A cross-sectional survey of false beliefs about COVID-19 and their association with vaccine hesitancy and uptake in the United States and China

Misinformation about COVID-19 vaccines fuel vaccine hesitancy and refusal. The prevalence of false beliefs contributes to differences in vaccine hesitancy across the US and China. We present cross sectional research assessing false beliefs about COVID-19 and the COVID-19 vaccine, and both vaccine/booster status and hesitancy in the US and China. We compared these variables across US (n = 454) and Chinese (n = 456) participants. Additionally, we use regression analyses to assess the relative association between false beliefs about COVID-19 and the COVID-19 vaccine and vaccine/booster hesitancy and uptake. The likelihood of receiving an initial vaccine was greater in China than the US (OR = 346.50, p < 0.001), and false beliefs about COVID-19 were associated with a decreased likelihood of receiving an initial vaccine (OR = 0.82, p = 0.05). The likelihood of receiving booster was just over three times greater in China than the US (OR = 3.45, p < 0.001) and false beliefs about COVID-19 were not associated with the likelihood of receiving a booster (OR = 0.92, p = 0.33). Vaccine hesitancy is more likely in the US than China (eB = 0.85, p < 0.001) and false beliefs about COVID-19 are positively associated with vaccine hesitancy (eB = 1.20, p < 0.01). There was significant interaction between country and false beliefs (eB = 0.93, p = 0.02). Booster hesitancy is more likely in the US than China (eB = 0.95, p = 0.04) and false beliefs about COVID-19 are positively associated with booster hesitancy (eB = 1.15, p < 0.001). False beliefs about COVID-19 were associated with attitudes (vaccine hesitancy) but not behaviors (vaccine status). Additionally, we found that the strength of the association between false beliefs and attitudes differed between the two countries. Trusted resources to combat false beliefs, that are tailored to the local context, could help reduce vaccine hesitancy and increase vaccine uptake.