COVID-19 vaccine intentions in the United States, a social-ecological framework

• Published in: Vaccine 2021-04, Vol.39 (16), p.2288-2294
• Main Authors: Latkin, Carl, Dayton, Lauren A., Yi, Grace, Konstantopoulos, Arianna, Park, Ju, Maulsby, Catherine, Kong, Xiangrong
• Format: Article
• Language: English
• Subjects: Adult; Attitudes; Behavior; Bivariate analysis; Coronaviruses; COVID-19; COVID-19 - prevention & control; COVID-19 vaccines; COVID-19 Vaccines - administration & dosage; Cross-Sectional Studies; Demography; Disease prevention; Disease transmission; Female; Gender; Gender aspects; Human papillomavirus; Humans; Ideology; Influenza; Intention; Male; Middle Aged; Multivariate analysis; Norms; Pandemics; Perceptions; Public health; Risk perception; Self image; Sex differences; Social distancing; Social identity; Social networks; Social norms; Social organization; Social-Ecological; United States; Vaccination; Vaccine hesitancy; Vaccines
• ISSN: 0264-410X; 1873-2518; 1873-2518
• DOI: 10.1016/j.vaccine.2021.02.058

COVID-19 vaccine hesitancy is a major obstacle for pandemic mitigation. As vaccine hesitancy occurs along multiple dimensions, we used a social-ecological framework to guide the examination of COVID-19 vaccine intentions. Using an online survey in the US conducted in July 2020, we examined intentions to obtain a COVID-19 vaccine, once available. 592 respondents provided data, including measures of demographics, vaccine history, social norms, perceived risk, and trust in sources of COVID-19 information. Bivariate and multivariate multinomial models were used to compare respondents who intended to be vaccinated against COVID-19 to respondents who did not intend or were ambivalent about COVID-19 vaccination. Only 59.1% of the sample reported that they intended to obtain a COVID-19 vaccine. In the multivariate multinomial model, those respondents who did not intend to be vaccinated, as compared to those who did, had significantly lower levels of trust in the CDC as a source of COVID-19 information (aOR = 0.29, CI = 0.17–0.50), reported lower social norms of COVID-19 preventive behaviors (aOR = 0.67, CI 0.51–0.88), scored higher on COVID-19 Skepticism (aOR = 1.44, CI = 1.28–1.61), identified as more politically conservative (aOR = 1.23, CI = 1.05–1.45), were less likely to have obtained a flu vaccine in the prior year (aOR = 0.21, CI = 0.11–0.39), were less likely to be female (aOR = 0.51, CI = 0.29–0.87), and were much more likely to be Black compared to White (aOR = 10.70, CI = 4.09–28.1). A highly similar pattern was observed among those who were ambivalent about receiving a COVID-19 vaccine compared to those who intended to receive one. The results of this study suggest several avenues for COVID-19 vaccine promotion campaigns, including social network diffusion strategies and cross-partisan messaging, to promote vaccine trust. The racial and gender differences in vaccine intentions also suggest the need to tailor campaigns based on gender and race.