Vaccine hesitancy in the United States predated the COVID-19 pandemic, but the pandemic added fuel to the fire. During the crisis, inconsistent public health messaging and emergency-use authorization of the COVID vaccine gave rise to a “parallel pandemic of vaccine hesitancy,” write researchers from Rush University College of Nursing in a new analysis published in Vaccine. That hesitancy led to many people being unnecessarily infected and hospitalized. 

“Some research has estimated nearly a quarter of a million preventable deaths due to non-vaccination in the US, during the period May 2021-Sept 2022,” they write. Average life expectancy in the United States decreased by almost two years because of COVID.

To better understand what drives Americans’ vaccine hesitancy, the researchers analyzed surveys from nearly 14,000 people. Their findings suggest that vaccination rates differed significantly by education level and age, and reasons for remaining unvaccinated differed by race and education level. 

Age, education, insurance tied to uptake

For the study, researchers analyzed data from 13,802 US adults who participated in the Community Engagement Alliance Common Survey 2 from November 2020 to November 2022. They found that 87.2% of participants had received at least one dose of the COVID vaccine. 

They also found that vaccination rates differed significantly across demographic groups. Non-Hispanic White participants had the highest vaccination rate, at 91.8%, compared with 87.9% among Hispanic participants and 81.8% among non-Hispanic Black participants.

Education and age were strongly associated with vaccination. About 21% of people without a high school degree were unvaccinated, compared with just 6.2% of those with a graduate degree. Adults 65 and older were less likely to be unvaccinated (5.5%) than youngest participants aged 18 to 24 (17.5%). Lack of health insurance was also associated with lower uptake: 25% of uninsured participants were unvaccinated, compared with 11% of those with insurance.

Distrust didn’t always translate to vaccine refusal

Less than 5% of participants said they didn’t trust their doctors as sources of COVID information.

Distrust of government institutions was more common, however. Yet many people who expressed distrust had still been vaccinated. 

Among participants who distrusted various institutions as sources of COVID information, vaccination rates ranged from 72.4% to 83.8%. Even among those who did not trust the Food and Drug Administration (FDA) to ensure the vaccine safety, 52.0% had received at least one dose.

Roughly 40% of respondents expressed a deep distrust in the federal government to provide a safe vaccine for children. They expressed greater trust in the FDA to make COVID vaccines safe for the public, with only 8.5% of participants saying they didn’t trust the FDA to make safe COVID vaccines for adults. 

Reasons for avoiding vaccination varied

Among the 1,772 unvaccinated participants, reasons for avoiding vaccination varied significantly by race and ethnicity, age, education, and employment. Differences included concerns about side effects, distrust of vaccine safety, and believing the vaccines didn’t work.

For example, among unvaccinated participants, the belief that vaccines didn’t work was most common among adults ages 25 to 34 (10.4%) and declined with age. Just 2.7% of adults over 65 believed vaccines didn’t work. Many respondents (67.2%) cited familial or cultural disapproval of vaccines as their reason for not getting vaccinated, compared with just 11.4% of Whites. 

Future vaccine campaigns should capitalize on the unique role physicians have in patient vaccine decision making.

The findings suggest that a one-size-fits-all approach to addressing vaccine hesitancy may miss important differences between populations. The researchers call for trusted community leaders to help address vaccine hesitancy in their communities. 

They also argue that the relatively high level of trust patients have in their doctors could help improve uptake. “There is unrealized potential for doctors educating patients about vaccination,” they write. “Future vaccine campaigns should capitalize on the unique role physicians have in patient vaccine decision making.”