Health concerns and government distrust: variation in types of COVID-19 vaccine hesitancy by racial and ethnic group before and at universal vaccine eligibility in the US

The development and deployment of COVID-19 vaccines were crucial to combating the global pandemic, but vaccine hesitancy posed a challenge and remains a crucial problem today. Understanding why people delay or refuse vaccination can help with current and future vaccine campaigns by suggesting both target audiences and messaging. Because hesitant individuals report different reasons for their hesitancy, distinguishing between different types of hesitancy can help identify who will benefit from which strategies. Using 311,494 responses from the U.S. COVID-19 Trends and Impact Survey (CTIS), we used Latent Class Analysis to examine distributions of concurrently reported reasons for hesitancy using latent class analysis, comparing distributions of responses across racial and ethnic groups. Using responses from both the early phase of vaccine availability and after all U.S. adults became eligible in the spring of 2021, we investigated differences between prospective vs. lived hesitancy. LCA revealed three different types of COVID-19 vaccine hesitancy. Some respondents primarily reported health-related concerns as reasons for hesitancy, while others indicates distrust of the government and vaccines, but the majority report fewer distinct reasons. In February 2021, White, Black, and Hispanic respondents had similar distributions of these types, but by May the results diverged. In May, White respondents were more likely to report trust concerns than Black or Hispanic respondents, who were more likely to report health concerns as their reasons for continued hesitancy.  Our results contribute to the development of a more nuanced picture of COVID-19 vaccine hesitancy and the motivations behind it. The distinction between health-concerned and distrustful types of vaccine hesitancy highlights the importance of confidence in vaccine uptake, and in targeted strategies to address hesitancy.