Deliberation, Dissent, and Distrust: Understanding Distinct Drivers of Coronavirus Disease 2019 Vaccine Hesitancy in the United States

Background Despite the availability of safe and efficacious coronavirus disease 2019 vaccines, a significant proportion of the American public remains unvaccinated and does not appear to be immediately interested in receiving the vaccine. Methods In this study, we analyzed data from the US Census Bureau's Household Pulse Survey, a biweekly cross-sectional survey of US households. We estimated the prevalence of vaccine hesitancy across states and nationally and assessed the predictors of vaccine hesitancy and vaccine rejection. In addition, we examined the underlying reasons for vaccine hesitancy, grouped into thematic categories. Results A total of 459 235 participants were surveyed from 6 January to 29 March 2021. While vaccine uptake increased from 7.7% to 47%, vaccine hesitancy rates remained relatively fixed: overall, 10.2% reported that they would probably not get a vaccine and 8.2% that they would definitely not get a vaccine. Income, education, and state political leaning strongly predicted vaccine hesitancy. However, while both female sex and black race were factors predicting hesitancy, among those who were hesitant, these same characteristics predicted vaccine reluctance rather than rejection. Those who expressed reluctance invoked mostly deliberative reasons, while those who rejected the vaccine were also likely to invoke reasons of dissent or distrust. Conclusions Vaccine hesitancy comprises a sizable proportion of the population and is large enough to threaten achieving herd immunity. Distinct subgroups of hesitancy have distinctive sociodemographic associations as well as cognitive and affective predilections. Segmented public health solutions are needed to target interventions and optimize vaccine uptake. Distinct drivers of coronavirus disease 2019 vaccine hesitancy reflect differences in intensity, nature, and underlying reasons, as well as variation among sociodemographic groups and across time. Segmented public health solutions are needed to target interventions and optimize vaccine uptake.

Automated summary

Despite the availability of COVID-19 vaccines, a significant portion of the American population remains hesitant or unwilling to get vaccinated. Factors such as income, education, and political leaning contribute to vaccine hesitancy. Slight differences exist in the reasons behind vaccine hesitancy and vaccine rejection, with deliberative reasons being more common among hesitant individuals and reasons of dissent or distrust being more common among those who reject the vaccine.