JMIR Publications

ABSTRACT

Background:

The autistic population is rapidly increasing; meanwhile autistic adults face disproportionate risks for adverse COVID-19 outcomes. Limited research indicates that autistic individuals have been accepting of initial vaccination, but research has yet to document this population’s perceptions and acceptance of COVID-19 boosters.

Objective:

The aim of this study is to identify person-level and community characteristics associated with COVID-19 vaccination and booster acceptance among autistic adults, along with self-reported reasons for their stated preferences. Understanding this information is crucial in supporting this vulnerable population given evolving booster guidelines, and the ending of the public health emergency for COVID-19.

Methods:

Data are from a survey conducted in Pennsylvania from April 11-September 12, 2022. Demographic characteristics, COVID-19 experiences, and COVID-19 vaccine decisions were compared across vaccination status groups. Chi-square analyses and one-way analysis of variance were conducted to test for significant differences. Vaccination reasons were ranked by frequency; co-occurrence was identified using phi-coefficient correlation plots.

Results:

Most autistic adults received or intended to receive the vaccine and booster (72.6%), 18.8% did not receive or intend to receive any vaccine, and 12.4% received or intended to receive the initial dose but were hesitant to accept booster doses. Reasons for vaccine acceptance or hesitancy varied by demographic factors and COVID-19 experiences. Among the most significant were previously contracting COVID-19, desire to access information about COVID-19, and discomfort with others not wearing a mask. County-level factors, including population density, and percentage of county to vote for President Biden were also significantly associated with differing levels of vaccination acceptance. Reasons for accepting the initial COVID-19 vaccine differed among those who were or were not hesitant to accept a booster dose. Those who accepted a booster were more likely to endorse protecting others and trusting the vaccine as the basis for their acceptance. On the other hand, those who were hesitant of the COVID-19 booster indicated their initial vaccine acceptance came from encouragement from someone they trusted. Among the minority of those hesitant to any vaccination, believing that the vaccine was unsafe and would make them feel unwell were most often reported.

Conclusions:

Intent or receiving the COVID-19 vaccination and booster was higher among autistic adults than the general population. Protecting others motivated vaccine acceptance, while safety concerns fueled vaccine hesitancy. These findings inform public health opportunities and strategies to further increase vaccination and booster rates among generally accepting autistic adults, to better support the already strained autism services and support system landscape. Vaccination uptake could be improved by leveraging passive information diffusion to combat vaccination misinformation among those not actively seeking COVID-19 information.