Themes, Policies, and Attention Shifts Regarding COVID-19 Vaccinations in German-Speaking Regions: Infoveillance Study Using Tweets.

backgroundSocieties worldwide have witnessed growing rifts separating advocates and opponents of vaccinations and other COVID-19 countermeasures. With the rollout of vaccination campaigns, the European German-speaking region (Germany, Austria, and Switzerland) initially exhibited a noticeably low vaccination uptake compared to other European regions. Later, uptake increased. It remains unclear which factors contributed to these changes.

objectiveThis study aimed to shed light on the intricacies of vaccine hesitancy among the German-speaking population and the possible dynamics between policy changes and public concerns using web discourse data. These insights are valuable for policymakers tasked with making far-reaching decisions-policies need to effectively curb the spread of the virus and at the same time respect fundamental civil liberties and minimize undesired consequences.

methodsThis study drew on data from Twitter (subsequently rebranded X). We used a hybrid pipeline to detect and analyze 191,750 German-language vaccination-related tweets using a semiautomatic seed list generation approach, topic modeling, sentiment analysis, and a minimum of social scientific domain knowledge to evaluate the discourse about vaccinations in light of the COVID-19 pandemic. We further analyzed the evolution of public attention during different phases of the pandemic and in relation to policy changes to identify potential drivers of shifts in public attention.

resultsThe discourse concerning vaccinations was associated with more negative sentiments than the general discourse on German-speaking Twitter (47,159/191,750, 24.59% vs 1,758,776/12,297,163, 14.3% predominantly negative tweets, respectively). The relative frequencies of the discussed themes fluctuated heavily (eg, safety and side effects was the most dominant theme in wave 3 [1,611/9,179, 17.55%] but ranked 6th in wave 5 [428/4,865, 8.8%], and effectiveness of vaccinations ranked 7th in wave 3 [711/9,179, 7.75%] and 2nd in wave 5 [831/4,865, 17.08%]). In wave 3, vaccines were authorized, and vaccinations were suspended and resumed due to safety concerns. Later, policies were implemented that restricted the freedom of unvaccinated citizens. Change points in attention aligned better with policy actions than with pandemic phases. During the later phases, vaccination uptake increased (wave 2: 5.6%, wave 3: 47%, and wave 5: 74% compared to 30%, 62%, and 78%, respectively, in the United Kingdom), and so did the attention to freedom and civil liberties (wave 2: 1,139/6,595, 17.27%; wave 5: 1,403/4,865, 28.84%). Substantially increasing negative and stronger sentiments were expressed.

conclusionsOur analyses suggest potential interactions among policies, public attention to different topics, and associated sentiments. While vaccination uptake increased, our findings indicate that citizens' doubts and concerns did not decrease and that, rather than being fully persuaded, they remained skeptical. This study showcases that monitoring web discourse can provide valuable insights for data-driven policymaking in highly dynamic contexts such as the COVID-19 pandemic.