Determinants and Trends of COVID-19 Vaccine Hesitancy and Vaccine Uptake in a National Cohort of US Adults: A Longitudinal Study

Abstract

We estimated the trends and correlates of vaccine hesitancy, and its association with subsequent vaccine uptake among 5,458 adults in the United States. Participants belonged to the CHASING COVID Cohort, a national longitudinal study. Trends and correlates of vaccine hesitancy were examined longitudinally in eight interview rounds from October 2020 to July 2021. We also estimated the association between willingness to vaccinate and subsequent vaccine uptake through July 2021. Vaccine delay and refusal decreased from 51% and 8% in October 2020 to 8% and 6% in July 2021, respectively. Compared to Non-Hispanic (NH) White participants, NH Black and Hispanic participants had higher adjusted odds ratios (aOR) for both vaccine delay (aOR: 2.0 [95% CI: 1.5, 2.7] for NH Black and 1.3 [95% CI: 1.0, 1.7] for Hispanic) and vaccine refusal (aOR: 2.5 [95% CI: 1.8, 3.6] for NH Black and 1.4 [95% CI: 1.0, 2.0] for Hispanic) in June 2021. COVID-19 vaccine hesitancy was associated with lower odds of subsequent vaccine uptake (aOR: 0.15, 95% CI: 0.13, 0.18 for vaccine-delayers and aOR: 0.02; 95% CI: 0.01, 0.03 for vaccine-refusers compared to vaccine-willing participants), adjusted for sociodemographic factors and COVID-19 history. Vaccination awareness and distribution efforts should focus on vaccine delayers.

Factors associated with reversals of COVID-19 vaccination willingness: Results from two longitudinal, national surveys in Japan 2021-2022

“…However, having comorbidities was found to predict vaccine uptake in a US cohort, suggesting that associations may be mixed. 25 Consistent with our findings, a history of annual influenza vaccine inoculations has generally been found to predict vaccine uptake and persistent vaccine willingness, 16,22 though one study has found evidence to support the opposite conclusion among a population of those living with multiple sclerosis. 23 Those with annual influenza vaccine routines may have stronger faith in the benefits of vaccines, predisposing them to remain vaccine willing in the face of misinformation and mass reporting of adverse effects.…”

“…22 A study of refugees living in the US and presenting for COVID-19 testing found that 19¢ 3% of those initially desiring vaccination changed their mind by follow-up four months later. 20 Our findings are comparable to the Asian-specific proportion reported by Rane et al (2021) (4¢8% vs 6¢0%), 25 whereas short followup periods and studies of limited, non-nationally representative subpopulations limit reasonable comparisons with the remaining research. That our findings resemble those in the US Asian population suggest that underlying cultural factors may play a role in determining the propensity to reverse vaccine willingness.…”

“…A US study found that between 6-19% of those previously willing to vaccinate had ultimately not been inoculated by followup nine months later; the proportion varied by race/ethnicity, with Asians (6¢0%) being least likely and non-Hispanic Blacks (19¢0%) most likely to have changes of heart. 25 In another nationally representative sample of US adults, 37¢3% and 17¢0% of those previously expressing interest in vaccination had continued interest in vaccination or had become unsure/unwilling, respectively; however, the follow-up period was less than two months. 24 A study of patients living with multiple The reference categories for multiple answer questions were those who did not select any given answer choice.…”

“…24 A similar study by Rane et al (2021) found that among those initially willing to receive vaccination in October 2020, between 6-19% (depending on race/ethnicity) had not yet been inoculated by July 2021. 25 Notably, the overwhelming majority of these studies focus on those who went from being unsure/unwilling to willing/vaccinated, but very few consider individuals who converted from willing to unsure/unwilling. Moreover, as most evidence is based on cross-sectional surveys, short followup periods, and specific sub-populations, definitive characterizations of these change-of-heart populations remain elusive.…”

Racial concentration and dynamics of COVID-19 vaccination in the United States

“…Arce et al, 2021 , Brown et al , Carson, 2021 , Chen and Krieger., 2021 , Kazemian et al, 2021 , Latkin et al, 2021 , Liao and De Maio., 2021 , Liu and GabrielLi, 2021 , Mollalo and Tatar, 2021 , Phelan and Bruce, 2015 , Rane et al, 2022 , Salomon et al, 2021 , Siegel et al, 2021 , Tal et al, 2020 , Willis et al, 2022 , Wright et al, 2014 …”