Survey finds 41% of United States residents unwilling to obtain a COVID-19 vaccine

A cross-sectional online survey conducted by the scientists of Johns Hopkins Bloomberg School of Public Health, USA, has revealed that about 41% of US residents are unwilling to receive a coronavirus disease 2019 (COVID-19) vaccine due to concern over vaccine safety and efficacy. Moreover, there are sub-group variations in willingness to receive a COVID-19 vaccine. The study is currently available on the medRxiv* preprint server.


As of February 3, 2021, the ongoing COVID-19 pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has affected more than 104 million people and claimed 2.26 million lives globally. Of these confirmed COVID-19 cases, more than 26 million have been reported in the United States. Despite the strict implementation of non-pharmacological control measures, such as face mask-wearing, hand washing, social distancing, and movement restriction, the COVID-19 trajectory continues to rise exponentially in many countries, especially in the United States. To better manage the pandemic situation, it is crucial to achieving population-level immunity or herd immunity, which can be accomplished through mass vaccination programs.     

Several COVID-19 vaccines with good safety and efficacy have already received emergency use approval from relevant authorities and are currently rolling out in many countries. However, to achieve herd immunity, a large proportion of a population should be willing to receive a vaccine. According to experts, about 70% of the US population needs to be vaccinated to achieve herd immunity and curb the SARS-CoV-2 transmission.

In the current survey, the scientists aimed to explore US residents’ willingness to accept a COVID-19 vaccine when it will be publicly available. Moreover, they explored whether there are racial, ethnic, and socio-demographic differences in willingness for vaccination.

Study design      

In this cross-sectional survey conducted from September 1 to September 7, 2020, randomly selected US residents were approached via email to assess their willingness to receive a COVID-19 vaccine. Moreover, their willingness to receive an influenza vaccine was explored. The participants with negative responses were asked to provide reasons for their unwillingness to receive a COVID-19 vaccine. The participants were also asked about sources from where they receive vaccine-related information.

Important observations

More than 16,000 US residents were contacted via email, of which 1,592 completed the survey. According to the survey findings, about 59% of participants showed a willingness to receive a COVID-19 vaccine when available for public use. In contrast, about 68% of participants showed their willingness to receive an influenza vaccine.

Gender wise, affirmative responses toward a COVID-19 vaccine were received from 66% of males and 51% of females. Compared to young adults (age: 18-24 years), middle-aged adults (age: 35-44 years) and older adults (age: 45 years and above) were most reluctant to receive a COVID-19 vaccine. Regarding racial or ethnic variation, African Americans showed significantly less willingness than White Americans. The highest levels of affirmative response were obtained from participants with a graduate degree. In contrast, socio-economically deprived participants showed the least eagerness to receive a COVID-19 vaccine. Compared to Republicans, politically independent participants showed less willingness for vaccination.

Several reasons were provided by the participants in support of their unwillingness to receive a COVID-19 vaccine. However, the most commonly provided reason was concern over vaccine safety and efficacy levels.

Regarding information sources, about 36%, 28%, and 11% of participants mentioned receiving vaccine-related information from their primary care physicians, the Centers for Disease Control and Prevention (CDC), and family, respectively. However, no significant correlation was observed between the information source and willingness to receive a COVID-19 vaccine.

Study significance

The survey findings reveal that only 59% of US residents are willing to receive a COVID-19 vaccine, which is less than the estimated threshold (70%) for achieving herd immunity. To improve the vaccine coverage, it is vital to understand and address the factors associated with public hesitancy to accept a COVID-19 vaccine. More efforts from concerned authorities are needed to provide relevant and authentic vaccine-related information to the general population.

*Important Notice

medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information.

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