Predictors of willingness to get a COVID-19 vaccine in the U.S

As nations across the globe continue to distribute COVID-19 vaccinations to eligible individuals, some health officials argue that the time is fast approaching when issues with logistics and short supply will be replaced by the need to reach those who are more reluctant to vaccinate [1, 2]. A global study found that 72% of people would take a Covid-19 vaccine if proven safe and effective, but willingness varied widely between nations [3]. Studies in Australia and Indonesia have found that willingness varies widely depending on the vaccine’s effectiveness and that safety is a concern [4, 5].

Given the unique features of this particular virus—its highly contagious nature, high severity for certain groups, and the significant impact it has had on people’s daily lives through social distancing and business closures—we sought to better understand the American public’s willingness to get a COVID-19 vaccine. We also sought to characterize willingness among groups most at risk for severe COVID-19 (e.g., people age 65 or older, those with specific underlying medical conditions, or with a body mass index (BMI) > 40; and Black and Hispanic Americans) [6]. We examined these questions in a national survey of U.S. adults.

Twenty-two percent of participants were age 65 or older (see Table 2). Seventeen percent had a BMI over 40, and 26% had one or more underlying medical conditions that could put them at higher risk of severe illness from the virus. Fifty-four percent had received the seasonal influenza vaccine in the last year, while 18% reported that they had never received the seasonal influenza vaccine. Twenty-seven percent of respondents had children.

Overall, 75% were willing to get a COVID-19 vaccine when it becomes available (37% strongly agreed and 38% agreed). Willingness for their children was similar, at 73% (32% strongly agreed and 41% agreed). Asked about the level of threat from the virus posed to self and family, 8% answered “very high,” 15% answered “high,” 40% said “moderate,” and 33% said “low or very low.” 4% did not know. Sixty-eight percent reported being worried about getting the novel coronavirus.

In a large nationally representative survey conducted in April 2020, the willingness of U.S. adults to receive a novel coronavirus vaccine was high. Most U.S. adults were willing to get the vaccine for themselves and for their children, which is encouraging in a climate in which vaccine hesitancy around childhood immunizations has received global attention. Those most willing to get a COVID-19 vaccine were over age 65, had a bachelor’s degree or higher, were worried about the novel coronavirus, and had received an influenza vaccine in the previous year.

Our estimate of the percentage of people who indicated that they were not willing to get vaccinated is similar to other polls during the same time period (e.g., [8]), but our estimate of those willing to vaccinate was somewhat higher. One explanation is that our survey forced respondents to report willingness or unwillingness to get the vaccine because the item did not include “don’t know” or “not sure” response options. Thus, our findings suggest that those who report they are unsure in some polls may be willing to do so when pressed to decide. More research is needed to determine the conditions under which that willingness will translate into action when the time comes to vaccinate.

Studies during previous infectious disease outbreaks suggest somewhat lower willingness to get a new vaccine during a pandemic of a novel pathogen. During the 2009 influenza A (H1N1) pandemic, 64% of adults in two North Carolina counties intended to receive a vaccine when available [9]. In that study, seasonal influenza vaccination was associated with intentions to get the H1N1 vaccine, but other factors (H1N1 vaccine knowledge, age, gender, race/ethnicity, work status, and having children under age 18 living at home) were not. During the 2016 Zika virus pandemic, 56% of respondents in a national study were willing to get the hypothetical vaccine [10]. The higher willingness to obtain a COVID-19 vaccine than those for these two previous disease outbreaks may reflect higher media coverage and higher perceived threat of COVID-19.

Black respondents were markedly less willing than White respondents to get a COVID-19 vaccine, a finding that is consistent with adult vaccination trends of, for example, lower seasonal influence vaccine coverage in the same group [11]. Given that Black people have experienced disproportionately high rates of hospitalization and death from COVID-19 [12], the disparity in COVID-19 vaccine willingness raises the possibility that vaccination could amplify existing disparities. Respondents of Hispanic origin expressed higher willingness than their non-Hispanic counterparts to get the vaccine. Although adult vaccine coverage has generally been lower for Hispanics than non-Hispanic Whites in recent years [13], their greater willingness to get a COVID-19 vaccine may reflect the virus’s disproportionate impact on Hispanic communities (e.g., [14]). It will be imperative to ensure equitable access to the vaccine even as efforts address vaccine hesitancy among diverse communities. The upcoming report by the National Academies of Sciences, Engineering, and Medicine on this question will provide critical guidance for the nation on addressing disparities in vaccine distribution and uptake.

People with lower socioeconomic status were generally less willing to get vaccinated. Lower income and lower education respondents had less willingness to get the vaccine. Those without insurance were nearly 30% less willing to get the vaccine than insured respondents. Interventions aimed at reducing financial barriers to vaccination and increasing vaccine availability are among the most successful [15]. Equity-oriented policy initiatives focused on cost and access barriers will need to be coupled with communication efforts to make sure those who need them are aware of the options available to them.

The findings from this study provide direction about areas to focus public health planning and communication efforts as vaccine efforts continue.

Future research should focus on reasons for some of the differences we found as well as explore how communication about the virus and vaccination has changed perceptions since this survey was conducted in April 2020. These results offer a snapshot of public perceptions early in U.S. COVID-19 pandemic experience. As public perceptions change over time, we can expect communication to continue to play a critical role in generating confidence in the programs and policies that allow nations to achieve high vaccine uptake [15]. Social processes including provider recommendations, social norms, and social media sharing also likely play an important role in vaccine uptake. Our study shows great willingness among Americans to vaccinate and yet we also can see possibilities for notable differences between some groups that warrant efforts to mitigate health inequity.