National Trends in the US Public’s Likelihood of Getting a COVID-19 Vaccine—April 1 to December 8, 2020 | Infectious Diseases | JAMA | JAMA Network
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Figure.  Percentage of US Adults Who Say They Are Likely to Get a COVID-19 Vaccine
Percentage of US Adults Who Say They Are Likely to Get a COVID-19 Vaccine

Data were not collected for the periods of June 10-23 and July 8-21. Percentages and 95% CIs are plotted. COVID-19 indicates coronavirus disease 2019.

Table.  Percentage of Adults Who Stated in April 2020 and December 2020 That They Were Somewhat or Very Likely to Get Vaccinated for COVID-19, and Change Over Time
Percentage of Adults Who Stated in April 2020 and December 2020 That They Were Somewhat or Very Likely to Get Vaccinated for COVID-19, and Change Over Time
1.
Reiter  PL, Pennell  ML, Katz  ML.  Acceptability of a COVID-19 vaccine among adults in the United States: how many people would get vaccinated?   Vaccine. 2020;38(42):6500-6507. doi:10.1016/j.vaccine.2020.08.043PubMedGoogle ScholarCrossref
2.
Fisher  KA, Bloomstone  SJ, Walder  J, Crawford  S, Fouayzi  H, Mazor  KM.  Attitudes toward a potential SARS-CoV-2 vaccine: a survey of US adults.   Ann Intern Med. 2020;173(12):964-973. doi:10.7326/M20-3569PubMedGoogle ScholarCrossref
3.
Malik  AA, McFadden  SM, Elharake  J, Omer  SB.  Determinants of COVID-19 vaccine acceptance in the US.   EClinicalMedicine. 2020;26:100495. doi:10.1016/j.eclinm.2020.100495PubMedGoogle Scholar
4.
Head  KJ, Kasting  ML, Sturm  LA, Hartsock  JA, Zimet  GD.  A national survey assessing SARS-CoV-2 vaccination intentions: implications for future public health communication efforts.   Science Communication. 2020;42(5):698-723. doi:10.1177/1075547020960463Google ScholarCrossref
5.
Kapteyn  A, Angrisani  M, Bennett  D,  et al  Tracking the effect of the COVID-19 pandemic on American households.   Surv Res Methods-Ger. 2020;14(2):179-185.Google Scholar
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    2 Comments for this article
    EXPAND ALL
    Accepting Vaccines Is Essential Against COVID-19
    Michael McAleer, PhD (Econometrics), Queen's | Asia University, Taiwan
    History will tell in the long run if safe, effective, durable, affordable, and available vaccines helped turn the tide against the COVID-19 pandemic.

    In the meantime, the short and medium term outcomes will need approved vaccines to be widely accepted in the community, without which any purported move toward herd immunity will be defeated.

    The interesting and informative research outcomes by a team of medical experts used four cross-sectional internet surveys in April and May 2020, which occurred in the early months of the pandemic, and a robust Poisson regression approach to estimate adjusted risk ratios, as well as cluster-robust
    linear regression models.

    Alternative models with associated diagnostic checks would be able to determine the robustness of the empirical estimates, standard errors, and valid confidence intervals.

    The empirical findings across all cohorts based on socio-economic and demographic characteristics, between early April (74%) and November-December 2020 (56%), showed a dismaying reduction in the percentage of survey respondents who were likely to be vaccinated.

    These results were obtained before the distribution of several vaccines globally, not all of which have passed stringent clinical trials, as well as in the USA, where two approved vaccines are presently being distributed, which are likely to affect the public's willingness to accept vaccination, especially as the second and higher waves of infections continue to escalate.
    CONFLICT OF INTEREST: None Reported
    READ MORE
    Why the Drop in Vaccination Willingness?
    Jeanne Kropko, Registered Nurse | Dialysis
    People trust government less and less as these years roll on. How does one re-establish trust? I think a long record of saying what you mean and meaning what you say would help. Until then, trust will fluctuate. Either make the vaccine mandatory, give it time and show the country it is going well to build trust, or pay people to take it.
    CONFLICT OF INTEREST: None Reported
    Research Letter
    December 29, 2020

    National Trends in the US Public’s Likelihood of Getting a COVID-19 Vaccine—April 1 to December 8, 2020

    Author Affiliations
    • 1Department of Pediatrics, University of California, Los Angeles
    • 2Dornsife College of Letters Arts and Sciences Center for Economic and Social Research, University of Southern California, Los Angeles
    • 3Los Angeles County Department of Public Health, Office of Health Assessment and Epidemiology, Los Angeles, California
    • 4Department of Medicine Statistics Core, University of California, Los Angeles
    JAMA. 2021;325(4):396-398. doi:10.1001/jama.2020.26419

    The coronavirus disease 2019 (COVID-19) pandemic is causing enormous morbidity and mortality across the US and is disproportionately affecting racial/ethnic minority populations and elderly persons. High acceptance of COVID-19 vaccines will be instrumental to ending the pandemic.

    Four cross-sectional internet surveys1-4 (3 using convenience samples1,3,4) from April2 and May1,3,4 2020 found that 58% to 69% of adults intended to get vaccinated against COVID-19, with higher percentages reported in April2 than in May.1,3,4 These studies did not track the same individuals over time, making it difficult to assess whether intent to get vaccinated has truly declined.

    We analyzed biweekly survey data from a nationally representative longitudinal study to describe changes over time in the public’s likelihood of getting a COVID-19 vaccine and across demographic subgroups.

    Methods

    The Understanding America Study (UAS) is a probability-based internet panel survey of approximately 9000 noninstitutionalized US adults.5 Respondents are recruited using address-based sampling, allowing for valid statistical inferences and avoiding coverage problems from convenience web panels. Internet-enabled tablets are provided if needed.

    Beginning March 10, 2020, the entire UAS panel has been invited to participate in biweekly tracking surveys about COVID-19; consenting respondents are invited on a rolling basis (590 invited daily) to participate in each wave and have 2 weeks to complete surveys.

    Beginning April 1-14 and continuing through November 25–December 8, we asked: “How likely are you to get vaccinated for coronavirus once a vaccine is available to the public?” Response options (very unlikely, somewhat unlikely, somewhat likely, very likely, unsure) were dichotomized into “somewhat or very likely” vs all others. A multivariable Poisson regression model with robust standard errors was used to estimate adjusted risk ratios (aRRs) and 95% CIs of the likelihood of getting vaccinated. Changes in likelihood of getting a COVID-19 vaccine (overall and by demographic subgroups) were analyzed using linear regression models with cluster-robust standard errors at the respondent level. Analyses (SAS version 9.4) accounted for survey sampling weights. Statistical significance was defined as a 95% CI that did not cross 1. The UAS panel oversamples residents of Los Angeles County and, to a lesser extent, residents of the rest of California; survey sampling weights adjust for this.

    Participants provided written informed consent and the University of Southern California’s institutional review board approved this study.

    Results

    To date, 8167 UAS panel respondents have consented to participate in the biweekly tracking surveys. The number of consenting respondents who completed the surveys varied across 2-week periods (range: 5259 to 6139; range of completion rate per 2-week period: 75%-97%).

    During November 25–December 8 (Table), the self-reported likelihood of getting COVID-19 vaccination was lower among women than men (51% vs 62%; aRR, 0.9 [95% CI, 0.8-0.9]) and Black vs White individuals (38% vs 59%; aRR, 0.7 [95% CI, 0.6-0.8]), and higher among adults aged 65 years and older vs those 18-49 years (69% vs 51%; aRR, 1.4 [95% CI, 1.3-1.5]) and those with at least a bachelor’s degree vs a high school education or less (70% vs 48%; aRR, 1.5 [95% CI, 1.3-1.6]).

    Between April 1-14 and November 25–December 8, the percentage who stated they were somewhat or very likely to get vaccinated declined from 74% to 56% (difference: 18 percentage points [95% CI, 16-20]) (Figure). Significant declines over time in the likelihood of seeking vaccination were observed for both women and men and in all age, racial/ethnic, and educational subgroups.

    Discussion

    In this nationally representative survey, self-reported likelihood of getting a COVID-19 vaccine declined from 74% in early April to 56% in early December 2020, despite the early November press releases of high vaccine efficacy for 2 vaccines in phase 3 trials, although prior to Emergency Use Authorization. Low likelihood of getting a COVID-19 vaccine among Black individuals and those with lower educational backgrounds is especially concerning because of their disproportionately higher burden from COVID-19 disease.

    Study strengths include analyses of change over time within the same group of individuals from a representative online survey panel. Limitations include use of only English- and Spanish-language surveys, self-reported metrics that may not correlate with future behavior, and small sample sizes for certain minority populations.

    Educational campaigns to raise the public’s willingness to consider COVID-19 vaccination are needed.

    Section Editor: Jody W. Zylke, MD, Deputy Editor.
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    Article Information

    Accepted for Publication: December 21, 2020.

    Published Online: December 29, 2020. doi:10.1001/jama.2020.26419

    Corresponding Author: Peter G. Szilagyi, MD, MPH, Department of Pediatrics, University of California, Los Angeles, 10833 LeConte, MC 175217, Los Angeles, CA 90095 (pszilagyi@mednet.ucla.edu).

    Author Contributions: Drs Szilagyi and Kapteyn had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

    Concept and design: Szilagyi, Shah, Vizueta, Thomas, Kapteyn.

    Acquisition, analysis, or interpretation of data: Szilagyi, Thomas, Shah, Cui, Vangala, Kapteyn.

    Drafting of the manuscript: Szilagyi.

    Critical revision of the manuscript for important intellectual content: All authors.

    Statistical analysis: Szilagyi, Cui, Vangala.

    Obtained funding: Szilagyi, Kapteyn.

    Administrative, technical, or material support: Szilagyi, Vizueta.

    Supervision: Szilagyi.

    Conflict of Interest Disclosures: Dr Szilagyi reported receiving a grant from UCLA David Geffen School of Medicine—Eli and Edythe Broad Center of Regenerative Medicine and Stem Cell Research Award Program for personnel and statistical time. Dr Szilagyi also reported receiving funding from NIH NCATS UCLA CTSI during the conduct of this study. Dr Kapteyn reported receiving funding from University of Southern California (USC) for partial support for the USC survey team, grants from Bill & Melinda Gates Foundation for partial support for the UAS survey, grants from the National Institute on Aging for partial support for the UAS survey, and grants from National Science Foundation for partial support for the UAS during the conduct of the study. Dr Thomas reported receiving funding from USC and the National Institute on Aging. No other disclosures were reported.

    Funding/Support: This work was supported by the UCLA David Geffen School of Medicine—Eli and Edythe Broad Center of Regenerative Medicine and Stem Cell Research Award Program, the University of Southern California, the Bill & Melinda Gates Foundation, and by federal funds from the National Center for Advancing Translational Sciences (NCATS), National Institutes of Health, through the Clinical and Translational Science Awards (CTSA) Program (grant UL1TR001881), the National Institute on Aging (grant 5U01AG054580-03), and the National Science Foundation (grant 2028683).

    Role of the Funder/Sponsor: The funding organizations had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

    Additional Contributions: We thank Paul Simon, MD, and Rashmi Shetgiri, MD, of the Los Angeles County Department of Public Health for their input on an early draft of this article. Neither of the individuals received compensation for their contributions to the study.

    References
    1.
    Reiter  PL, Pennell  ML, Katz  ML.  Acceptability of a COVID-19 vaccine among adults in the United States: how many people would get vaccinated?   Vaccine. 2020;38(42):6500-6507. doi:10.1016/j.vaccine.2020.08.043PubMedGoogle ScholarCrossref
    2.
    Fisher  KA, Bloomstone  SJ, Walder  J, Crawford  S, Fouayzi  H, Mazor  KM.  Attitudes toward a potential SARS-CoV-2 vaccine: a survey of US adults.   Ann Intern Med. 2020;173(12):964-973. doi:10.7326/M20-3569PubMedGoogle ScholarCrossref
    3.
    Malik  AA, McFadden  SM, Elharake  J, Omer  SB.  Determinants of COVID-19 vaccine acceptance in the US.   EClinicalMedicine. 2020;26:100495. doi:10.1016/j.eclinm.2020.100495PubMedGoogle Scholar
    4.
    Head  KJ, Kasting  ML, Sturm  LA, Hartsock  JA, Zimet  GD.  A national survey assessing SARS-CoV-2 vaccination intentions: implications for future public health communication efforts.   Science Communication. 2020;42(5):698-723. doi:10.1177/1075547020960463Google ScholarCrossref
    5.
    Kapteyn  A, Angrisani  M, Bennett  D,  et al  Tracking the effect of the COVID-19 pandemic on American households.   Surv Res Methods-Ger. 2020;14(2):179-185.Google Scholar
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