Predictors of intention to vaccinate against COVID-19: Results of a nationwide survey
Introduction
An epidemic of severe acute respiratory disease linked to a new strain of coronavirus (COVID-19) emerged in late December 2019 in Wuhan, China [1]. By mid-October 2020, the number of documented cases and deaths reported globally exceeded 38 million and 1.08 million, respectively [2]. Within the U.S., there have been more than 7.8 million cases, resulting in over 216,000 deaths at the time of this writing [2]. The COVID-19 illness spectrum is broad, ranging from asymptomatic infection to acute respiratory distress syndrome, culminating in death [3].
Dozens of vaccine development programs have been initiated in response to the pandemic [4]. Once a vaccine is approved, high rates of vaccine uptake will be required to protect human health [1]. If seasonal influenza vaccination rates are any indication, acceptance of a COVID-19 vaccine in the U.S. will be suboptimal [5]. The lethality of COVID-19 should encourage high rates of immunization when a vaccine becomes available. Unfortunately, recent public opinion polls in the U.S. suggest otherwise, with 20–27% of the public reporting that they will decline to get vaccinated against the virus [6], [7], [8].
An understanding of the factors that foster COVID-19 vaccination hesitancy is critically important. To overcome people’s doubts about such vaccines, robust public health campaigns must be developed and sustained. Effective public communication requires formative research that explicates the knowledge deficits, attitudes, beliefs, health perceptions and demographic characteristics that give rise to anticipated COVID-19 vaccine hesitancy.
This study had four objectives. First, we measured intention to vaccinate against COVID-19 if and when a vaccine becomes available. Vaccine safety concerns, in particular, have been shown to adversely affect vaccination decisions. Such concerns may be amplified by efforts to expedite COVID-19 vaccine development [9]. Other potential reasons assessed include worries about vaccine effectiveness, assumptions about one’s personal susceptibility to and severity of COVID-19, the possibility of being immune from a past COVID-19 infection, to name a few.
Second, we sought a demographic and health status profile of individuals least likely to vaccinate. Given the extensive media coverage of the pandemic, we predicted that most individuals are aware of the risk factors associated with COVID-19 and thus expected intent to vaccinate to be strongest for respondents with these factors [10]. These groups include men, people aged 65 and over, individuals with pre-existing conditions, and minorities [11], [12]. While we know of no research on the matter, a potential geographic predictor of intent to vaccinate is living in the Northeast part of the country, the first epicenter of the pandemic in the U.S. Regarding health predictors, we predicted that intentions would be strongest for those with more of the pre-existing health conditions that make one susceptible to COVID-19. It was also our expectation that being vaccinated against influenza in the current flu season would serve as a marker for strong COVID-19 vaccination intentions.
Third, we investigated the role played by general vaccine knowledge, vaccine conspiracy beliefs, and perceived susceptibility to and severity of COVID-19 in people’s intentions to get a COVID-19 vaccine [13], [14], [15]. Previous studies found that people who are educated about the benefits of vaccination and the significance of herd immunity are more accepting of vaccines [16]. We thus expected that those with lower vaccine knowledge would be less likely to report a willingness to vaccinate against COVID-19. Similarly, conspiracy beliefs about vaccinations can exacerbate vaccination hesitancy [17], and we expected this to be no different for any COVID-19 vaccine that comes to market. Perception of one’s personal vulnerability to serious harm from COVID-19 were also hypothesized to enhance vaccination intentions [18]. This approach is supported by the Health Belief Model tenet that people will take action if they regard themselves as susceptible to COVID-19 and if they believe COVID-19 poses a serious threat [13], [14], [15].
Fourth, we sought to cast light on the role of media and partisan politics in resistance to vaccination. Vaccine conspiracy beliefs are often spread through conservative media sources, so those who consume conservative media are expected to have weaker intentions to vaccinate against COVID-19 [8], [19]. The possibility of a COVID-19 vaccine, in particular, has often been framed in partisan terms by the media [8]. Thus, a concern of this study was to assess the impact of people’s main media source of COVID-19 information on vaccine hesitancy. Although our analyses were exploratory, we did predict that a preference for Fox News and social media to be associated with weaker intentions to vaccinate against COVID-19.
Section snippets
Survey sample
The sample consisted of 804 compensated English-speaking adults residing in the U.S. Respondents were recruited through the Dynata Samplify platform (www.dynata.com) from this survey firm’s panel of 2.5 million U.S. residents. A nationwide nonprobability quota sampling design was employed to create a sample representative of the nation with regard to region of residence, gender, and age. The questionnaire was hosted on the Qualtrics survey platform (www.qualtrics.com). Data were collected over
Preliminary analyses
The sample is described in Table 1. By design, the quota sample was representative of the U.S. population in terms of region of residence, sex, and age, but also diverse with regard to all demographic variables assessed. Means, standard deviations, and reliabilities for the primary study variables are reported in Table 2. The composite variables reported in the table were based on an averaging of items. Scale reliabilities were high. The mean vaccination knowledge score was only slightly above
Discussion
Vaccination remains the most effective public health approach to disease prevention, but is undermined by vaccine refusal [24]. Results of this national survey support four broad conclusions. First, the survey confirms previous polling that suggests hesitancy will be a challenge when novel COVID-19 vaccines become available. More than one third of our respondents were either not likely to get a COVID-19 vaccine or unsure about doing so. Those respondents with a disinclination to be vaccinated
Declaration of Competing Interest
The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
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