Changes in intentions, behavior, and reasons to receive COVID-19 vaccination December 2020–August 2023
Yanhan Shen,
Kate Penrose,
McKaylee M. Robertson,
Laura Puzniak,
Kristen E. Allen,
Avantika Srivastava,
Sarah G. Kulkarni,
Joann M. Zamparo,
Frank R. Ernst,
Christian Grov,
John M. McLaughlin,
Denis Nash
Affiliations
Yanhan Shen
Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY), New York, NY, USA; Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York (CUNY), New York, NY, USA; Corresponding author at: City University of New York Institute for Implementation Science in Population Health, 55 W 125th St, New York, NY 10027, USA.
Kate Penrose
Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY), New York, NY, USA; Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York (CUNY), New York, NY, USA
McKaylee M. Robertson
Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY), New York, NY, USA; Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York (CUNY), New York, NY, USA
Laura Puzniak
Pfizer, Inc., New York, NY, USA
Kristen E. Allen
Pfizer, Inc., New York, NY, USA
Avantika Srivastava
Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY), New York, NY, USA; Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York (CUNY), New York, NY, USA
Sarah G. Kulkarni
Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY), New York, NY, USA
Joann M. Zamparo
Pfizer, Inc., New York, NY, USA
Frank R. Ernst
Pfizer, Inc., New York, NY, USA
Christian Grov
Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY), New York, NY, USA; Department of Community Health and Social Sciences, Graduate School of Public Health and Health Policy, City University of New York (CUNY), New York City, NY, USA
John M. McLaughlin
Pfizer, Inc., New York, NY, USA
Denis Nash
Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY), New York, NY, USA; Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York (CUNY), New York, NY, USA
Background: Staying up-to-date with COVID-19 vaccination reduces the risk of severe COVID-19 outcomes, yet U.S. uptake remains low. We described changes in intentions, behavior, and reasons for receiving COVID-19 vaccines among individuals who completed a primary series and assessed predictors of not receiving an updated vaccine (BA.4/5 bivalent). Methods: We analyzed data from the community-based CHASING COVID Cohort, a sociodemographically diverse sample of U.S. adults enrolled March–July 2020. The study included adults who completed a primary SARS-CoV-2 vaccine series and participated in at least one quarterly follow-up assessment during April–October 2023. Primary exposures were sociodemographic characteristics and COVID-19 history. Outcomes included intentions to receive a COVID-19 vaccine, vaccine uptake, and self-reported reasons for receiving or not receiving COVID-19 vaccine over time between December 2020 and August 2023. Results: Among 4411 eligible participants, 58 % intended to get vaccinated in December 2020 (before broad availability), and 86 % received the 2021–2022 vaccine (monovalent) between September 2021 and August 2022. However, willingness to receive a bivalent vaccine between October and December 2022 declined by ≥10 %. Among those who received the primary series and 2021–2022 vaccine, 56 % received the 2022–2023 vaccine. The prevailing reason for non-receipt from Fall 2022 to Summer 2023 was doubts about vaccine effectiveness. Logistic difficulties were predominantly reported in Winter 2022 and confusion about eligibility increased in Spring/Summer 2023. Lower bivalent vaccine uptake was observed among younger, female, non-White, less-educated, lower-income, uninsured individuals, and residents of the South or rural/suburban areas. Those with recent SARS-CoV-2 infection or previous long COVID were less likely to receive updated vaccines. Present comorbidities did not impact vaccines uptake. Conclusions: Findings highlighted a 3-year decline in willingness and receipt of COVID-19 vaccinations following their public introduction. Broad messaging and targeted outreach are needed to reinforce the protection up-to-date COVID-19 vaccination provides against severe illness and death.
