Influences on Attitudes Regarding Potential COVID-19 Vaccination in the United States

Abstract

The COVID-19 pandemic continues to ravage the world, with the United States being highly affected. A vaccine provides the best hope for a permanent solution to controlling the pandemic. However, to be effective, a vaccine must be accepted and used by a large majority of the population. The aim of this study was to understand the attitudes towards and obstacles facing vaccination with a potential COVID-19 vaccine. To measure these attitudes a survey was administered to 316 respondents across the United States by a survey corporation. Structural equation modeling was used to analyze the relationships of several factors with attitudes toward potential COVID-19 vaccination. Prior vaccine usage and attitudes predicted attitudes towards COVID-19 vaccination. Assessment of the severity of COVID-19 for the United States was also predictive. Approximately 68% of all respondents were supportive of being vaccinated for COVID-19, but side effects, efficacy and length of testing remained concerns. Longer testing, increased efficacy and development in the United States were significantly associated with increased vaccine acceptance. Messages promoting COVID-19 vaccination should seek to alleviate the concerns of those who are already vaccine-hesitant. Messaging directed at the benefits of vaccination for the United States as a country would address the second predictive factor. Enough time should be taken to allay concerns about both short- and long-term side effects before a vaccine is released.

Keywords: COVID-19; SARS-CoV-2; vaccine attitudes; vaccine development; vaccine hesitancy.

Figure 1

Design and results of the structural equation model. Vaccine history (VH) and Perceived Impact on America significantly predicted COVID-19 vaccine attitudes (ACV). Understanding of vaccine immunity (UVI) was not predictive. Of the covariates, the Perceived Impact on America was predictive, but not other demographic factors or personal relationships with infected individuals. The specific questions represented in the model are listed in Table 2.

Figure 2

Vaccine acceptance, COVID-19 importance, and side effect concerns in the study population. (A) Intent to vaccinate. Survey participants were presented with the statement “I am likely to be vaccinated when a vaccine for COVID-19 becomes available” and asked to choose how they felt about the statement, ranging from “strongly agree” to “strongly disagree.” In total, 68.54% either chose “agree” or “strongly agree.” (B) Participants were asked to rate how much of a problem COVID-19 is in America. (C) Participants were provided the statement “A vaccine is important to end the COVID-19 pandemic,” and asked to rate their level of agreement. (D) Participants were given the statement “I am worried about side effects of a vaccine for myself” and asked to rate how much they agreed with the statement.

Figure 3

The time frame of vaccine testing influences the intent to vaccinate. (A) When asked if they would vaccinate themselves if a vaccine were available in the next 30 days, 66.05% of respondents answered affirmatively. When the time frame for vaccine availability was extended to 6 months, the number of people willing to be vaccinated significantly increased to 74.38% (* p = 0.02). The number of respondents willing to vaccinate their children also increased with increasing time to availability, but not significantly so. (B) Study participants were asked how much they agreed with the statement “I worry that the rushed pace of testing for a new COVID-19 vaccine will fail to detect potential side effects or dangers.” In total, 35.49% “strongly agreed,” and 37.65% “agreed” with this statement. (C) When asked “What is the minimum length of time a testing process would take that would make you feel comfortable with a COVID-19 vaccine?” the most common answer was 6 months to 1 year, at 38.89%; 3–6 months was second, at 27.78%, and 1–2 years was third, at 20.68%.

Figure 4

Vaccine efficacy contributes to intent to vaccinate. (A) Survey participants were given three scenarios, where the hypothetical vaccine was 50% effective, 75% effective, or 99% effective, and asked to rank how likely they were to be vaccinated under each scenario. The 99% effective vaccine was significantly better received than the other two, with 78.26 of respondents either somewhat or extremely likely to be vaccinated (p = 0.022 compared to 75%, p = 0.00023 compared to 50%). (B) Participants were asked about their attitudes towards a vaccine needing to be re-administered each year. There was no significant difference between intent to use a yearly vaccine and overall intent to be vaccinated.

Figure 5

Location of vaccine development influences willingness to vaccinate. Survey respondents were asked to rate the statement “Knowing a COVID-19 vaccine was developed in America would make me feel more comfortable receiving it” from “Strongly Disagree” to “Strongly Agree.” There was a significantly higher level of comfort with an American-developed vaccine compared to a vaccine developed either in Europe (p = 0.0015) or “Other” locations (p = 1.99 × 10⁻⁷). European development was also favored over “Other” (p = 0.011).

Figure 6

Economic indicators correlate with intent to vaccinate. Three survey questions (A: “Which category best describes your yearly household income before taxes? Include all income received from employment, social security, support from children or other family, welfare, Aid to Families with Dependent Children (AFDC), bank interest, retirement accounts, rental property, investments, etc.”, B: “Level of Education”, and C: “How would you rate your health insurance?”) were compared to the responses to the statement “I am likely to be vaccinated for COVID-19 when a vaccine becomes available” (Intent to vaccinate). All three economic measures were strongly positively correlated with intent to vaccinate (p < 0.0001 for each). Due to the large number of responses, only the trendlines are shown for each correlation.