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November 18, 2020

What Is Driving the Decline in People’s Willingness to Take the COVID-19 Vaccine in the United States?

Author Affiliations
  • 1Public Opinion Strategies, Alexandria, Virginia
JAMA Health Forum. 2020;1(11):e201393. doi:10.1001/jamahealthforum.2020.1393

Over the past few months, there has been an indisputable decline in the number of people in the US who say they plan to get the vaccine for coronavirus disease 2019 (COVID-19) when one becomes available. A national survey by Pew Research Center in May found that 72% of people in the US said they would get the vaccine if it were available. By September, that number had dropped to 51%. Survey results from CNN showed a similar decline, from 66% who said they would get the vaccine in May to 51% in early October.

What is disputable, however, is why this decline is occurring. The COVID-19 pandemic has become highly politicized, with partisanship affecting attitudes toward wearing a mask and confidence in the accuracy and validity of COVID-19 statistics. Similarly, much has been made about the politicization of the vaccine. And a number of voters believe that politics have influenced the development of the vaccine. A Kaiser Family Foundation survey from early October found that 62% of people in the US are worried that the US Food and Drug Administration (FDA) will rush to approve a COVID-19 vaccine without making sure that it is safe and effective owing to political pressure from the Trump administration. Moreover, the survey found that 55% of people believe that President Trump is intervening with the FDA’s job of reviewing and approving a COVID-19 vaccine.

But while coverage has primarily pinpointed the driver of the decline to be political in nature, there are a number of other factors at hand. First, people in the US have a history of reluctance to accept new vaccines. Shortly after the polio vaccine was made available in 1954, Gallup found that 60% of people said they would get the newly created vaccine, while 31% said they would not get the vaccine and 9% were not sure. We know how history transpired, with near universal adoption of the polio vaccine in the US today; however, a sizable number of people were hesitant at the outset. Similarly, after the attacks of September 11 elevated concerns of biological attacks on people in the US, including the use of smallpox, Gallup found that 55% of people would get a smallpox vaccine, while 35% would not get the vaccine and 10% were unsure.

Next, attitudes in the US on the importance of vaccines have endured some erosion over the past 20 years (though they are still high). A 2019 Gallup survey found that 84% of people believe it is extremely important that parents get their children vaccinated, down from 94% who said the same in 2001. Similarly, a 2018 Research America/Zogby Analytics national survey found that 70% of people in the US said they believe vaccines are very important to the health of our society, down from 80% who said the same in 2008.

The decline in willingness to get the COVID-19 vaccine might be a result of who people believe are driving decisions on the vaccine itself. A 2016 Pew Research Center survey in the US found that 73% of people believed that medical scientists should have a major role in making decisions about policy issues related to childhood vaccines. Comparatively, just 25% felt that elected officials should have a major role in those decisions. A study published in JAMA Network Open based on a convenience sample collected in July 2020 found that the probability of choosing a COVID-19 vaccine was higher when recommended by the Centers for Disease Control and Prevention or the World Health Organization than by President Trump or former Vice President Biden.1

Many people in the US are concerned about the expedited development and trial process. The Kaiser Family Foundation/The Undefeated Survey on Race and Health conducted in September found that 43% of people are not confident that the COVID-19 vaccine will have been properly tested for safety and effectiveness when one becomes available. And despite our desire to return to normalcy, a survey from Pew Research Center in September found that 78% of people in the US are more concerned that the approval of a COVID-19 vaccine will move too fast, compared with 20% who are more concerned that the approval will move too slow. The same survey found that 77% of people believe it is likely that a vaccine will be used before we fully understand whether it is safe and effective.

Black individuals in the US, who have indicated from the early days of the pandemic that they are much less likely to be willing to get the vaccine than White individuals in the US, are highly skeptical about the development of the vaccine. The Kaiser Family Foundation/The Undefeated survey found that 33% of Black individuals are confident that the development of a COVID-19 vaccine is taking the needs of Black people into account, compared with 65% who are not confident.

The decline in willingness to take the vaccine has not been more significant for voters of one party or another. As the Pew Research Center data show, in May, 79% of Democrats and 65% of Republicans said they would get the vaccine. By September, those numbers had dropped to 58% of Democrats and 44% of Republicans, a 21-point drop among voters of both parties.

People in the US are ready to move on from the COVID-19 pandemic, but when it comes to a vaccine, many have a wait-and-see attitude. An October NBC News/Wall Street Journal survey found that just 20% of people in the US say they will get the vaccine as soon as they can, while another 50% plan to wait until the vaccine has been available for a while to see if there are major problems or adverse effects.

The mumps vaccine was the fastest vaccine to be developed, taking 4 years. All signs point to the development of the COVID-19 vaccine shattering that record. The breakneck pace of development is a testament to our innovative medical system and the research and development efforts by pharmaceutical companies and public health agencies. But as we move toward having an approved COVID-19 vaccine, it is important to understand that for many, it will take time to feel comfortable and confident in getting the vaccine. While the politicization of the vaccine is to blame for some of that delay, the increased reluctance of people in the US to get a COVID-19 vaccine runs much deeper than politics.

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Article Information

Open Access: This is an open access article distributed under the terms of the CC-BY License.

Corresponding Author: Jarrett Ramos Lewis, BA, MBA, Public Opinion Strategies, 214 N Fayette St, Alexandria, VA 22314 (jarrett@pos.org).

Conflict of Interest Disclosures: None reported.

Kreps  S, Prasad  S, Brownstein  JS,  et al.  Factors associated With US adults’ likelihood of accepting COVID-19 vaccination.   JAMA Netw Open. 2020;3(10):e2025594. doi:10.1001/jamanetworkopen.2020.25594PubMedGoogle Scholar
3 Comments for this article
COVID-19, Vaccinations, and Fatigue
Gary Ordog, MD, DABMT, DABEM | County of Los Angeles, Department of Health Services, (retired)
This is strictly a business perspective based upon polling data. Must I say: "We all know the validity of polling over the past 10 years!" Hopefully, the acceptance rate will be higher than these polls report, or we may have a big problem with 'vaccine-mediated herd immunity'. A number I have heard is that we need at least 70% of the population immunized to produce 'vaccine-mediated herd immunity.' Fortunately, the effectivity of the recent vaccines is about 95%, otherwise we would need a higher percentage. The thing that we don't know is how long the vaccine immunity lasts. If it is only a year, this will be a further problem. This future fact, plus the fact that two doses are required, combined with the other myriad of vaccinations now recommended, may result in a new syndrome that I will call "vaccine fatigue." Culturally, this may not bode well with the other newly found syndrome, "COVID-19 fatigue". Thank you and stay safe please.
My Clinical Trial
Terry Clayton, PhD | Wisconsin
I am disappointed with the drop in public trust. I feel there is a global effort to develop vaccines and a demonstrated transparency.

I am sharing my clinical trial experience for others to read with hopes at driving to a vaccine but also building back that trust (1); I am a participant in the AstraZenca clinical trial.


1. https://www.terryclayton.com/post/azd1222-sars-cov-2-vaccine-trial
Pros and Cons of a SARS-CoV-2 vaccine
William Prince, MD, FRCSC | Oakville Trafalgar Hospital
I live in Canada but we get the same newscasts as Americans. These vaccines being developed are being patterned after messenger RNA and the most promising ones appear to be targeting the “spikes” on the virus which interact with cell enzymes to allow the virus to enter the cell. As Hispanic and Black Americans have a higher complication rate, they are hoping to test the new vaccine on volunteers from those groups. I believe that the initial results are good and politicians and Presidents should have no say as to when and how the vaccine should be given