Health concerns and government distrust: variation in types of COVID-19 vaccine hesitancy by racial and ethnic group before and at universal vaccine eligibility in the US

Abstract The development and deployment of COVID-19 vaccines were crucial to combating the global pandemic, but vaccine hesitancy posed a challenge and remains a crucial problem today. Understanding why people delay or refuse vaccination can help with current and future vaccine campaigns by suggesting both target audiences and messaging. Because hesitant individuals report different reasons for their hesitancy, distinguishing between different types of hesitancy can help identify who will benefit from which strategies. Using 311,494 responses from the U.S. COVID-19 Trends and Impact Survey (CTIS), we used Latent Class Analysis to examine distributions of concurrently reported reasons for hesitancy using latent class analysis, comparing distributions of responses across racial and ethnic groups. Using responses from both the early phase of vaccine availability and after all U.S. adults became eligible in the spring of 2021, we investigated differences between prospective vs. lived hesitancy. LCA revealed three different types of COVID-19 vaccine hesitancy. Some respondents primarily reported health-related concerns as reasons for hesitancy, while others indicates distrust of the government and vaccines, but the majority report fewer distinct reasons. In February 2021, White, Black, and Hispanic respondents had similar distributions of these types, but by May the results diverged. In May, White respondents were more likely to report trust concerns than Black or Hispanic respondents, who were more likely to report health concerns as their reasons for continued hesitancy. Our results contribute to the development of a more nuanced picture of COVID-19 vaccine hesitancy and the motivations behind it. The distinction between health-concerned and distrustful types of vaccine hesitancy highlights the importance of confidence in vaccine uptake, and in targeted strategies to address address hesitancy. Competing Interest Statement Dr. Do, Dr. Mejia, and Ms. Ellingwood have no competing interests to report. Dr. Reinhart received summer salary support from an unrestricted gift from Facebook. Funding Statement This analysis uses data from the COVID-19 Trends & Impact Survey, which was supported by Facebook (unrestricted gift) and a cooperative agreement from the Centers for Disease Control and Prevention (U01IP001121). Facebook was involved in the design and conduct of the COVID-19 Trends & Impact Survey. The CDC provided funding only. Neither Facebook nor the Centers for Disease Control and Prevention had a role in the collection, management, analysis, and interpretation of the data preparation, review, or approval of the manuscript or decision to submit the manuscript for publication. All opinions, findings and conclusions or recommendations expressed in this material are those of the authors. Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The Carnegie Mellon University Institutional Review Board approved the survey protocol and instrument (STUDY2020_00000162). Survey respondents gave written informed consent. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Data Availability Survey microdata is not publicly available because survey participants only consented to public disclosure of aggregate data. The microdata is available to researchers under a nondisclosure agreement permitting research uses. Access can be requested at https://www.icpsr.umich.edu/web/ICPSR/studies/39207