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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.


  • 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.

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.

This report is part of the RAND research report series. RAND reports present research findings and objective analysis that address the challenges facing the public and private sectors. All RAND reports undergo rigorous peer review to ensure high standards for research quality and objectivity.

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