The Determinants of Covid-19 Vaccine Uptake in Americans

A national survey of US adults about the Covid-19 vaccine provides information that could be used to promote vaccination.

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As the Covid-19 pandemic was raging, vaccines against Covid-19 were developed and deployed at ‘warp’ speed. With this, the question of vaccine acceptance by the public became the focus of discussion. Countries assumed to have brought the disease under control are facing subsequent surges in infection, and it is critical to get more people vaccinated to reach herd immunity.

The World Health Organization reports that vaccination programs save millions of lives every year. Despite the strong science, and solid public health reasons to vaccinate, the proportion of people questioning vaccines is a growing threat.

Despite the profound and broad-ranging impact of the pandemic, the fact that certain people across the globe continue to hesitate to get vaccinated is reason to study the factors that drive intentions to vaccinate. We surveyed a nationally representative sample of American adults and found that only 65-68% of the sample was willing to get a Covid-19 vaccine for themselves or for children. Many factors influence people’s decision to vaccinate, and we examined a number of them in our study to understand the reasons behind their intention to vaccinate or not.

We found that Americans who felt that they were more susceptible to Covid-19 and at risk for severe illness were more willing to vaccinate themselves and people under their care than those who felt a low sense of vulnerability. This is in line with previous research demonstrating that risk perceptions play a role in vaccination.

Our study results suggest that Americans with confidence in scientists are more likely to vaccinate self or children compared to those with less confidence.

Previous studies have shown that trust in information sources such as government, medical authorities, and physicians is critical to vaccination intentions and behaviors. Our study results suggest that Americans with confidence in scientists are more likely to vaccinate self or children compared to those with less confidence. Political ideology (party identification) was also strongly associated with an unwillingness to get the Covid-19 vaccine.

The Covid-19 ‘infodemic’ has made it clear that the media platforms we turn to for Covid-19 news influence vaccination decisions. We found that people who relied on mainstream print outlets such as The New York Times or Washington Post as their primary news source were more willing to vaccinate self and children compared to those who got their information from other sources, especially “conservative” news sources such as Fox News.  Despite social media receiving significant importance as a source of both health information and misinformation, it was not a direct factor in determining individual vaccine uptake in our study.

Covid-19 has disproportionately affected people with lower socioeconomic status and from minority racial and ethnic groups. Despite their high vulnerability, these groups have been less receptive of vaccines. The fact that non-Hispanic Blacks were least likely to get a Covid-19 vaccine in our study is not surprising given the history of mistrust going back to the Tuskegee study and perpetuated by medical and structural racism. We must understand the reasons for reluctance and address communication inequalities  to find the best strategies to reach different groups.

The data from our representative national survey show that deployment of vaccines is necessary but not enough to improve widespread acceptance across the broad spectrum of American experience. We need to organize a pro-active communication campaign strategy to elevate perceptions of risk, increase trust, and ensure that that vaccination access is uniform across different population groups.

Even though vaccination of most US residents has been moving at a rapid clip, we are still short of the goal articulated by President Biden. There are many regions of the country where vaccination rates remain well below what is needed. This calls for more urgent, aggressive and strategically designed efforts to persuade people and our study points to some helpful ways that this can be done.

Adapted from: “Viswanath K, Bekalu M, Dhawan D, Pinnamaneni R, Lang J, McLoud R. Individual and social determinants of Covid-19 vaccine uptake. BMC Public Health. 2021 Apr 28;21(1):818. doi: 10.1186/s12889-021-10862-1. PMID: 33910558; PMCID: PMC8081000.”

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