COVID-19 Vaccine Hesitancy: A Moving Target

COVID-19 vaccine hesitancy is not set in stone, with a little under a third of study participants who said they would not get the vaccine in late 2020 becoming vaccinated in early 2021, researchers found.

Among those reporting hesitancy at baseline in a serosurvey analysis of over 3,400 individuals, 32% (95% CI 27-37%) received at least one dose of a COVID-19 vaccine at follow-up, while 37% (95% CI 32-42%) said they were likely to get vaccinated at some point in the future and 32% (95% CI 27-37%) said they were unlikely to get vaccinated, reported researchers led by Aaron J. Siegler, PhD, MHS, of Emory University in Atlanta.

For individuals who initially said they were likely to get vaccinated, 54% (95% CI 50-57%) received at least one vaccine dose at follow-up, 39% still planned to get vaccinated (95% CI 36-43%), and 7% (95% CI 5-9%) said they were now unlikely to get vaccinated, the authors wrote in JAMA Network Open.

"There is a clear public health opportunity to convert higher vaccine willingness into successfully delivered vaccinations," they noted.

For their study, Siegler and colleagues evaluated data on 4,654 participants, recruited based on national address data, who responded to a survey on vaccination willingness from August 9 to December 8, 2020 (baseline) and completed follow-up from March 2 to April 21, 2021 (n=3,439; 74%).

Over half of baseline participants were women (59%) with an average age of 51. Of those who completed follow-up, 1,061 reported vaccine hesitancy at baseline, while 2,378 said they were likely to get vaccinated.

A higher proportion of those with a bachelors or graduate degree were willing to get vaccinated compared to those with a lower education level (76% vs 65%, respectively), and indeed, vaccination rates in the study were ultimately higher among those with higher levels of education (54% vs 43%), the authors wrote.

Interestingly, the authors noted that while non-Hispanic white and Hispanic individuals had similar vaccination willingness rates at baseline (69% vs 71%, respectively), fewer Hispanic individuals were vaccinated at follow-up (31%) compared with whites (51%).

"Although some people have come off the fence since the FDA approval of Pfizer/[BioNTech's] vaccine, I have found that many remain with solidly fixed opinions that rest on two main issues," Paul G. Auwaerter, MD, of Johns Hopkins University School of Medicine in Baltimore, told MedPage Today. "These are concerns regarding safety or the confusion that booster use suggests that the vaccines don't work well."

"The other is similar to why people say the influenza vaccine is not needed: they are unlikely to get COVID-19 or if they do, natural immunity is superior to vaccine-induced" immunity, added Auwaerter, who was not involved in this study.

As part of their study, the researchers also measured individuals' antibody responses and found that self-reported vaccination status generally aligned with serological findings. Self-report among nearly 2,000 participants had a 98.2% positive predictive value and 97.3% negative predictive value, with a sensitivity and specificity of 94.8% and 99.1%, respectively.

Limitations included that study follow-up ended prior to the widespread availability of vaccines for all individuals ages 16 and older, so many participants were ineligible to receive the vaccine within the duration of the study.

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