Factors Associated With US Adults' Likelihood of Accepting COVID-19 Vaccination

Abstract

Importance: The development of a coronavirus disease 2019 (COVID-19) vaccine has progressed at unprecedented speed. Widespread public uptake of the vaccine is crucial to stem the pandemic.

Objective: To examine the factors associated with survey participants' self-reported likelihood of selecting and receiving a hypothetical COVID-19 vaccine.

Design, setting, and participants: A survey study of a nonprobability convenience sample of 2000 recruited participants including a choice-based conjoint analysis was conducted to estimate respondents' probability of choosing a vaccine and willingness to receive vaccination. Participants were asked to evaluate their willingness to receive each hypothetical vaccine individually. The survey presented respondents with 5 choice tasks. In each, participants evaluated 2 hypothetical COVID-19 vaccines and were asked whether they would choose vaccine A, vaccine B, or neither vaccine. Vaccine attributes included efficacy, protection duration, major adverse effects, minor adverse effects, US Food and Drug Administration (FDA) approval process, national origin of vaccine, and endorsement. Levels of each attribute for each vaccine were randomly assigned, and attribute order was randomized across participants. Survey data were collected on July 9, 2020.

Main outcomes and measures: Average marginal component effect sizes and marginal means were calculated to estimate the relationship between each vaccine attribute level and the probability of the respondent choosing a vaccine and self-reported willingness to receive vaccination.

Results: A total of 1971 US adults responded to the survey (median age, 43 [interquartile range, 30-58] years); 999 (51%) were women, 1432 (73%) White, 277 (14%) were Black, and 190 (10%) were Latinx. An increase in efficacy from 50% to 70% was associated with a higher probability of choosing a vaccine (coefficient, 0.07; 95% CI, 0.06-0.09), and an increase from 50% to 90% was associated with a higher probability of choosing a vaccine (coefficient, 0.16; 95% CI, 0.15-0.18). An increase in protection duration from 1 to 5 years was associated with a higher probability of choosing a vaccine (coefficient, 0.05 95% CI, 0.04-0.07). A decrease in the incidence of major adverse effects from 1 in 10 000 to 1 in 1 000 000 was associated with a higher probability of choosing a vaccine (coefficient, 0.07; 95% CI, 0.05-0.08). An FDA emergency use authorization was associated with a lower probability of choosing a vaccine (coefficient, -0.03; 95% CI, -0.04 to -0.01) compared with full FDA approval. A vaccine that originated from a non-US country was associated with a lower probability of choosing a vaccine (China: -0.13 [95% CI, -0.15 to -0.11]; UK: -0.04 [95% CI, -0.06 to -0.02]). Endorsements from the US Centers for Disease Control and Prevention (coefficient, 0.09; 95% CI, 0.07-0.11) and the World Health Organization (coefficient, 0.06; 95% CI, 0.04-0.08), compared with an endorsement from President Trump were associated with higher probabilities of choosing a vaccine. Analyses of participants' willingness to receive each vaccine when assessed individually yielded similar results. An increase in efficacy from 50% to 90% was associated with a 10% higher marginal mean willingness to receive a vaccine (from 0.51 to 0.61). A reduction in the incidence of major side effects was associated with a 4% higher marginal mean willingness to receive a vaccine (from 0.54 to 0.58). A vaccine originating in China was associated with a 10% lower willingness to receive a vaccine vs one developed in the US (from 0.60 to 0.50) Endorsements from the Centers for Disease Control and Prevention and World Health Organization were associated with increases in willingness to receive a vaccine (7% and 6%, respectively) from a baseline endorsement by President Trump (from 0.52 to 0.59 and from 0.52 to 0.58, respectively).

Conclusions and relevance: In this survey study of US adults, vaccine-related attributes and political characteristics were associated with self-reported preferences for choosing a hypothetical COVID-19 vaccine and self-reported willingness to receive vaccination. These results may help inform public health campaigns to address vaccine hesitancy when a COVID-19 vaccine becomes available.

Figure 1.. Vaccine Attributes and Vaccination Preferences

Panel A shows the estimated effect size of each attribute value on the probability of a study respondent choosing a hypothetical coronavirus disease 2019 (COVID-19) vaccine. The average marginal component effect sizes plotted here are the regression coefficients reported in Model 1 in Table 3. The points without error bars denote the base level value for each attribute. Panel B shows the marginal means for each attribute value for willingness to receive a hypothetical COVID-19 vaccine. Estimates are based on Model 3 in Table 3, and numerical point estimates and confidence intervals are reported in eTable 2 in the Supplement. In both panels, error bars represent 95% CIs around each point estimate. CDC indicates Centers for Disease Control and Prevention; FDA, US Food and Drug Administration; and WHO, World Health Organization.

Figure 2.. Estimated Willingness to Receive 5 Hypothetical Vaccines

This plot shows US adults’ estimated willingness to receive 5 different vaccines. The hypothetical vaccines have the attribute profiles of experimental vaccines at the 1st, 25th, 50th, 75th, and 99th percentiles in terms of estimated willingness to receive vaccination. The estimates are derived from an ordinary least squares regression in which the dependent variable was coded 1 if the individual was at least slightly likely to accept the described vaccine (Model 3 in Table 3). Error bars represent 95% CIs obtained from simulations. CDC indicates Centers for Disease Control and Prevention; EUA, emergency use authorization; FDA, US Food and Drug Administration; and WHO, World Health Organization.