the Netlytic settings, because tweets older than 1 week would not be captured [
The data scraping covered 2 months from January 24, 2022, to March 24, 2022. The timeline reflected an important period of many changes, including the start of the booster shot recommendation [
(Corona OR covid OR coronaviruset OR coronavirussverige OR coronasverige OR coronavirus OR COVID-19) AND (spruta OR vaccin OR coronavaccin OR vaccinspruta OR coronaspruta OR påfyllnadsdos OR tredjedos)
All tweets from scraping iterations were merged into a single data set. The total number of retrieved tweets was 2877, which underwent cleaning and eligibility screening phases (
The master sheet was cleaned from duplicate tweets (n=493), which included copy-pasted text with no changes. In addition, as the study aimed to explore individuals’ attitudes, tweets from organizational accounts (n=112), such as RegionStockholm, Krisinformation, WHO, Public Health Agency of Sweden, and Dagensnyheter, were removed from the data set.
Account names were also removed from the data set for ethical considerations.
The eligibility screening phase was conducted using the qualitative data analysis software NVivo (version 12 Pro; QSR International) with 2272 tweets. Tweets that did not present personal opinions about COVID-19 vaccines, were irrelevant to the research topic, or contained unclear statements were coded as irrelevant and excluded from the study (n=606). Irrelevant posts were predominantly posts that did not present personal opinions (including news, posts from organizations, and advertisements), and there were a few posts that were not included because the statement was not legible. In addition, semiduplicated tweets that included changes but did not present additional context compared with their original tweets were also excluded (n=81). As a result, tweets that contained a clear attitude related to the COVID-19 vaccines—whether the tweets were in favor of vaccination or skeptical toward it—were eligible for the qualitative analysis (n=1585). All tweets found eligible (n=1585) were included in the final sample.
Tweet selection flow.
The data were analyzed using qualitative thematic analysis (TA), inspired by the 2006 guide by Braun and Clarke [
The TA was also led by the 3C model: confidence, complacency, and convenience [
To ensure the trustworthiness of the qualitative research process, we applied the following strategies [
No ethics approvals were needed as the study analyzed publicly available data on the internet. All tweets identified in the study were anonymized after screening for eligibility to protect the privacy of users. Aspects of confidentiality and anonymization of data were respected as no data used in the final report can be linked to actual users. One of the measures taken to protect the identity of Twitter users behind the tweets in our data set was to translate all the quotes used in the analysis, ensuring that they cannot be traced back to their author. In addition, no interaction occurred between the study researchers and Twitter users. This approach is consistent with guidelines on the ethical conduct of qualitative research in web-based communities [
The analysis resulted in 3 main themes and 18 categories, guided by the WHO’s 3C model (
Confidence: safety and effectiveness concerns and mistrust in authorities
Concerns about messenger RNA COVID-19 vaccines safety and side effects
COVID-19 vaccines effectiveness is limited
The risks from the vaccines outweigh the benefit
Concerns about the number of booster shots
The spread of rumors and conspiracy theories
Lack of transparency from the government and the Public Health Agency of Sweden
Limited trust in the authority’s management of the COVID-19 pandemic
Against mandatory vaccination and vaccine passes
The media presented biased evidence in favor of COVID-19 vaccination
Mistrust in scientific experts and pharmaceutical companies
Complacency: fading belief in vaccination necessity
The perceived necessity of vaccination against COVID-19 is low, especially among healthy adults
Changes in the perceived risk of COVID-19 infection
Natural immunity is superior to vaccines
Conflicting opinions toward children’s vaccination against COVID-19
Convenience: unappealing vaccination services and unclear information
Limited availability of COVID-19 vaccination appointments
COVID-19 vaccination services are unorganized
Contradicting evidence
Unanswered questions related to COVID-19 vaccination
The analysis shows that
The analysis demonstrated that there are multiple safety concerns related to COVID-19 vaccines. There is a shared belief that the messenger RNA vaccines are produced too quickly and do not undergo all the testing processes required for approval. This rapid development of vaccines has resulted in side effects:
It takes several years to develop and test vaccines before they are released on the market. The C-vax [COVID-19 vaccines] is quickly developed and emergency-approved in just a few months. Therefore, more people get side effects than COVID.
In addition to the number of side effects, there was a specific concern regarding the severity of side effects and deaths related to vaccination:
COVID-19 injections have probably caused 2-50 million deaths and many more disabling injuries worldwide.
In addition, some tweets compared the number and severity of COVID-19 vaccines’ side effects to the H1N1 pandemic influenza vaccine Pandemrix, for example:
Side-effects reported by the Medical Products Agency. Right now, just over 95,000 are reported, just over 17,000 handled and just over 9,000 treated as serious. Compare with Pandemrix which had 300 severe, narcolepsy.
In terms of effectiveness, the data show that Twitter users in this study perceived vaccines as prophylactic injections, which reduce the severity of the infection. However, they did not consider them as effective as traditional vaccines. Many tweets expressed people’s frustration with becoming infected after being vaccinated:
Vaccines usually prevent diseases, right? At least the ones I have taken from birth onwards. The current COVID-19 “vaccine” is useless.
The skepticism and concerns about the vaccines seen in the data were primarily related to COVID-19 vaccines, as many tweets clearly expressed trust in other vaccines:
Being against the COVID-19 vaccine does not mean that you are against all vaccines.
However, some people expressed mistrust of future vaccines:
The failure of the COVID-19 vaccine makes me hesitant about any future vaccine.
Moreover, many people argued that the risk of vaccination outweighs its benefits:
There’s no way I’m taking a third Covid-19 syringe! The side effects after both make me give up. In addition, my daughter and her husband were sick, really sick, despite two syringes! So no thanks!
Several tweets reported safety concerns regarding the number of injections the body can tolerate and the immunity period provided by the vaccines, which are continuously decreasing. There were many sarcastic tweets on the booster shots:
You need to take booster shots until you are dead.
To add to the uncertainty about effectiveness, there were repeated rumors, myths, and misinformation about the COVID-19 vaccine, for example, that COVID-19 vaccines cause AIDS by weakening the immune system of the human body:
The more “vaccines” a person receives against the COVID-19 coronavirus, the faster the body will die from the AIDS-like immune loss syndrome!
Moreover, theories regarding the origin of the virus are rampant. Some argue that the virus was synthesized by political forces and that COVID-19 vaccines are biological weapons used against the public:
The virus came from a lab in Wuhan that was sponsored by the US government to conduct “gain-of-function” research that was banned by Obama.
The data show that there was mistrust in the statistics and numbers related to the COVID-19 vaccines’ side effects and infection rates published by the authorities. For example, it was highlighted that the Public Health Agency of Sweden did not report the full numbers to encourage vaccination:
The problem is generally that the numbers are inflated and unreliable...Why not report who died OF COVID? Why are patients with syringes 1 + 2 reported as unvaccinated? Why not report figures for the unvaccinated?
The tweets in this study show that Sweden’s regulation was inconsistent with those of other countries. In addition, many tweets criticized the government’s delay in taking action, which led to serious consequences. For example, they accused the government of not protecting older adults:
Sweden’s strategy can never be “right.” A choice was made, in February 2020, where it was decided that it was ok to let the elderly get sick and die before they knew how to cure COVID-19 or have a vaccine. It is morally indefensible.
Furthermore, Twitter users in this study expressed skepticism based on governmental recommendations concerning COVID-19 vaccines:
On 12 January, the Swedish Public Health Agency stated that the vaccine protects well against serious illness, also against the omicron variant, for more than 6 months. That was less than THREE weeks ago! They currently have no idea what they are doing.
The enforcement of the vaccine pass was further criticized. The tweets expressed their disapproval of mandatory vaccination, even for people who took the vaccine, as it was perceived as a violation of personal freedom:
I have taken two doses of the vaccine and became ill with corona. The vaccine pass does not reduce the spread of infection, it is only a way to control people.
Moreover, the media agencies were criticized for being biased toward the government, where they blindly supported governmental decisions and undermined space for critical opinions.
The last category within this theme is the mistrust of scientific experts and pharmaceutical companies. The data demonstrate that there was a common belief that pharmaceutical companies benefit the most from the sale of vaccines. Some tweets suggested that scientific experts were pushed to ignore other potential factors to promote vaccination:
Everything that was not done to prevent the spread of COVID-19 that could have worked, ivermectin [ivermectin is an antiparasitic drug used by some countries to treat COVID-19], Vitamin D, etc. Instead, they all invested in one card—vaccination with a vaccine they had not tried before.
Tweets analyzed under the
No one under the age of 50 would have become sicker without a vaccine. It would most likely have been just as mild symptoms anyway. Greater risk of crossing the street than getting seriously ill in COVID-19 if you are healthy and younger.
Many studies have compared COVID-19 infection with the usual influenza infection. In addition, the analysis of the tweets highlights that the new mild variants negatively affect people’s willingness to be vaccinated, even among infected individuals who reported strong symptoms:
Now COVID-19 is like a severe cold, I had Omicron now, had pain in the body, a little runny nose, sore throat, headache where I thought the eyes would fall out a little awkwardly with asthma but always so with a cold. I did not need a vaccine for this.
Moreover, there was a common belief that direct infection provides better protection than the immunity provided by vaccines. Many tweets expressed that individuals would rather be infected with COVID-19 than get vaccinated:
No one who has had COVID-19 needs to be vaccinated, natural immunity is superior to the temporary protection that this vaccine provides.
Swedish Twitter users in this study expressed a strong trust in natural immunity; therefore, many tweets encouraged other people to get infected to be protected:
Omicron is just a vaccine without a reservation
Conflicting opinions were observed among the retrieved tweets on the necessity of vaccinating children against COVID-19, where the same arguments used to demand vaccination for children were used against vaccination but in a different context. Many tweets argued that children were also at risk of contracting COVID-19, contrary to what was previously believed. Tweets in favor of vaccination highlight that it is a child’s right to get vaccinated and be provided with the best possible care:
COVID-19 is to be spread and children between 5-11 years are deprived of the opportunity to be protected with a vaccine.
In addition, some Twitter users expressed fear for their children, as they can become severely ill and require hospitalization:
Many children are cared for in COVID-19 hospitals. The fact that they are offered vaccines is important to reduce the risk of them being seriously affected.
By contrast, tweets against vaccinating children expressed disbelief in the other group’s evidence, where they insisted that there is certainly no reason to fear COVID-19 infection:
COVID-19 is not dangerous for children. This is just propaganda because they want to throw vaccines at everyone when they have invested so much in it.
Similar to what was found in terms of the low perceived risk of COVID-19 in healthy adults, many people expressed that the risk of becoming seriously ill among healthy children is relatively low:
There is still no reason at all to vaccinate healthy children. Children who have risk factors are another matter, but there is in principle no healthy child in the whole world who has died from COVID-19 during the latter part of the pandemic.
The
I’m unvaccinated, my wife had COVID-19 last week. It was a severe flu with a high fever for a few days...I was going to get vaccinated, but it was hard to find anything near where I live.
Available vaccination appointments were especially a problem for booster shots, and those who managed to get vaccinated complained of long waiting queues:
Today I took the 3rd vaccine against COVID-19. Cheers to us who stood in line for about an hour.
Moreover, some tweets revealed dissatisfaction with the vaccination system, as they did not receive invitations for their doses according to the published guidelines:
Tested the phone booking and seemed to be free to come forward. Most people wonder why I did not receive an offer...According to 1177 [Swedish health information website and number], those who received the second dose in mid-August will receive an offer today, I received it at the end of July.
In addition, many people on Twitter felt lost while following contradicting evidence and information related to COVID-19 vaccines distributed on the internet. Many people have highlighted their limited ability to understand scientific reports:
I think people have a hard time understanding that what is coming out here is true. There are research articles that claim completely different things, so it is not surprising that people get confused.
Many Twitter users felt that they needed more clarification regarding the COVID-19 vaccines. Tweets described insufficient information on the effects and immunity provided by the COVID-19 vaccines.
Why would it make sense to get vaccinated when you have had COVID-19? Why not highlight the risks of vaccines as well as the benefits?
In addition, many questions were related to the COVID-19 booster intervals. Twitter users in this study demonstrated a low understanding of the dose guidelines and how they should schedule their boosters after getting infected:
Some thoughts about vaccination. How do you do it if you just had COVID-19, do you take booster 3 or should you wait a couple of months?
Some tweets were very specific in that they asked questions related to certain medical conditions or age groups:
Look at the risk to the foetus/mother. These are extremely low if the mother is healthy, not overweight...How much risk should COVID-19 pose to recommend a vaccine where the clinical studies are not complete?
The overall aim of the study was to understand the attitudes of Swedish Twitter users toward COVID-19 vaccines. The study found that tweets expressing opinions about vaccines and the vaccination process were predominantly negative. The tweets expressed low confidence in the COVID-19 vaccines, policy makers, and scientific experts. Further concerns were related to complacency, which reflected a low understanding of the severity of COVID-19 infection and a low perception of the necessity to vaccinate, particularly with regard to booster shots. Moreover, the study found that convenience was not seen as a major challenge; however, the accessibility of information and the quality and availability of vaccination services were criticized.
Swedish Twitter users in this study had major concerns about the safety of the vaccines. This supports the findings of other studies that highlight the importance of people’s confidence in vaccine safety in promoting vaccination uptake [
This study further demonstrates that people’s beliefs in the effectiveness of COVID-19 vaccines have decreased over time. The findings show that these arguments were commonly raised against COVID-19 vaccines and booster shot uptakes and might be related to the low booster coverage seen among the Swedish population [
The data further show that people express mistrust in authorities and demand more transparency from the government and the responsible authorities, mainly from the Public Health Agency of Sweden and the Swedish Medical Products Agency (SMPA), about the incidence and severity of the side effects caused by the vaccines. The SMPA releases a monthly update of the registered side effects and a list of death cases suspected to be related to COVID-19 vaccines [
Tweets analyzed under the
The
This study has some limitations. It is important to note that Twitter API provides free access to only a 1% sample of all Twitter data [
In addition, although the number of web-based users in Sweden has increased in recent years, they cannot be considered representative of the entire Swedish population. As it was not possible to capture users’ demographics for technical reasons, as such details are not available on Twitter, the transferability of the study is also limited because of the lack of such information. However, studies on the demographics of Twitter users have shown that the web-based population constitutes the younger generation, with females especially overrepresented [
Finally, there are limitations to language-restricted searches as they may include Swedish expats who live in a different context than Sweden. It is of course possible that expats are part of the discussion; according to this report, as many as 700,000 Swedes actually live abroad, or around 7% of Swedish people [
This study contributes to ongoing public health efforts to promote COVID-19 vaccination and address vaccine hesitancy, particularly in Sweden. These data were collected in early 2022, when COVID-19 vaccine coverage for 2 doses was nearly 90% of the eligible Swedish population. Since then, Sweden has experienced a decrease in the uptake of the third dose [
This study indicates that COVID-19 vaccine acceptance is not unchallenged and should be closely monitored to address emerging COVID-19 vaccine hesitancy. It also shows that social media studies provide valuable insights into the factors that shape public attitudes toward vaccination. Furthermore, the evidence illustrates that clear health communication and consistent messages are needed to maintain public trust. Moreover, this study emphasizes the importance of addressing the spread of rumors and misinformation to overcome COVID-19 vaccine hesitancy and its potential implications for future vaccines.
This study contributes to the existing literature on COVID-19 vaccines by exploring the attitudes of Swedish users on the web. Still, further social media studies are needed to explore and quantify attitudes toward COVID-19 vaccines on the entire spectrum of social media platforms.
Public trust in government, experts, and authorities can be reinforced by facilitating open dialogue and channels with the public. Furthermore, innovative approaches, such as internet-based interventions to address the growing web-based community, could be considered to increase public trust in COVID-19 vaccines. The Public Health Agency of Sweden and other health-related authorities should expand their presence on the web to provide accurate information on various social media platforms. Additional resources should be considered to increase the quality of vaccination services and the vaccination support system to provide opportunities for personalized consultations on vaccination.
This study shows that Swedish Twitter users engaged in discussing COVID-19 vaccination expressed safety and effectiveness concerns about COVID-19 vaccines and mistrust in governmental authorities, scientific organizations, and media agencies. The tweets indicated a fading belief in vaccination necessity linked to changes in the perceived severity of COVID-19 infection and belief in the superiority of natural immunity. In comparison, the quality of vaccination services was discussed less frequently; however, some complaints related to the limited availability of vaccination appointments did appear. Moreover, there was an observed information gap on COVID-19 and vaccines related to contradicting evidence and unanswered questions. The study highlights the importance of enhancing health communication, increasing public trust in the government, and countering misinformation.
application programming interface
Swedish Medical Products Agency
thematic analysis
World Health Organization
None declared.