Risk Perception and Vaccine Uptake: An analysis of changes in vaccination coverage and new vaccinations before and after the US COVID-19 Delta-Surge Restricted; Files Only

Abstract

Background: The COVID-19 Delta variant caused widely disseminated spikes in cases and hospitalizations. Risk perception of case severity has been documented as a facilitator to vaccine intent. We examined changes in COVID-19 vaccination coverage and vaccination rates associated with the COVID-19 Delta variant caused case surge in the summer of 2021.

Methods: Using the US county as our unit of study, we modeled weekly national COVID-19 vaccination coverage (% of the US population with one or more dose) and vaccination rates (per capita newly initiated vaccinations), separately, using linear regression. We compared outcomes before and after publicized indicators of the US case surge, used as proxies for risk perception, to study which event had the highest associated increase in vaccine uptake.

Results: County-level vaccination coverage increased from pre-surge to surge periods for all three definitions of the surge; the largest increase--3.8 pp (95% CI 3.58-4.01)--was using the July 27^th surge date. Similarly, rate of new vaccinations increased for all three surge dates, and the rate increase was largest for the July 27^th date (0.44 pp; 95% CI 0.37 – 0.52). Weekly vaccination coverage was statistically significantly lower in counties with the largest share of limited English speakers (-6.75 pp; 95% CI -8.37 – -5.31) and minorities (-5.43 pp; 95% CI -7.26 – -3.59). However, counties with the largest share of foreign born had 7.15 pp (95% CI 5.32 – 8.98) higher vaccine coverage. Change in vaccination rates for these comparison by county characteristics related to immigration were not significant.  

Discussion: We observed significant increase in vaccine uptake across multiple definitions of the Delta case surge, suggesting that perceived risk played a role. These results highlight the importance of repeated messaging on disease severity and may help to improve risk communication strategies for future surges and outbreaks.

Table of Contents

Table of Contents

INTRODUCTION .......................................................................................................1

BACKGROUND AND LITERATURE REVIEW ..............................................................2

DEVELOPMENT OF US COVID-19 VACCINES ............................................................2

COVID-19 VARIANTS ............................................................................................2

VACCINATION POLICY: FAILURES ........................................................................3

ONGOING BARRIERS TO VACCINATION UPTAKE IN THE US POPULATION............4

POTENTIAL FOR HEALTH OUTCOME INEQUITIES DUE TO SOCIAL DETERMINANTS OF HEALTH .........5

THE ROLE OF RISK PERCEPTION IN VACCINATION INTENT ...................6

METHODS ....................................................................................7

DATA SOURCES ..............................................................................7

OUTCOME DEFINITIONS ...............................................................8

VACCINATION PERIODS ...............................................................8

KEY IMMIGRATION-RELATED COUNTY COVARIATES ....................9

STATISTICAL ANALYSIS ...............................................................9

RESULTS .....................................................................................10

CHARACTERISTICS OF US COUNTIES ...........................................10

TRENDS IN COUNTY VACCINATION ............................................11

DIFFERENCES IN WEEKLY VACCINATION COVERAGE AND RATES ASSOCIATED WITH THE DELTA SURGE ACROSS THE 2021 CALENDAR YEAR ............................................12

COUNTY-LEVEL CHANGES IN WEEKLY VACCINATION COVERAGE AND RATES ASSOCIATED WITH THE DELTA SURGE IN THE MONTH BEFORE AND AFTER THE SURGE...............13

COUNTY-LEVEL CHANGES IN WEEKLY VACCINATION COVERAGE AND RATES ASSOCIATED WITH THE DELTA SURGE BY COUNTY IMMIGRATION CHARACTERISTICS ............14

DISCUSSION............................................................................14

STRENGTHS AND LIMITATIONS: .............................................17

CONCLUSION..........................................................................18

REFERENCES ..........................................................................20

TABLES AND FIGURES ............................................................24 

About this Master's Thesis

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School	Rollins School of Public Health
Department	Epidemiology
Subfield / Discipline	Global Epidemiology - MPH & MSPH
Degree	M.S.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Epidemiology Health Sciences, Public Health
Palabra Clave	COVID-19 inequities risk perception Delta-surge
Committee Chair / Thesis Advisor	Shivani A. Patel, Emory University

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