Segmentation analysis of the unvaccinated US adult population 2 years into the COVID-19 pandemic, 1 December 2021 to 7 February 2022

Objective: We performed a segmentation analysis of the unvaccinated adult US population to identify sociodemographic and psychographic characteristics of those who were vaccine accepting, vaccine unsure and vaccine averse.

Design: Cross-sectional.

Setting: Nationally representative, web-based survey.

Participants: 211 303 participants aged ≥18 years were asked in the Household Pulse Survey conducted during 1 December 2021 to 7 February 2022, whether they had ever received a COVID-19 vaccine. Those answering 'No' were asked their receptivity to the vaccine and their responses were categorised as vaccine averse, unsure and accepting. Adjusted prevalence ratios (APR) were calculated in separate multivariable Poisson regression models to evaluate the correlation of the three vaccine dispositions.

Results: Overall, 15.2% of US adults were unvaccinated during 1 December 2021 to 7 February 2022, ranging from 5.8% in District of Columbia to 29.0% in Wyoming. Of the entire unvaccinated population nationwide, 51.0% were vaccine averse, 35.0% vaccine unsure and 14.0% vaccine accepting. The likelihood of vaccine aversion was higher among those self-employed (APR=1.11, 95% CI 1.02 to 1.22) or working in a private company (APR=1.09, 95% CI 1.01 to 1.17) than those unemployed; living in a detached, single-family house than in a multiunit apartment (APR=1.15, 95% CI 1.04 to 1.26); and insured by Veterans Affairs/Tricare than uninsured (APR=1.22, 95% CI 1.01 to 1.47). Reasons for having not yet received a vaccine differed among those vaccine accepting, unsure and averse. The percentage reporting logistical or access-related barriers to getting a vaccine (eg, difficulty getting a vaccine, or perceived cost of the vaccine) was relatively higher than those vaccine accepting. Those vaccine unsure reported the highest prevalence of barriers related to perceived safety/effectiveness, including wanting to 'wait and see' if the vaccines were safe (45.2%) and uncertainty whether the vaccines would be effective in protecting them from COVID-19 (29.6%). Those vaccine averse reported the highest prevalence for barriers pertaining to lack of trust in the government or in the vaccines (50.1% and 57.5% respectively), the perception that COVID-19 was not that big of a threat (32.2%) and the perception that they did not need a vaccine (42.3%).

Conclusions: The unvaccinated segment of the population is not a monolith, and a substantial segment may still get vaccinated if constraining factors are adequately addressed.