Narrative Review of COVID-19 Vaccine Hesitancy: Evidence in Late 2021

Abstract

The coronavirus disease, COVID-19, has changed daily life dramatically since early 2020. Although COVID-19 vaccines are available in the United States, many express distrust in this primary prevention measure and doubt both the seriousness of COVID-19 and its associated morbidity and mortality. Vaccine hesitancy, also described as the reluctance or refusal of vaccines despite availability, exists on a continuum and was a known public health threat prior to the coronavirus pandemic. This narrative review examines studies related to the determinants of COVID-19 vaccine hesitancy among adults in the United States. Also explored are the factors related to COVID-19 vaccine risk communication and available interventions to address COVID-19. Perceived severity of and susceptibility to COVID-19, trust in public health authorities and government in general, educational attainment, income, race, and sex were found to be significant determinants of vaccine hesitancy. Due to lack of available evidence-based interventions to counter COVID-19 vaccine hesitancy, peer-reviewed commentaries and other health communication principles formed the basis of additional recommendations for COVID-19 vaccine hesitancy interventions. Recommendations included trust-building efforts at the community, national, and institutional levels, as well as addressing social determinants of health. These findings may be limited by recent vaccine mandates related to education and to employment. Future research is needed to identify any changes in acceptance, uptake, and trust in institutions such as public health agencies and universities, and representatives of those institutions.