Vaccine hesitancy and reasons for refusing the COVID-19 vaccination among the U.S. public: A cross-sectional survey
Summary (2 min read)
Introduction
- 1 Importance 17 Although widespread vaccination will be the most important cornerstone of the public health 18 response to the COVID-19 pandemic, a critical question remains as to how much of the United 19 States population will accept it.
- 20 Objective 21 Determine: 1) rate of COVID-19 vaccine hesitancy in the United States public, 2) patient 22 characteristics associated with hesitancy, 3) reasons for hesitancy, 4) healthcare sites where 23 NOTE:.
- This preprint reports new research that has not been certified by peer review and should not be used to guide clinical practice.
- Vaccine acceptors would prefer to be vaccinated.
- 24 Design 25 43-question cross-sectional survey conducted November 17-18, 2020, distributed on Amazon 26 Mechanical Turk, an online labor marketplace where individuals receive a nominal fee (here, 27 $1.80) for anonymously completing tasks.
Main Outcome Measure 32
- Multivariable logistic regression modeled the primary outcome of COVID-19 vaccine hesitancy 33 (defined as non-acceptance or being unsure about acceptance of the COVID-19 vaccine) with 34 respondent characteristics.
- Preferred sites for vaccination for acceptors were primary doctors’ 44 offices/clinics, pharmacies, and dedicated vaccination locations.
- Over one-third of respondents were COVID-19 vaccine hesitant.
- The three tenets of the public health 52 response to the pandemic remain social distancing, mask wearing, and vaccination (2,3).
- 53 However, these mitigation measures are only as effective as their broad acceptance and 54 implementation.
Study Setting and Population 78
- The authors distributed this cross-sectional survey from November 17 to November 18, 2020 on 79 Amazon Mechanical Turk (MTurk, https://www.mturk.com), an online labor marketplace in 80 which individuals anonymously complete tasks, including surveys, and in return receive a 81 nominal fee (in this case, $1.80).
- MTurk is well-validated for behavioral experiments and 82 increasingly used to study healthcare questions, and data from MTurk are considered reliable 83 (13,14).
- Because their goal was to assess vaccine hesitancy in a more medically naïve 86 population, the authors excluded respondents self-identifying as healthcare workers.
- The survey included questions regarding demographic characteristics, 89 health insurance status, healthcare utilization, employment and housing status, and political 90 affiliation.
- Respondents who responded that they would accept it were then 95 asked their preferred location to receive a COVID-19 vaccine.
Primary and Secondary Outcome Measures 99
- The primary outcome measure was COVID-19 vaccine hesitancy - defined as either non-100 acceptance or being unsure about acceptance of the COVID-19 vaccine.
- In terms of sample size calculation, the authors sought to power the primary outcome to 95% in 118 assessment of its association with four characteristics - gender, race, age, and political affiliation.
- The authors found significant vaccine 172 hesitancy in the U.S. population that was more common in women, Blacks, and people with 173 lower education levels or who identified as Republicans.
- To improve 236 efficient and equitable vaccine distribution, educational messaging campaigns should seek to 237 address non-acceptors’ primary concerns of safety and side effects of the vaccine.
- Available from: 295 https://www.nih.gov/news-events/news-releases/promising-interim-results-clinical-trial-296 nih-moderna-covid-19-vaccine 297 22. CDC.
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Frequently Asked Questions (15)
Q2. How many people will need to be vaccinated?
For COVID-19 vaccination to effectively confer herd 60 immunity, experts agree that at least 60-70% of the population will need to be vaccinated (5).
Q3. how many people were hesitant about the covid-19 vaccine?
When asked about acceptance of the COVID-19 vaccine, 37.8% (663) were COVID-19 142 vaccine hesitant: 374 (21.3%) non-acceptors and 289 (16.5%) unsure about accepting.
Q4. What was the primary outcome measure of the COVID-19 vaccine?
98The primary outcome measure was COVID-19 vaccine hesitancy - defined as either non-100 acceptance or being unsure about acceptance of the COVID-19 vaccine.
Q5. What is the way to reduce hesitancy in the vaccine?
a framework of engaging community and religious leaders, 224 active messaging in various digital and non-digital media, education campaigns, targeted and 225 incentivized vaccine drives, and wide distribution of vaccine at trusted sites will likely be 226 required in order to decrease vaccine hesitancy.
Q6. What is the way to address hesitancy in vaccines?
One of the potential ways to address vaccine hesitancy is to ensure that vaccines are 217 dispensed at locations where patients are most comfortable receiving them.
Q7. What are the anticipated control measures for COVID-19?
55 Along with research and development of therapeutics, the most anticipated control 56 measures are a series of COVID-19 vaccines, two of which - as of this writing - have received 57 United States (U.S.) Food and Drug Administration emergency use authorizations (4).
Q8. Why did the authors exclude respondents who were not medically nave?
Because their goal was to assess vaccine hesitancy in a more medically naïve 86 population, the authors excluded respondents self-identifying as healthcare workers.
Q9. What were the primary reasons for hesitancy?
Primary reasons 42 for hesitancy were concerns about side effects, need for more information, and doubts about 43 vaccine efficacy.
Q10. What is the common reason for refusal of the COVID-19 vaccine?
192 Driven in part by popular perception of poor efficacy and fear of side effects, influenza 193 vaccine hesitancy is common (8–11,19).
Q11. What is the common type of hesitancy in the U.S.?
234 In conclusion, COVID-19 vaccine hesitancy is common in the U.S. population and more 235 prevalent in women, Blacks, people with lower education levels and Republicans.
Q12. What was the primary outcome of the COVID-19 vaccine hesitancy?
The authors transformed the primary outcome of 107 COVID-19 vaccine hesitancy from a nominal to a dichotomized (no/yes) categorical variable for 108 primary analysis and used the Chi-squared test with Bonferroni correction for multiple 109 comparisons to assess association of this outcome with characteristics of age, gender, race, 110 political affiliation, and receipt of influenza in previous years.
Q13. How many people were hesitant about the COVID-19 vaccine?
35 Results 36 A total 663 respondents (37.8%) were COVID-19 vaccine hesitant (374 [21.3%] non-acceptors 37 and 289 [16.5%] unsure about accepting).
Q14. What is the anticipated control for the hesitancy of the influenza vaccine?
61 Vaccine hesitancy, a phenomenon which predates the pandemic, has been well studied with other 62 vaccinations, including the influenza and Measles/Mumps/Rubella vaccines.
Q15. What are the reasons for the hesitancy of the vaccine?
vaccine 202 hesitancy may further exacerbate the disproportionate effects of the pandemic on Latinx, 203 African-American and Native American populations (22).