Abstract
Persistent and pervasive inequities in access to COVID-19 vaccines: Findings from a nationally-representative survey of Americans
APHA 2022 Annual Meeting and Expo
Background. COVID-19 vaccination is the center of our national pandemic response, yet only 66.7% of Americans have been vaccinated and less than half have received booster shots to date. With new variants expected to emerge and billions of dollars in much-needed pandemic relief aid stalled in Congress, the US could soon face another surge with fewer resources available to protect the most vulnerable Americans.
Objectives. This study aimed to ascertain Americans’ sentiments related to vaccines, trusted sources of information, obstacles to accessing COVID-19 vaccines, and whether increased ease-of-access and incentives could sway the unvaccinated.
Methods. Between February 28th and March 11th, 2022, we conducted an online, cross-sectional survey of 4,545 US adults (aged 18 and older) about their experiences and attitudes related to vaccines and their health (95% CI, +/- 1.6%). The sample was nationally-representative by age, gender, race, ethnicity, region, income, and insurance source. From August 13 – Aug 27th, 2021, we conducted a nationally-representative survey of 3,000 US adults on the same topic (aged 18 and older), which included an oversample of 1,200 non–fully-vaccinated individuals.
Results: Access, scheduling, and inconvenient hours were the primary barriers to COVID-19 vaccination reported by respondents. Among unvaccinated respondents who want the vaccine, 21% reported transportation difficulties as the primary reason they were not vaccinated (20% in 2021), with the greatest difficulties facing those earning less than $25k per year (33%) and Black respondents (30%). Difficulty scheduling was the top barrier for 19% of consumers earning under $50k per year (11% in 2021). More respondents (18%) also cited canceled appointments as the top reason they were unvaccinated in 2022 (13% in 2021). Only 5% reported they would get the vaccine due to incentives, while many (15% = “refusers , 33% = “not unless required ) reported they would get the vaccine in various hassle-free access scenarios. Trust in doctors as vaccine information sources remains high (95%).
Conclusions: Findings suggest substantial barriers to vaccine access persist, especially for racial minorities and low-income groups, while monetary incentives have limited efficacy persuading the unvaccinated.
Public Health Implications: Vaccines will be a required tool for protection against the next COVID-19 variant. Improvements in accessibility via transportation, convenient hours, and scheduling (walk-in or phone options) targeted to vulnerable communities will be critical to improve vaccination rates. Doctors continue to be the most trusted source consumers look to for information on vaccines, and largely underutilized resources for advocating and administering vaccines.