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Research Question

  1. What strategies should public health and health care officials, health care providers, policymakers, and researchers pursue to boost COVID-19 vaccination rates in the United States in order to achieve herd immunity and overcome the pandemic?

This report presents the results of an evaluation of the root causes of COVID-19 vaccine hesitancy to inform strategies to boost vaccine acceptance among vaccine-hesitant populations in the United States. The authors conducted a literature review of the causes of vaccine hesitancy and vaccine acceptance; focus groups with patients, pre-hospital first responders, and hospital-based health care providers; a social media platform sentiment analysis to review attitudes regarding the COVID-19 vaccine; and a roundtable discussion with experts on vaccine hesitancy.

Drawing on this mixed-methods analysis, the authors recommend strategies to help boost COVID-19 vaccine acceptance in the United States, grouping them according to three overall goals: boosting confidence in the safety and effectiveness of the COVID-19 vaccines, combating complacency about the pandemic, and increasing the convenience of getting vaccinated. The authors emphasize that combating misinformation about the COVID-19 vaccine is key to achieving these goals. These recommendations can inform the development of a toolkit of strategies to reach herd immunity and end the pandemic.

Key Findings

The mixed-methods analysis revealed common themes associated with COVID-19 vaccine hesitancy in the United States

  • Strategies to boost COVID-19 vaccine acceptance need to be tailored to root causes of hesitancy in different populations.
  • Currently hesitant populations might be willing to obtain the vaccine if the right influencer helps to convey a recommendation to do so.

Strategies to boost acceptance of the COVID-19 vaccine can be grouped within the World Health Organization's "three Cs" model of confidence, complacency, and convenience

  • Boosting COVID-19 vaccine acceptance in the United States can be achieved by (1) boosting confidence in the safety and effectiveness of the COVID-19 vaccines, (2) combating complacency about the pandemic, and (3) increasing the convenience of getting vaccinated.
  • Combating misinformation about the COVID-19 vaccine is key to achieving these goals.

Recommendations

  • Expand vaccination access at the community level through various services.
  • Increase awareness, knowledge, and dissemination of accurate vaccination information.
  • Address conspiracy theories, misinformation, and disinformation through constant and consistent truth-telling and myth-busting public health campaigns.
  • Develop communication strategies that use personal narratives and emphasize the "why" of vaccination.
  • Employ multiple vaccination-acceptance-boosting strategies directed at more than one level of engagement among hesitant populations.
  • Tailor vaccination-acceptance-boosting messages, messengers, and messaging platforms to a particular community's root causes of hesitancy.
  • Develop and implement unified federal, state, and local vaccination campaigns and initiatives that are apolitical.
  • Identify strategies to boost vaccine acceptance among those with political, religious, or conspiratorial reasons for vaccine avoidance, and individuals who may identify with the anti-vaccination movement that existed prior to COVID-19.
  • Normalize vaccination as a patriotic or public health action that strives to help the greater good and overcome a common threat while removing any semblance of performativity.
  • Foster a sense of belonging and community associated with vaccination to replace the appeal of endorsing conspiracy theories.
  • Leverage technology to promote vaccinations, such as convenient, "smart" scheduling and tailoring messages via text-messaging to those who have not yet been reached.
  • Prioritize research and further evaluation of effective strategies to overcome hesitancy in hard-to-reach populations and to inform vaccination-acceptance efforts in the ongoing COVID-19 and future pandemics.
  • Develop and implement vaccination programs through public-private partnerships.

Table of Contents

  • Chapter One

    Background and Objectives

  • Chapter Two

    Environmental Scan

  • Chapter Three

    Focus Groups

  • Chapter Four

    Social Media Sentiment Analysis

  • Chapter Five

    Expert Roundtable

  • Chapter Six

    Recommendations

  • Appendix A

    Environmental Scan Search Strategy

  • Appendix B

    Social Media Analysis Search Terms

  • Appendix C

    Semistructured Focus Group Interview Guide

Research conducted by

This research was co-funded by the University of Michigan Department of Emergency Medicine and RAND, and carried out within the ACRU and the Access and Delivery Program in RAND Health Care.

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