Snapshot of Public Attitudes and COVID-19 Vaccine Acceptance in the United States

By Erik Nisbet, PhD on March 1, 2021

With the ongoing global spread of SARS-CoV-2 infections and the evolving COVID-19 pandemic, vaccine development and initial rollout have occurred with unprecedented speed. Within the US, the first round of vaccinations among high-risk sectors, including healthcare workers, has been accompanied by both positive and negative media. Despite some ongoing hesitancy among the general population, a recent Kaiser poll¹ indicated that reluctance to be vaccinated against COVID-19 is beginning to abate. Almost half of adults surveyed in January stated they had received the vaccine or want to as soon as possible – up from approximately one-third in December.¹ Continued efforts to build trust in and acceptance of COVID-19 vaccines during 2021 will play a key role in combating the pandemic.

Dr. Erik C. Nisbet, Associate Professor and Owen L. Coon Professor of Policy Analysis and Communication and Director of Northwestern University’s Center for Communication and Public Policy, is heading the ongoing COVID-19 RAPID study, funded by the National Science Foundation.² RAPID aims to quantify evolving public attitudes regarding COVID-19, including vaccination, in the US.  From December 2020 through June 2021, monthly surveys are being conducted among a group of 1200* randomly selected Americans to track COVID-related attitudes and behaviors. Early results for December 2020 through February 2021 were presented this month.

COVID information and perceptions

More than two-thirds of participants stated they mostly rely on high-credibility sources for COVID-related information, including the news media (23%), federal health agencies (CDC or FDA) (18%), scientists (11%), medical professionals (11%), and public health experts (9%). Few named social media, family and friends, or state and local leaders as their most preferred information sources.

When asked about the perceived likelihood of acquiring COVID-19, respondents on average estimated around a one-in-three chance of infection, which remained relatively constant over the three months of data collection. Respondents believed they had about a 2 in 5 chance of being hospitalized if they contracted COVID-19, and this also remained fairly constant. However, the perceived risk of COVID-related death declined from 30% in December to 27% in February – a statistically significant drop.

Policy support varies

Regarding support for COVID-19 public policy, 61% of Americans said they currently support a mask mandate – a two percentage point rise since December.  Though the percentage of Americans who supported closing bars and restaurants (44%) and places of worship (40%) were about the same in December, since that time, sentiments have diverged. In February, support for bar and restaurant closures dropped six percentage points to 38%, whilst the percentage of Americans supporting closing places of worship grew slightly (Figure 1). 

Support for a national vaccination mandate was weaker, but increasing. Fewer than one-third (31%) supported a national vaccine mandate in December/January; rising to 35% in February (Figure 1). Thirty-nine percent of Americans were opposed or strongly opposed to mandated vaccination. However, the alternative approach of creating herd immunity by allowing COVID-19 to spread whilst protecting the elderly and vulnerable, was supported by only 17% of respondents, with 56% strongly opposed to the idea in December.

Figure 1. Percentage supporting/strongly supporting COVID-19 policies (December 2020 – February 2021)

Around six in ten survey respondents believed vaccination is necessary to protect their own health and that of the community, the importance of “protection of self” rising 11% from December to January, but falling 6% in February (Figure 2). Americans were evenly split on vaccine safety and effectiveness, with 50% believing COVID-19 vaccines are safe, and over 50% believing they are effective. There was some fluctuation in perceptions of efficacy over the three months.

Notably, between December and February there was a substantial drop in the belief that the COVID-19 vaccine is “easy to get” (35% vs. 15%, respectively).

Figure 2. Perceptions of COVID-19 Vaccine: December 2020 vs. January 2021

Vaccination intentions remain steady

While vaccine acceptance was low, survey participants were more likely to be accepting of receiving a vaccine, than resistant (Figure 3). More than four in ten reported they would be likely or extremely likely to accept vaccination when offered, while fewer than one-third were resistant. Respondents who were unsure (the “vaccine hesitant” group) also comprised fewer than one-third.

Figure 3. Likelihood of getting a COVID-19 vaccine

Compared with the vaccine accepting group, those who were vaccine resistant were more likely to be younger, Black, and with less education. This group reported less interest in the news media, and lower trust in scientists and pharmaceutical companies. They were also less likely to get an annual influenza shot. In addition, the vaccine resistant group believed they had a low likelihood of contracting COVID-19, especially severe COVID illness. Generally, this group perceived COVID-19 vaccines as less safe and less effective.

Those who were vaccine hesitant were more likely to be female, Black, and more religious than vaccine accepters. This group were less trusting of public health experts and healthcare providers, less interested in the news, and less likely to get an annual influenza shot. They generally perceived COVID-19 vaccines as less safe and somewhat less effective.

Strategic communications may help increase vaccine support

Given these findings, Dr Nisbet and colleagues suggested several strategic approaches for building vaccine acceptance on a population level. Messaging should be focused particularly on vaccine safety rather than effectiveness – though this should be monitored if perceptions of efficacy continue to fall. It was also suggested that health providers and public health actors work to build engagement and address historical distrust of vaccines among the Black community and other hesitant or resistant groups, while remaining aware of subtle gender differences in vaccine communication. Building trust will require leveraging peer network and community champions, especially religious leaders and organizations.

Further COVID-19 vaccine rollout during 2021 will yield increasingly robust real-world data and experience. In the coming months, continued collaborative efforts to build public trust through appropriate safety and efficacy messaging should continue to improve population-wide vaccine uptake, contributing to a much-anticipated alleviation of the global pandemic burden.

*1200 respondents were randomly selected from a YouGov survey panel and were followed over time. To adjust for attrition in subsequent months, monthly results were weighted to match the general US population.

References

1. Kaiser Family Foundation. Kaiser Health News. Poll: Nearly half of American adults now want the Covid vaccine – ASAP. Available at: https://khn.org/news/article/poll-nearly-half-of-american-adults-now-want-the-covid-vaccine-asap/. Accessed 17 February, 2021.
2. Quantifying the Downstream Effects of COVID-19 Online Health Information on Risk Perceptions, Decision-making, Policy Preferences, and Preventive Health Behaviors. Principal Investigator: E.C. Nisbet, Co-PIs: G. Dixon, R.K. Garrett, D. Wegener, R. Bond, S. Hovick. National Science Foundation. Directorate of Decision, Risk, and Management Science and Secure and Trustworthy Cyberspace. Award# 2031705. See https://nsf.gov/awardsearch/showAward?AWD_ID=2031705.

Medical writing assistance from Geri Skidmore of Bellbird Medical Communications Ltd.