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HomeAmerican Journal of Epidemiologyindex/list_12208_1Determinants and Trends of COVID-19 Vaccine Hesitancy and Vaccine Uptake in a...

Determinants and Trends of COVID-19 Vaccine Hesitancy and Vaccine Uptake in a National Cohort of US Adults

Abstract and Introduction

Abstract

We estimated the trends and correlates of vaccine hesitancy and its association with subsequent vaccine uptake among 5,458 adults in the United States. Participants belonged to the Communities, Households, and SARS-CoV-2 Epidemiology COVID (CHASING COVID) Cohort, a national longitudinal study. Trends and correlates of vaccine hesitancy were examined longitudinally in 8 interview rounds from October 2020 to July 2021. We also estimated the association between willingness to vaccinate and subsequent vaccine uptake through July 2021. Vaccine delay and refusal decreased from 51% and 8% in October 2020 to 8% and 6% in July 2021, respectively. Compared with non-Hispanic (NH) White participants, NH Black and Hispanic participants had higher adjusted odds ratios (aOR) for both vaccine delay (for NH Black, aOR = 2.0 (95% confidence interval (CI): 1.5, 2.7), and for Hispanic, 1.3 (95% CI: 1.0, 1.7)) and vaccine refusal (for NH Black, aOR = 2.5 (95% CI: 1.8, 3.6), and for Hispanic, 1.4 (95% CI: 1.0, 2.0)) in June 2021. COVID-19 vaccine hesitancy, compared with vaccine-willingness, was associated with lower odds of subsequent vaccine uptake (for vaccine delayers, aOR = 0.15, 95% CI: 0.13, 0.18; for vaccine refusers, aOR = 0.02; 95% CI: 0.01, 0.03 ), adjusted for sociodemographic factors and COVID-19 history. Vaccination awareness and distribution efforts should focus on vaccine delayers.

Introduction

As the coronavirus disease 2019 (COVID-19) pandemic continues to be a health crisis globally, widespread vaccination is the most effective and sustainable long-term mitigation strategy. Thirteen safe and efficacious vaccines were developed and authorized worldwide within a span of a year since the World Health Organization (WHO) declared the COVID-19 outbreak a pandemic.[1] In the United States, as of September 2021, the Pfizer-BioNTech BNT162b2 vaccine (Pfizer, Inc., New York, New York, and BioNTech, Mainz, Germany)[2] is fully approved for adults, while the Moderna mRNA-1273 (ModernaTX, Inc., Cambridge, Massachusetts)[3] and the Janssen Ad26.COV2.S vaccines (Janssen Pharmaceuticals Companies of Johnson & Johnson, Beerse, Belgium)[4] are currently authorized for emergency use. The BNT162b2 and the mRNA-1273 vaccines are both 2-dose mRNA vaccines, while the Ad26.COV2.S vaccine is a single dose, nonreplicating viral vector vaccine. Among US residents 12 years or older, 62% have received at least 1 dose and 52.7% have been fully vaccinated as of September 2, 2021; however, vaccination rates vary by state and county, and demand for coronavirus vaccines has decreased in recent months.[5,6] As vaccine eligibility criteria expand and vaccine uptake increases, we would expect dramatic reductions in COVID-19 incidence, hospitalizations, and mortality in all age groups.[7]

For the COVID-19 vaccination program to be as impactful as possible, large numbers of people must be vaccinated quickly while also ensuring equity in access and uptake. Low vaccine acceptance and lack of easy access to vaccinations can be barriers to achieving both high and equitable vaccination coverage.[8] This could create vaccination cold spots where periodic disease outbreaks can still occur[9] and vaccine-resistant strains might evolve.[10] While antivaccine sentiment remains a threat to COVID-19 vaccine uptake in the United States, other factors, such as political mistrust, lack of assurance about safety and efficacy, and a lack of clear public health messaging may have influenced vaccine hesitancy specifically for coronavirus vaccines.[11] The rapid production of COVID-19 vaccines in less than a year may have engendered concerns among the public, considering the average vaccine development timeline spans around 10 years.[12] According to a Kaiser Family Foundation poll from August 2020, a majority (62%) of respondents believed that sociopolitical factors and pressures could lead to a rushed approval for the COVID-19 vaccine without assurances of safety and efficacy, and only 42% of the participants were willing to get the COVID-19 vaccine if approved before the US presidential elections in November 2020.[13] Based on a systematic review of surveys conducted between April and October 2020, the United States recorded lower intention to vaccinate against COVID-19 (ranging from 38% to 49% across regions) compared with other high-income countries such as Denmark (80%) and the United Kingdom (79%).[14]

Understanding COVID-19 vaccine hesitancy and addressing it promptly is essential for a successful and equitable vaccine roll-out. In this study, we aimed to 1) measure trends in vaccine hesitancy in the United States for adults; 2) identify subpopulations that might be less willing to be vaccinated; 3) examine sociodemographic and behavioral factors as well as COVID-related risk perceptions that correlate with vaccine hesitancy; and finally, 4) assess the association between vaccine hesitancy and subsequent vaccine uptake.

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