The COVID-19 US Vaccine Sentiment Series

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

Since January, 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. From April 20 to April 25, BCG conducted a fourth US COVID-19 Vaccine Sentiment Survey to understand how perceptions and hesitancy have evolved over the past few months. Our findings suggest—encouragingly—that despite some entrenched hesitancy, there is a path not only to reach 70% of US adults, but also potentially to reach 70% of the broader population, by focusing on the vaccine hesitant and teenage populations.

Vaccinate the Eager to Achieve 70% Adult Uptake

In early May, as the number of US adults with at least one COVID-19 vaccine dose approached 150 million, President Biden added another seemingly audacious goal: to vaccinate 70% of US adults by July 4. If we include in our calculations all Americans ages 16 and older who have been eligible for vaccines since April 19, we estimate that the US can achieve the president’s goal by vaccinating everyone who is currently scheduled and eager to get vaccinated. (See Exhibit 1.)

Nevertheless, hesitancy remains largely unchanged across the US adult population, with some significant variations by age group, household income, gender, race, and ethnicity. (See Exhibits 2 and 3.)

Access Continues to Be a Hurdle for Many Americans

Using a set of questions similar to those we posed in our previous Vaccine Sentiment Snapshot, we asked respondents about the vaccination process from end to end, starting with wanting to get the vaccine and ending with finding and successfully scheduling a workable appointment. Survey participants indicated that eligibility and availability issues have decreased since February, but that availability and urgency hurdles remain. (See Exhibit 4.) The White House's most recent vaccination plan builds on many techniques that states across the country have used successfully: funding community groups to perform door-to-door outreach, accommodating walk-in appointments, and offering SMS tools to help people find their nearest vaccination center.

Vaccinate the Hesitant to Protect Our Communities

Although it may be possible to vaccinate 70% of US adults by making appointments more accessible to the remaining population of eager potential recipients, exceeding this goal would entail changing the hearts and minds of some members of the “resilient red”—the 20% or so of US adults who are still strongly hesitant. This percentage has changed little since January.

Persuading members of this group to get vaccinated will require applying localized solutions that address a three-part demand generation framework. (See Exhibit 5.)

In accordance with this framework, states and local governments should pursue actions directed toward three key objectives:

• Educate individuals to combat vaccine hesitancy. The key here is to enlist the support of messengers who are most trusted by members of strongly hesitant populations. (See Exhibit 6.) Thematically, medical professionals and friends/family fall into that category, so local health officials should partner with primary care providers, hospitals, and other medical institutions to help promote the message that everyone should get vaccinated.
• Facilitate easier access to vaccines. People tend to approach some locations more often than others in trying to register for a vaccine. (See Exhibit 7.) Nearly a third of Americans have attempted to get vaccinated through their local physician's office or their local pharmacy. As operations at mass vaccination sites wind down in response to a gradual slowdown in demand, it will be critical to reduce barriers to immunization by shifting messaging and doses to places where people expect to get vaccinated.
• Incentivize individuals by creating additional benefits to getting vaccinated. Although local employers and officials continue to wait for FDA guidance on vaccine mandates, many national organizations are pushing for the government to introduce incentives. West Virginia has started offering savings bonds to younger individuals who get vaccinated; other states, such as New Jersey, are partnering with local breweries to provide free beer for people who get their vaccine. Most recently, Ohio announced a state lottery that will award five $1 million prizes over the next five weeks; the lottery is open to any adult Ohio resident who has received at least one dose of a COVID-19 vaccine. For their part, the National Basketball Association, the National Football League, Major League Baseball, and other national sports leagues are offering access to better seats, discounts on swag, and lotteries for vaccinated fans.

While winning over members of the highly hesitant group will continue to be a challenge, the imperative to protect our communities and neighbors remains a strong motivation for attempting to sway them. Luckily, another tranche of individuals will soon become eligible for the vaccine.

Vaccinate Adolescents to Protect Our Families

The recent decision to approve the Pfizer COVID-19 vaccine for emergency use authorization (EUA) with 12- to 15-year-olds opens another promising path to 70% vaccination of the broader population. Besides offering protection to another segment of the population, the approval expands the reach of the vaccine to more Americans, increasing overall community protection and reducing COVID-19’s ability to spread.

Before the EUA was officially announced, we asked survey respondents who were parents if they would vaccinate their teenagers. (See Exhibit 8.) We found a strong correlation between parents' vaccine eagerness and their plans for their own children. As a result, achieving a goal of getting at least 60% to 70% of this group vaccinated seems feasible in the short term, with the aid of strong incentives such as school vaccine mandates and access to inoculation through trusted channels such as pediatricians.

The End of This Phase Is in Sight

Undeniably, vaccinating the remaining US population will be difficult. The challenge has been on leaders’ minds since December, and no silver-bullet solution is likely to emerge. But by maintaining the pace to vaccinate the eager, the hesitant, and newly eligible teenagers, the government can meet its goal of achieving 70% coverage of the eligible US population. COVID-19 certainly won’t disappear from the world in the short term, but minimizing the disease burden and transitioning to a new post-pandemic reality should be a rallying cry leading up to an incredible July 4 celebration.