. 2023 May 24;13(1):8360.

doi: 10.1038/s41598-023-34340-3.

Unraveling attributes of COVID-19 vaccine acceptance and uptake in the U.S.: a large nationwide study

Sean D McCabe^#^{1

2}, E Adrianne Hammershaimb^#^{1

3

4}, David Cheng¹, Andy Shi^{1

2}, Derek Shyr^{1

2}, Shuting Shen^{1

2}, Lyndsey D Cole⁵, Jessica R Cataldi^{5

6}, William Allen^{1

7}, Ryan Probasco¹, Ben Silbermann¹, Feng Zhang^{1

8

9

10

11}, Regan Marsh^{12

13

14}, Mark A Travassos^{15

16

17}, Xihong Lin^{18

19

20

21}

Affiliations

¹ The How We Feel Project, San Leandro, CA, USA.
² Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
³ Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, USA.
⁴ Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, USA.
⁵ Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, USA.
⁶ Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, CO, USA.
⁷ Harvard University, Cambridge, MA, USA.
⁸ Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA.
⁹ McGovern Institute for Brain Research, Massachusetts Institute of Technology, Cambridge, MA, USA.
¹⁰ Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, Cambridge, MA, USA.
¹¹ Howard Hughes Medical Institute, Chevy Chase, MD, USA.
¹² Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, USA.
¹³ Department of Emergency Medicine, Harvard Medical School, Boston, MA, USA.
¹⁴ Partners in Health, Boston, MA, USA.
¹⁵ The How We Feel Project, San Leandro, CA, USA. mtravass@som.umaryland.edu.
¹⁶ Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, USA. mtravass@som.umaryland.edu.
¹⁷ Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, USA. mtravass@som.umaryland.edu.
¹⁸ The How We Feel Project, San Leandro, CA, USA. xlin@hsph.harvard.edu.
¹⁹ Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA. xlin@hsph.harvard.edu.
²⁰ Broad Institute of MIT and Harvard, Cambridge, MA, USA. xlin@hsph.harvard.edu.
²¹ Department of Statistics, Harvard University, Cambridge, MA, USA. xlin@hsph.harvard.edu.

^# Contributed equally.

PMID: 37225748
PMCID: PMC10209066
DOI: 10.1038/s41598-023-34340-3

Unraveling attributes of COVID-19 vaccine acceptance and uptake in the U.S.: a large nationwide study

Sean D McCabe et al. Sci Rep. 2023.

. 2023 May 24;13(1):8360.

doi: 10.1038/s41598-023-34340-3.

Authors

Affiliations

¹ The How We Feel Project, San Leandro, CA, USA.
² Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
³ Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, USA.
⁴ Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, USA.
⁵ Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, USA.
⁶ Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, CO, USA.
⁷ Harvard University, Cambridge, MA, USA.
⁸ Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA.
⁹ McGovern Institute for Brain Research, Massachusetts Institute of Technology, Cambridge, MA, USA.
¹⁰ Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, Cambridge, MA, USA.
¹¹ Howard Hughes Medical Institute, Chevy Chase, MD, USA.
¹² Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, USA.
¹³ Department of Emergency Medicine, Harvard Medical School, Boston, MA, USA.
¹⁴ Partners in Health, Boston, MA, USA.
¹⁵ The How We Feel Project, San Leandro, CA, USA. mtravass@som.umaryland.edu.
¹⁶ Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, USA. mtravass@som.umaryland.edu.
¹⁷ Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, USA. mtravass@som.umaryland.edu.
¹⁸ The How We Feel Project, San Leandro, CA, USA. xlin@hsph.harvard.edu.
¹⁹ Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA. xlin@hsph.harvard.edu.
²⁰ Broad Institute of MIT and Harvard, Cambridge, MA, USA. xlin@hsph.harvard.edu.
²¹ Department of Statistics, Harvard University, Cambridge, MA, USA. xlin@hsph.harvard.edu.

^# Contributed equally.

PMID: 37225748
PMCID: PMC10209066
DOI: 10.1038/s41598-023-34340-3

Abstract

SARS-CoV-2 vaccines are useful tools to combat the Coronavirus Disease 2019 (COVID-19) pandemic, but vaccine reluctance threatens these vaccines' effectiveness. To address COVID-19 vaccine reluctance and ensure equitable distribution, understanding the extent of and factors associated with vaccine acceptance and uptake is critical. We report the results of a large nationwide study in the US conducted December 2020-May 2021 of 36,711 users from COVID-19-focused smartphone-based app How We Feel on their willingness to receive a COVID-19 vaccine. We identified sociodemographic and behavioral factors that were associated with COVID-19 vaccine acceptance and uptake, and we found several vulnerable groups at increased risk of COVID-19 burden, morbidity, and mortality were more likely to be reluctant to accept a vaccine and had lower rates of vaccination. Our findings highlight specific populations in which targeted efforts to develop education and outreach programs are needed to overcome poor vaccine acceptance and improve equitable access, diversity, and inclusion in the national response to COVID-19.

PubMed Disclaimer

Conflict of interest statement

The authors declare no competing interests.

Figures

**Figure 1**
COVID-19 Acceptance rates: (a) (Left) Number of responses and (Right) unweighted and weighted percentages. (b) Weighted average willingness and undecided rates by state.

**Figure 2**
Demographic Acceptance Rates: (a) Weighted percentages of reluctant responses by race/ethnicity, profession, location, age, income, and use of protective measures. State level weighted reluctance rates by (b) cumulative case rates (/100 individuals), (c) cumulative death rates (/1000 individuals), (d) and average number of users practicing protective behavior.

**Figure 3**
Logistic regression-based association analysis results of vaccine acceptance: Forest plots for (Left) unweighted and (Right) weighted multivariable logistic regression analyses for vaccine reluctance with 95% confidence intervals. Non-significant variables at the 0.05 level (white), significant positive associations (red), and significant negative associations (blue).

**Figure 4**
Vaccine Uptake Rates: (a) Vaccine uptake question responses for all users. (b) Weighted vaccination rates by state of (Left) all users that responded to the vaccine uptake question and (right) users that were offered a vaccine. (c) Weighted vaccination uptake of users that were offered a vaccine by vaccine acceptance and (d) race/ethnicity.

**Figure 5**
Logistic regression-based association analysis results of vaccine uptake: Forest plots for (Left) unweighted and (Right) weighted multivariable logistic regression analyses for vaccination uptake with 95% confidence intervals. Non-significant variables at the 0.05 level (white), significant positive associations (red), and significant negative associations (blue).

See this image and copyright information in PMC

Update of

Unraveling Attributes of COVID-19 Vaccine Hesitancy and Uptake in the U.S.: A Large Nationwide Study.
McCabe SD, Hammershaimb EA, Cheng D, Shi A, Shyr D, Shen S, Cole LD, Cataldi JR, Allen W, Probasco R, Silbermann B, Zhang F, Marsh R, Travassos MA, Lin X. McCabe SD, et al. medRxiv [Preprint]. 2021 Jul 2:2021.04.05.21254918. doi: 10.1101/2021.04.05.21254918. medRxiv. 2021. Update in: Sci Rep. 2023 May 24;13(1):8360. doi: 10.1038/s41598-023-34340-3. PMID: 33851172 Free PMC article. Updated. Preprint.

References

1. Huang C, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395(10223):497–506. doi: 10.1016/S0140-6736(20)30183-5. - DOI - PMC - PubMed
1. Corey L, et al. A strategic approach to COVID-19 vaccine R&D. Science. 2020;368(6494):948–950. doi: 10.1126/science.abc5312. - DOI - PubMed
1. Randolph HE, Barreiro LB. Herd immunity: Understanding COVID-19. Immunity. 2020;52(5):737–741. doi: 10.1016/j.immuni.2020.04.012. - DOI - PMC - PubMed
1. Funk C, Tyson A. Growing Share of Americans Say they Plan to Get a COVID-19 Vaccine—or Already Have. Pew Research Center; 2021.
1. U.S. Food and Drug Administration. Pfizer-BioNTech COVID-19 Vaccine. https://www.fda.gov/emergency-preparedness-and-response/coronavirus-dise.... Accessed 16 June 2021.

Publication types

Actions
Actions

MeSH terms

Actions
Actions
Actions
Actions
Actions
Actions
Actions

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

Unraveling attributes of COVID-19 vaccine acceptance and uptake in the U.S.: a large nationwide study

Affiliations

Unraveling attributes of COVID-19 vaccine acceptance and uptake in the U.S.: a large nationwide study

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

Update of

References

Publication types

MeSH terms

Substances

Grants and funding

LinkOut - more resources

Full Text Sources

Medical

Miscellaneous