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

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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Hesitant or Not Hesitant? A Systematic Review on Global COVID-19 Vaccine Acceptance in Different Populations

Vaccines ◽

10.3390/vaccines9080873 ◽

2021 ◽

Vol 9 (8) ◽

pp. 873

Author(s):

Maria Giulia Salomoni ◽

Zeno Di Valerio ◽

Elisa Gabrielli ◽

Marco Montalti ◽

Dario Tedesco ◽

...

Keyword(s):

Systematic Review ◽

Geographical Origin ◽

Vaccine Hesitancy ◽

Vaccine Acceptance ◽

Public Health Systems ◽

Pubmed Database ◽

Collection Data ◽

Different Populations ◽

Acceptance Rates ◽

Study Setting

Vaccination currently appears to be the only strategy to contain the spread of COVID-19. At the same time, vaccine hesitancy (VH) could limit its efficacy and has, therefore, attracted the attention of Public Health Systems. This systematic review aimed at assessing anti-COVID-19 vaccine acceptance rates worldwide and at identifying populations more prone to vaccine hesitancy, for which specific interventions should be planned. PubMed database was searched using a purposely formulated string. One hundred out of the 9243 studies retrieved were considered pertinent and thus included in the analyses. VH rate was analyzed according to patient geographical origin, ethnicity, age, study setting, and method used for data collection; data from specific populations were separately analyzed. Overall, this study demonstrated significant differences in terms of VH in the general population and in the specific subgroups examined according to geographical, demographic factors, as well as associated comorbidities, underlining the need for purposely designed studies in specific populations from the different countries, to design targeted programs aimed at increasing awareness for confidence and complacency toward COVID-19 vaccines.

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A Theory-Based Analysis of COVID-19 Vaccine Hesitancy among African Americans in the United States: A Recent Evidence

Healthcare ◽

10.3390/healthcare9101273 ◽

2021 ◽

Vol 9 (10) ◽

pp. 1273

Author(s):

Manoj Sharma ◽

Kavita Batra ◽

Ravi Batra

Keyword(s):

African Americans ◽

Behavioral Interventions ◽

Health Behavior Change ◽

The United States ◽

Theory Model ◽

T Test ◽

Vaccine Uptake ◽

Vaccine Hesitancy ◽

Fourth Generation ◽

North East

African Americans have been disproportionately vaccinated at lower rates, which warrants the development of theory-based interventions to reduce vaccine hesitancy in this group. The fourth-generation theories, e.g., multi-theory model (MTM) of health behavior change, are vital in developing behavioral interventions. Therefore, the current study aims to determine recent trends in COVID-19 vaccination rates and to test the MTM model in predicting the initiation of COVID-19 vaccines among vaccine-hesitant Blacks. A sample of 428 unvaccinated African Americans were recruited through a web-based survey using a 28-item psychometric valid questionnaire. Chi-square, independent-samples-t-test or Welch’s t test, and Pearson’s correlation tests were utilized for the analyses. Hierarchical regression modelling was performed to determine the increment in variation accounted for through addition of predictors over a set of models. Nearly 48% of unvaccinated Blacks reported being vaccine-hesitant. The vaccine-hesitant group was relatively younger (40.5 years ± 15.8 vs. 46.2 years ± 17.4, p < 0.001), were Republicans (22.1% vs. 10.0%, p < 0.001), lived in the North-East region (26.0% vs. 11.4%, p < 0.001) and had religious affiliations other than Christianity (21.2% vs. 13.6%, p = 0.04). The mean scores of perceived advantages ((9.01 ± 3.10 vs. 7.07 ± 3.60, p < 0.001) and behavioral confidence (8.84 ± 3.76 vs. 5.67 ± 4.09, p < 0.001) were higher among vaccine non-hesitant group as opposed to the hesitant ones. In a final regression model, all MTM constructs) predicted nearly 65% of variance in initiating COVID-19 vaccination behavior among the vaccine-hesitant group (adjusted R2 = 0.649, F = 32.944, p < 0.001). With each unit increment in MTM constructs (e.g., participatory dialogue and behavior confidence), the initiation of COVID-19 vaccination among vaccine-hesitant Blacks increased by 0.106 and 0.166 units, respectively. Based on the findings of this study a m-health educational intervention to promote COVID-19 vaccine uptake behavior among Blacks is proposed.

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

10.1101/2021.05.16.21257290 ◽

2021 ◽

Author(s):

Mark É Czeisler ◽

Shantha M.W. Rajaratnam ◽

Mark E Howard ◽

Charles A Czeisler

Keyword(s):

Post Infection ◽

Political Ideology ◽

The United States ◽

Vaccine Uptake ◽

Vaccine Hesitancy ◽

Efficacy Data ◽

Post Vaccination ◽

Safety And Efficacy ◽

Vaccine Refusal ◽

The Us

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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Examining the Role of Family History of US Enslavement in Health Care System Distrust Today

Ethnicity & Disease ◽

10.18865/ed.31.3.417 ◽

2021 ◽

Vol 31 (3) ◽

pp. 417-424

Author(s):

Lorraine T. Dean ◽

Genee S. Smith

Keyword(s):

Health Care ◽

African American ◽

Family History ◽

African Americans ◽

Health Care System ◽

The United States ◽

Black African ◽

The Us ◽

History Of ◽

Care System

Objective: Black/African American people have long reported high, albeit warranted, distrust of the US health care system (HCS); however, Blacks/African Americans are not a homogenous racial/ethnic group. Little information is available on how the subgroup of Black Americans whose families suffered under US chattel slavery, here called Descendants of Africans Enslaved in the United States (DAEUS), view health care institutions. We compared knowledge of unethical treatment and HCS distrust among DAEUS and non-DAEUS.Design and Setting: A cross-sectional random-digit dialing survey was administered in 2005 to Blacks/African Americans, aged 21-75 years, from the University of Pennsylvania Clinical Practices in Philadelphia, Penn.Participants: Blacks/African Americans self-reported a family history of persons enslaved in the US (DAEUS) or no family history of persons enslaved in the US (non- DAEUS).Main Outcome Measures: HCS distrust was measured by a validated scale assessing perceptions of unethical experimentation and active or passive discrimination.Methods: We compared responses to the HCS distrust scale using Fisher’s exact and t-tests.Results: Of 89 respondents, 57% self-reported being DAEUS. A greater percentage of DAEUS reported knowledge of unethical treatment than non-DAEUS (56% vs 21%; P<.001), were significantly more likely to express distrust, and to endorse the presence of covert (eg, insurance-based) than overt forms (eg, race-based) of discrimination by the HCS.Conclusions: DAEUS express greater HCS distrust than non-DAEUS, patterned by awareness of unethical treatment and passive discrimination. Understanding how long-term exposure to US institutions influences health is critical to resolving disparities for all Black/African American groups. Rectifying past injustices through reparative institutional measures may improve DAEUS’ trust and engagement with the US HCS.Ethn Dis. 2021:31(3):417-424; doi:10.18865/ed.31.3.417

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Attitudes toward the SARS-CoV-2 Vaccine: Results from the Saudi Residents’ Intention to Get Vaccinated against COVID-19 (SRIGVAC) Study

Vaccines ◽

10.3390/vaccines9070798 ◽

2021 ◽

Vol 9 (7) ◽

pp. 798

Author(s):

Sami H. Alzahrani ◽

Mukhtiar Baig ◽

Mohammed W. Alrabia ◽

Mohammed R. Algethami ◽

Meshari M. Alhamdan ◽

...

Keyword(s):

Saudi Arabia ◽

Health Beliefs ◽

Multinomial Logistic Regression ◽

Demographic Data ◽

Vaccine Uptake ◽

Vaccine Hesitancy ◽

Relative Risk Ratio ◽

Cross Sectional ◽

Vaccine Acceptance ◽

Web Based

Vaccine uptake could influence vaccination efforts to control the widespread COVID-19 pandemic; however, little is known about vaccine acceptance in Saudi Arabia. The present study aimed to assess the Saudi public’s intent to get vaccinated against COVID-19 and explore the associated demographic determinants of their intentions as well as the reasons for vaccine hesitancy. A cross-sectional, web-based survey was distributed to public individuals in Saudi Arabia between 25 December 2020 and 15 February 2021. Participants were asked if they were willing to get vaccinated, and the responses, along with demographic data were entered into a multinomial logistic regression model to assess the relative risk ratio (RRR) for responding “no” or “unsure” versus “yes”. Among 3048 participants (60.1% female, 89.5% Saudi), 52.9% intend to get vaccinated, 26.8% were unsure, and 20.3% refused vaccination. Vaccine hesitancy was significantly higher among females (RRR = 2.70, p < 0.0001) and those who had not been recently vaccinated for influenza (RRR = 2.63, p < 0.0001). The likelihood was lower among Saudis (RRR = 0.49, p < 0.0001), those with less than a secondary education (RRR = 0.16, p < 0.0001), perceived risks of COVID-19, and residents of the southern region (RRR = 0.46, p < 0.0001). The most often cited reasons for hesitancy were short clinical testing periods and concerns about adverse events or effectiveness. Vaccine hesitancy is mediated by many demographic factors and personal beliefs. To address vaccine-related concerns and amend deeply rooted health beliefs, communication should provide transparent information.

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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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1172. SARS-CoV-2 Vaccine Hesitancy in Caregivers of Hospitalized Children

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab466.1365 ◽

2021 ◽

Vol 8 (Supplement_1) ◽

pp. S677-S677

Author(s):

Marisa Orbea ◽

Rachel Cunningham ◽

C Mary Healy ◽

Julie A Boom ◽

Claire Bocchini

Keyword(s):

Vaccine Uptake ◽

Vaccine Hesitancy ◽

Hospitalized Children ◽

Parent Attitudes ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Vaccine Acceptance ◽

And Behaviors ◽

Childhood Vaccines ◽

To Receive

Abstract Background SARS-CoV-2 vaccine hesitancy (VH) is hindering nationwide vaccination efforts; little is known about caregiver SARS-CoV-2 vaccine acceptance for children. We aimed to identify associations with SARS-CoV-2 VH in caregivers of hospitalized children. Methods We conducted a prospective cross-sectional survey in English and Spanish of caregiver COVID-19 knowledge, attitudes, behaviors, and associated VH among hospitalized children 6 months - 18 years at a large pediatric medical institution. Parents were approached daily, averaging 4-5 days/week, from 12/8/2020--4/5/2021. VH was assessed using the Parent Attitudes about Childhood Vaccines (PACV) survey; PACV score ≥50 denoted VH. Descriptive statistics and multivariable logistic regression were used. Responses were categorized. Results 295/307 (96%) of approached caregivers enrolled; 79% were ≥ 30 years, 68% were married/ living with a partner, and 57% had at least some college. 36% identified as white, 19% Black, and 46% Hispanic/ Latino. 53% of caregiver children had public insurance. 91% of caregivers self-reported their children were up to date with routine vaccines. 17% of caregivers were vaccine-hesitant overall. 50% of caregivers were willing to receive COVID-19 vaccine themselves. Figure 1 shows intention to vaccinate their child by PACV score. 65% knew someone who was hospitalized for COVID-19. 67% were scared of their child getting COVID-19. However, 49% were scared of their child getting the vaccine, 28% did not want to vaccinate their child and 27% were neutral in the intention to vaccinate their child. Caregivers who did not intend to vaccinate their child were more likely to be Black (27% vs. 16%, p=0.04) and less likely to be Hispanic/ Latino (33% vs. 49%, p=0.02). Table 1 shows attitudes, beliefs, and behaviors surrounding the COVID-19 pandemic and vaccine in caregivers who did or did not intend to vaccinate their child. Figure 1 COVID-19 vaccine uptake by PACV score Table 1 Caregiver attitudes, beliefs, and behaviors surrounding the COVID-19 pandemic and the COVID-19 vaccine Conclusion The majority of caregivers believe that SARS-CoV-2 vaccine will help control the pandemic, but less than half plan to vaccinate their children. A quarter of caregivers expressed uncertainty regarding the vaccine and therefore may be amenable to education and discussion. COVID-19 VH is different from VH towards routine vaccinations. More research is needed to address COVID-19 specific VH. Disclosures C. Mary Healy, MD, Dexcom (Shareholder)Intuitive (Shareholder)Quidel Corporation (Shareholder)Up to Date (Other Financial or Material Support, Honorarium)Vapotherm (Shareholder)

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Using an HIV Disclosure Model to Slow the Spread of COVID-19

Health Promotion Practice ◽

10.1177/15248399211035075 ◽

2021 ◽

pp. 152483992110350

Author(s):

Antonio J. Gardner ◽

Ashley White Jones

Keyword(s):

United States ◽

Primary Prevention ◽

The United States ◽

Hiv Disclosure ◽

Vaccine Hesitancy ◽

Community Settings ◽

Black African ◽

Disclosure Decisions ◽

Prevention Method ◽

Black Populations

Black/African American populations in the United States are disproportionately affected by the COVID-19 pandemic, and there is evidence suggesting that vaccine hesitancy is a concern among this group. As an alternative to the primary prevention method of vaccination, the tertiary method of disclosing one’s COVID-19 status after contracting the virus is of utmost importance in reducing the spread of the virus. Recommendations to inform disclosure decisions based on an HIV disclosure model can be applied to COVID-19-positive Black populations in clinical and community settings to reduce the spread of the virus among this population.

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