Vaccination and Vacci-notions: Understanding the Barriers and Facilitators of Seasonal Influenza and COVID-19 Vaccine Uptake during the 2020-21 COVID-19 Pandemic Open Access

Abstract

Vaccination strategies to mitigate the public health burden of the pandemic respiratory virus COVID-19 resemble those for other respiratory viruses that circulate annually, such as seasonal influenza, yet seasonal influenza vaccine uptake is typically low due to factors including vaccine hesitancy. This study examined the demographic characteristics, experiences, and disease- and vaccine-related risk perceptions that influence an individual’s decision to adhere to current vaccine recommendations for seasonal influenza and evolving vaccine recommendations for COVID-19. The study utilized a mixed-methods telephone survey to collect quantitative and qualitative responses from 57 participants about their seasonal influenza and COVID-19 vaccine intentions. The results of this study revealed that the primary facilitators of uptake for both vaccines were personal protection, protecting others, preserving public health, and general vaccine confidence. Concerns about vaccine side effects, misinformation about vaccination, personal aversions to the vaccines, general distrust in vaccination, complacency, and distrust in government were the primary barriers to vaccine uptake. Profession, prior vaccination habits, and trust in healthcare providers also played an important role in seasonal influenza vaccine intentions, while race, trust in government health officials, and concerns about the COVID-19 vaccine trials impacted COVID-19 vaccine intentions. The results of this research can inform public health officials on how to best target COVID-19 vaccine communications to optimize future vaccine uptake.

Table of Contents

Table of Contents

Chapter 1. Introduction..............................................................................................................................1

1.1 Introduction to the COVID-19 Pandemic................................................................................................1

1.2 The Public Health Value of Vaccines.......................................................................................................2

1.3 The Status of COVID-19 Vaccine Development and Deployment...............................................................3

1.4 Socio-Political Context of the COVID-19 Pandemic.................................................................................5

1.5 Vaccine Hesitancy.................................................................................................................................7

The Health Belief Model.............................................................................................................................7

The 3C’s Model and 4C’s Model of Vaccine Hesitancy....................................................................................8

The WHO SAGE Working Group’s Determinants of Vaccine Hesitancy Matrix..................................................9

Assessing Vaccine Hesitancy......................................................................................................................10

Lessons on Vaccine Hesitancy from Influenza Vaccine Uptake......................................................................11

Hesitancy and Uptake of the COVID-19 Vaccine..........................................................................................13

1.6 Research Objectives.............................................................................................................................15

Objectives................................................................................................................................................16

Hypothesis...............................................................................................................................................16

Chapter 2. Methods...................................................................................................................................17

2.1 Project Approval.................................................................................................................................17

2.2 Participant Recruitment......................................................................................................................17

2.3 Data Collection Procedures..................................................................................................................18

2.4 Survey instrument for Data Collection..................................................................................................20

2.5 Qualitative Analysis............................................................................................................................22

2.6 Statistical Analysis..............................................................................................................................22

Chapter 3. Results.....................................................................................................................................25

3.1 Overview of Study Population..............................................................................................................25

3.2 Personal or Demographics-Based Aversions to Vaccination....................................................................25

3.3 Risk-Based Perceptions on Vaccination.................................................................................................28

Perceived Personal Susceptibility...............................................................................................................28

Perceived Susceptibility of Others..............................................................................................................31

Perceived Benefits of Vaccination...............................................................................................................34

Perceived Severity of Disease.....................................................................................................................36

Access to Information About Vaccines........................................................................................................38

Perceived Barriers to Vaccination...............................................................................................................39

External Cues to Action.............................................................................................................................44

3.4 Influence of Personal Experiences on Vaccine Intentions........................................................................48

3.5 Concerns of Participants Who Intend to Receive the Seasonal Influenza Vaccine but Not a New COVID-19 Vaccine....................................................................................................................................................49

3.6 Perspectives on Vaccine Messaging.......................................................................................................51

3.7 Multivariable Analysis.........................................................................................................................53

COVID-19 Analysis...................................................................................................................................53

Seasonal Influenza Analysis......................................................................................................................54

3.8 Tables of Results.................................................................................................................................57

Chapter 4. Discussion................................................................................................................................73

4.1 Individual and Social Influences on Vaccine Hesitancy...........................................................................73

Individual Experience...............................................................................................................................73

Individual Demographic Characteristics.....................................................................................................77

4.2 Vaccine and Vaccination-specific Influences on Vaccine Hesitancy..........................................................79

4.3 Contextual Influences on Vaccine Hesitancy..........................................................................................81

Trust in Institutions..................................................................................................................................81

Misinformation.........................................................................................................................................83

4.4 Overall Determinants of Seasonal Influenza and COVID-19 Vaccine Hesitancy.........................................85

4.5 Study Limitations................................................................................................................................86

4.6 Recommendations and Actionable Suggestions.....................................................................................87

4.8 Conclusion..........................................................................................................................................92

Chapter 5. Appendix..................................................................................................................................94

5.1 Study Questionnaire............................................................................................................................94

5.2 Detailed Tables from Multivariable Analysis........................................................................................104

Chapter 6. References.............................................................................................................................112

About this Honors Thesis

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School	Emory College
Department	Human Health
Degree	B.A.
Submission	Honors Thesis
Language	English
Research Field	Health Sciences, Public Health
Keyword	Vaccine Uptake Seasonal Influenza Vaccination Health Education Vaccine Hesitancy COVID-19 Vaccination
Committee Chair / Thesis Advisor	Matthew Collins, Emory University
Committee Members	Cynthia Whitney, Emory University Ruth Link-Gelles, Centers for Disease Control and Prevention Rachel Hall-Clifford, Emory University

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