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Review 1: "Demographic Differences in US Adult Intentions to Receive a Potential Coronavirus Vaccine and Implications for Ongoing Study"

This study presents a reliable analysis of polling data, and draws attention to the population "unsure" of whether or not they will accept a coronavirus vaccine. Nevertheless, it leaves many questions unanswered that would be useful for policymakers going forward.

Published onOct 08, 2020
Review 1: "Demographic Differences in US Adult Intentions to Receive a Potential Coronavirus Vaccine and Implications for Ongoing Study"
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key-enterThis Pub is a Review of
Demographic Differences in US Adult Intentions to Receive a Potential Coronavirus Vaccine and Implications for Ongoing Study

Abstract Background: The coronavirus pandemic9s public health and economic impacts have led to much hope in the US regarding the prospect of a safe, effective vaccine to either prevent infection or minimize symptoms and reduce mortality risk. However, recent US polls indicate a concerning level of hesitancy that will likely lead to suboptimal uptake if such a vaccine becomes available. This study investigated demographic differences regarding US adults9 intent, uncertainty, and refusal to receive a potential coronavirus vaccine and specific reasons for intention to receive it. Methods and findings: Multivariable analysis of Associated Press (AP)-NORC Center for Public Affairs Research cross-sectional survey data collected in May 2020 from a US nationally representative panel of adults (n=1000). Respondents were asked if they would receive a coronavirus vaccine (yes, unsure, no). Among those answering yes, the specific reasons were: to protect self, family, and community; chronic health condition; and having a doctor who recommends vaccines. Multinomial logistic regression models indicated numerous subgroup differences between participants who indicating (1) uncertainty versus refusal, (2) intent versus refusal, and (3) intent versus uncertainty, with the highest number of significant differences observed in the third comparison. Overall, higher likelihood of intention to receive the vaccine versus uncertainty and refusal were mostly observed among respondents with a college education or greater, White, non-Hispanic racial-ethnic identity, ages 60 or older, and more liberal (versus conservative) ideology. Despite variation in endorsement across the five reasons for wanting to receive the vaccine, subgroup differences were fairly consistent across these specific reasons when comparing respondents endorsing such intentions versus, respectively, refusal and uncertainty in separate analyses. Conclusions: These findings suggest that the approval of a vaccine will potentially face problems with overall uptake due to uncertainty or refusal and contribute to creating significant demographic disparities in COVID-19 morbidity and mortality risk. Ongoing assessment of such attitudes are needed as Phase III trials proceed, but the findings highlight need for measuring uncertainty and its underlying reasons, as well as multiple types of education and outreach efforts for those who are uncertain as well as avoidant.

RR:C19 Evidence Scale rating by reviewer:

  • Strong. The main study claims are very well-justified by the data and analytic methods used. There is little room for doubt that the study produced has very similar results and conclusions as compared with the hypothetical ideal study. The study’s main claims should be considered conclusive and actionable without reservation.



The paper is based on pre-existing data that the author did not collect, and as always with secondary analyses, there are limitations that the author cannot do anything about. Nevertheless, the author has done a great job at analysing the dataset with a particular focus on trying to draw out similarities/differences between people who say they’ll definitely get the COVID vaccine, those who say they’ll definitely not get the vaccine, and then unsure or hesitant group in the middle. Obviously, asking hypothetical questions about a hypothetical vaccine has its drawbacks in terms of ‘actual’ policy relevance, but the author acknowledges this and sets up analyses which will hopefully help policy makers work out which groups might require different types of support and education, and what kinds of information might be required in which groups. So in this way, a potentially useful paper. There are the beginnings of a number of early reports and publications more broadly on the binary analysis of who will/not get the vaccine, but this paper distinguishes itself by also importantly focusing on the ‘fence sitters’. I undertake lots of research with parents who are ‘fence sitters’ in terms of vaccination decisions for childhood vaccinations, and its pretty clear that the ‘vaccine hesitant’ groups will have the most ‘bang for the buck’ – so I applaud the author for the paper. The analyses are fine and generally, their explanation should be relatively easy to understand for most readers (often a drawback of some statistics-focused papers).

The Introduction sets up the paper well and draws on some relevant COVID-19 literature. As a researcher in the area of childhood vaccinations, I was surprised to see a complete lack of engagement with that literature – I understand that the data used for analysis does not ask about whether or not they would get a vaccination for their children, but there may well be useful links to draw between the large literature on parental ‘hesitancy’ and the ‘unsure’ people in this paper – in terms of whether these are similar social groups (are people who are hesitant about their children’s vaccinations also hesitant about a potential COVID-19 vaccination? It may be that the empirical question cannot be answered within this paper, but there are certainly future research studies and implications that could be drawn out in this paper. There are also policy directions within the childhood vaccinations literature – might they be similar for this group? For example, a large proportion of ‘hesitant’ parents also engage in ‘natural parenting’, eschew big-pharma, big-food, big-government, big-science etc (across literature in the US, UK, France and Australia at least) which invites ideas about communication the risks and benefits of vaccinations in different ways and through different conduits – might that also be an implication of the findings in this paper? I’m in no way suggesting a focus here – but simply that some of the findings in the childhood vaccination literature (especially the sociological and anthropological literature on this) may be useful in thinking about the implications of the analyses in this paper.

The methods section was good and thorough – were any questions asked in the survey on whether the person is already fully vaccinated, whether they get annual Flu vaccinations, whether their children (if they have any) are vaccinated? If these questions are not asked, then the author could raise this issue for future surveys, since one may assume that previous vaccination behaviour would be a good predictor of future behaviour.
The results are generally well described. One of the variables that predicts differences in vaccination intention is Census Region – for non US readers, the ‘meaning’ of this needs to be explained better. I did not know how to ‘interpret the finding that, for example, people in the Midwest are more likely to say ‘no’ than people in the Northeast – other than simply two different regions in the US, I have no cultural reference for what this means – is it about political differences, social class differences etc? On Page 14, paragraph 2, line 4, I think the word ‘unsure’ should be either ‘yes’ or ‘no’.

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