ABSTRACT
Background: Vaccine hesitancy is defined as "delay in acceptance or refusal of vaccination despite the availability of vaccination services". When individuals choose not to get vaccinated, efforts to control the spread of the disease are hindered. Despite scientific evidence that COVID-19 vaccines are safe and effective, one in four adults in the United States is not fully vaccinated. However, some individuals, despite being previously vaccine-hesitant got the COVID-19 vaccine and vice versa, leading to an intention-behavior gap. In this study, we ask an important question: What sociodemographic, psychological, ideological, and communication-related factors can contribute to the vaccination-related intention-behavior gap? An understanding of these factors can also help create communication strategies to encourage the vaccine-hesitant to get vaccinated, especially in populations where there are greater vaccine disparities. Method(s): This longitudinal study uses two nationally representative surveys of Americans from 2020 and 2021 to determine the factors that contribute to COVID-19 vaccination-related intention-behavior gap and overcome vaccine hesitancy, using multivariable logistic regression. Result(s): The results indicated that 51% of previously vaccine-hesitant individuals were vaccinated against COVID-19, and only 14% of previously provaccine individuals remained unvaccinated. Some factors associated with a higher likelihood of vaccine-hesitant individuals getting vaccinated were high perceptions of risk, high vaccine acceptance, being informed about the vaccines, endorsing less COVID-19 misinformation, having confidence in scientists, being over 60 years old, and being female. Alternatively, some factors associated with a lower likelihood of pro-vaccine individuals not getting vaccinated were high perceptions of risk, high vaccine acceptance, being informed about the vaccines, identifying as a Republican, having confidence in scientists, having access to healthcare, and having higher education. Conclusion(s): The study indicates that it is possible to convince the vaccine-hesitant individuals to get vaccinated as well as prevent the pro-vaccine individuals from realizing their vaccination intentions. Developing evidence-based persuasive and targeted communication strategies can help convince the unvaccinated and increase the uptake of COVID-19 vaccines. Targeted communication strategies can also help reduce disparities among populations that have lower vaccination rates. Moreover, such strategies may also be useful to increase the uptake of other vaccines such as human papillomavirus (HPV) vaccines to lower the rates of HPV-attributable cancers in the United States.