Who has not been vaccinated, fully vaccinated, or boosted for COVID-19?

We assessed COVID-19 vaccination coverage (≥1 dose, full vaccination, and booster vaccination) using a large, nationally representative survey of US households (December 29, 2021-January 10, 2022). Almost 1 in 6 adults have not been vaccinated or not been fully vaccinated, and almost one-half of fully vaccinated adults have not received a booster vaccine. All eligible individuals should receive the recommended number of vaccines to prevent further transmission of COVID-19.

Modeling the relationship between SARS-CoV-2 RNA in wastewater or sludge and COVID-19 cases in three New England regions.

BACKGROUND: We aimed to compare statistical techniques estimating the association between SARS-CoV-2 RNA in untreated wastewater and sludge and reported coronavirus disease 2019 (COVID-19) cases. METHODS: SARS-CoV-2 RNA concentrations (copies/mL) were measured from 24-h composite samples of wastewater in Massachusetts (MA) (daily; 8/19/2020-1/19/2021) and Maine (ME) (weekly; 9/1/2020-3/2/2021) and sludge samples in Connecticut (CT) (daily; 3/1/2020-6/1/2020). We fit linear, generalized additive with a cubic regression spline (GAM), Poisson, and negative binomial models to estimate the association between SARS-CoV-2 RNA concentration and reported COVID-19 cases. RESULTS: The models that fit the data best were linear [adjusted R2=0.85 (MA), 0.16 (CT), 0.63 (ME); root-mean-square error (RMSE)=0.41 (MA), 1.14 (CT), 0.99 (ME)), GAM (adjusted R2=0.86 (MA), 0.16 (CT) 0.65 (ME); RMSE=0.39 (MA), 1.14 (CT), 0.97 (ME)], and Poisson [pseudo R2=0.84 (MA), 0.21 (CT), 0.52 (ME); RMSE=0.39 (MA), 0.67 (CT), 0.79 (ME)]. CONCLUSIONS: Linear, GAM, and Poisson models outperformed negative binomial models when relating SARS-CoV-2 RNA in wastewater or sludge to reported COVID-19 cases.

Parents' Willingness to Vaccinate Children for COVID-19: Conspiracy Theories, Information Sources, and Perceived Responsibility.

Understanding parental decision-making about vaccinating their children for COVID-19 is essential to promoting uptake. We conducted an online survey between April 23-May 3, 2021, among a national sample of U.S. adults to assess parental willingness to vaccinate their child(ren). We also examined associations between parental intentions to VACCINATE their children for COVID-19 and conspiracy theory beliefs, trusted information sources, trust in public authorities, and perceptions regarding the responsibility to be vaccinated. Of 257 parents of children under 18 years that responded, 48.2% reported that they would vaccinate their children, 25.7% were unsure, and 26.1% said they would not vaccinate. After adjusting for covariates, each one-point increase in the Vaccine Conspiracy Beliefs Scale was associated with 25% lower odds of parents intending to vaccinate their children compared to those who did not intend to (adjusted odds ratio (AOR) = 0.75, 95% confidence interval (CI): 0.64-0.88). Parents that perceived an individual and societal responsibility to be vaccinated were more likely to report that they intended to vaccinate their children compared to those that did not intend to vaccinate their children (AOR = 5.65, 95% CI: 2.37-13.44). Findings suggest that interventions should focus on combatting conspiracy beliefs, promoting accurate and trusted information sources, and creating social norms emphasizing shared responsibility for vaccination.

COVID-19 booster vaccination coverage among adults, children and adolescents and reasons for non-receipt, United States.

We assessed COVID-19 booster vaccination coverage and reasons for non-receipt using a large, nationally representative survey (June - August, 2022). Booster vaccination coverage was 71.7% among adults, 36.8% among children, and 51.6% among adolescents. Reasons for non-receipt included the belief that it was not necessary and lack of time for vaccination. All eligible individuals should receive the updated booster vaccines as soon as possible to protect against new variants of COVID-19.

COVID-19 Adult, Childhood, and Adolescent Vaccination Coverage Among Military and Civilian Families, United States.

INTRODUCTION: The COVID-19 pandemic affected the lives of military members and their families, with over 400,000 cases among U.S. military members since the start of the pandemic. The objective of this study is to examine and compare COVID-19 vaccination coverage of military members (active duty and Reserve/National Guard) and their family members (spouses, children, and adolescents) to that of their civilian counterparts using a large, nationally representative study. METHODS: Data from March 2 to May 9, 2022, of the Household Pulse Survey were analyzed for this study (n = 207,758). COVID-19 vaccination status (≥1 dose) was assessed for military members and their spouses, civilians, and children (aged 5 to 11 and 12 to 17 years) from both military and civilian families. Differences between military members, spouses, and their children compared to civilian adults and children were assessed using chi-squared and t-tests. Multivariable logistic regression was used to examine the association between military status and COVID-19 vaccination after controlling for sociodemographic characteristics. Reasons for not getting vaccinated for adults and children from military and civilian families were assessed. RESULTS: Compared to civilian adults and adjusted for sociodemographic characteristics, military members were more likely to be vaccinated (adjusted prevalence ratio = 1.07, 95% CI: 1.01-1.13). Vaccination coverage between active duty and civilian adults differed by subgroups. For example, among military members, COVID-19 vaccination coverage decreased with increasing age, from 87.5% among those aged 18 to 39 years to 56.0% among those aged ≥55 years. In contrast, among civilian adults, vaccination coverage increased with increasing age, from 78.5% among those aged 18 to 39 years to 91.2% among those aged ≥55 years. Military members were also less likely to be vaccinated than their civilian counterparts if they were Hispanic (68.5% vs. 85.2%), had a Bachelor's degree or higher (87.5% vs. 93.8%), or had $100,000 or more in annual household income (76.7% vs. 92.6%). Military members who had anxiety or depression (70.1%) were less likely to be vaccinated compared to civilian adults (84.4%). Military spouses (74.4%) were less likely to be vaccinated than civilian adults (84.7%). Children and adolescents who were homeschooled (35.1%) or had no preventive checkups in the past year (32.4%) were less likely to be vaccinated than their respective counterparts (52.5% and 54.0%, respectively). Military adults compared to civilian adults were more likely to report lack of trust in the government (47.5% vs. 35.2%) and, for children/adolescents, the belief that the vaccine is not needed (42.1% vs. 28.1%) as reasons for non-vaccination. CONCLUSIONS: Despite vaccine mandates and the high vaccination coverage found among the majority of military members, disparities exist in some subgroups. Educational interventions and increased communication from trusted leaders, such as medical providers and commanders, could increase confidence in vaccines among military families. Ensuring access to vaccines, empowering healthcare providers to recommend vaccines, and reminding parents of missed vaccinations or preventive checkups can help improve vaccination coverage. Achieving high vaccination among military members and their families is essential in protecting those in the forefront of the pandemic response and promoting the safety and security of the nation.

Trends in vaccination schedules and up-to-date status of children 19-35 months, United States, 2015-2020.

OBJECTIVES: To estimate trends in, and factors associated with, vaccination patterns and up-to-date immunization status of U.S. children by 19 to 35 months of age. METHODS: Data from the 2015 to 2020 National Immunization Surveys were used to assess trends in vaccination patterns, up-to-date status, and zero vaccination status of U.S. children by 19-35 months. Vaccination patterns were categorized as: 1) recommended, 2) alternate, or 3) unknown or unclassifiable. Multivariable analyses were conducted to examine factors associated with each vaccination pattern and up-to-date status for all recommended vaccines. RESULTS: From 2015 to 2020, the proportion of U.S. children completing the recommended schedule increased from 62.5% to 69.4%, alternative schedule decreased from 21.6% to 16.2%, and unknown or unclassifiable schedules decreased from 15.9% to 14.3%. In addition, being not up-to-date decreased from 39.7% to 35.6%. There was no change in the percentage of children receiving zero vaccinations from 2015 to 2020 (0.9% to 0.9%). Respondents with lower household income or who were uninsured were more likely to follow an alternate or unknown/unclassifiable schedule, or not be up-to-date with vaccines. CONCLUSION: Following any schedule other than the recommended schedule was associated with not being up-to-date on immunizations. Increased efforts to catch up on recommended vaccines is important for protecting children's health. Further efforts should be made to improve timely adherence to recommended vaccination schedules, particularly among populations with the largest disparities in coverage through a tailored approach to increase confidence in and access to vaccines.

Medical mistrust, discrimination, and COVID-19 vaccine behaviors among a national sample U.S. adults.

Background: COVID-19 vaccine uptake has been suboptimal and disparities in uptake have exacerbated health inequities. It has been postulated that mistrust in the healthcare system and experiences of discrimination or unfair treatment in other settings may be barriers to uptake of the COVID-19 vaccine, although few studies to date have investigated medical mistrust and perceived discrimination together. Method: We conducted a cross-sectional online survey between April 23-May 3, 2021, among a national sample of U.S. adults ages 18 years and older. We assessed receipt of and intention to be vaccinated for COVID-19 and associations with the validated Medical Mistrust Index and Everyday Discrimination Scale. Results: 1449 individuals responded, of whom 70.2% either had ≥1 dose of COVID-19 vaccine or reported that they were 'very' or 'somewhat' likely to be vaccinated in the future. In bivariate analyses, vaccination status was significantly associated with age, race/ethnicity, education, income, employment, marital status, health insurance, and political party affiliation. In multivariable analyses comparing those who had ≥1 vaccine dose or were likely to get vaccinated in the future with those who had not had any vaccine doses or did not intend to be vaccinated, each additional point in the Medical Mistrust Index was independently associated with a 16% decrease in the odds of vaccination (adjusted odds ratio = 0.84; 95% confidence interval = 0.81, 0.86). Discriminatory experiences were not associated with vaccination behavior or intention in bivariate or multivariable analyses. Conclusions: Medical mistrust is significantly associated with vaccination status and intentions. Increasing uptake of COVID-19 vaccines will likely require substantive efforts on the part of public health and healthcare officials to build trust with those who are not yet fully vaccinated. We recommend that these efforts focus on building the 'trustworthiness' of these entities, an approach that will require a paradigm shift away from a focus on correcting individual beliefs and knowledge, to acknowledging and addressing the root causes underlying mistrust.

Experiences with and impacts of the COVID-19 pandemic by substance use disorder in the early phase of pandemic in the United States: A cross-sectional survey, 2020.

INTRODUCTION: The coronavirus disease 2019 (COVID-19) pandemic could disproportionately affect individuals who have a substance use disorder (SUD). However, little information exists on COVID-19-related experiences among individuals with a SUD. We examined whether individuals with a SUD differ from other individuals with regard to COVID-19 testing, susceptibility, and employment-related vulnerability. METHODS: We used data from a U.S. nationally representative survey (n = 1,208). Using logistic regressions, we examined whether individuals with SUDs differ from other individuals regarding underlying health conditions, COVID-19 testing, access to paid sick leave, and loss of employment. Data were collected in late May-early June, 2020. RESULTS: Four percent of participants reported that a healthcare professional had told them they had a SUD. We found that, compared to those without SUDs, respondents with SUDs had higher odds of having lost their job due to the pandemic (adjusted odds ratio [AOR]:5.17, 95% confidence interval [CI]:2.28-11.74). Among individuals who were employed prior to the pandemic, people with SUDs had lower odds of having paid sick leave (AOR:0.26, 95% CI:0.09-0.74). CONCLUSION: Our study indicates that individuals with SUDs could be disproportionately affected by COVID-19 economically, which might worsen SUD and racial/ethnic health disparities.

Delays in Children's Preventive Health Services During the COVID-19 Pandemic.

BACKGROUND AND OBJECTIVES: Stay-at-home orders, social isolation recommendations, and fear of COVID-19 exposure have led to delays in children's preventive health services during the pandemic. Delays can lead to missed opportunities for early screening and detection of health problems, and increased risks for outbreaks of vaccine-preventable diseases. Understanding prevalence of and reasons for missed, delayed, or skipped preventive health services is important for developing strategies to achieve rapid catch-up of essential health services. METHODS: Using the Household Pulse Survey (n=37,064), a large, nationally-representative household survey fielded from April 14 to May 10, 2021, we examined prevalence of households with children who have missed, delayed, or skipped preventive health services, and factors associated with and reasons contributing to missed, delayed, or skipped preventive health services. RESULTS: About one-quarter of parents had children who missed, delayed, or skipped preventive check-ups in the past year. Delays in children's preventive health services were more common among respondents with higher education, households with greater numbers of children, and children who learned remotely or did not participate in formal education. Main reasons attributed to delayed preventive health services were limited appointments at health providers' offices (42.9%), concern about COVID-19 exposure at health providers' offices (42.2%), and closed health providers' offices due to the pandemic (29.0%). CONCLUSIONS: Physician office closures and concern about COVID-19 exposure resulted in over one-quarter of parents delaying preventive services for their children since the pandemic began. Coordinated efforts are needed to achieve rapid catch-up of preventive services and routine vaccines.

Associations among political voting preference, high-risk health status, and preventative behaviors for COVID-19.

BACKGROUND: We investigate the relationships among political preferences, risk for COVID-19 complications, and complying with preventative behaviors, such as social distancing, quarantine, and vaccination, as they remain incompletely understood. Since those with underlying health conditions have the highest mortality risk, prevention strategies targeting them and their caretakers effectively can save lives. Understanding caretakers' adherence is also crucial as their behavior affects the probability of transmission and quality of care, but is understudied. Examining the degree to which adherence to prevention measures within these populations is affected by their health status vs. voting preference, a key predictor of preventative behavior in the U. S, is imperative to improve targeted public health messaging. Knowledge of these associations could inform targeted COVID-19 campaigns to improve adherence for those at risk for severe consequences. METHODS: We conducted a nationally-representative online survey of U.S. adults between May-June 2020 assessing: 1) attempts to socially-distance; 2) willingness/ability to self-quarantine; and 3) intention of COVID-19 vaccination. We estimated the relationships between 1) political preferences 2) underlying health status, and 3) being a caretaker to someone with high-risk conditions and each dependent variable. Sensitivity analyses examined the associations between political preference and dependent variables among participants with high-risk conditions and/or obesity. RESULTS: Among 908 participants, 75.2% engaged in social-distancing, 94.4% were willing/able to self-quarantine, and 60.1% intended to get vaccinated. Compared to participants intending to vote for Biden, participants who intended to vote for Trump were significantly less likely to have tried to socially-distance, self-quarantine, or intend to be vaccinated. We observed the same trends in analyses restricted to participants with underlying health conditions and their caretakers Underlying health status was independently associated with social distancing among individuals with obesity and another high-risk condition, but not other outcomes. CONCLUSION: Engagement in preventative behavior is associated with political voting preference and not individual risk of severe COVID-19 or being a caretaker of a high-risk individual. Community based strategies and public health messaging should be tailored to individuals based on political preferences especially for those with obesity and other high-risk conditions. Efforts must be accompanied by broader public policy.

Trends in adolescent COVID-19 vaccination receipt and parental intent to vaccinate their adolescent children, United States, July to October, 2021.

INTRODUCTION: There was a five-fold increase in COVID-19 hospitalization case counts among children and adolescents between June and October 2021. However, polls suggest that adolescent COVID-19 vaccination coverage has plateaued in the United States. METHODS: Using the Census Bureau's Household Pulse Survey, we assessed trends in COVID-19 vaccination among adolescents ages 12-17 years, parents' intention to vaccinate their adolescent children, and their reasons for not intending to vaccinate their children from July to October 2021 using a large, nationally representative survey of U.S. households (n = 59,424). Trends in COVID-19 adolescent vaccination coverage, nationally and by sociodemographic characteristics, factors associated with adolescent vaccination status and parental intent to vaccinate their adolescent children, as well as changes in reasons for non-vaccination were examined using regression models. RESULTS: Receipt of ≥1 dose of a COVID-19 vaccine among adolescents ages 12-17 years increased five percentage points, from 56% (July) to 61% (October), with significant increases across most sociodemographic variables. However, there were no significant changes in parental intention to vaccinate their adolescent children during the same time period. Approximately one-quarter of parents were unsure about or reluctant to vaccinate their children, which remained consistent from July to October. Among those who had not vaccinated their children, lack of trust in the government and vaccines, and the belief that the COVID-19 vaccine is not needed or effective, was higher in October compared to July. CONCLUSIONS: Parental intention to vaccinate their children has remained relatively stable throughout the late summer and early fall of 2021. Encouraging paediatricians to discuss the importance and safety of COVID-19 vaccines, addressing concerns and misinformation, as well as recommending and offering vaccines are important for increasing parental confidence in vaccines as well as vaccination uptake among adolescents.KEY MESSAGEReceipt of ≥1 dose of a COVID-19 vaccine among adolescents ages 12-17 years increased five percentage points, from 56% (July) to 61% (October), with significant increases across most sociodemographic variables.Approximately one quarter of parents were unsure about or reluctant to vaccinate their children, which remained consistent from July to October.Encouraging paediatricians to discuss the importance and safety of COVID-19 vaccines, addressing concerns and misinformation, as well as recommending and offering vaccines is important for increasing parental confidence in vaccines as well as vaccination uptake among adolescents.

COVID-19 Vaccination Coverage, Behaviors, and Intentions among Adults with Previous Diagnosis, United States.

To determine the extent of gaps in coronavirus disease (COVID-19) vaccine coverage among those in the United States with and without previous COVID-19 diagnoses, we used data from a large, nationally representative survey conducted during July 21-August 2, 2021. We analyzed vaccine receipt (≥1 dose and full vaccination) and intention to be vaccinated for 63,266 persons. Vaccination receipt was lower among those who had a prior diagnosis of COVID-19 compared to those without: >1 dose: 73% and 85%, respectively, p<0.001; full vaccination: 69% and 82%, respectively, p<0.001). Reluctance to be vaccinated was higher among those with a previous COVID-19 diagnosis (14%) than among those without (9%). These findings suggest the need to focus educational and confidence-building interventions on adults who receive a COVID-19 diagnosis during clinic visits, or at the time of discharge if hospitalized, and to better educate the public about the value of being vaccinated, regardless of previous COVID-19 infection.

Trends in COVID-19 vaccination receipt and intention to vaccinate, United States, April to August, 2021.

To assess trends in and factors associated with COVID-19 vaccination coverage, data from the Household Pulse Survey were analyzed. From April to August 2021, vaccination coverage with at least 1 dose increased from 70%-82%, while vaccination intent increased from 82%-86%, with the highest increase among the most vulnerable groups. More efforts are needed to boost confidence in vaccines and to encourage all eligible people to be fully vaccinated.

Prior COVID-19 Infection, Mental Health, Food and Financial Insecurity, and Association With COVID-19 Vaccination Coverage and Intent Among College-Aged Young Adults, US, 2021.

INTRODUCTION: More than 700,000 COVID-19 cases have been linked to American colleges and universities since the beginning of the pandemic. However, studies are limited on the effects of the pandemic on college-aged young adults and its association with their COVID-19 vaccination status and intent. METHODS: Using the Census Bureau's Household Pulse Survey (HPS), a large, nationally representative survey fielded from April 14 through May 24, 2021, we assessed the effects of the pandemic (COVID-19 infection, mental health, food and financial security) on COVID-19 vaccination coverage (≥1 dose) and intentions toward vaccination among college-aged young adults in the United States (N = 6,758). We examined factors associated with vaccination coverage and intent, and reasons for not getting vaccinated. RESULTS: Approximately one-fifth (19.6%) of college-aged young adults had a previous diagnosis of COVID-19, 43.5% and 39.1% reported having anxiety or depression, respectively, 10.9% reported that they sometimes or often did not have enough food to eat, and 22.6% and 12.3% found it somewhat or very difficult, respectively, to pay for household expenses. Of college-aged young adults, 63.1% had received at least 1 dose of the COVID-19 vaccine, 15.4% probably would be vaccinated or were unsure about getting the vaccine, and 14.0% probably will not or definitely will not get vaccinated. Adults who were non-Hispanic Black (vs non-Hispanic White) or had food or financial insecurities (vs did not) were less likely to be vaccinated or intend to be vaccinated. Among adults who probably will not or definitely will not be vaccinated, more than one-third said that they did not believe a vaccine was needed. CONCLUSION: Ensuring high and equitable vaccination coverage among college-aged young adults is critical for safely reopening in-person learning and resuming prepandemic activities.

Disparities in national and state estimates of COVID-19 vaccination receipt and intent to vaccinate by race/ethnicity, income, and age group among adults ≥ 18 years, United States.

INTRODUCTION: COVID-19 morbidity and mortality has disproportionately affected vulnerable populations such as minority racial/ethnic groups. Understanding disparities in vaccine intentions and reasons for vaccine hesitancy are important for developing effective strategies for ameliorating racial/ethnic COVID-19 inequities. METHODS: Using six waves of the large, nationally representative Census Bureau's Household Pulse Survey data from January 6-March 29, 2021 (n = 459,235), we examined national and state estimates for vaccination intent, defined as receipt of ≥ 1 dose of the COVID-19 vaccine or definite intent to be vaccinated, by race/ethnicity with stratification by household income and age group. In separate logistic regression models, we also examined the interaction between race/ethnicity and household income, and race/ethnicity and age group, and its association with vaccination intent. Lastly, we examined reasons for not vaccinating by race/ethnicity. RESULTS: Vaccination intent differed by racial/ethnic group, household income, and age group nationally and by Health and Human Services (HHS) region and state. A significant interaction was observed between race/ethnicity and household income (F(8,72) = 4.50, p < 0.001), and race/ethnicity and age group (F(8,72) = 15.66, p < 0.001). Non-Hispanic Black adults with lower income (<$35,000) and younger age (18-49 years) were least likely to intend to vaccinate. Similar disparities across racial/ethnic groups were seen across most HHS regions and states. Concerns about possible side effects and effectiveness were significantly higher among all minority groups compared to non-Hispanic White adults. CONCLUSION: Disparities in vaccination intent by racial/ethnic groups underscore the need for interventions and recommendations designed to improve vaccination coverage and confidence in underserved communities, such as younger and lower income racial/ethnic minority groups. Efforts to reduce disparities and barriers to vaccination are needed to achieve equity in vaccination coverage, and ultimately, to curb COVID-19 transmission.

Changes in COVID-19 vaccination receipt and intention to vaccinate by socioeconomic characteristics and geographic area, United States, January 6 - March 29, 2021.

INTRODUCTION: Previous studies suggested that almost one-third of U.S. adults did not plan to get a COVID-19 vaccine once it is available to them. The purpose of this study was to examine changes in vaccine intentions and attitudes by sociodemographic characteristics and geographic areas, factors associated with vaccination intent, and reasons for non-vaccination among a nationally representative sample of U.S. adults. METHODS: Data from six waves of the Household Pulse Survey (6 January - 29 March 2021) were analyzed. Differences between January and March were assessed using t-tests. Factors associated with vaccination intent were examined in multivariable logistic regression models. RESULTS: From early January to late March, vaccination receipt of ≥1 dose of the COVID-19 vaccine or intention to definitely get vaccinated increased from 54.7 to 72.3%; however, disparities in vaccination intent continued to exist by age group, race/ethnic groups, and socioeconomic characteristics. Vaccine receipt and the intent were the lowest for region 4 (southeastern U.S.) throughout this period. Adults who had a previous COVID-19 diagnosis or were unsure if they have had COVID-19 were less likely to intend to get vaccinated [prevalence ratio = 0.92 (95%CI: 0.90-0.93) and 0.80 (95%CI: 0.74-0.85), respectively]. The belief that a vaccine is not needed increased by more than five percentage points from early January to late March. CONCLUSION: Intent to definitely get a COVID-19 vaccine increased by almost 18 percentage points from early January to late March; however, younger adults, adults who are non-Hispanic Black or other races, adults of lower socioeconomic status, and adults living in the southeastern U.S. region (Region 4) continue to have higher coverage gaps and levels of vaccine hesitancy. Emphasizing the importance of vaccination among all populations, and removing barriers to vaccines, may lead to a reduction of COVID-19 incidence and bring an end to the pandemic.KEY MESSAGESReceipt of ≥1 dose of the COVID-19 vaccine and intent to probably or definitely get vaccinated increased from early January to late March; however, disparities in vaccine intent continued to exist by age group, race/ethnic groups, and socioeconomic characteristics.Vaccine receipt and the intent were the lowest for region 4 (southeastern U.S.) compared to other regions during this period.Adults who had a previous COVID-19 diagnosis or were unsure if they have had COVID-19 were less likely to intend to get vaccinated; overall, the belief that a vaccine is not needed to be increased by more than 5% points from early January to late March.[Formula: see text].

Why are some people reluctant to be vaccinated for COVID-19? A cross-sectional survey among U.S. Adults in May-June 2020.

Understanding reasons for COVID-19 vaccine hesitancy is necessary to ensure maximum uptake, needed for herd immunity. We conducted a cross-sectional online survey between May 29-June 20, 2020 among a national sample of U.S. adults ages 18 years and over to assess cognitive, attitudinal and normative beliefs associated with not intending to get a COVID-19 vaccine. Of 1219 respondents, 17.7% said that they would not get a vaccine and 24.2% were unsure. In multivariable analyses controlled for gender, age, income, education, religious affiliation, health insurance coverage, and political party affiliation, those who reported that they were unwilling be vaccinated (versus those who were willing) were less likely to agree that vaccines are safe/effective (Relative Risk Ratio (RRR): 0.45, 95% confidence interval (CI): 0.31, 0.66), that everyone has a responsibility to be vaccinated (RRR: 0.39, 95% CI: 0.30, 0.52), that public authorities should be able to mandate vaccination (RRR: 0.75, 95% CI: 0.58, 0.98), and more likely to believe that if everyone else were vaccinated they would not need a vaccine (RRR: 1.36, 95% CI: 1.04, 1.78). Our results suggest that health messages should emphasize the safety and efficacy of vaccines, as well as the fact that vaccinating oneself is important, even if the level of uptake in the community is high.