COVID-19 Vaccine Intentions in the United States, December 2020 to March 2021

Importance SARS-CoV-2 containment is estimated to require attainment of high (>80%) post-infection and post-vaccination population immunity. Objective To assess COVID-19 vaccine intentions among US adults and their children, and reasons for vaccine hesitancy among potential refusers. Design Internet-based surveys were administered cross-sectionally to US adults during December 2020 and February to March 2021 (March-2021). Setting Surveys were administered through Qualtrics using demographic quota sampling. Participants A large, demographically diverse sample of 10,444 US adults (response rate, 63.9%). Main Outcomes and Measures COVID-19 vaccine uptake, intentions, and reasons for potential refusal. Adults living with or caring for children aged 2 to 18 years were asked about their intent to have their children vaccinated. Multivariable weighted logistic regression models were used to estimate adjusted odds ratios for vaccine refusal. Results Of 5256 March-2021 respondents, 3467 (66.0%) reported they would definitely or most likely obtain a COVID-19 vaccine as soon as possible (ASAP Obtainers), and an additional 478 (9.1%) reported they were waiting for more safety and efficacy data before obtaining the vaccine. Intentions for children and willingness to receive a booster shot largely matched personal COVID-19 vaccination intentions. Vaccine refusal (ie, neither ASAP Obtainers nor waiting for more safety and efficacy data) was most strongly associated with not having obtained an influenza vaccine in 2020 (adjusted odds ratio, 4.11 [95% CI, 3.05-5.54]), less frequent mask usage (eg, rarely or never versus always or often, 3.92 [2.52-6.10]) or social gathering avoidance (eg, rarely or never versus always or often, 2.65 [1.95-3.60]), younger age (eg, aged 18-24 versus over 65 years, 3.88 [2.02-7.46]), and more conservative political ideology (eg, very conservative versus very liberal, 3.58 [2.16-5.94]); all P<.001. Conclusions and Relevance Three-quarters of March-2021 respondents in our large, demographically diverse sample of US adults reported they would likely obtain a COVID-19 vaccine, and 60% of adults living with or caring for children plan to have them vaccinated as soon as possible. With an estimated 27% of the US population having been infected with SARS-CoV-2, once vaccines are available to children and they have been vaccinated, combined post-infection and post-vaccination immunity will approach 80% of the US population in 2021, even without further infections.

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Growing Need for Alternative Covid-19 Vaccination Strategy in the Face of Vaccination Uptake Hesitancy in the United States

Journal of Medical and Biological Science Research ◽

10.36630/jmbsr_21005 ◽

2021 ◽

Vol 7 (4) ◽

pp. 15-18

Author(s):

Nura Ikhalea ◽

◽

Hafsah Mohammed ◽

Nura Ikhalea ◽

Hafsah Mohammed ◽

...

Keyword(s):

Negative Impact ◽

Herd Immunity ◽

Vaccination Strategy ◽

The United States ◽

Vaccine Uptake ◽

Vaccine Hesitancy ◽

Ripple Effect ◽

The Us ◽

Legal Strategies ◽

Vaccine Information

There has been accelerated effort geared towards the swift creation of COVID-19 vaccines; however, this fast pace poses a negative impact on vaccine acceptance. The current US COVID vaccine hesitancy of 23-33% has a ripple effect and makes it impossible to attain community immunity. The primary aim of this study was to assess the current COVID vaccine hesitancy rates and to argue for the need of more effective strategies to improve its uptake in the US. This paper reviewed quantitative peer-reviewed publications assessing COVID vaccine hesitancy in the US. It was revealed that COVID-19 vaccine hesitancy was influenced by myriad factors like gender, education, political affiliation, race and location. Transparency and a mix of communication, local partnerships, incentives and arguably legal strategies can be adopted to attenuate US COVID vaccine hesitancy. Lastly, vulnerable demographics (black Americans and conservatives) need targeted COVID vaccine information. Keywords: Covid 19 Vaccines, Herd Immunity, Vaccine Uptake, Hesitancy and Vaccine Education

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Socioeconomic privilege and political ideology are associated with racial disparity in COVID-19 vaccination

Proceedings of the National Academy of Sciences ◽

10.1073/pnas.2107873118 ◽

2021 ◽

Vol 118 (33) ◽

pp. e2107873118

Author(s):

Ritu Agarwal ◽

Michelle Dugas ◽

Jui Ramaprasad ◽

Junjie Luo ◽

Gujie Li ◽

...

Keyword(s):

Racial Disparities ◽

Republican Party ◽

Political Ideology ◽

Adult Population ◽

The United States ◽

Vaccine Uptake ◽

Vaccine Hesitancy ◽

Median Income ◽

Structural Inequities ◽

The Impact

Vaccine uptake is critical for mitigating the impact of COVID-19 in the United States, but structural inequities pose a serious threat to progress. Racial disparities in vaccination persist despite the increased availability of vaccines. We ask what factors are associated with such disparities. We combine data from state, federal, and other sources to estimate the relationship between social determinants of health and racial disparities in COVID-19 vaccinations at the county level. Analyzing vaccination data from 19 April 2021, when nearly half of the US adult population was at least partially vaccinated, we find associations between racial disparities in COVID-19 vaccination and median income (negative), disparity in high school education (positive), and vote share for the Republican party in the 2020 presidential election (negative), while vaccine hesitancy is not related to disparities. We examine differences in associations for COVID-19 vaccine uptake as compared with influenza vaccine. Key differences include an amplified role for socioeconomic privilege factors and political ideology, reflective of the unique societal context in which the pandemic has unfolded.

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COVID-19 Vaccine Hesitancy in the United States: A Systematic Review

Frontiers in Public Health ◽

10.3389/fpubh.2021.770985 ◽

2021 ◽

Vol 9 ◽

Author(s):

Farah Yasmin ◽

Hala Najeeb ◽

Abdul Moeed ◽

Unaiza Naeem ◽

Muhammad Sohaib Asghar ◽

...

Keyword(s):

Systematic Review ◽

African Americans ◽

The United States ◽

Vaccine Uptake ◽

Vaccine Hesitancy ◽

Vaccine Acceptance ◽

Black African ◽

Income Status ◽

Pubmed Database ◽

The Us

Vaccine hesitancy in the US throughout the pandemic has revealed inconsistent results. This systematic review has compared COVID-19 vaccine uptake across US and investigated predictors of vaccine hesitancy and acceptance across different groups. A search of PUBMED database was conducted till 17th July, 2021. Articles that met the inclusion criteria were screened and 65 studies were selected for a quantitative analysis. The overall vaccine acceptance rate ranged from 12 to 91.4%, the willingness of studies using the 10-point scale ranged from 3.58 to 5.12. Increased unwillingness toward COVID-19 vaccine and Black/African Americans were found to be correlated. Sex, race, age, education level, and income status were identified as determining factors of having a low or high COVID-19 vaccine uptake. A change in vaccine acceptance in the US population was observed in two studies, an increase of 10.8 and 7.4%, respectively, between 2020 and 2021. Our results confirm that hesitancy exists in the US population, highest in Black/African Americans, pregnant or breastfeeding women, and low in the male sex. It is imperative for regulatory bodies to acknowledge these statistics and consequently, exert efforts to mitigate the burden of unvaccinated individuals and revise vaccine delivery plans, according to different vulnerable subgroups, across the country.

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COVID-19 Pediatric Vaccine Hesitancy among Racially Diverse Parents in the United States

Vaccines ◽

10.3390/vaccines10010031 ◽

2021 ◽

Vol 10 (1) ◽

pp. 31

Author(s):

Celia B. Fisher ◽

Aaliyah Gray ◽

Isabelle Sheck

Keyword(s):

Online Survey ◽

Community Support ◽

Vaccine Safety ◽

The United States ◽

Health Science ◽

Vaccine Uptake ◽

Vaccine Hesitancy ◽

Safety And Efficacy ◽

White Parents ◽

Race Ethnicity

On 29 October 2021, the U.S. FDA authorized the Pfizer-BioNTech COVID-19 (SARS-CoV-2) vaccine for emergency use in children ages 5–11 years. Racial/ethnic minorities have born the greatest burden of pediatric COVID-19 infection and hospitalization. Research indicates high prevalence of parental vaccine hesitancy among the general population, underscoring the urgency of understanding how race/ethnicity may influence parents’ decision to vaccinate their children. Two weeks prior to FDA approval, 400 Hispanic and non-Hispanic Asian, Black, and White parents of children 5–10 years participated in an online survey assessing determinants of COVID-19 pediatric vaccine hesitancy. Compared to 31% Black, 45% Hispanic, and 25% White parents, 62% of Asian parents planned to vaccinate their child. Bivariate and multivariate ordinal logistic regression demonstrated race/ethnicity, parental vaccine status, education, financial security, perceived childhood COVID-19 susceptibility and severity, vaccine safety and efficacy concerns, community support, and FDA and physician recommendations accounted for 70.3% of variance for vaccine hesitancy. Findings underscore the importance of multipronged population targeted approaches to increase pediatric COVID-19 vaccine uptake including integrating health science literacy with safety and efficacy messaging, communication efforts tailored to parents who express unwillingness to vaccinate, and interventions developed in partnership with and delivered through existing trusted community coalitions.

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Assessing the distribution and drivers of vaccine hesitancy using medical claims data

Online Journal of Public Health Informatics ◽

10.5210/ojphi.v9i1.7590 ◽

2017 ◽

Vol 9 (1) ◽

Cited By ~ 2

Author(s):

Sandra Goldlust ◽

Elizabeth Lee ◽

Shweta Bansal

Keyword(s):

United States ◽

Claims Data ◽

The United States ◽

Vaccine Uptake ◽

Vaccine Hesitancy ◽

Modeling Framework ◽

Medical Claims ◽

Vaccine Refusal ◽

The Social ◽

Disparate Data

ObjectiveThe purpose of this study was to investigate the use of large-scalemedical claims data for local surveillance of under-immunizationfor childhood infections in the United States, to develop a statisticalframework for integrating disparate data sources on surveillance ofvaccination behavior, and to identify the determinants of vaccinehesitancy behavior.IntroductionIn the United States, surveillance of vaccine uptake for childhoodinfections is limited in scope and spatial resolution. The NationalImmunization Survey (NIS) - the gold standard tool for monitoringvaccine uptake among children aged 19-35 months - is typicallyconstrained to producing coarse state-level estimates.1In recent years,vaccine hesitancy (i.e., a desire to delay or refuse vaccination, despiteavailability of vaccination services)2has resurged in the United States,challenging the maintenance of herd immunity. In December 2014,foreign importation of the measles virus to Disney theme parks inOrange County, California resulted in an outbreak of 111 measlescases, 45% of which were among unvaccinated individuals.3Digitalhealth data offer new opportunities to study the social determinantsof vaccine hesitancy in the United States and identify finer spatialresolution clusters of under-immunization using data with greaterclinical accuracy and rationale for hesitancy.4MethodsOur U.S. medical claims data comprised monthly reports ofdiagnosis codes for under-immunization and vaccine refusal(Figure 1). These claims were aggregated to five-digit zip-codes bypatient age-group from 2012 to 2015. Spatial generalized linear mixedmodels were used to generate county-level maps for surveillanceof under-immunization and to identify the determinants of vaccinehesitancy, such as income, education, household size, religious grouprepresentation, and healthcare access. We developed a Bayesianmodeling framework that separates the observation of vaccinehesitancy in our data from true underlying rates of vaccine hesitancyin the community. Our model structure also enabled us to borrowinformation from neighboring counties, which improves predictionof vaccine hesitancy in areas with missing or minimal data. Estimatesof the posterior distributions of model parameters were generated viaMarkov chain Monte Carlo (MCMC) methods.ResultsOur modeling framework enabled the production of county-levelmaps of under-immunization and vaccine refusal in the UnitedStates between 2012-2015, the identification of geographic clustersof under-immunization, and the quantification of the associationbetween various epidemiological factors and vaccination status.In addition, we found that our model structure enabled us to accountfor spatial variation in reporting vaccine hesitancy, which improvedour estimation.ConclusionsOur work demonstrate the utility of using large-scale medicalclaims data to improve surveillance systems for vaccine uptake andto assess the social and ecological determinants of vaccine hesitancy.We describe a flexible, hierarchical modeling framework forintegrating disparate data sources, particularly for data collectedthrough different measurement processes or at different spatial scales.Our findings will enhance our understanding of the causes of under-immunization, inform the design of vaccination policy, and aid inthe development of targeted public health strategies for optimizingvaccine uptake.Figure 1. Instances of vaccine refusal (per 100,000 population) for UnitedStates counties in 2014 as observed in medical claims data.

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Public perceptions of who counts as a scientist for controversial science

Public Understanding of Science ◽

10.1177/0963662519856768 ◽

2019 ◽

Vol 28 (7) ◽

pp. 797-811 ◽

Cited By ~ 4

Author(s):

Brianne Suldovsky ◽

Asheley Landrum ◽

Natalie Jomini Stroud

Keyword(s):

Climate Change ◽

Media Coverage ◽

Political Ideology ◽

Genetically Modified Organisms ◽

The United States ◽

Public Perceptions ◽

The Public ◽

The Us ◽

Science Media

In an era where expertise is increasingly critiqued, this study draws from the research on expertise and scientist stereotyping to explore who the public considers to be a scientist in the context of media coverage about climate change and genetically modified organisms. Using survey data from the United States, we find that political ideology and science knowledge affect who the US public believes is a scientist in these domains. Our results suggest important differences in the role of science media attention and science media selection in the publics “scientist” labeling. In addition, we replicate previous work and find that compared to other people who work in science, those with PhDs in Biology and Chemistry are most commonly seen as scientists.

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Protecting America’s borders: Christian nationalism, threat, and attitudes toward immigrants in the United States

Group Processes & Intergroup Relations ◽

10.1177/1368430220978291 ◽

2021 ◽

pp. 136843022097829

Author(s):

Rosemary L. Al-Kire ◽

Michael H. Pasek ◽

Jo-Ann Tsang ◽

Joseph Leman ◽

Wade C. Rowatt

Keyword(s):

Political Ideology ◽

The United States ◽

Political Orientation ◽

Religious Fundamentalism ◽

Immigration Policies ◽

Negative Attitudes ◽

Attitudes Toward Immigrants ◽

The Us ◽

Immigrant Policies ◽

Christian Nationalism

Attitudes toward immigrants and immigration policies are divisive issues in American politics. These attitudes are influenced by factors such as political orientation and religiousness, with religious and conservative individuals demonstrating higher prejudice toward immigrants and refugees, and endorsing stricter immigration policies. Christian nationalism, an ideology marked by the belief that America is a Christian nation, may help explain how religious nationalist identity influences negative attitudes toward immigrants. The current research addresses this through four studies among participants in the US. Across studies, our results showed that Christian nationalism was a significant and consistent predictor of anti-immigrant stereotypes, prejudice, dehumanization, and support for anti-immigrant policies. These effects were robust to inclusion of other sources of anti-immigrant attitudes, including religious fundamentalism, nationalism, and political ideology. Further, perceived threats from immigrants mediated the relationship between Christian nationalism and dehumanization of immigrants, and attitudes toward immigration policies. These findings have implications for our understanding of the relations between religious nationalism and attitudes toward immigrants and immigration policy in the US, as well as in other contexts.

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The comparison of vaccine hesitancy of COVID-19 vaccination in China and the United States

10.1101/2021.04.29.21256317 ◽

2021 ◽

Author(s):

Taoran Liu ◽

Zonglin He ◽

Jian Huang ◽

Ni Yan ◽

Qian Chen ◽

...

Keyword(s):

United States ◽

Propensity Score ◽

Propensity Score Matching ◽

Discrete Choice ◽

Choice Experiments ◽

The United States ◽

Discrete Choice Experiments ◽

Vaccine Hesitancy ◽

The Us ◽

The Cost

AbstractObjectivesTo investigate the differences in vaccine hesitancy and preference of the currently available COVID-19 vaccines between two countries, viz. China and the United States (US).MethodA cross-national survey was conducted in both China and the US, and discrete choice experiments as well as Likert scales were utilized to assess vaccine preference and the underlying factors contributing to the vaccination acceptance. A propensity score matching (PSM) was performed to enable a direct comparison between the two countries.ResultsA total of 9,077 (5,375 and 3,702, respectively, from China and the US) respondents have completed the survey. After propensity score matching, over 82.0% respondents from China positively accept the COVID-19 vaccination, while 72.2% respondents form the US positively accept it. Specifically, only 31.9% of Chinese respondents were recommended by a doctor to have COVID-19 vaccination, while more than half of the US respondents were recommended by a doctor (50.2%), local health board (59.4%), or friends and families (64.8%). The discrete choice experiments revealed that respondents from the US attached the greatest importance to the efficacy of COVID-19 vaccines (44.41%), followed by the cost of vaccination (29.57%), whereas those from China held a different viewpoint that the cost of vaccination covers the largest proportion in their trade-off (30.66%), and efficacy ranked as the second most important attribute (26.34%). Also, respondents from China tend to concerned much more about the adverse effect of vaccination (19.68% vs 6.12%) and have lower perceived severity of being infected with COVID-19.ConclusionWhile the overall acceptance and hesitancy of COVID-19 vaccination in both countries are high, underpinned distinctions between countries are observed. Owing to the differences in COVID-19 incidence rates, cultural backgrounds, and the availability of specific COVID-19 vaccines in two countries, the vaccine rollout strategies should be nation-dependent.

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A Community-Based Management of COVID-19 in a Mobile Container Unit

Vaccines ◽

10.3390/vaccines9111362 ◽

2021 ◽

Vol 9 (11) ◽

pp. 1362

Author(s):

Elena Petrova ◽

Timothy Farinholt ◽

Tejas P. Joshi ◽

Hannah Moreno ◽

Mayar Al Mohajer ◽

...

Keyword(s):

Healthcare Workers ◽

Vaccine Coverage ◽

The United States ◽

Vaccine Uptake ◽

Vaccine Hesitancy ◽

Air Filtration ◽

Clinical Environment ◽

Mobile Clinic ◽

Community Based ◽

Community Healthcare

Vaccine uptake is a multifactor measure of successful immunization outcomes that includes access to healthcare and vaccine hesitancy for both healthcare workers and communities. The present coronavirus disease (COVID-19) pandemic has highlighted the need for novel strategies to expand vaccine coverage in underserved regions. Mobile clinics hold the promise of ameliorating such inequities, although there is a paucity of studies that validate environmental infection in such facilities. Here, we describe community-based management of COVID-19 through a Smart Pod mobile clinic deployed in an underserved community area in the United States (Aldine, Harris County, TX, USA). In particular, we validate infection control and biological decontamination of the Smart Pod by testing surfaces and the air-filtration system for the COVID-19 virus and bacterial pathogens. We show the Smart Pod to be efficacious in providing a safe clinical environment for vaccine delivery. Moreover, in the Smart Pod, up-to-date education of community healthcare workers was provided to reduce vaccine hesitancy and improve COVID-19 vaccine uptake. The proposed solution has the potential to augment existing hospital capacity and combat the COVID-19 pandemic locally and globally.

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Overcoming COVID-19 Vaccine Hesitancy: Insights from an Online Population-Based Survey in the United States

Vaccines ◽

10.3390/vaccines9101100 ◽

2021 ◽

Vol 9 (10) ◽

pp. 1100

Author(s):

Hoda Badr ◽

Xiaotao Zhang ◽

Abiodun Oluyomi ◽

LeChauncy D. Woodard ◽

Omolola E. Adepoju ◽

...

Keyword(s):

Multivariable Analysis ◽

Health Belief ◽

The United States ◽

Population Based ◽

Vaccine Uptake ◽

Vaccine Hesitancy ◽

Individual Level ◽

Cues To Action ◽

Belief Model ◽

Population Based Survey

This study sought to identify individual-level determinants of COVID-19 vaccine hesitancy based on the Health Belief Model (HBM) and Theory of Planned Behavior (TPB). An online population-based survey was distributed in English and Spanish. Data were derived from 1208 U.S. adults (52% female; 38.7% minorities), 43.5% of whom reported vaccine hesitancy. Multivariable analysis revealed that unemployed individuals were more likely (OR = 1.78, 95% CI: 1.16–2.73, p = 0.009) and married (OR = 0.57, 95% CI: 0.39–0.81, p = 0.002) and higher income individuals (OR = 0.52, 95% CI 0.32–0.84, p = 0.008) were less likely to be hesitant. Individuals with greater perceived susceptibility to COVID-19 (OR = 0.82, 95% CI: 0.71–0.94, p = 0.006), who perceived vaccination as being convenient (OR = 0.86, 95% CI: 0.74–1.00, p = 0.047), and who afforded greater importance to cues to action from government (OR = 0.84, 95% CI: 0.74–0.95, p = 0.005), public health (OR = 0.70, 95% CI: 0.59–0.82, p < 0.001), and healthcare experts (OR = 0.59, 95% CI: 0.50–0.69, p < 0.001) were also less likely to be hesitant. Findings suggest that HBM and TPB constructs may be useful in informing strategies to improve COVID-19 vaccine uptake. Specifically, framing appeals based on perceptions of COVID-19 susceptibility, making vaccination convenient, and rebuilding trust through unified cues to action may help to overcome vaccine hesitancy.

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