Who would take part in a pandemic preparedness cohort study? The role of vaccine-related affective polarisation: Cross-sectional survey

Aziz Mert Ipekci; Eva Maria Hodel; Maximilian Filsinger; Selina Wegmüller; Simone Schuller; Markus Freitag; Annika Frahsa; Gilles Wandeler; Nicola Low

doi:10.1371/journal.pone.0346420

Peer Review History

Original SubmissionOctober 13, 2025
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A summary table of these studies, categorized by variables influencing vaccine hesitancy and highlighting the most relevant aspects (country and years studied, methodology used, and results), would be very useful. Likewise, the "comparison with other studies" section should be more comprehensive, including more studies, and a table comparing the results of this work with those of others would also be helpful. Although the variables included in the quantitative analysis are correct and commonly included in this field of research, it should be discussed why affective polarization is included as a variable and not other political factors that empirical literature has shown to influence attitudes toward the Covid-19 pandemic, such as political ideology, political affiliation, and trust in the government and political institutions. Likewise, the exclusion of a highly likely relevant variable, identified by the authors, namely altruism, should be discussed. ****** -->6. 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Revision 1
12 Mar 2026 Author Response We would like to thank the editor and the reviewer for their comments and for the opportunity to revise our manuscript. We have numbered the editor’s and reviewer’s comments and copied them below. We respond to each comment and describe the changes made in the revised version of the manuscript. We give the line numbers for the location of the revised text in the clean version. Editor’s comments 1) If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter. Authors' response: We have added the financial disclosure statement to the cover letter. We have resubmitted the figure files, following the guidelines. 2) If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. Authors' response: The request does not apply to our study, which did not use laboratory-based methods. Nevertheless, we aimed to ensure reproducibility through detailed reporting of the study design, data sources, and analytical methods in the Methods section. 3) Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf Authors' response: We would like to thank the editor for this reminder. We have followed the style templates for the text and supplementary material and ensured they are correctly referenced throughout the manuscript. 4) Your ethics statement should only appear in the Methods section of your manuscript. If your ethics statement is written in any section besides the Methods, please delete it from any other section. Authors' response: We deleted the additional ethics statement at the end of the manuscript and retained the ethics statement only in the Methods section (page 4, lines 97-99). 5) Please provide a complete Data Availability Statement in the submission form, ensuring you include all necessary access information or a reason for why you are unable to make your data freely accessible. Authors' response: We thank the editor for this request. We appreciate the benefits of publicly available datasets. Due to concerns about the potential for identifying individuals, our data cannot be shared publicly. Please find our Data Availability statement in our response to point 6, below. 6) We note that you have indicated that there are restrictions to data sharing for this study. For studies involving human research participant data or other sensitive data, we encourage authors to share de-identified or anonymized data. However, when data cannot be publicly shared for ethical reasons, we allow authors to make their data sets available upon request. For information on unacceptable data access restrictions, please see http://journals.plos.org/plosone/s/data-availability#loc-unacceptable-data-access-restrictions. If there are ethical or legal restrictions on sharing a de-identified data set, please explain them in detail (e.g., data contain potentially identifying or sensitive patient information, data are owned by a third-party organization, etc.) and who has imposed them (e.g., a Research Ethics Committee or Institutional Review Board, etc.). Please also provide contact information for a data access committee, ethics committee, or other institutional body to which data requests may be sent. Please update your Data Availability statement in the submission form accordingly. Authors' response: Our Data Availability statement has been updated in the submission form, and reads. “The data from this study are not publicly available because of the risk of identification of an individual participant. Some municipalities in the study area had very few respondents, and the characteristics reported could be combined to identify a person. Data are available upon reasonable request. Researchers interested in accessing the data from this online survey can request it by contacting the project management team at BEready.mcid@unibe.ch or by filling in the request form (https://www.beready.unibe.ch/for_researchers/). De-identified data will be made available to qualified researchers for approved analyses, and access will be granted following review and approval of a study proposal, establishment of a data use and transfer agreement, and successful ethical approval. Restrictions may apply depending on the specific nature of the data requested to ensure participant privacy and compliance with institutional policies. A shared dataset will exclude study participants from municipalities with fewer than 5 respondents. Fees may apply for data preparation and transfer, depending on the nature of the collaboration. We encourage multidisciplinary collaboration on projects that align with the goals of our study, particularly those focused on pandemic preparedness.” 7) We note that the grant information you provided in the ‘Funding Information’ and ‘Financial Disclosure’ sections do not match. When you resubmit, please ensure that you provide the correct grant numbers for the awards you received for your study in the ‘Funding Information’ section. Authors' response: We confirm that we have written the same grant numbers in the ‘Funding Information’ and ‘Financial Disclosure’ sections. The wording of the Financial Disclosure (p18, lines 381-383) is, “This work was supported by the Multidisciplinary Center for Infectious Diseases, University of Bern (grant number MA21 awarded to AF, MarF, NL and the BEready project, no grant number, awarded to NL, GW).” Please note that this statement lists more than one co-author for each grant. The automated Funding Information section in the submission portal only allows one co-author to be associated with a grant, so this information only includes the first of the authors listed in the statement. 8) We note that Figure 1 in your submission contain [map/satellite] images which may be copyrighted. All PLOS content is published under the Creative Commons Attribution License (CC BY 4.0), which means that the manuscript, images, and Supporting Information files will be freely available online, and any third party is permitted to access, download, copy, distribute, and use these materials in any way, even commercially, with proper attribution. Authors' response: We appreciate the editors for pointing this out. We have received confirmation from Swiss Federal Office of Public Health, in an email dated 25.02.2026, that, “There are no fees or special authorization for using standard services (Internet). It is important to cite the source (‘Federal Statistical Office, name of statistics + year’ <e.g. ‘Federal Statistical Office, Structural Survey 2017’>).” Figure 1 was created using two datasets: swissBOUNDARIES3D and the official directory of towns and cities, both published by the Federal Office of Topography swisstopo (swisstopo.admin.ch), and the lakes and rivers 2025_GEOM_TK dataset of Swiss Federal Statistical Office (bfs.admin.ch). We have added citations to the Federal Office of Topography and the Federal Statistical Office (ref 31, 32) and web addresses to the caption of Figure 1 (page 9, line 214-218). 9) Please include captions for your Supporting Information files at the end of your manuscript, and update any in-text citations to match accordingly. Please see our Supporting Information guidelines for more information: http://journals.plos.org/plosone/s/supporting-information. Authors' response: We have included captions for our Supporting Information files at the end of our manuscript (page 27, lines 560-569). We have reorganised the supplementary materials to comply with the journal’s requirements and matched all in-text citations accordingly. 10) If the reviewer comments include a recommendation to cite specific previously published works, please review and evaluate these publications to determine whether they are relevant and should be cited. There is no requirement to cite these works unless the editor has indicated otherwise. Authors' response: Thank you for this advice. The reviewer did not ask us to cite specific works. The reviewer did ask us to provide additional citations to support statements in the Introduction and Discussion, Comparison with other studies sections. We agreed with the comments and chose relevant references ourselves. In the Introduction, we added one reference (number 18). In the discussion, we added two references (numbers 38 and 39). 11) Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice. Authors' response: We have verified that our reference list contains no retracted articles. Our response to the reviewer includes all additional references, and the location in the text where they are cited. Reviewer’s comments 1) A "literature review" section (immediately before the "Methods" section) should be included to strengthen the work by providing arguments in favor of the variables included in the quantitative analysis. In this regard, the "literature review" section should reference empirical studies on vaccine hesitancy, particularly for COVID-19. A summary table of these studies, categorized by variables influencing vaccine hesitancy and highlighting the most relevant aspects (country and years studied, methodology used, and results), would be very useful. Authors' response: Thank you for the feedback about the need for a relevant literature review in the Introduction. We appreciate the opportunity to clarify the scope of our work. We apologise if we gave the reviewer the wrong impression about the subject of our study. To clarify, we have not used the words ‘vaccine hesitancy’ in any part of the manuscript. Our paper is about willingness to take part in research about pandemic preparedness – and how this might be affected by people’s feelings and opinions. We assessed feelings using a measure of affective polarisation in relation to views about COVID-19 vaccination – both positive and negative. Our review of the literature in the Introduction therefore included: studies about factors associated with willingness to participate in research before the COVID-19 pandemic (refs 4-6, cited p3); reasons why the COVID-19 pandemic might have affected willingness to participate (refs 7-11, cited p3); and the relevance of polarisation and affective polarisation (refs 12-17, cited p4). To address the reviewer’s comment, we made changes to: - Abstract: we have made the subject of the study clearer at the start of the Abstract, “Willingness to participate in research is associated with multiple factors. Little is known about the role of people’s feelings, especially in the aftermath of the COVID-19 pandemic.” (page 2, lines 21-24). - Introduction: we added a new reference, which is a systematic review about affective polarisation related to COVID-19 vaccination “Whilst affective polarisation was first defined and studied in the United States of America to understand [14], the COVID-19 pandemic revealed associations between affective polarisation and health behaviours such as COVID-19 vaccination uptake, adherence to pandemic countermeasures or anxiety about COVID-19 [14-18]” (page 3, line 80, ref 18). We have followed the submission guidelines of the journal to provide “a brief review of the key literature.” Given that our literature review covers a range of different issues to put the study into context, we did not think it appropriate to tabulate these studies. 2) Likewise, the "comparison with other studies" section should be more comprehensive, including more studies, and a table comparing the results of this work with those of others would also be helpful. Authors' response: We thank the reviewer for this constructive suggestion. We have expanded the "Comparison with other studies" section. We added two relevant studies (refs 38, 39), giving examples of other types of population-based health research (page 16, line 308-312), “Similarly, a large European survey involving 32 countries found that 53.3% of respondents were willing to provide personal information to a biobank [38]. In Australia, a telephone survey found that 61% of respondents were willing to participate in health research in general, with willingness increasing when specific information about the study was provided [39].” We believe that the six cited studies provide a concise but sufficient narrative overview of the current literature. Regarding the suggested table, we would like to retain the description within the narrative of the text. These studies are examples of other types of research about willingness to participate. We feel that a table with detailed study-level information might give the impression of a comprehensive systematic literature search, which is beyond the scope of our study. We believe that introducing a table with a large amount of additional data at this stage might confuse the reader, potentially distracting from the primary focus of our study. 3) Although the variables included in the quantitative analysis are correct and commonly included in this field of research, it should be discussed why affective polarization is included as a variable and not other political factors that empirical literature has shown to influence attitudes toward the Covid-19 pandemic, such as political ideology, political affiliation, and trust in the government and political institutions. Authors' response: We thank the reviewer for this comment and for the opportunity to articulate our choices more clearly. We agree that there is already empirical literature about political factors. We now acknowledge this explicitly in the Introduction (page 3-4, lines 72-74), “Political polarisation, according to ideology, partisan affiliation or trust in political institutions, has characterised responses to many aspects of COVID-19 prevention [12-13].” We found a gap in the evidence about the role of affective polarisation, however. We have revised the introduction to make this point more clearly (page 4, lines 80-84), “Measures of people’s feelings about public health measures such as COVID-19 vaccination, and how they view others, are more proximate to health-associated behaviours than partisan or ideological differences. Whether affective polarisation is associated with willingness to take part in research about pandemics more generally is not well understood.” In practice, the number of questions permitted in the questionnaire was restricted. We acknowledge this limitation in the Discussion, Strengths and limitations, including three new references (33, 34, 35) (page 16, lines 289-293), “Third, the number of questions in the survey was restricted since a lengthy questionnaire might have decreased the response rate [33]. Whilst there is evidence that political ideology and trust in government institutions are associated with an individual’s willingness to participate in scientific research [34, 35], we were not able to include questions about a broader range of political variables.” 4) Likewise, the exclusion of a highly likely relevant variable, identified by the authors, namely altruism, should be discussed. Authors' response: We thank the reviewer for raising this important point. We agree that altruism is indeed a relevant factor in willingness to participate in research. Unfortunately, it was not measured as a standalone variable in our survey and therefore coul Attachments Attachment Submitted filename: PLOSOne Reviewer comments_formatted_offline.docx https://doi.org/10.1371/journal.pone.0346420.r002
19 Mar 2026 Decision Letter - Angelo Moretti, Editor Who would take part in a pandemic preparedness cohort study? The role of vaccine-related affective polarisation: cross-sectional survey PONE-D-25-54952R1 Dear Dr. Low, We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements. Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication. An invoice will be generated when your article is formally accepted. Please note, if your institution has a publishing partnership with PLOS and your article meets the relevant criteria, all or part of your publication costs will be covered. 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The conclusions must be drawn appropriately based on the data presented. --> Reviewer #1: Yes ****** -->3. Has the statistical analysis been performed appropriately and rigorously? --> Reviewer #1: Yes ****** -->4. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.-->requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.--> Reviewer #1: Yes ****** -->5. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.--> Reviewer #1: Yes ****** -->6. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)--> Reviewer #1: (No Response) ****** -->7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.). If published, this will include your full peer review and any attached files.). If published, this will include your full peer review and any attached files.). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our For information about this choice, including consent withdrawal, please see our For information about this choice, including consent withdrawal, please see our For information about this choice, including consent withdrawal, please see our Privacy Policy..-->..--> Reviewer #1: Yes:Pedro Atienza MonteroPedro Atienza MonteroPedro Atienza MonteroPedro Atienza Montero ******** https://doi.org/10.1371/journal.pone.0346420.r003
Formally Accepted
Acceptance Letter - Angelo Moretti, Editor PONE-D-25-54952R1 PLOS One Dear Dr. Low, I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS One. Congratulations! Your manuscript is now being handed over to our production team. At this stage, our production department will prepare your paper for publication. This includes ensuring the following: * All references, tables, and figures are properly cited * All relevant supporting information is included in the manuscript submission, * There are no issues that prevent the paper from being properly typeset You will receive further instructions from the production team, including instructions on how to review your proof when it is ready. Please keep in mind that we are working through a large volume of accepted articles, so please give us a few days to review your paper and let you know the next and final steps. Lastly, if your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. You will receive an invoice from PLOS for your publication fee after your manuscript has reached the completed accept phase. If you receive an email requesting payment before acceptance or for any other service, this may be a phishing scheme. Learn how to identify phishing emails and protect your accounts at https://explore.plos.org/phishing. If we can help with anything else, please email us at customercare@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Dr. Angelo Moretti Academic Editor PLOS One https://doi.org/10.1371/journal.pone.0346420.r004

Open letter on the publication of peer review reports

PLOS recognizes the benefits of transparency in the peer review process. Therefore, we enable the publication of all of the content of peer review and author responses alongside final, published articles. Reviewers remain anonymous, unless they choose to reveal their names.

We encourage other journals to join us in this initiative. We hope that our action inspires the community, including researchers, research funders, and research institutions, to recognize the benefits of published peer review reports for all parts of the research system.

Learn more at ASAPbio .