Study population and setting
In May 2020, 2,006 adults across 50 US States and the District of Columbia were recruited to participate in an online survey assessing willingness to receive a hypothetical vaccine against SARS-CoV-2 when one became available. COVID-19 vaccination intention was measured in a single survey question, but the investigators collapsed response categories, comparing participants who reported “probable” or “definite” willingness to receive a vaccine to those who expressed uncertainty (“not sure”) or reluctance (“probably not willing” or “definitely not willing”).
Summary of Main Findings
A majority (69% total; 48% “definitely” and 21% “probably”) of participants expressed willingness to receive a COVID-19 vaccine when one became available; 17% of participants reported uncertainty about accepting a COVID-19 vaccine in the future. When adjusting for other factors, willingness to accept a COVID-19 vaccine was significantly higher among participants who were male (75% vs. 64%, p<0.01), who lived in households with annual incomes above $50,000 (76% vs. 62% p<0.05), who espoused moderate or liberal political beliefs (73% vs. 59%, p<0.05), who reported a prior COVID-19 diagnosis (85% vs. 68%, p<0.05), and who thought a healthcare provider would recommend the vaccine (76% vs. 30%, p<0.01). Individuals who perceived themselves as susceptible to COVID-19 (prevalence ratio [PR]: 1.05, 95% confidence interval [CI]: 1.01–1.09), who feared severity of COVID-19 infection (PR 1.08, 95% CI: 1.04–1.11), or who perceived a COVID-19 vaccine as effective in preventing disease (PR 1.46, 95% CI: 1.40–1.52) were also significantly more likely to express willingness to receive a COVID-19 vaccine. Uninsured individuals (50% vs. 71%, p<0.05) and participants who expressed concerns about harms associated with COVID-19 vaccination (PR 0.95, 95% CI: 0.92–0.98) were significantly less likely to express willingness to receive a COVID-19 vaccine. Relative to non-Latinx white participants, non-Latinx Black participants were significantly less likely to declare intention to receive a COVID-19 vaccine in the future, and Latinx participants were no more or less willing than non-Latinx white participants to endorse willingness to receive a COVID-19 vaccine. Among factors impacting COVID-19 vaccination intentions, vaccine effectiveness, physician recommendations, personal health history, and COVID-19 burdens in the community were cited most frequently and at higher rates among participants expressing willingness to receive a COVID-19 vaccine, relative to those who were unwilling or uncertain. Potential vaccine side effects were the only factor cited more frequently among participants who were unwilling or uncertain about receiving a COVID-19 vaccine, relative to those who expressed willingness to receive a vaccine.
The study population included a relatively heterogeneous sample of adults across income strata, racial identities, and residence settings. Vaccine intentions were also measured using an ordinal Likert scale, which allowed investigators to assess COVID-19 vaccine acceptance along a continuum. Factors shaping decision-making around vaccination intentions were also collected in the survey, which are seldom measured in survey research on COVID-19 prevention.
In their statistical models, the investigators collapsed vaccine willingness response options into a binary item; this could result in misclassification of participant’s vaccine intentions and produce misleading results, especially if individuals who are uncertain about accepting a COVID-19 vaccine are substantially different from individuals who express hesitancy and willingness, respectively, to receive a COVID-19 vaccine. Because the study population was an online convenience sample, findings may not be generalizable to the broader U.S. adult population, since participants may be substantially different from non-participants. Lastly, the survey measured intentions to accept a hypothetical COVID-19 vaccine, which had not been developed when this study was conducted; self-reported intentions may, therefore, not reflect actual vaccine uptake behaviors once a COVID-19 vaccine is offered to participants.
This study highlights sociodemographic and social disparities in self-reported COVID-19 vaccine intentions among U.S. adults, which can support targeted communication efforts to increase vaccine demand in subpopulations expressing higher degrees of COVID-19 vaccine uncertainty or hesitancy.
This review was posted on: 26 February 2021