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

Background: 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.

Methods: 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.

Results: 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.

Conclusion: 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.