COVID-19 Vaccine Acceptability and Inequity in the United States: Results from a nationally representative survey
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Abstract
Background
At the time of this survey, September 1 st , there were roughly 6 million COVID-19 cases and 176,771 deaths in the United States and no federally approved vaccine. The objective of this study was to explore the willingness to accept a COVID-19 vaccine in the United States and describe variability in this acceptability by key racial, ethnic and socio-demographic characteristics.
Methods
This was a cross-sectional digital survey that sampled participants from a nationally-representative panel maintained by a third party, Dynata. Dynata randomly sampled their database and emailed web-based surveys to United States residents ensuring the sample was matched to US Census estimates for age, race, gender, income, and Census region. Participants were asked how willing or unwilling they would be to: 1) receive a COVID-19 vaccine as soon as it was made publicly available, and 2) receive the influenza vaccine for the upcoming influenza season. Participants could respond with extremely willing, willing, unwilling, or extremely unwilling. For those who reported being unwilling to receive a COVID-19 vaccine, reasons for this hesitancy were captured. All participants were asked about where they obtain vaccine-related information, and which sources they trust most. Univariable and multivariable logistic regressions were conducted to examine the association of all demographic characteristics with willingness to receive COVID-19 vaccine.
Findings
From September 1 st to September 7, 2020, 1592 respondents completed the online survey. Overall, weighted analyses found that only 58.9% of the sample population were either willing or extremely willing to receive a COVID-19 vaccine as soon as it was made publicly available. In comparison, 67.7% of the respondents were willing or extremely willing to take the influenza vaccine. By gender, 66.1% of males and 51.5% of females were willing to receive a COVID-19 vaccine. Males were significantly more willing to receive a COVID-19 vaccine (adjusted odds ratio (OR)=1.98, 95% CI: 1.56, 2.53; p<0.001) than females. Blacks were the least willing racial/ethnic group (48.8%) Blacks, (aOR=0.59, 95%CI: 0.43, 0.80; p<0.001) were significantly less willing, than whites, to receive a COVID-19 vaccine. There were numerous reasons provided for being unwilling to receive a COVID-19 vaccine. The most common reason was concern about the vaccine’s safety (36.9%), followed by concerns over its efficacy (19.1%).
Interpretation
In conclusion, we found that a substantial proportion (41%) of United States residents are unwilling to receive a COVID-19 vaccine as soon as one is made publicly available. We found that vaccine acceptance differs by sub-populations. In addition to sub-group differences in willingness to receive the vaccine, respondents provided a variety of reasons for being unwilling to receive the vaccine, driven by various sources of vaccine information (and misinformation). This compounds the challenge of delivering a safe and efficacious COVID-19 vaccine at a population level to achieve herd immunity. A multi-pronged and targeted communications and outreach effort is likely needed to achieve a high level of immunization coverage.
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SciScore for 10.1101/2021.01.29.21250784: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement IRB: 22 The study protocol and survey instruments were approved by the Institutional Review Board at Johns Hopkins Bloomberg School of Public Health (IRB00012413)
Consent: All participants provided consent (electronically).Randomization Procedures: Given a targeted set of socio-demographic characteristics, Dynata randomly sampled their database and emailed web-based surveys to United States residents ensuring the sample was matched to US Census estimates for age, race, gender, income, and Census region. Blinding not detected. Power Analysis not detected. Sex as a biological variable not detected. Table 2: Resources
No key resources detected.
Results from OddPub: We did …
SciScore for 10.1101/2021.01.29.21250784: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement IRB: 22 The study protocol and survey instruments were approved by the Institutional Review Board at Johns Hopkins Bloomberg School of Public Health (IRB00012413)
Consent: All participants provided consent (electronically).Randomization Procedures: Given a targeted set of socio-demographic characteristics, Dynata randomly sampled their database and emailed web-based surveys to United States residents ensuring the sample was matched to US Census estimates for age, race, gender, income, and Census region. Blinding not detected. Power Analysis not detected. Sex as a biological variable not detected. Table 2: Resources
No key resources detected.
Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:There are several limitations that are worth highlighting. First, our respondents were identified using a web-based platform, which required access to a smartphone or computer with internet access to participate in the survey. In addition, while our analysis was weighted to capture differences in vaccine acceptance by White, African American, or Hispanic racial groups, we were unable to capture differences among smaller racial/ethical subgroups. Third, we cannot assume that reported willingness to take COVID-19 vaccine (or lack thereof) would result in actual action. Since data collection was conducted in September 2020, before the public release of safety and efficacy results from Phase III clinical trials for several vaccine candidates, it may be possible that our estimates of vaccine willingness may be underestimated given the high efficacy and safety profiles of leading vaccine candidates.5,6 In conclusion, we found that a substantial proportion (41%) of United States residents are unwilling to receive a COVID-19 vaccine as soon as one is made publicly available. However, we found that vaccine acceptance differs by sub-populations; with females, African Americans, and older age respondents reporting being less willing to receive the vaccine. This is particularly concerning from a public health perspective given that several of these sub-groups are at highest risk for severe disease outcomes. In addition to sub-group differences in willingness to receive the vaccine, respo...
Results from TrialIdentifier: No clinical trial numbers were referenced.
Results from Barzooka: We found bar graphs of continuous data. We recommend replacing bar graphs with more informative graphics, as many different datasets can lead to the same bar graph. The actual data may suggest different conclusions from the summary statistics. For more information, please see Weissgerber et al (2015).
Results from JetFighter: We did not find any issues relating to colormaps.
Results from scite Reference Check: We found one citation with an erratum. We recommend checking the erratum to confirm that it does not impact the accuracy of your citation.
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