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Factors Associated With US Adults’ Likelihood of Accepting COVID-19 Vaccination

Educational Objective
To identify the key insights or developments described in this article
1 Credit CME
Key Points

Question  What factors are associated with US adults’ choice of and willingness to accept a hypothetical COVID-19 vaccine?

Findings  In this survey study of a national sample of 1971 US adults, vaccine-related attributes (eg, vaccine efficacy, adverse effects, and protection duration) and political factors (eg, US Food and Drug Administration approval process, national origin of vaccine, and endorsements) were associated with preferences for choosing a hypothetical COVID-19 vaccine. Health care attitudes and practices, political partisanship, and demographic characteristics, including age, sex, and race/ethnicity, were also associated with willingness to receive a vaccination.

Meaning  The results of this survey study may help inform public health campaigns to address vaccine hesitancy.


Importance  The development of a coronavirus disease 2019 (COVID-19) vaccine has progressed at unprecedented speed. Widespread public uptake of the vaccine is crucial to stem the pandemic.

Objective  To examine the factors associated with survey participants’ self-reported likelihood of selecting and receiving a hypothetical COVID-19 vaccine.

Design, Setting, and Participants  A survey study of a nonprobability convenience sample of 2000 recruited participants including a choice-based conjoint analysis was conducted to estimate respondents’ probability of choosing a vaccine and willingness to receive vaccination. Participants were asked to evaluate their willingness to receive each hypothetical vaccine individually. The survey presented respondents with 5 choice tasks. In each, participants evaluated 2 hypothetical COVID-19 vaccines and were asked whether they would choose vaccine A, vaccine B, or neither vaccine. Vaccine attributes included efficacy, protection duration, major adverse effects, minor adverse effects, US Food and Drug Administration (FDA) approval process, national origin of vaccine, and endorsement. Levels of each attribute for each vaccine were randomly assigned, and attribute order was randomized across participants. Survey data were collected on July 9, 2020.

Main Outcomes and Measures  Average marginal component effect sizes and marginal means were calculated to estimate the relationship between each vaccine attribute level and the probability of the respondent choosing a vaccine and self-reported willingness to receive vaccination.

Results  A total of 1971 US adults responded to the survey (median age, 43 [interquartile range, 30-58] years); 999 (51%) were women, 1432 (73%) White, 277 (14%) were Black, and 190 (10%) were Latinx. An increase in efficacy from 50% to 70% was associated with a higher probability of choosing a vaccine (coefficient, 0.07; 95% CI, 0.06-0.09), and an increase from 50% to 90% was associated with a higher probability of choosing a vaccine (coefficient, 0.16; 95% CI, 0.15-0.18). An increase in protection duration from 1 to 5 years was associated with a higher probability of choosing a vaccine (coefficient, 0.05 95% CI, 0.04-0.07). A decrease in the incidence of major adverse effects from 1 in 10 000 to 1 in 1 000 000 was associated with a higher probability of choosing a vaccine (coefficient, 0.07; 95% CI, 0.05-0.08). An FDA emergency use authorization was associated with a lower probability of choosing a vaccine (coefficient, −0.03; 95% CI, −0.04 to −0.01) compared with full FDA approval. A vaccine that originated from a non-US country was associated with a lower probability of choosing a vaccine (China: −0.13 [95% CI, −0.15 to −0.11]; UK: −0.04 [95% CI, −0.06 to −0.02]). Endorsements from the US Centers for Disease Control and Prevention (coefficient, 0.09; 95% CI, 0.07-0.11) and the World Health Organization (coefficient, 0.06; 95% CI, 0.04-0.08), compared with an endorsement from President Trump were associated with higher probabilities of choosing a vaccine. Analyses of participants’ willingness to receive each vaccine when assessed individually yielded similar results. An increase in efficacy from 50% to 90% was associated with a 10% higher marginal mean willingness to receive a vaccine (from 0.51 to 0.61). A reduction in the incidence of major side effects was associated with a 4% higher marginal mean willingness to receive a vaccine (from 0.54 to 0.58). A vaccine originating in China was associated with a 10% lower willingness to receive a vaccine vs one developed in the US (from 0.60 to 0.50) Endorsements from the Centers for Disease Control and Prevention and World Health Organization were associated with increases in willingness to receive a vaccine (7% and 6%, respectively) from a baseline endorsement by President Trump (from 0.52 to 0.59 and from 0.52 to 0.58, respectively).

Conclusions and Relevance  In this survey study of US adults, vaccine-related attributes and political characteristics were associated with self-reported preferences for choosing a hypothetical COVID-19 vaccine and self-reported willingness to receive vaccination. These results may help inform public health campaigns to address vaccine hesitancy when a COVID-19 vaccine becomes available.

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Article Information

Accepted for Publication: September 16, 2020.

Published: October 20, 2020. doi:10.1001/jamanetworkopen.2020.25594

Correction: This article was corrected on November 23, 2020, to fix the third-to-last sentence in the last paragraph of the Results, where the phrase “lower willingness” was incorrectly used; the correct phrase is “greater willingness.”

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2020 Kreps S et al. JAMA Network Open.

Corresponding Author: Douglas L. Kriner, PhD, Department of Government, Cornell University, 209 White Hall, Ithaca, NY 14850 (kriner@cornell.edu).

Author Contributions: Drs Kreps and Kriner had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Kreps, Prasad, Garibaldi, Hswen, Zhang, Kriner.

Acquisition, analysis, or interpretation of data: Prasad, Brownstein, Garibaldi, Kriner.

Drafting of the manuscript: Kreps, Prasad, Kriner.

Critical revision of the manuscript for important intellectual content: Prasad, Brownstein, Hswen, Garibaldi, Zhang, Kriner.

Statistical analysis: Garibaldi, Hswen, Zhang, Kriner.

Obtained funding: Kreps, Kriner.

Administrative, technical, or material support: Prasad.

Supervision: Kreps, Prasad, Hswen, Kriner.

Conflict of Interest Disclosures: None reported.

Funding/Support: Drs Kreps and Kriner would like to thank the Cornell Atkinson Center for Sustainability for financial support.

Role of the Funder/Sponsor: The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

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