COVID-19 Vaccine Intentions in the United States—December 2020 to March 2021
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Abstract
Importance
SARS-CoV-2 containment is estimated to require attainment of high (>80%) post-infection and post-vaccination population immunity.
Objective
To assess COVID-19 vaccine intentions among US adults and their children, and reasons for vaccine hesitancy among potential refusers.
Design
Internet-based surveys were administered cross-sectionally to US adults during December 2020 and February to March 2021 (March-2021).
Setting
Surveys were administered through Qualtrics using demographic quota sampling.
Participants
A large, demographically diverse sample of 10,444 US adults (response rate, 63.9%).
Main Outcomes and Measures
COVID-19 vaccine uptake, intentions, and reasons for potential refusal. Adults living with or caring for children aged 2 to 18 years were asked about their intent to have their children vaccinated. Multivariable weighted logistic regression models were used to estimate adjusted odds ratios for vaccine refusal.
Results
Of 5256 March-2021 respondents, 3467 (66.0%) reported they would definitely or most likely obtain a COVID-19 vaccine as soon as possible (ASAP Obtainers), and an additional 478 (9.1%) reported they were waiting for more safety and efficacy data before obtaining the vaccine. Intentions for children and willingness to receive a booster shot largely matched personal COVID-19 vaccination intentions. Vaccine refusal (ie, neither ASAP Obtainers nor waiting for more safety and efficacy data) was most strongly associated with not having obtained an influenza vaccine in 2020 (adjusted odds ratio, 4.11 [95% CI, 3.05-5.54]), less frequent mask usage (eg, rarely or never versus always or often, 3.92 [2.52-6.10]) or social gathering avoidance (eg, rarely or never versus always or often, 2.65 [1.95-3.60]), younger age (eg, aged 18-24 versus over 65 years, 3.88 [2.02-7.46]), and more conservative political ideology (eg, very conservative versus very liberal, 3.58 [2.16-5.94]); all P <.001.
Conclusions and Relevance
Three-quarters of March-2021 respondents in our large, demographically diverse sample of US adults reported they would likely obtain a COVID-19 vaccine, and 60% of adults living with or caring for children plan to have them vaccinated as soon as possible. With an estimated 27% of the US population having been infected with SARS-CoV-2, once vaccines are available to children and they have been vaccinated, combined post-infection and post-vaccination immunity will approach 80% of the US population in 2021, even without further infections.
Key Points
Question
What are COVID-19 vaccines intentions, for adults and for children under their care?
Findings
Two-thirds of 5256 US adults surveyed in early 2021 indicated they would obtain a COVID-19 vaccine as soon as possible. Intentions for children and booster vaccines largely matched personal vaccine intentions. Refusal was more common among adults who were younger, female, Black, very politically conservative, less educated, less adherent with COVID-19 prevention behaviors (eg, wearing masks), had more medical mistrust, or had not received influenza vaccines in 2020.
Meaning
Tailored vaccine promotion efforts and vaccine programs may improve vaccine uptake and contribute to US immunity against COVID-19.
Article activity feed
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SciScore for 10.1101/2021.05.16.21257290: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Ethics not detected. Sex as a biological variable not detected. Randomization not detected. Blinding not detected. Power Analysis 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:Limitations include self-reported metrics that may not correlate with future behavior and Internet-based survey methods that may not fully represent the US population. However, our data for the prevalence of COVID-19 vaccine recipients as of mid-February to …
SciScore for 10.1101/2021.05.16.21257290: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Ethics not detected. Sex as a biological variable not detected. Randomization not detected. Blinding not detected. Power Analysis 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:Limitations include self-reported metrics that may not correlate with future behavior and Internet-based survey methods that may not fully represent the US population. However, our data for the prevalence of COVID-19 vaccine recipients as of mid-February to early March 2021 were consistent with nationwide surveillance data,70 and 88.7% of respondents who had received 1 dose in a 2-dose regimen indicated that they planned to complete the series, consistent with CDC surveillance data (88.0%).71 Projections of US population immunity are contingent on assumptions.72,73 First, post-vaccination population immunity requires efficacy against infection above 80%,74 well below current estimates.6 Second, evidence from other coronaviruses75,76 and preliminary reports of SARS-CoV-2 re-infection77-79 or breakthrough infections among fully vaccinated individuals80-83 suggest both vaccination- and infection-derived immunity may be transient, requiring re-vaccination. Third, current FDA-approved vaccines are not authorized for children aged under 12 years. Fourth, most current vaccines require multiple doses for maximal efficacy, presenting a barrier to distribution.84 However, nearly 90% of people in 2-dose COVID-19 vaccine regiments received both doses, and more than 95% of completers did so within the recommended interval between the first and second doses.71 Finally, considerable regional differences in vaccination rates will affect local transmission of the SARS-CoV-2 viral infections. ...
Results from TrialIdentifier: No clinical trial numbers were referenced.
Results from Barzooka: We did not find any issues relating to the usage of bar graphs.
Results from JetFighter: We did not find any issues relating to colormaps.
Results from rtransparent:- Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
- Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
- No protocol registration statement was detected.
Results from scite Reference Check: We found no unreliable references.
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