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Will Americans Take the COVID-19 Vaccine?

All indications are that a significant number will delay or refuse vaccination.

“I’m really hesitant about it… For the ones of us who are asking questions, there’s just a lot of questions. I would legitimately still need convincing.” —Dr. Kida Thompson, a family physician.

If you have checked news headlines recently, chances are you’ve seen the rah-rah, we-can’t-wait stories about the forthcoming COVID-19 vaccine. For example, last week, when I searched using the phrase “COVID-19 vaccine” as I was writing this post, every recent news article that came up had an optimistic tone. The news stories covered the FDA’s accelerated timeline to approve the emergency vaccine, how quickly the vaccine will be distributed throughout the country, who should get the vaccine first, and how it will improve air travel.

Source: Vera Davidova/Unsplash
Source: Vera Davidova/Unsplash

In these narratives, the media seem to be banking on the implicit assumption that Americans can’t wait to get vaccinated against the COVID-19 virus and will line up in droves to do so the moment the vaccine is released. However, if we dig a little deeper, the situation is quite a bit more nuanced and uncertain.

In this blog post, I want to examine the validity of the optimistic narrative that Americans will widely adopt COVID-19 vaccination. Is this a reasonable expectation? Will the vaccine be widely accepted and adopted quickly as its access spreads? Or should we be wary and prepare for slow and faltering adoption? I want to answer these questions by considering recent survey data with a psychological lens.

What do COVID-19 vaccination intentions surveys find?

Here are snippets of survey results conducted with Americans by different reputable organizations during the past three months or so. Each survey asked the vaccination intentions question differently, and there were other methodological differences, but together they paint a consistent picture.

  • In a September 2020 Pew Research study, 49 percent said they definitely or probably would not get vaccinated when the vaccine became available. This number was 27 percent in a May survey, suggesting more widespread resistance to vaccination in the fall.
  • In early October, a poll conducted for CNN found similar results, with 51 percent saying they "would try to get vaccinated,” and 45 percent saying they would not try. (I am not sure the “would try” phrasing in the survey is great, but that’s a discussion for another day.)
  • An October poll by Gallup asked, “If an FDA-approved vaccine to prevent coronavirus/COVID-19 was available right now at no cost, would you agree to be vaccinated?” At the beginning of November, the percentage saying “yes” was 58 percent, up from 50 percent in October.
  • According to Morning Consult’s November 30, 2020 update, “The share of adults who said they’d get a coronavirus vaccine if one became available ticked down to 50 percent… As of Nov. 29, 62 percent of Democrats, 46 percent of Republicans, and 40 percent of independents said they’d seek a vaccine.” The headline number has steadily declined in their surveys, starting from a high of 72 percent in early April.

If we generalize from these studies, it is clear that a large and significant proportion, anywhere from a third to half of all Americans, are unlikely to take a vaccine even if it is free and widely available. Note that this includes both people who are likely to actively refuse vaccination and those who were hesitant at the moment they responded but may get on board once they see others vaccinate and go about their lives without adverse side-effects.

Surveys of specific groups

We know that two groups are significantly affected by COVID-19: health care workers and older Americans. Where do they stand with respect to their vaccination intentions? The results from surveys of these two groups are telling.

Source: CDC/Unsplash
Source: CDC/Unsplash

A survey conducted by the American Nurses Foundation that included 12,939 nurses in October found that only 34 percent said they would voluntarily take the vaccine. Thirty-six percent said they would refuse, and 31 percent were unsure. Another academic survey of 1,069 health care workers conducted in September found that 66.5 percent of the respondents intended to delay vaccination, with 49.9 percent indicating that they would prefer to wait and see how the vaccine affects others first. Ominously (but not surprisingly), the authors said, “Notably, we observed several instances where women and racial or ethnic minorities expressed more hesitant attitudes towards vaccines than their counterparts.”

University of Michigan physicians surveyed 1,556 older Americans (50-80 years old) in October. They found that 58 percent indicated they would be likely to get the vaccine, while 28 percent were unlikely, and 14 percent were unsure. There were also racial differences, with a higher proportion of White respondents indicating they would get the vaccine (63 percent) vs. Hispanic (51 percent) or Black (40 percent) respondents. Other surveys have also found that Black Americans are more cynical about COVID-19 vaccination than other groups and report lower intentions to take the vaccine. These findings, which are quite consistent across studies, lead to two rather gloomy conclusions:

1. An even greater proportion of health care workers compared to the general American public is not on board with COVID-19 vaccination. This is a problem. Health care workers tend to be the experts and opinion leaders driving adoption by their patients and communities. If they are themselves resistant, they could alarm laypeople and slow down vaccine adoption among people they influence.

2. A significant number of vulnerable groups (older Americans in general, Hispanic and Black older Americans in particular) are indifferent or, even worse, resistant to getting vaccinated against COVID-19 at the moment.

Why these survey results may actually be overestimating vaccine adoption

At least three reasons raise the distinct and frightening possibility that many respondents who say they will get the vaccine in a survey may not follow through and do so. First, at this moment in time, the act of vaccinating against COVID-19 has a robust social desirability component. Refusing to vaccinate has all sorts of negative connotations attached to it. This may result in a significant degree of yay-saying when respondents don’t mean it. Recall "Shy Trump Voters" from a few weeks ago? This is the same concept, and we could call these respondents "Shy Vaccine Resisters."

Second, in the best of times, getting vaccinated, like other medical procedures, is an effortful behavior. Some COVID-19 vaccines require even more effort than normal. Two doses have to be taken days apart, with the possibility of not feeling well after the first dose. In social psychology, we know all too well that when a behavior involves effort, the gap between behavioral intentions and behavior increases. Enthusiasm does not always translate into action.

And third, getting the COVID-19 vaccine is inherently risky at the moment, and given its nature, there is no way to reduce the risk. This is because some of the risk arises from the potential long-term adverse consequences of taking the vaccine. Until sufficient time passes (at a minimum, several months, and more realistically, two to three years post-inoculation), there is just no way to know if anything bad will happen from taking the vaccine over the long term. When the time to get vaccinated draws near, this unknown risk is likely to loom large for many Americans, resulting in a lack of follow-through.

My pessimistic conclusion

The mainstream media is painting a far-too-positive and one-sided picture of COVID-19 vaccine adoption, especially about the early days and weeks after it becomes available. The rosy-eyed narrative ignores the very real possibility that a majority of Americans, including a significant proportion of health care workers and those belonging to the most vulnerable groups, will refuse to take the vaccine or at least delay it for a lot longer than the current scenarios suggest. The most formidable challenge public health officials may face is not getting the COVID-19 vaccine doses ready and distributing them widely across the country but in persuading Americans to take the vaccine sooner rather than later (or even worse, not taking it at all).