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Observational Study
. 2021 Jun;60(6):766-773.
doi: 10.1016/j.amepre.2021.01.008. Epub 2021 Feb 15.

Willingness to Vaccinate Against COVID-19 in the U.S.: Representative Longitudinal Evidence From April to October 2020

Michael Daly  1 , Eric Robinson  2
Affiliations
Observational Study

Willingness to Vaccinate Against COVID-19 in the U.S.: Representative Longitudinal Evidence From April to October 2020

Michael Daly et al. Am J Prev Med. 2021 Jun.

Abstract

Introduction: Vaccines against COVID-19 have been developed in unprecedented time. However, the effectiveness of any vaccine is dictated by the proportion of the population willing to be vaccinated. This observational population-based study examines intentions to be vaccinated against COVID-19 throughout the pandemic.

Methods: In November 2020, longitudinal data from a nationally representative sample of 7,547 U.S. adults enrolled in the Understanding America Study were analyzed using multinomial logistic regression. Participants reported being willing, undecided, and unwilling to get vaccinated against COVID-19 across 13 assessments conducted from April to October 2020. Public attitudes to vaccination against COVID-19 were also assessed on a 4-point Likert-type scale.

Results: Willingness to vaccinate declined from 71% in April to 53.6% in October. This was explained by an increase in the percentage of participants undecided about vaccinating (from 10.5% to 14.4%) and the proportion of the sample unwilling to vaccinate (from 18.5% to 32%). The population subgroups most likely to be undecided/unwilling to vaccinate were those without a degree (undecided: RR=2.47, 95% CI=2.04, 3.00; unwilling: RR=1.92, 95% CI=1.67, 2.20), Black participants (undecided: RR=2.18, 95% CI=1.73, 2.74; unwilling: RR=1.98, 95% CI=1.63, 2.42), and female participants (undecided: RR=1.41, 95% CI=1.20, 1.65; unwilling: RR=1.29, 95% CI=1.14, 1.46). Participants who were older or were on higher incomes were least likely to be undecided or unwilling to vaccinate. Concerns about potential side effects of a vaccine were common.

Conclusions: Intentions to be vaccinated against COVID-19 have declined rapidly during the pandemic, and close to half of Americans are undecided or unwilling to be vaccinated.

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Figures

Figure 1
Figure 1
Change in vaccination intentions across the 13 waves of the Understanding America Study conducted between April 1, 2020 and October 31, 2020. Note: Graph is based on an analysis of 78,453 observations on 7,547 participants. Estimates are predicted probabilities from the marginal effects calculated after a multinomial logistic regression model adjusted for age, sex, race/ethnicity, household income, educational attainment, and the presence of pre-existing health conditions. 95% CIs are presented in gray.
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