New study identifies nuanced reasons why Americans get—or refuse—COVID-19 vaccines

A new study from the Texas A&M University School of Public Health suggests that persuading the majority of Americans to vaccinate against new strains of COVID-19 will be challenging—and could result in a major setback for public health as we enter prime flu and COVID-19 season this winter.

“At the same time that skepticism about vaccines in general—and the COVID-19 vaccine specifically—is growing, experts predict tens of thousands of deaths and hundreds of thousands of hospitalizations in the United States from COVID-19 this winter alone,” said Simon Haeder, PhD, an associate professor in the Department of Health Policy and Management, who led the study. “Many of these deaths and hospitalizations could be prevented through widespread vaccination.”

Haeder’s study, published in the journal Health Affairs Scholar, investigated the nuances of COVID-19 vaccination hesitancy and is one of the first to evaluate Americans’ intention to receive existing and newly released vaccines for fall and winter 2023-24. In addition, it analyzed support for resuming federal funding to provide COVID-19 testing, vaccinations and treatment for free.

For the study, Haeder administered surveys via Lucid to 3,958 adult Americans on Aug. 18 and 19, 2023. After answering questions about COVID-19 and their vaccination history, respondents were randomly assigned toone of three groups: a control group, a group that focused on recent increases in COVID-19 cases in the United States or a group that focused on the elimination of federal funding for COVID-19 tests, vaccines and treatment and the expected cost of these items.

After that, respondents were asked about their intention to vaccinate this fall and winter. Moreover, all respondents were also asked whether they would like for the federal government to bring back free COVID-19tests, vaccines and treatments.

All respondents also were asked about any COVID-19 vaccines they had received. Haeder then asked those who had not gotten two or more boosters why they made this decision, using 12 choices such as concerns about vaccine safety, whether they already had COVID-19 and whether doing so was against their religious beliefs. Respondents, including those who had never been vaccinated, were also asked about their intentions to vaccinate or get a booster in the future. In addition, all respondents were asked whether they thought the federal government should resume making COVID-19 tests, vaccines and treatments available free of charge.

To assess vaccination refusal and intention to vaccinate as well as support for federal funding, respondents were asked about their experiences with COVID-19, concern that current vaccines would not protect against new strains of the disease and beliefs that the vaccines were safe, effective and important. The study used respondents’ political party affiliation and religiosity as measures of overall support for vaccination policy and for COVID-19 in particular.

Haeder found that 26.8 percent of respondents had not received a single dose of the COVID-19 vaccine; 30.4 percent had not completed the initial COVID-19 vaccination sequence; 55.2 percent had not received the first booster shot and 73.4 percent had not received a second booster shot. These numbers are comparable to findings from similar studies.

Respondents with higher levels of concern about COVID-19, who had been tested for COVID-19 before, who thought vaccines were safe and who thought vaccines were important had higher vaccination rates. Voting for President Trump in 2020 was strongly associated with increases in vaccination refusal across all stages. In addition, uninsured individuals, those on Medicaid and those with lower levels of education consistently indicated lower rates of vaccinations.

Regarding past vaccine refusal, Haeder found that concern about vaccine safety was the top concern among those who had never received a COVID-19 vaccination, those who received the initial shot but did not complete the initial series and those not receiving all vaccinations except the first booster. For those who had received all vaccinations except the second booster, the top reason given was having previously been sick with COVID-19. Concern about side effects was the top issue for those who had not received any booster and those who had not received the second booster.

When asked about plans to get vaccinated with the existing vaccine for COVID-19 in the “near future,” 67.4 percent of those who had never been vaccinated for COVID-19 stated they would not. When asked about getting the existing booster, the answers were roughly split from “definitely not” to “definitely yes,” which is in line with other studies.

Regarding intention to get vaccinated with the new annual vaccine, 37 percent stated they intended to get the booster, with almost 45 percent indicating hesitancy, 28.4 percent noting they definitely would not get vaccinated and another 15.5 percent indicating they would probably not get vaccinated. Support for President Trump in 2020 and having experienced a COVID-19 infection were associated with reduced intention for the current booster and the future vaccine. Those with higher trust in vaccine safety indicated they were more likely to seek out the current booster and new annual vaccine, as were those who indicated they were more at risk of getting COVID-19.

Regarding support for renewed federal funding, more than 70 percent of respondents supported federal funding to make tests, vaccines and treatments available to Americans at no cost.

“The overall lesson from this is the major challenge we face in getting the majority of Americans vaccinated not just with existing COVID-19 vaccines, but also those developed as new strains emerge,” Haeder said. “Officials should focus on the public’s concerns about vaccine safety and side effects, a lack of information about vaccines and the disease, and previous exposure.”

Haeder also noted that the public’s overwhelming support for renewed federal investment in free COVID-19 testing, vaccines and treatments, which was recently phased out, could be a crucial tool for addressing COVID-19 in the near future.

“COVID-19 is no longer in the headlines, but the threat continues, and vaccines are an effective solution,” Haeder said.