By Kaelin Goulet, Ankit Jain, Lara Koslow, and Marin Gjaja

For the past two months, BCG has been surveying Americans to understand levels of COVID-19 vaccine hesitancy and to explore the factors preventing or discouraging individuals who are currently eligible and want to get vaccinated from receiving their inoculation. Over the past two weeks, numerous states have begun relaxing eligibility criteria for adults and broadening vaccine access. From March 16 to March 21, BCG conducted a third US COVID-19 Vaccine Sentiment Survey to understand how perceptions and hesitancy have evolved over the past two months. Our survey results reinforce the view that the United States must generate additional demand to drive vaccine uptake.

US Vaccine Sentiment Has Not Dramatically Changed Since January

Overall, the estimated size of the US’s hesitant population hasn't changed dramatically since our January survey. In January, we estimated that approximately 40% of unvaccinated adults would be hesitant to take the COVID-19 vaccine if it were offered to them. Given the number of people who were already vaccinated or scheduled for vaccination at that time, this represented approximately 83 million adults. Our newer estimates from the March survey indicate that the share of individuals who are unvaccinated and hesitant has decreased very slightly, to about 80 million across the US. (See Exhibit 1.) Exhibits 2 and 3 demonstrate how the cumulative totals break down across the US adult population by age group, household income, gender, race, and ethnicity.

BCG also ran a separate survey to follow up with our respondents from January regarding their current vaccine sentiment. Consistent with our national survey findings, about 9% of hesitant or “Maybe” respondents from January have shifted to more positive “Maybe” or “Eager” categories, while about 5% of formerly “Eager” or “Maybe” respondents have become more negative, moving to the “Maybe” or hesitant categories. (See Exhibit 4.) Although 6% of respondents who previously fell into the "Maybe" or "Hesitant" categories have reported being vaccinated in the past two months, the steady state of overall hesitancy implies that simply giving people more time to change their minds and get a shot will not suffice if the US is to meet the White House goal of vaccinating all adult residents by July.

The Vaccination Campaign May Slow in May Due to Insufficient Demand

Assuming that the country’s current child population (approximately 75 million) cannot be vaccinated and that its hesitant adult population (approximately 80 million) holds steady, the US is at risk of hitting a vaccination ceiling of 55% for the entire population. (See Exhibit 5.) If vaccine manufacturers continue to meet their supply commitments at a steady rate, we expect that US vaccination efforts will begin slowing down by early May. (See Exhibit 6.)

The Need to Proactively Generate Demand

To better protect the vulnerable and to slow the disease’s spread, state and local governments must quickly activate marketing and outreach campaigns, in close coordination with their plans to increase supply and expand eligibility. Public health campaigns require time and multiple touchpoints to change attitudes and behaviors, and the COVID-19 vaccine campaign will likely be no different. Instead of waiting until all eager US residents have all been vaccinated and excess vaccines begin accumulating prior to delivery to vaccination stations, states should launch their COVID-19 outreach campaigns soon if the country is to achieve its national goal of vaccinating all adults by the middle of the summer.