As of December 4, 2020, cases of novel coronavirus disease 2019 (COVID-19) have topped 14.3 million in the US with nearly 300 000 associated deaths. While mitigation measures such as social distancing, use of face coverings, and avoidance of crowds can help keep case counts in check, a safe and effective COVID-19 vaccine will be essential to ending the pandemic.
Yet, an effective vaccine will be of limited benefit across the population unless enough people are willing to receive it. Two of the priority groups for vaccination will be adults aged 65 years and older and individuals at high risk for severe COVID-19 illness because of their underlying medical conditions. Understanding the perspectives and concerns of high-priority groups for vaccination is vital for determining how clinicians and policy makers can best communicate with these individuals to maximize vaccine uptake.
In a nationally representative survey of 1556 adults aged 50 to 80 years, conducted in October 2020 by the University of Michigan National Poll on Healthy Aging, 58% of older adults indicated they would be likely to get a COVID-19 vaccine, 28% said they were unlikely, and 14% were either unsure or did not know if they would get vaccinated. Interest in getting a COVID-19 vaccine was more common among those aged 65 to 80 years compared with those aged 50 to 64 years (63% vs 54%), men compared with women (64% vs 52%), and White people compared with Hispanic and Black people (63% vs 51% vs 40%). Individuals who lived with other people, had higher household incomes, and had more education were also more likely to report they would get a COVID-19 vaccine.
The proportion interested in getting a COVID-19 vaccine went up to 66% when respondents were asked the question differently: 20% said they would want to get vaccinated right away when vaccines become available, and 46% said they would rather wait for others to get vaccinated first before doing so themselves; 20% were unsure about getting vaccinated, and 14% said they did not want to get vaccinated.
Those more likely to want to get a COVID-19 vaccine as soon as possible included individuals aged 65 to 80 years (24%, compared with 17% of those aged 50-64 years), men (25%, compared with 15% of women), and White individuals (24%, compared with 14% of Hispanic and 7% of Black individuals). Those with underlying conditions, higher household incomes, and more education were also more likely to want to get vaccinated as soon as possible.
In deciding whether to get a COVID-19 vaccine, older adults rated the following factors as very important: how well it works (80%), their own research (56%), and if it was recommended by their physician (52%), public health officials (42%), or family and friends (13%). Although 30% of respondents rated cost as very important, COVID-19 vaccines purchased with US taxpayer dollars are expected to be provided without cost to all people in the US. Nearly half (46%) were worried about the safety of a COVID-19 vaccine that was developed quickly.
Just more than half of adults aged 50 to 80 years (52%) said they personally know someone who had COVID-19, and 2% reported having had it themselves; 19% indicated they personally know someone who died from COVID-19. The likelihood of wanting to get a COVID-19 vaccine did not differ based on whether respondents knew someone who had COVID-19 or who died from it.
Recent press releases from both Pfizer and Moderna report vaccine efficacy greater than 90% for mRNA vaccines and few long-term safety concerns. This high vaccine efficacy will likely be a factor in many older adults’ decisions to get vaccinated, as indicated by 4 in 5 respondents reporting “how well it works” as being very important in their decision to receive a COVID-19 vaccine, which is consistent with prior survey data.1 Nearly half of adults aged 50 to 80 years were worried about the safety of a vaccine that was developed quickly, a finding that underscores the need for full transparency around clinical data from vaccine trials by vaccine manufacturers and the US Food and Drug Administration, especially because initial approval is expected to come as an Emergency Use Authorization.2
Although final distribution plans are still under development, because of an increased risk of serious disease and death, older adults are expected to be a priority group for immunization. Results from the National Poll on Healthy Aging highlight several considerations to inform planning while preparing for a vaccine to become available. For example, many older adults reported that recommendations from their physician would be a very important factor in their decision to receive a COVID-19 vaccine. Given existing time constraints during visits, physicians should be provided with easy-to-understand, streamlined, and culturally appropriate resources to aid in discussions regarding a COVID-19 vaccine, including information that clearly explains the potential benefits as well as the risk of transient adverse effects related to immunization, such as fatigue, fevers, and muscle aches.
Interest in receiving a COVID-19 vaccine was lower among Black and Hispanic older adults, despite these communities experiencing higher rates of COVID-19 cases and associated complications, including death. Additional focused inquiry may help clarify reasons for hesitancy and inform how to address specific types of concerns. Engagement of trusted community members is one approach to sharing accurate information through formal and informal networks. It is also notable that fewer women were interested in vaccination, especially considering that women are likely to make health care decisions for other family members.3
The current survey did not explore issues of access and logistics, but understanding how to make the physical process of getting vaccinated easy and convenient is essential, especially given less interest among those with lower incomes, who would likely face additional barriers, such as transportation, parking, and the need to take time off from work. Given some concerns about short-term tolerability, attention should also be given to strategies to optimize uptake of the second doses of a COVID-19 vaccine. Financial incentives could have a role given that vaccination requires a 2-dose series.
Ultimately, having a highly effective and safe vaccine that large numbers of people are hesitant to receive would be tragic. The availability of a vaccine will not end the pandemic on its own but will require high uptake and completion of both doses to reach its mitigation potential. However, given widespread transmission across the US, and the risk of serious illness among older adults in particular, the choice between developing COVID-19 and taking a vaccine, even if an individual has some lingering safety concerns, may ultimately be an easy one.
Open Access: This is an open access article distributed under the terms of the CC-BY License.
Corresponding Author: Preeti N. Malani, MD, MSJ, F4135 University Hospital South, 1500 E Medical Center Dr, Ann Arbor, MI 48109 (firstname.lastname@example.org).
Conflict of Interest Disclosures: Dr Solway reported receiving grants from AARP related to the submitted work. Dr Kullgren reported receiving grants from AARP and Michigan Medicine related to the submitted work and personal fees from SeeChange Health, HealthMine, Kaiser Permanente Washington Health Research Institute, Robert Wood Johnson Foundation, AbilTo, Kansas City Area Life Sciences Institute, American Diabetes Association, and Luxembourg National Research Fund outside the submitted work; support was also provided by the US Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service. No other disclosures were reported.
Funding/Support: The National Poll on Healthy Aging is conducted by the University of Michigan Institute for Healthcare Policy and Innovation and sponsored by AARP and Michigan Medicine, the University of Michigan’s academic medical center.
Role of the Funder/Sponsor: The sponsors had no role in the preparation, review, or approval of the manuscript and decision to submit the manuscript for publication.
Disclaimer: The views expressed in the article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the US government.
Additional Contributions: We acknowledge the contributions of Dianne Singer, MPH, and Matthias Kirch, MS (University of Michigan).
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Malani PN, Solway E, Kullgren JT. Older Adults’ Perspectives on a COVID-19 Vaccine. JAMA Health Forum. 2020;1(12):e201539. doi:10.1001/jamahealthforum.2020.1539