COVID-19 Vaccine Intentions in the United States—December 2020 to March 2021

Importance SARS-CoV-2 containment is estimated to require attainment of high (>80%) post-infection and post-vaccination population immunity. Objective To assess COVID-19 vaccine intentions among US adults and their children, and reasons for vaccine hesitancy among potential refusers. Design Internet-based surveys were administered cross-sectionally to US adults during December 2020 and February to March 2021 (March-2021). Setting Surveys were administered through Qualtrics using demographic quota sampling. Participants A large, demographically diverse sample of 10,444 US adults (response rate, 63.9%). Main Outcomes and Measures COVID-19 vaccine uptake, intentions, and reasons for potential refusal. Adults living with or caring for children aged 2 to 18 years were asked about their intent to have their children vaccinated. Multivariable weighted logistic regression models were used to estimate adjusted odds ratios for vaccine refusal. Results Of 5256 March-2021 respondents, 3467 (66.0%) reported they would definitely or most likely obtain a COVID-19 vaccine as soon as possible (ASAP Obtainers), and an additional 478 (9.1%) reported they were waiting for more safety and efficacy data before obtaining the vaccine. Intentions for children and willingness to receive a booster shot largely matched personal COVID-19 vaccination intentions. Vaccine refusal (ie, neither ASAP Obtainers nor waiting for more safety and efficacy data) was most strongly associated with not having obtained an influenza vaccine in 2020 (adjusted odds ratio, 4.11 [95% CI, 3.05-5.54]), less frequent mask usage (eg, rarely or never versus always or often, 3.92 [2.52-6.10]) or social gathering avoidance (eg, rarely or never versus always or often, 2.65 [1.95-3.60]), younger age (eg, aged 18-24 versus over 65 years, 3.88 [2.02-7.46]), and more conservative political ideology (eg, very conservative versus very liberal, 3.58 [2.16-5.94]); all P <.001. Conclusions and Relevance Three-quarters of March-2021 respondents in our large, demographically diverse sample of US adults reported they would likely obtain a COVID-19 vaccine, and 60% of adults living with or caring for children plan to have them vaccinated as soon as possible. With an estimated 27% of the US population having been infected with SARS-CoV-2, once vaccines are available to children and they have been vaccinated, combined post-infection and post-vaccination immunity will approach 80% of the US population in 2021, even without further infections. Key Points Question What are COVID-19 vaccines intentions, for adults and for children under their care? Findings Two-thirds of 5256 US adults surveyed in early 2021 indicated they would obtain a COVID-19 vaccine as soon as possible. Intentions for children and booster vaccines largely matched personal vaccine intentions. Refusal was more common among adults who were younger, female, Black, very politically conservative, less educated, less adherent with COVID-19 prevention behaviors (eg, wearing masks), had more medical mistrust, or had not received influenza vaccines in 2020. Meaning Tailored vaccine promotion efforts and vaccine programs may improve vaccine uptake and contribute to US immunity against COVID-19.