COVID-19 vaccination intent, perceptions, and reasons for not vaccinating among groups prioritized for early vaccination — United States, September and December 2020

This article describes perceptions of the COVID-19 vaccine among US adults, and reports that younger adults, women, non-Hispanic Black adults, adults living in nonmetropolitan areas, adults with less education and income, and adults without health insurance have the highest estimates of nonintent to receive vaccination; due to concerns about side effects and safety of the COVID-19 vaccine, lack of trust in the government, and concern that COVID-19 vaccines were developed too quickly are the primary reasons for deferring vaccination. Solid organ transplant candidates and recipients may harbor similar concerns about vaccination, and further, may rely more heavily on herd immunity for protection from COVID-19, since the efficacy of COVID-19 vaccination among immunosuppressed individuals remains ill-defined. Promoting vaccine confidence among transplant candidates, transplant recipients, and the general population will thus be critical to preventing spread of COVID-19. This article describes perceptions of the COVID-19 vaccine among US adults, and reports that younger adults, women, non-Hispanic Black adults, adults living in nonmetropolitan areas, adults with less education and income, and adults without health insurance have the highest estimates of nonintent to receive vaccination; due to concerns about side effects and safety of the COVID-19 vaccine, lack of trust in the government, and concern that COVID-19 vaccines were developed too quickly are the primary reasons for deferring vaccination. Solid organ transplant candidates and recipients may harbor similar concerns about vaccination, and further, may rely more heavily on herd immunity for protection from COVID-19, since the efficacy of COVID-19 vaccination among immunosuppressed individuals remains ill-defined. Promoting vaccine confidence among transplant candidates, transplant recipients, and the general population will thus be critical to preventing spread of COVID-19. As of February 8, 2021, 59.3 million doses of vaccines to prevent coronavirus disease 2019 (COVID-19) had been distributed in the United States, and 31.6 million persons had received at least one dose of the COVID-19 vaccine.1CDCCOVID data tracker: COVID-19 vaccinations in the United States. US Department of Health and Human Services. CDC, Atlanta, GA2021Google Scholar However, national polls conducted before vaccine distribution began suggested that many persons were hesitant to receive COVID-19 vaccination.2Kaiser Family FoundationCoronavirus (COVID-19). KFF COVID-19 vaccine monitor: December 2020. Kaiser Family Foundation, San Francisco, CA2020Google Scholar To examine perceptions toward COVID-19 vaccine and intentions to be vaccinated, in September and December 2020, CDC conducted household panel surveys among a representative sample of U.S. adults. From September to December, vaccination intent (defined as being absolutely certain or very likely to be vaccinated) increased overall (from 39.4% to 49.1%); the largest increase occurred among adults aged ≥65 years. If defined as being absolutely certain, very likely, or somewhat likely to be vaccinated, vaccination intent increased overall from September (61.9%) to December (68.0%). Vaccination nonintent (defined as not intending to receive a COVID-19 vaccination) decreased among all adults (from 38.1% to 32.1%) and among most sociodemographic groups. Younger adults, women, non-Hispanic Black (Black) persons, adults living in nonmetropolitan areas, and adults with lower educational attainment, with lower income, and without health insurance were most likely to report lack of intent to receive COVID-19 vaccine. Intent to receive COVID-19 vaccine increased among adults aged ≥65 years by 17.1 percentage points (from 49.1% to 66.2%), among essential workers by 8.8 points (from 37.1% to 45.9%), and among adults aged 18–64 years with underlying medical conditions by 5.3 points (from 36.5% to 41.8%). Although confidence in COVID-19 vaccines increased during September–December 2020 in the United States, additional efforts to tailor messages and implement strategies to further increase the public’s confidence, overall and within specific subpopulations, are needed. Ensuring high and equitable vaccination coverage across all populations is important to prevent the spread of COVID-19 and mitigate the impact of the pandemic. The Advisory Committee on Immunization Practices (ACIP) has issued interim recommendations for COVID-19 vaccine allocation, with initial limited supplies of vaccines recommended for healthcare personnel and residents of long-term care facilities (phase 1a); frontline essential workers and persons aged ≥75 years (phase 1b); and persons aged 65–74 years, persons aged 16–64 years at high risk for severe COVID-19 illness because of underlying medical conditions,* and other workers in essential and critical infrastructure sectors† not included in phases 1a and 1b (phase 1c).3Dooling K McClung N Chamberland M et al.The Advisory Committee on Immunization Practices’ interim recommendation for allocating initial supplies of COVID-19 vaccine—United States, 2020.MMWR Morb Mortal Wkly Rep. 2020; 69 (https://doi.org/10.15585/mmwr.mm6949e1. PMID:33301429.): 1857-1859Crossref PubMed Google Scholar,4Dooling K Marin M Wallace M et al.The Advisory Committee on Immunization Practices’ updated interim recommendation for allocation of COVID-19 vaccine—United States, December 2020.MMWR Morb Mortal Wkly Rep. 2021; 69 (https://doi.org/10.15585/mmwr.mm695152e2. PMID:33382671.): 1657-1660Crossref PubMed Google Scholar Vaccinating a large proportion of persons in the United States against COVID-19 is critical for preventing SARS-CoV-2–associated morbidity and mortality and helping bring an end to the global pandemic. During September 3–October 1, CDC conducted a probability-based Internet panel survey (IPSOS KnowledgePanel)§ of a nationally representative sample of 3541 U.S. adult panelists aged ≥18 years to assess intent to receive a COVID-19 vaccine and perceptions about the vaccine.5Nguyen KH Kahn K Hoehner J et al.AdultVaxView: COVID-19 vaccination intent, perceptions, and reasons for not vaccinating among groups prioritized for early vaccination, United States, September 2020. US Department of Health and Human Services, CDC, Atlanta, GA2021Google Scholar During December 18–20, CDC sponsored questions on two probability-based household panel omnibus surveys (IPSOS KnowledgePanel¶ and NORC Amerispeak****) administered to 2033 panelists (approximately 1000 panelists each) to reassess COVID-19 vaccination intent and related perceptions.†† This activity was reviewed by CDC and was conducted consistent with applicable federal law and CDC policy.§§ The same questions about COVID-19 vaccine intentions, perceptions, and reasons for not receiving a COVID-19 vaccine were asked in the September and December surveys. However, most respondents were different for each survey; only 123 panelists (3.5%) completed both the September and December IPSOS survey. Intent was assessed by response to the following question: “If a vaccine against COVID-19 were available today at no cost, how likely would you be to get it?” Response options were “absolutely certain,” “very likely,” “somewhat likely,” and “not likely.” Respondents who answered “absolutely certain” or “very likely” to receive a COVID-19 vaccination were defined as intending to be vaccinated, and respondents who answered “not likely” were defined as not intending to be vaccinated. Vaccination intentions and related perceptions were stratified by the following three mutually exclusive groups representing the ACIP priorities for initial doses of COVID-19 vaccine after healthcare providers and long-term care residents: (1) essential workers,¶¶ (2) adults aged 18–64 years with underlying medical conditions, and (3) adults aged ≥65 years.***** Sample size for the December surveys was not large enough to stratify the analysis by age group (65–74 years vs. ≥75 years) or essential worker subgroups (healthcare personnel, other frontline essential workers, and other non-frontline essential workers). Analyses were also conducted to provide estimates among all adults and among adults not included in the initial ACIP priority groups (aged 18–64 years with no underlying medical conditions and who were not essential workers). Responses to questions on intent, perceptions, and reasons for not getting vaccinated were examined by sociodemographic characteristics and priority groups for the September and December surveys. Because of similar sampling methods and characteristics of respondents, the averages of the estimates from the two December surveys were calculated, and the difference between the September survey and the average of the December surveys was determined using t-tests. All surveys were weighted to ensure representativeness of the U.S. population, and all analyses were conducted using SAS-callable SUDAAN (version 11.0; RTI International). From September to December, the proportion of adults reporting intent to receive COVID-19 vaccine as absolutely certain or very likely increased significantly by 9.7% points (from 39.4% to 49.1%), and the proportion reporting nonintent decreased by 6.0% points (from 38.1% to 32.1%) (Table 1). Among priority groups, intent increased by 17.1 percentage points among adults aged ≥65 years (from 49.1% to 66.2%), by 8.8% points among essential workers (from 37.1% to 45.9%), and by 5.3% points among adults aged 18–64 years with underlying medical conditions (from 36.5% to 41.8%) (Supplementary Figure, https://stacks.cdc.gov/view/cdc/101583).TABLE 1COVID-19 vaccination intent among surveyed adults, by vaccination priority group — United States, September and December 2020CharacteristicWeighted % (95% CI)IPSOS, Sep 2020*IPSOS KnowledgePanel Survey, fielded September 3–October 1. (n = 3541)IPSOS, Dec 2020†IPSOS KnowledgePanel Omnibus Survey, fielded December 18–20. (n = 1005)NORC, Dec 2020§NORC AmeriSpeak Omnibus Survey, fielded December 18–20. (n = 1028)Average of Dec IPSOS†IPSOS KnowledgePanel Omnibus Survey, fielded December 18–20. and NORC§NORC AmeriSpeak Omnibus Survey, fielded December 18–20. estimates (n = 2,033)Difference between Dec and Sep estimates¶CIs for differences that exclude zero are statistically significant.All adultsIntent to get COVID-19 vaccineAbsolutely certain/very likely**Might include some persons who already received the COVID-19 vaccine.39.4 (37.7–41.2)50.3 (46.9–53.6)47.8 (42.7–52.8)49.1 (46.0–52.1)9.7 (6.2–13.2)Somewhat likely22.5 (21.0–24.0)16.8 (14.2–19.4)21.0 (17.4–24.8)18.9 (16.4–21.4)–3.6 (–6.5 to –0.7)Not likely38.1 (36.4–39.8)33.0 (29.7–36.2)31.2 (26.5–35.8)32.1 (29.6–34.6)–6.0 (–9.0 to –3.0)Essential workersIntent to get COVID–19 vaccineAbsolutely certain/Very likely**Might include some persons who already received the COVID-19 vaccine.37.1 (34.2–40.0)49.0 (42.9–55.1)42.8 (34.9–50.6)45.9 (40.9–50.9)8.8 (3.0–14.6)Somewhat likely22.8 (20.2–25.3)14.4 (9.9–19.1)23.0 (16.6–29.6)18.7 (14.0–23.4)–4.1 (–9.4 to 1.2)Not likely40.2 (37.3–43.2)36.6 (30.7–42.3)34.2 (25.8–42.6)35.4 (30.8–40.0)–4.8 (–10.3 to 0.7)Adults aged ≥65 yearsIntent to get COVID-19 vaccineAbsolutely certain/very likely**Might include some persons who already received the COVID-19 vaccine.49.1 (45.6–52.6)66.5 (60.0–73.0)65.8 (59.0–72.6)66.2 (61.5–70.8)17.1 (11.3–22.9)Somewhat likely21.1 (18.3–23.9)12.8 (8.4–17.2)17.4 (12.0–22.9)15.1 (11.6–18.6)–6.0 (–10.5 to –1.5)Not likely29.8 (26.6–33.0)20.6 (14.9–26.4)16.8 (10.2–23.3)18.7 (14.3–23.0)–11.1 (–16.5 to –5.7)Adults aged 18–64 years with underlying medical conditionsIntent to get COVID–19 vaccineAbsolutely certain/very likely**Might include some persons who already received the COVID-19 vaccine.36.5 (33.4–39.6)44.8 (38.0–51.5)38.8 (32.6–45.1)41.8 (37.2–46.4)5.3 (–0.2 to 10.8)Somewhat likely23.0 (20.3–25.7)19.2 (13.3–25.0)20.6 (14.7–26.6)19.9 (15.7–24.1)–3.1 (–8.1 to 1.9)Not likely40.4 (37.3–43.7)36.0 (29.4–42.8)40.5 (34.5–46.5)38.3 (33.8–42.8)–2.1 (–7.6 to 3.4)Adults aged 18–64 years without underlying medical conditions and nonessential workersIntent to get COVID-19 vaccineAbsolutely certain/very likely**Might include some persons who already received the COVID-19 vaccine.38.0 (34.5–41.4)46.3 (40.5–52.1)48.7 (40.0–57.4)47.5 (42.3–52.7)9.5 (3.3–15.7)Somewhat likely22.4 (19.4–25.2)18.4 (13.8–23.1)22.2 (13.2–31.3)20.3 (15.2–25.4)–2.1 (–8.0 to 3.8)Not likely39.8 (36.4–43.1)35.2 (29.5–41.0)29.0 (20.9–37.2)32.2 (27.2–37.1)–7.6 (–13.6 to –1.6)Abbreviations: CI, confidence interval; COVID-19, coronavirus disease 2019.* IPSOS KnowledgePanel Survey, fielded September 3–October 1.† IPSOS KnowledgePanel Omnibus Survey, fielded December 18–20.§ NORC AmeriSpeak Omnibus Survey, fielded December 18–20.¶ CIs for differences that exclude zero are statistically significant.** Might include some persons who already received the COVID-19 vaccine. Open table in a new tab Abbreviations: CI, confidence interval; COVID-19, coronavirus disease 2019. Vaccination nonintent differed by sociodemographic characteristics and decreased across most socioeconomic groups from September to December (Table 2). For example, nonintent decreased by 10.3 percentage points among adults aged 50–64 years and by 11.1 percentage points among adults aged ≥65 years. Although nonintent was higher among women, nonintent among both women and men decreased by 6.0 percentage points between September and December. Nonintent was highest among Black persons in September (56.1%) and December (46.5%) compared with other racial/ethnic groups, with the difference between months (–9.6) not statistically significant. Nonintent was higher among adults with lower educational attainment and lower income but decreased across most education and income categories: among adults with a high school diploma or less, nonintent decreased 7.9% points, and in households with annual incomes of $35 000–$49 999, nonintent decreased by 10.8% points. Vaccination nonintent also decreased in metropolitan statistical areas††† by 6.7% points and among adults in all regions of the United States, except the Northeast, including decreases of 8.3% points in the South, 6.8 in the Midwest, and 6.8 in the West. In December, nonintent was highest among persons without health insurance (44.5%), compared with those who had private health insurance (30.7%) and public health insurance (29.6%), and was similar in September and December.TABLE 2Prevalence of intent not to receive COVID-19 vaccine, by selected characteristics — United States, September and December 2020CharacteristicWeighted % (95% CI)IPSOS, Sep 2020*IPSOS KnowledgePanel Survey, fielded September 3–October 1. (n = 3541)Average of Dec IPSOS†IPSOS KnowledgePanel Omnibus Survey, fielded December 18–20. and NORC§NORC AmeriSpeak Omnibus Survey, fielded December 18–20. estimates (n = 2033)Difference between Dec and Sep estimates¶CIs for differences that exclude zero are statistically significant.All adults, aged ≥18 yearsAge group, years18–49 (ref)39.5 (36.9–42.0)37.6 (33.5–41.7)–1.9 (–6.7 to 3.0)50–6442.0 (38.9–45.2)31.7 (26.6–36.8)–10.3 (–16.3 to –4.3)≥6529.8**p < 0.05 compared with respective reference category for each variable (by t < 0.05 compared with respective reference category for each variable (by t (–16.5 to < 0.05 compared with respective reference category for each variable (by t < 0.05 compared with respective reference category for each variable (by t to to non-Hispanic to < 0.05 compared with respective reference category for each variable (by t < 0.05 compared with respective reference category for each variable (by t to to (–16.5 to school or less to or < 0.05 compared with respective reference category for each variable (by t < 0.05 compared with respective reference category for each variable (by t to < 0.05 compared with respective reference category for each variable (by t < 0.05 compared with respective reference category for each variable (by t to to in (–10.3 to household income, to to to to < 0.05 compared with respective reference category for each variable (by t < 0.05 compared with respective reference category for each variable (by t to to to < 0.05 compared with respective reference category for each variable (by t to to insurance health insurance to health to health < 0.05 compared with respective reference category for each variable (by t < 0.05 compared with respective reference category for each variable (by t to < 0.05 compared with respective reference category for each variable (by t < 0.05 compared with respective reference category for each variable (by t to vaccination certain to < 0.05 compared with respective reference category for each variable (by t (–16.5 to < 0.05 compared with respective reference category for each variable (by t < 0.05 compared with respective reference category for each variable (by t about COVID-19 illness for to < 0.05 compared with respective reference category for each variable (by t < 0.05 compared with respective reference category for each variable (by t to about side effects of vaccine for (–7.6 to < 0.05 compared with respective reference category for each variable (by t < 0.05 compared with respective reference category for each variable (by t to to ensure the COVID-19 vaccine is for the trust to not < 0.05 compared with respective reference category for each variable (by t to CI, confidence interval; COVID-19, coronavirus disease metropolitan statistical reference IPSOS KnowledgePanel Survey, fielded September 3–October 1.† IPSOS KnowledgePanel Omnibus Survey, fielded December 18–20.§ NORC AmeriSpeak Omnibus Survey, fielded December 18–20.¶ CIs for differences that exclude zero are statistically significant.** < 0.05 compared with respective reference category for each variable (by t Open table in a new tab is already about polls conducted before vaccine distribution began suggested that many persons were hesitant to receive COVID-19 is by September to December 2020, intent to receive COVID-19 vaccination increased from 39.4% to 49.1% among adults and across all priority groups, and nonintent decreased from 38.1% to decreases in nonintent from September to December, younger adults, women, non-Hispanic Black adults, adults living in nonmetropolitan areas, and adults with less education and income, and without health insurance to have the highest estimates of nonintent to receive COVID-19 are the for public health high and equitable vaccination coverage among all including by reasons for not intending to receive vaccination, is critical to prevent the spread of COVID-19 and bring an end to the pandemic. Abbreviations: CI, confidence interval; COVID-19, coronavirus disease metropolitan statistical reference is already about polls conducted before vaccine distribution began suggested that many persons were hesitant to receive COVID-19 vaccination. is by From September to December 2020, intent to receive COVID-19 vaccination increased from 39.4% to 49.1% among adults and across all priority groups, and nonintent decreased from 38.1% to decreases in nonintent from September to December, younger adults, women, non-Hispanic Black adults, adults living in nonmetropolitan areas, and adults with less education and income, and without health insurance to have the highest estimates of nonintent to receive COVID-19 vaccination. are the for public health Ensuring high and equitable vaccination coverage among all including by reasons for not intending to receive vaccination, is critical to prevent the spread of COVID-19 and bring an end to the pandemic. Among adults in the December surveys who not to get vaccinated, the reasons most were concerns about side effects and safety of the COVID-19 vaccine to to the vaccine is and receiving lack of trust in the and concern that COVID-19 vaccines were developed too quickly (Table percentage of the December survey September safety concerns as a vs. and a percentage concern that vaccines were developed too quickly vs. reasons for not intending to get COVID-19 respondents who that are not likely to receive the COVID-19 vaccine. United States, September and December % (95% CI)IPSOS, Sep 2020†IPSOS KnowledgePanel Survey, fielded September 3–October 1. (n = 3541)Average of Dec KnowledgePanel Omnibus Survey, fielded December 18–20. and AmeriSpeak Omnibus Survey, fielded December 18–20. estimates (n = 2033)Difference between Dec and Sep for differences that exclude zero are statistically about the side effects and safety of the that the vaccine is being developed too to to and is and may get (–7.6 to trust the to to to to a of group that is at high risk for to is not a to vaccine will not to vaccine to COVID-19 and be (–0.2 to to has not recommended a COVID-19 vaccine to to a vaccine against to about the with the vaccine as or vaccine to CI, confidence interval; COVID-19, coronavirus disease 2019.* Among respondents who that are not likely to receive the COVID-19 IPSOS KnowledgePanel Survey, fielded September 3–October IPSOS KnowledgePanel Omnibus Survey, fielded December 18–20.¶ NORC AmeriSpeak Omnibus Survey, fielded December CIs for differences that exclude zero are statistically significant. Open table in a new tab Abbreviations: CI, confidence interval; COVID-19, coronavirus disease 2019. From September to December 2020, vaccination intent increased among all adults by percentage points and across all priority groups, with the largest increase in intent to be vaccinated among adults aged ≥65 vaccination nonintent decreased among all adults by percentage points and across most sociodemographic groups. However, in vaccination intent since KH Kahn K Hoehner J et al.AdultVaxView: COVID-19 vaccination intent, perceptions, and reasons for not vaccinating among groups prioritized for early vaccination, United States, September 2020. US Department of Health and Human Services, CDC, Atlanta, GA2021Google Scholar only about of persons aged 18–64 years surveyed in December being very likely to receive COVID-19 vaccination, among those who were essential workers and persons aged 18–64 years with underlying medical Younger adults, women, Black persons, adults living in nonmetropolitan areas, and adults with lower educational attainment, with lower income, and without insurance were most likely to report that not to receive COVID-19 vaccination. similar and in vaccination intent and of receiving a COVID-19 vaccine among groups by COVID-19, including Black persons and those with lower educational K et in the US public’s of getting a COVID-19 to December 8, 2020; PubMed Google J of COVID-19 vaccine in the 2020; PubMed Google Scholar Because many of groups are at increased risk for morbidity and et of persons who with States, February 2020.MMWR Morb Mortal Wkly Rep. 2020; 69 PubMed Google Scholar COVID-19 vaccination is important for the health of populations and health The in report are to at least panel and data were to nationally representative respondents not be representative of the general U.S. adult because the sample of persons surveyed in December was not from the sample of persons surveyed in analysis of in from the same sample of persons was not sample analyses of some priority groups by as healthcare personnel, frontline and other essential workers, and adults aged 65–74 years and ≥75 years. because essential worker and medical conditions were be for Respondents were also mutually exclusive vaccine priority groups, not for persons who within groups essential workers aged 18–64 years with underlying medical and perceptions and not be of reasons for not intending to receive a COVID-19 vaccine. are national estimates and be to the or not be to other national polls or surveys because of differences in survey sample population, and questions related to vaccination to vaccine confidence by to concerns of persons and is critical to preventing the spread of COVID-19. a in nonintent as as concerns about vaccine safety among priority populations in the United States and have for messages and strategies that confidence in COVID-19 vaccines and essential workers, and the general public about the safety of the vaccine and the and safety of COVID-19 with to confidence in COVID-19 US Department of Health and Human Services. CDC, Atlanta, Scholar providers are to be a of about vaccines for many persons and to have with about the for vaccination. US Department of Health and Human Services, CDC, Atlanta, Scholar Ensuring high and equitable vaccination coverage in all populations is critical to preventing the spread of COVID-19 and an end to the pandemic. with underlying medical conditions were defined as those who of the following disease conditions or from organ and Respondents aged 18–64 years reporting of one or more of conditions were as in the This of underlying medical conditions not include was to the on December 2020. of underlying medical conditions is available at essential workers include those who a of and that are essential to critical infrastructure including and critical and among included are workers who and for critical The but are not limited medical and health and and and and law from the September and December surveys an sampling that all households in the United States of or Internet with a of all among all of IPSOS IPSOS and NORC were fielded in and and non-Hispanic Black and non-Hispanic other panel were to ensure sample size for analyses by et workers were defined as those who to the following question: or are you as an essential exclusive groups were in the following essential workers, adults aged ≥65 years, and adults aged 18–64 years with an underlying medical who as an essential worker was as an essential of aged ≥65 years was as adult aged ≥65 years. aged 18–64 years with an underlying medical was as adult aged 18–64 years with an underlying medical All were as adults aged 18–64 years who were not essential workers and had no underlying medical statistical was determined by group using the For a of panelists for the was not was to