COVID-19 Vaccination Disparities and Hesitancy in the United States

Background: Currently, 62.8% of Americans are fully vaccinated against COVID-19, which is lower than most first-world countries. Despite the ongoing COVID-19 pandemic and complications, many Americans are still hesitant to vaccinate. Objectives: The purpose of this study is to identify vaccine rates and trends by biological and socioeconomic demographics and determine reasons for vaccine hesitancy in the U.S. Methods: This is a repeated cross-sectional analysis with data on American adults without missing data on vaccine status and vaccine intent (N = 59,989) from the U.S. Census Bureau's Household Pulse Survey (Phases 3.2-3.3, July 21, 2021-February 7, 2022). The Household Pulse Survey is an online randomized survey to get information on how COVID-19 affects American households. The survey is collected every two weeks in phases. Vaccine hesitancy was divided into two groups: 1) probably, not sure, probably not, and definitely not receiving the vaccine, and 2) received the vaccine and definitely will get the vaccine. Chi-square tests and logistic regressions were conducted using replicate weights with SAS. Logistic regressions adjusted for sex, age, race and ethnicity, income, education, Covid-19 infection, health insurance, food insecurity, children under 17 years in the household, remote work, health worker status, functional status, and mental health. Results: During the December 1-13, 2021 survey period, 78.9% had received at least two doses of the COVID-19 vaccine. A majority of the vaccinated (51.6%) received the Pfizer vaccine. Those that were highly educated with a college degree (68.1%) and had a salary of $100,000+ (38.5%) were more likely to be vaccinated. Of those not vaccinated (Wt N = 33,340,678), 87.7% reported that they are unsure, probably, or definitely not (51.5%) get the vaccine. In adjusted analyses, older adults (AOR = 0.85, 95% CI=0.77 - 0.94 for 5-year increments) and health workers (AOR = 0.24, 95% CI = 0.08-0.69) were less likely to be vaccine-hesitant. Those with high school education were more likely to be vaccine-hesitant (AOR = 2.37, 95% CI = 1.44-3.90) compared to college-educated adults. Adults with COVID-19 infection were more likely to be vaccine-hesitant (AOR = 2.24, 95% CI = 1.41-3.57). Mistrust of the vaccine or government (52.1%), side-effects (50.2%), vaccine not needed (32.1%), and the vaccine will not protect me (23.6%) were cited as the top four reasons for vaccine hesitancy. Blacks and Hispanics reported similar reasons. Individuals in the South were more likely to cite distrust in COVID-19 vaccines than any other region. Conclusions: Among unvaccinated, over 50% of adults reported that they are "definitely not getting the vaccine". Vaccine hesitant adults were more likely to distrust the vaccine or the government; they were also concerned about the side effects. Targeted interventions by clinicians, public health officials, and policy makers to educate the public about side effects of the vaccine and increase trust in the health care system may help improve vaccination rates and achieve herd immunity in the US.