AbstractIntroductionCOVID-19 vaccine hesitancy increased among US adults April-December, 2020, and threatens efforts to end the pandemic. Among US adults 18-64 years, we report prevalence of and reasons for vaccine hesitancy, overall and by employment and occupation, during the COVID-19 vaccine rollout.MethodsThe Delphi Group at Carnegie Mellon University conducted a COVID-19 survey administered by Facebook. In January, February and March, 2021, 791,716, 710,529, and 732,308 Facebook users, respectively, reported age 18-64 years and answered a vaccine acceptance question. Weights matched the sample to the age, gender, and state profile of the US population. Percentages and risk ratios (RR) for vaccine hesitancy were estimated using a weighted Poisson regression; 95% confidence intervals (CI) were calculated using robust standard errors.ResultsVaccine hesitancy decreased among adults 18-64 years from January (27.5% [95%CI, 27.3-27.6]) to March (22.1% [95%CI, 21.9-22.2]). Vaccine hesitancy varied widely by occupational category: 9.6%, (95%CI, 8.5-10.7) in life/physical/social sciences to 46.4% (95%CI, 45.1-47.7) in construction/extraction. Almost half (47.9%, 95%, 47.6-48.3) of hesitant participants indicated concern about side effects, and over a third didn’t believe they needed the vaccine, didn’t trust the government, were waiting to see if it was safe, and didn’t trust COVID-19 vaccines (versus 14.5% [95%CI, 14.3-14.8] who didn’t like vaccines in general).ConclusionsIn this nationally representative survey of adults 18-64 years, vaccine hesitancy decreased to 22.1% by March, 2021. Still, hesitancy, which varies widely by occupation, remains a barrier to pandemic control. Reasons for hesitancy indicate messaging about safety and addressing trust are paramount.