Understanding the rationales and information environments for early, late, and nonadopters of the COVID-19 vaccine
npj Vaccines 9, Article number: 168 (2024)
Abstract
Anti-vaccine sentiment during the COVID-19 pandemic grew at an alarming rate, leaving much to understand about the relationship between people’s vaccination status and the information they were exposed to. This study investigated the relationship between vaccine behavior, decision rationales, and information exposure on social media over time. Using a cohort study that consisted of a nationally representative survey of American adults, three subpopulations (early adopters, late adopters, and nonadopters) were analyzed through a combination of statistical analysis, network analysis, and semi-supervised topic modeling. The main reasons Americans reported choosing to get vaccinated were safety and health. However, work requirements and travel were more important for late adopters than early adopters (95% CI on OR of [0.121, 0.453]). While late adopters’ and nonadopters’ primary reason for not getting vaccinated was it being too early, late adopters also mentioned safety issues more often and nonadopters mentioned government distrust (95% CI on OR of [0.125, 0.763]). Among those who shared Twitter/X accounts, early adopters and nonadopters followed a larger fraction of highly partisan political accounts compared to late adopters, and late adopters were exposed to more neutral and pro-vaccine messaging than nonadopters. Together, these findings suggest that the decision-making process and the information environments of these subpopulations have notable differences, and any online vaccination campaigns need to consider these differences when attempting to provide accurate vaccine information to all three subpopulations.
Introduction
COVID-19 remains an ongoing public health concern, and all indications suggest that the virus will persist for the foreseeable future1. Vaccines have been crucial in mitigating COVID-19, and their uptake as new boosters develop will remain an important element of a public health strategy to manage the continued presence of this virus2. Most Americans (81% according to the CDC) have received at least one dose of a COVID-19 vaccine since the shots became widely available in early 2021. While many were initially eager to roll up their sleeves, a moderate portion of the country expressed hesitancy3, with some waiting months before getting vaccinated. Around one in five Americans remained unvaccinated two years later4, and only one quarter of those who received the original vaccine received the latest recommended booster5. Compared to other countries, Americans had lower COVID-19 vaccine acceptance rates (57%) during the initial rollout phase at the end of 20206.
COVID-19 vaccine hesitancy has been associated with political and social divides, questions around safety of vaccines, declining public trust in government and science, and misinformation more broadly7,8,9,10,11,12,13,14,15,16. In general, online information consumption has been linked to offline behaviors17, and there is also evidence that misinformation on the internet, particularly on social media and YouTube, is associated with hesitancy18. This presence of online misinformation can be more impactful because it exists against a backdrop of low health literacy with respect to COVID-1919. Some research also raised the potential that these sources of misinformation may be associated with partisanship20,21,22. Misinformation about COVID-19 is not limited to the United States; it is a global phenomenon23 with false information disseminating worldwide on social media platforms15,24,25,26,27,28,29.
Despite the considerable body of research on vaccine acceptance and hesitancy, there is a gap in our understanding of the more nuanced nature of individual perceptions and decisions about vaccination. Existing work sheds light on two components of this process—the types of people that report hesitancy30,31,32 and the extent to which various message streams contain problematic information33,34,35—but it does not directly link these components, meaning that it is unclear whether certain types of beliefs and attitudes undergird hesitancy or whether both just happen to be present (perhaps because hesitant individuals bolster their rejection of the vaccination by accepting misinformation36). To the extent that digital platforms have been acknowledged as a significant source of vaccine information37,38,39,40, there is a need for a more in-depth examination of how individuals engage with these channels and whether this is related to how they subsequently form their perceptions about vaccination.
This article is an important step toward understanding this relationship. We first determined what factors are associated with decisions to obtain the COVID-19 vaccine. Using the subpopulation categorization presented by Kang et al.41, we then compared rationalizations of those who vaccinated early (early adopters), those who initially expressed skepticism about getting vaccinated but later change their minds (late adopters), and those who chose not to get vaccinated during our study period (nonadopters). One important part of understanding vaccine hesitancy is identifying the types of information different subpopulations are exposed to and how that may have influenced their behavior. A number of studies documented high levels of ideological segregation of political information on social media42,43,44,45. Given this, our final analysis investigated differences in the information environments of these three subpopulations on Twitter/X. This line of inquiry allowed us to better understand any distinguishing features of each of these subpopulations, including the vaccine messaging received and prominent accounts followed.
While previous research investigated the reasons why some people chose to vaccinate and others chose not to11,46,47, these studies focused primarily on one particular group (e.g., late adopters46,47 or nonadopters11). In this longitudinal study, we compared the reasons why early adopters and late adopters chose to get vaccinated, as well as the reasons why the late adopters initially hesitated and nonadopters did not. While investigating all three subgroups, we focused more on those who initially chose not to get vaccinated, but eventually did, in order to gain insight into what the people who changed their minds were thinking and how their rationale aligned with (or deviated from) the other subgroups. This line of research is important because persuasion of initially hesitant individuals constitutes a primary goal for public health officials, and insights into the thought processes and information environments of those who have already undergone this change directly supports this goal. Also, decisions to delay or refuse vaccines have important implications beyond their ability to save lives during the pandemic48, including the tendency to stay up to date on subsequent COVID-19 shots and vaccines for other diseases49
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