Why are Americans reluctant to get a COVID-19 vaccine?

Why are Americans reluctant to get a COVID-19 vaccine?
By Jessie Rouder, Kathryn Harper, Olivia Saucier, Melinda Scott, and Debbie Krug-Mangipudi
Nov 23, 2020

Editor’s Note (11/23/2020): This article includes findings from ICF’s COVID-19 Monitor Survey of U.S. Adults, including the eighth wave of data collection that was fielded October 26 through November 1. Each wave collected 1,000 completes using a census-balanced, national non-probability sample. The new information, shared below, examines American attitudes towards a COVID-19 vaccine.

Learn more about the ICF COVID-19 Monitor Survey of U.S. Adults.

According to our latest COVID-19 Monitor Survey, more than half of U.S. adults (53%) say they are not likely to get an FDA-approved coronavirus vaccine as soon as it becomes available. Only about one in five U.S. adults (21%) in October reported that they would be very likely to get the vaccine. This number has been decreasing steadily since the early summer, when over one-third of adults (34%) said they would be very likely to get the vaccine.

Likelihood of getting COVID-19 vaccine as soon as available by wave

What might this mean for the future of the pandemic? If a vaccine is not broadly adopted, it will make it very difficult to achieve herd immunity and other forms of mitigation such as mask-wearing and social distancing will need to stay in place longer.

Although other surveys have found public reluctance to adopt a COVID-19 vaccine, there has been little research on the unaided, top-of-mind reasons for this reluctance. We asked over 1,800 individuals from our June, July, and August COVID-19 Monitoring Survey who said they would not be very likely to get the vaccine to explain in their own words why not. Respondents provided open-ended responses describing their reasoning and motivations. A group of qualitative researchers within our survey research practice analyzed these reasons and coded them thematically into major and minor themes. Responses are displayed visually below.

Visual representation of reasons US adults may be reluctant to get COVID-19 vaccine

A majority of Americans expressed concern about the safety of a COVID-19 vaccine.

These open-ended responses allow us to see the motivations and decision-making processes of individuals in more depth and with greater nuance compared to a quantitative survey. Just over half of the responses (51%) were related to concerns about the safety and effectiveness of the vaccine, including:

  • A desire to “wait and see” how the vaccine might affect the first people to receive it.
  • Concerns about side effects.
  • Concerns about the speed of development and/or the lack of proper trials or testing.

These respondents were not anti-vaccine per se, and in fact many left the door open to getting the vaccine in the future. They described their reluctance to get the vaccine specifically because of concerns related to its unknown effects. Within this group, the most common reason why individuals would not receive a vaccine as soon as it is available is they wanted to “wait and see” how the vaccine would affect the populations who received it first. For many, the vaccine was simply “too new,” and they needed evidence of its safety before committing to receiving it. Some respondents specifically stated they did not want to be a “guinea pig” or a “test case.”

A small number of people cited a specific fear of getting the live virus from the vaccine (2.1% of all responses mentioned this).

Americans also cited a lack of trust or a lack of necessity as reasons not to get a COVID-19 vaccine.

Other common mentions involved “distrust” or that the vaccine was “not needed.” Within the distrust category, respondents cited suspicion of government’s and political figures' motives and wariness toward “Big Pharma” and vaccine developers. A small number of respondents (1.5%) cited a specific conspiracy theory.

Those who said the vaccine was not needed said they believed they were at low risk of contracting COVID-19 due to their age or health status, that they have antibodies already, or that they prefer to build up natural immunity to the virus. Still others compared the virus to the flu, both in its severity and in the fact that the flu vaccine is optional. A small number offered religious or spiritual considerations.

Fewer than 10% of respondents presented some other reason for not receiving the vaccine, including that there may be shortages and the vaccine may simply not be available in their area, that they need more information in order to decide, that they “just don’t want it,” or that they have a medical condition that may preclude being able to get it. Less than 3% of those not very likely to get a COVID-19 right away stated an anti-vaccine position as their reason.

Over a turbulent summer, more Americans cited uncertainty as a reason not to get a COVID-19 vaccine.

Since there was a statistically significant decline between June and August in the willingness to get a vaccine as soon as it became available, it is important to consider whether the reason for not being very willing changed during this period. The most striking finding is that the sense of uncertainty as a reason for vaccine reluctance increased in importance from June to August. This may be related to the mixed feelings that individuals may hold, as well as the mixed messages around vaccines emanating from political campaigns throughout the summer months.

Change in importance of reasons provided (Waves 4-6)

These data show that the majority of Americans who are reluctant to get a COVID-19 vaccine right away cite concerns about the vaccine’s safety and effectiveness, and that has been the top reason throughout the summer of 2020. However, while these individuals may not be willing to get the vaccine as soon as it becomes available, they may be open to it after they are able to observe or learn about the impact and whether there are any side effects.

As our latest survey data from October shows, we see higher willingness to get the vaccine within six months of arrival on the market if there are no problems with the product. Only time will tell, as this willingness appears to be decreasing month to month.

Likelihood to get vaccine within 6 months if no problems reported

With the recent news that the Pfizer and Moderna vaccines may be effective at preventing COVID-19, it’s more important now than ever to look at the reasons why many Americans say they will not get a vaccine when one becomes available. The number of people who would be willing to get the vaccine early on has only decreased since this qualitative data was collected, though the willingness to get the vaccine if it proves to be safe and effective is still high enough to make a difference. Right now, we are seeing a growing majority look to a shrinking minority of fellow Americans to get the vaccine first in order to assuage broad concerns about vaccine safety and effectiveness.

Meet the authors
  1. Jessie Rouder, Lead Research Scientist, Behavioral Health

    Jessie is a public health expert dedicated to helping staff think more visually. View bio

  2. Kathryn Harper, Senior Project Manager, Survey Research
  3. Olivia Saucier, Project Manager, Survey Research
  4. Melinda Scott, Research Data Analyst, Survey Research
  5. Debbie Krug-Mangipudi, Senior Research Data Analyst, Survey Research