COVID-19 vaccine intentions in the United States, a social-ecological framework

Background: COVID-19 vaccine hesitancy is a major obstacle for pandemic mitigation. As vaccine hesitancy occurs along multiple dimensions, we used a social-ecological framework to guide the examination of COVID-19 vaccine intentions. Methods: Using an online survey in the US conducted in July 2020, we examined intentions to obtain a COVID-19 vaccine, once available. 592 respondents provided data, including measures of demographics, vaccine history, social norms, perceived risk, and trust in sources of COVID-19 information. Bivariate and multivariate multinomial models were used to compare respondents who intended to be vaccinated against COVID-19 to respondents who did not intend or were ambivalent about COVID-19 vaccination. Results: Only 59.1% of the sample reported that they intended to obtain a COVID-19 vaccine. In the multivariate multinomial model, those respondents who did not intend to be vaccinated, as compared to those who did, had significantly lower levels of trust in the CDC as a source of COVID-19 information (aOR = 0.29, CI = 0.17-0.50), reported lower social norms of COVID-19 preventive behaviors (aOR = 0.67, CI 0.51-0.88), scored higher on COVID-19 Skepticism (aOR = 1.44, CI = 1.28-1.61), identified as more politically conservative (aOR = 1.23, CI = 1.05-1.45), were less likely to have obtained a flu vaccine in the prior year (aOR = 0.21, CI = 0.11-0.39), were less likely to be female (aOR = 0.51, CI = 0.29-0. 87), and were much more likely to be Black compared to White (aOR = 10.70, CI = 4.09-28.1). A highly similar pattern was observed among those who were ambivalent about receiving a COVID-19 vaccine compared to those who intended to receive one. Conclusion: The results of this study suggest several avenues for COVID-19 vaccine promotion campaigns, including social network diffusion strategies and cross-partisan messaging, to promote vaccine trust. The racial and gender differences in vaccine intentions also suggest the need to tailor campaigns based on gender and race. (C) 2021 Elsevier Ltd. All rights reserved.