Deliberation, Dissent, and Distrust: Understanding Distinct Drivers of Coronavirus Disease 2019 Vaccine Hesitancy in the United States

Abstract

Background Despite the availability of safe and efficacious COVID-19 vaccines, a significant proportion of the American public remains unvaccinated and does not appear immediately interested in receiving the vaccine. Methods In this study, we analyzed data from the U.S. Census Bureau’s Household Pulse Survey, a biweekly cross-sectional survey of U.S. households. We estimated the prevalence of vaccine hesitancy across states and nationally and assessed the predictors of vaccine hesitancy and vaccine rejection. Additionally, we examined the underlying reasons for vaccine hesitancy, grouped into thematic categories. Results A total of 459,235 participants were surveyed from January 6 to March 29, 2021. While vaccine uptake increased from 7.7 to 47 percent, vaccine hesitancy rates remained relatively fixed: overall, 10.2 percent reported that they would probably not get a vaccine, and 8.2 percent would definitely not get a vaccine. Income, education, and state political leaning strongly predicted vaccine hesitancy. However, while both female sex and Black race were factors predicting hesitancy, among those who were hesitant, these same characteristics predicted vaccine reluctance rather than rejection. Those who expressed reluctance invoked mostly “deliberative” reasons while those who rejected the vaccine were also likely to invoke reasons of “dissent” and “distrust”. Conclusion Vaccine hesitancy comprises a sizable proportion of the population and is large enough to threaten achieving herd immunity. Distinct subgroups of hesitancy have distinctive socio-demographic associations as well as cognitive and affective predilections. Segmented public health solutions are needed to target interventions and optimize vaccine uptake.

Multilevel determinants of COVID-19 vaccination hesitancy in the United States: A rapid systematic review

“…Figure 2 shows the trend of COVID-19 vaccine acceptance rates in the US from 17 nationally representative samples. ( Mercadante and Law, 2021 , Agley et al, 2021 , Daly and Robinson, 2021 , Szilagyi et al, 2021 , Ruiz and Bell, 2021 , Romer and Jamieson, 2020 , Fisher et al, 2020 , Roozenbeek et al, 2020 , Malik et al, 2020 , Latkin et al, 2021 , Callaghan et al, 2021 , Allen et al, 2021 , Viswanath et al, 2021 , Coe et al, 2021 , Berg and Lin, 20212021 , Tram et al, 2021 , King et al, 2021 ) COVID-19 acceptance was defined as already receiving at least one dose of the vaccine, definitely or probably getting it when available. Ten nationally representative studies were excluded from the figure due to the lack of survey period or inconsistent measurement of vaccine acceptance.…”

Preferences for COVID-19 vaccine distribution strategies in the US: A discrete choice survey

“…Those who probably or definitely did NOT intend to vaccinate most commonly reported deliberative reasons, such as concerns about side-effects and efficacy (78.0%), followed by distrustful reasons including mistrust of the government or COVID vaccines (37.9%), and lastly dissenting reasons such as a lack of belief in vaccines or that COVID-19 is a serious illness (19.7%) [16].…”

“…�� Characterized by Tram et. al[16]. Deliberative reasons: I am concerned about the cost of the vaccine; I think other people need it more; I plan to wait and see if it is safe; My doctor has not recommended it; I don't know if the vaccine will work; I am concerned about possible side effects; I already had COVID-19; I am not a member of a high-risk group; I plan to use masks or other precautions instead.…”

“…Deliberative reasons: I am concerned about the cost of the vaccine; I think other people need it more; I plan to wait and see if it is safe; My doctor has not recommended it; I don't know if the vaccine will work; I am concerned about possible side effects; I already had COVID-19; I am not a member of a high-risk group; I plan to use masks or other precautions instead. Distrustful reasons: I don't trust the government; I don't trust COVID-19 vaccines.Dissenting reasons: I don't like vaccines; I don't believe COVID-19 is a serious illness; I don't think vaccines are beneficial[16].https://doi.org/10.1371/journal.pone.0256394.t002Fig 2. Weighted mean preferences (relative utilities) for vaccination campaign features, in total population (N = 2,985).…”

Can tracking mobility be used as a public health tool against COVID-19 following the expiration of stay-at-home mandates?

“…While highly effective vaccines are readily available in the United States, uptake remains low [1] and interventions aimed at minimizing human contact remain necessary to mitigate the spread of 1 INTRODUCTION SARS-CoV-2 [2,3,4,5]. Decreasing mobility patterns within populations, has been shown to be an effective strategy to curb infectious disease transmission.…”