COVID-19 Vaccine Hesitancy

Sep 22, 2021

COVID-19 vaccine hesitancy declined in the United States in late 2020 and early 2021, according to a survey of more than 7,000 adults. “This decrease is important because COVID-19 vaccine acceptance has been particularly low among these groups, who have experienced a disproportionate burden of severe illness and death because of COVID-19,” Michael Daly, PhD, associate professor of psychology and behavioral science at Maynooth University in Maynooth, Ireland, and colleagues wrote. “Declines in hesitancy were reported alongside an increase in public trust in vaccine development and the governmental approval process.”

Social Vulnerability Index (SVI)

The CDC’s Social Vulnerability Index (SVI) summarizes the extent to which a community is socially vulnerable to disaster. The factors considered in developing the SVI include economic data as well as data regarding education, family characteristics, housing language ability, ethnicity, and vehicle access. SVI values range from 0 (least vulnerable) to 1 (most vulnerable). The SVI can also be categorized as follows: Very Low (0.0-0.19), Low (0.20-0.39); Moderate (0.40-0.59); High (0.60-0.79); Very High (0.80-1.0).

COVID-19 vaccine hesitancy rates remain high in some states – especially in Wyoming, just one state where cases are spiking due to the delta variant, according to new data released Wednesday by the U.S. Census Bureau.

The latest batch of data from the bureau’s Household Pulse Survey – which collects statistics on how people’s lives have been impacted by the coronavirus pandemic – shows that hesitancy nationwide continues to decline, from 21.6% between Jan. 6-18 to 10.8% between June 23 and July 5. But rates remain high in certain states, with the most hesitant populations being in Wyoming (25.6%), West Virginia (22.4%), North Dakota (22.2%) and Alaska (20.5%).

The hesitancy that remains in parts of the country is alarming as COVID-19 cases spike in a majority of states. States seeing some of the highest increases in cases include Alabama, Arkansas, California, Florida, Georgia, Kansas, Louisiana, Nevada and Tennessee, according to data from Johns Hopkins University. In some of those states – Alabama, Arkansas, Louisiana and Tennessee – vaccine hesitancy rates are higher than 15%, according to the Census Bureau.

CVAC level of concern (Surgo Covid-19 Vaccine Coverage Index)

The Surgo Covid-19 Vaccine Coverage Index (CVAC) captures supply- and demand-related challenges that may hinder rapid, widespread COVID-19 vaccine coverage in U.S. counties, through five specific themes: historic undervaccination, sociodemographic barriers, resource-constrained healthcare system, healthcare accessibility barriers, and irregular care-seeking behaviors. The CVAC measures the level of concern for a difficult rollout on a range from 0 (lowest concern) to 1 (highest concern). These are categorised by:

  1. Very Low (0.0-0.19)
  2. Low (0.20-0.39)
  3. Moderate (0.40-0.59)
  4. High (0.60-0.79)
  5. Very High (0.80-1.0) Concern


Although the pandemic has impacted everyone, COVID-19 disease burden disproportionately falls on members of racial/ethnic minority groups. Black and Hispanic or Latino individuals are nearly 3-fold more likely to be hospitalized owing to COVID-19 and approximately 2-fold more likely to die from the disease compared with White non-Hispanic individuals. With 3 authorized SARS-CoV-2 vaccines available for emergency use in the U.S, it is important to increase access to COVID-19 vaccines and address COVID-19 vaccine hesitancy in communities where it is still high.

The vaccine allocation process in the US prioritized health care workers (HCWs) and residents of long-term care facilities, who were the first to be offered COVID-19 vaccines. As COVID-19 vaccination expands, it is important to continue to assess uptake of vaccination among HCWs across different racial/ethnic groups and ensure equitable allocation of vaccines. HCWs face occupational and community exposure to COVID-19, and they are essential to the public health response to this pandemic. Although the risk of occupational infection is low with proper use of personal protective equipment, studies have found that Black and Hispanic or Latino HCWs have a higher burden of infection, associated with increased community exposure to SARS-CoV-2. In a large study of 10 275 HCWs, community exposure and living in areas with increased COVID-19 prevalence were associated with most infections among HCWs. The odds of being infected with COVID-19 were increased 2-fold among Black HCWs and HCWs with multiracial backgrounds compared with White HCWs. The differential risk for community acquisition of SARS-CoV-2 among HCWs from racial/ethnic minority groups likely stems from historical and systemic practices that have disadvantaged communities of color and led to residential segregation, which is associated with increased exposure to SARS-CoV-2. Thus, uptake of COVID-19 vaccines is particularly crucial for HCWs living in communities with increased disease burden.


This study found that approximately half of all HCWs were hesitant about COVID-19 vaccines, with the highest rates among Black and Hispanic or Latino HCWs. These results suggest that more work is needed to ensure confidence in COVID-19 vaccination, particularly among Black and Hispanic or Latino individuals, who are disproportionately impacted by the pandemic. Developing messaging emphasizing the individual, family, and community benefits of getting the vaccine and providing continued transparency on the safety profile of COVID-19 vaccines are simple approaches that may be rapidly disseminated across health care systems to improve vaccine acceptance among HCWs.