Which Americans are still hesitant to take the COVID vaccine — and how to change their minds

Four months after the FDA authorized emergency use of the first COVID-19 vaccine, President Joe Biden announced he is directing states to offer vaccines to all American adults by April 19.

Now to the next phase of the pandemic battle: ensuring vaccine demand meets supply.

The good news is that overall enthusiasm for the vaccine is on the upswing. According to Civis Analytics’ latest models, based on thousands of survey respondents, 61 percent of Americans are willing to receive an FDA-authorized COVID-19 vaccine, up from 47 percent in the autumn of 2020, when the prospect of an FDA-approved vaccine was still purely hypothetical.

Vaccine willingness increased across all subgroups, with the largest gains recorded among the 65-plus demographic, which grew 23 percentage points from 55 percent in the fall to 78 percent in the spring. “They were the first subgroup to receive the vaccine, and probably know somebody who’s taken it,” says Katelyn Rowley, senior applied data scientist at Civis. “When we’re looking at people who know somebody in their household who has taken the vaccine, they’re generally more willing to get the vaccine, as opposed to people who don’t.”

Among other subgroups broken out by age, 63 percent of Americans between 50 and 64 are willing to receive an FDA-authorized vaccine, up 15 percentage points from the fall. Willingness among Americans ages 35 to 49 rose from 43 percent in the fall 2020 model to 53 percent in the spring 2021 model, and the 18-to-34 group advanced from 43 percent to 53 percent.

Hispanic people also experienced a large increase in vaccine willingness, from 42 percent in the fall to 60 percent in the spring — an 18 percentage-point leap. Asians remain the racial group demonstrating the strongest willingness to receive the vaccine, growing from 54 percent in the fall to 68 percent in the spring. Whites are next, increasing from 49 percent to 62 percent.

Not all the signs are encouraging, however. For example, as the chart directly below depicts, just 53 percent of Black people are willing to get the COVID vaccine, well below the overall average of 61 percent (although willingness did increase 14 percentage points from fall to spring).

Location also plays a decisive role in vaccine willingness, as the chart directly below illustrates. Urban residents surged from 47 percent willingness in the fall to 65 percent in the spring, an 18 percentage-point increase that vaulted them ahead of suburbanites (up from 50 percent to 63 percent, a 13 percentage-point change from fall to spring). Rural residents trail at 51 percent, up 12 percent since fall 2020 but still well below the overall national average.

How do we explain such striking differences across demographic groups? So much about COVID-19 vaccine willingness depends on the messages people hear — and perhaps more importantly, from whom they hear those messages.

When Civis looks at the 65-and-over group by racial makeup, for example, we find willingness rising sharply across all demographics. While Hispanics 65 and up experienced the greatest increase from fall to spring at 28 percentage points, Blacks 65 and up were not far behind at 27 percentage points, followed by Whites (22 percentage points), Native populations (20 percentage points), and Asians (19 percentage points).

“Because the vaccine has been released to older groups first, individuals 65 and older are more likely to hear of a direct experience with vaccination from their close friends and family,” says Franklin Marsh, a data science lead at Civis. “That we see the largest increase in willingness in that 65 and older group who’s had access to the vaccine is a really encouraging sign.”

This doesn’t necessarily mean that merely opening up access to younger populations will mobilize them to get vaccinated, however. Civis research indicates that interest in getting a COVID-19 vaccine is highly correlated with concerns about the dangers of contracting the virus: according to our data, younger people have not been as worried about COVID-19 because, as a population, they do not run the same health risks as seniors.

Boosting vaccine confidence among populations younger than 65 also depends on dialing down messages from conventional messengers like medical professionals and scientists. Our data indicates that campaigns emphasizing vaccine safety are ineffective — and even can backfire with certain key populations.

Skeptics of all backgrounds are instead much more open to hearing vaccine messages from everyday people who have experienced COVID-19, or who received the vaccine and experienced no negative side effects or complications.

As COVID vaccine access opens to a larger share of the U.S. population, it grows more and more critical that healthcare officials and their partners approach messaging differently than they have on previous public health campaigns, says Crystal Son, Civis’s director of healthcare analytics.

“We’re making significant strides, but the vaccine rollout is probably not going to see continued linear growth,” Son warns. “Pretty soon, we’re going to shift to populations that are harder to reach, with more hesitation, and there may be a leveling-out with how successful we are at vaccinating these populations. Identifying them, bringing vaccines to them, and talking to them in the right way are all going to be even more important.”

There are five essential steps to boosting COVID-19 vaccine willingness:

1. Identify which members of a target population are persuadable, and pinpoint any non-attitudinal barriers to vaccination (financial, logistical, etc.).
2. Determine what this persuadable population believes — what they want or need to overcome their reluctance to vaccination, and what psychological barriers stand in their path.
3. Scientifically validate the correct way to speak to target audiences and the right person(s) to deliver these messages, and flag any messages that could backfire.
4. Communicate these insights to field managers and outreach coordinators to translate thought into action.
5. Constantly measure campaign success, and pivot in the moment if necessary.

Time is of the essence, says Marsh.

“Vaccine distribution will go from supply-limited to demand-limited, and I think the speed of that shift will be surprising to folks,” he explains. “All of a sudden, instead of running out of the vaccine, we’re going to run out of willing people. This is not a fall 2021 problem. It’s a problem that’s perhaps two or three months out.”

Civis is uniquely qualified to work with you to address the vaccine hesitancy challenge. We have the datasets to understand the audience, and the tools you need to test your messages and messengers. To learn more, email hello@civisanalytics.com.