Influences on Attitudes Regarding Potential COVID-19 Vaccination in the United States

"Controlling or ending the pandemic through a vaccination program requires an understanding of the reasons behind hesitancy towards a COVID-19 vaccine in the United States, as well as strategies to overcome this hesitancy."

Overall vaccine hesitancy, which has been found to be growing in more than 90% of countries worldwide, is likely to play a significant role in COVID-19-specific vaccine hesitancy. Research shows that an approach to vaccine refusal that deals with the concerns of different groups is more effective than a homogenous strategy. Thus, understanding varying vaccine attitudes is important, particularly in the United States (US), given messages that COVID-19 vaccine development is being accelerated (as part of that government's "Operation Warp Speed") and in light of the fact that a vaccine may be released even before clinical trials are completed. In that context, the aim of this study was to understand US residents' attitudes towards and obstacles related to a potential COVID-19 vaccine.

The researchers designed an online survey using structural equation modeling (SEM) to investigate multiple potential contributing factors to COVID-19 vaccine refusal, which was administered to 316 respondents across the US.

Selected findings:

• Approximately 68% of all respondents were supportive of being vaccinated for COVID-19.
• Respondents overall acknowledged the importance of a COVID-19 vaccine, with 54.83% selecting "strongly agree", and 23.36% selecting "somewhat agree" with the statement "A vaccine is important to stop the COVID-19 pandemic."
• Respondents who routinely got vaccines were more likely to be receptive to receiving the COVID-19 vaccine.
• The greater the perceived impact of COVID-19 on the US, the more receptive the respondent was to receiving a potential COVID-19 vaccine.
• An understanding of vaccines and immunity had no impact on the respondents' attitudes; the number of people they knew with COVID-19 also appeared to be non-influential on their decisions. Furthermore, household income and political ideology showed no relationship with attitudes toward the COVID-19 vaccine.
• A majority (63.47%) of respondents either answered "strongly agree" or "somewhat agree" when given the statement, "I am worried about the side effects of the vaccine for myself". A substantial number of respondents (although not a majority) worried that the side effects of a potential vaccine would be worse than the disease itself.
• When asked about the length of time a potential vaccine should be tested, 66.05% said they would be vaccinated if a vaccine was available in the next 30 days. For the 30-day time period, concerns about vaccine safety were the most commonly cited (45.45%), followed by "other" (15.45%), and lack of trust in the source that encouraged them to receive the vaccine (13.54%). The number of people willing to be vaccinated increased to 74.38% if the time span before a vaccine was available was extended to 6 months, a statistically significant increase.
• When given a free-response option to identify their biggest fear about a potential COVID-19 vaccine, 51.85% of the meaningful responses expressed concerns about safety or side effects. Effectiveness was the second most expressed concern, at 10.65%. Not enough testing was third, with 10.18%. Finances were the primary concern for 2.77%.
• More recipients were comfortable with a US-made vaccine than one made any other location (e.g., Europe), with 21.67% of respondents selecting "strongly agree" and 33.44% selecting "agree".

Thus, the study found that most people in the US consider COVID-19 to be a severe problem, and most of them view a vaccine against COVID-19 as necessary and something they are willing to receive. However, "the number of enthusiastic or highly enthusiastic people still falls short of ideal, and possibly short of the numbers necessary to stop the pandemic. Several factors contribute to concerns about the vaccine, and a vaccine development and promotion strategy that addresses these concerns would be useful in increasing participation in a vaccination campaign."

Specifically, the findings indicate that COVID-19 vaccine acceptance could be enhanced by the sharing of information about the safety of vaccines, as well as efforts to improve the transparency and thoroughness of testing. These suggestions are particularly relevant given "the current push towards the early release of a vaccine, which, if it appears politically motivated or results in significant side effects, may have the effect of decreasing confidence in vaccines in general...." It may also be helpful to emphasise the consequences of the pandemic on the overall well-being of the US, including the economic, social, and public costs of the disease. Finally, because the data show that lower-income people may be less likely to intend to be vaccinated, messages addressing their specific concerns may be effective - both in serving the most COVID-19-affected population and in increasing overall vaccine usage.

The researchers conclude that a repetition of this type of survey could be useful to understand the changing attitudes towards a COVID-19 vaccine, as both the availability of an actual vaccine and the US presidential elections (November 2020) approach.