Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.
Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.
PLoS One. 2021 Nov 17;16(11):e0258462. doi: 10.1371/journal.pone.0258462. eCollection 2021.
Novel coronavirus disease 2019 (COVID-19) vaccine hesitancy is a barrier to achieving herd immunity, and thus, a prominent public health concern. This study aimed to identify the determinants of COVID-19 vaccine hesitancy based on the World Health Organization's '3Cs' model (i.e., confidence, complacency, and convenience) in the United States (U.S.) and Canada.
Data from 7678 adults ages 18 or older were collected from the four most populous U.S. States, specifically New York, California, Florida, and Texas, and from English-speaking Canada at three timepoints, in May and July 2020, and March 2021 using a web-based survey (www.covid19-database.com). Sociodemographic information was collected, and comprehensive psychological assessments were administered. Univariate analyses were performed to identify the individual determinants of vaccine hesitancy, which were categorized as: 1) vaccine confidence, 2) vaccine complacency, 3) sociodemographic, and 4) other psychological factors. A series of models were computed using these categorizations.
Mistrust of vaccine benefit (β(SE) = 0.67(0.01), p<0.001, partial η2 = 0.26) and lower perceived seriousness of COVID-19 (β(SE) = 0.68(0.02), p<0.001, partial η2 = 0.12) were the principal determinants of vaccine hesitancy. Right-wing political affiliation (β(SE) = 0.32(0.02), p<0.001, partial η2 = 0.03), higher risk propensity (β(SE) = 0.24(0.02), p<0.001, partial η2 = 0.03), and less negative mental health effects of the COVID-19 pandemic (β(SE) = 0.20(0.01), p<0.001, partial η2 = 0.03) were the main sociodemographic and psychological determinants. Other sociodemographic determinants included younger age, women, race, and employment status. Lack of vaccine confidence and complacency explained 38% and 21% of the variance in vaccine hesitancy, respectively; whereas, sociodemographic and psychological determinants explained 13% and 11% of the variance in vaccine hesitancy, respectively.
Targeted and tailored public health interventions that enhance the public's confidence in vaccines and emphasize the risk and seriousness of COVID-19 may address COVID-19 vaccine hesitancy. Efforts directed toward specific marginalized and underserved groups may be required to promote vaccine confidence.
新型冠状病毒病 2019（COVID-19）疫苗犹豫是实现群体免疫的障碍，因此是一个突出的公共卫生问题。本研究旨在根据世界卫生组织（WHO）的“3C”模型（即信心、自满和便利），确定美国和加拿大 COVID-19 疫苗犹豫的决定因素。
从美国四个人口最多的州（纽约州、加利福尼亚州、佛罗里达州和得克萨斯州）和讲英语的加拿大收集了 7678 名年龄在 18 岁或以上的成年人的数据，分别在 2020 年 5 月和 7 月以及 2021 年 3 月使用了一个基于网络的调查（www.covid19-database.com）。收集了社会人口统计学信息，并进行了全面的心理评估。进行了单变量分析，以确定疫苗犹豫的个体决定因素，这些因素分为：1）疫苗信心，2）疫苗自满，3）社会人口统计学和 4）其他心理因素。使用这些分类计算了一系列模型。
对疫苗益处的不信任（β（SE）=0.67（0.01），p<0.001，部分 η2=0.26）和对 COVID-19 严重性的感知降低（β（SE）=0.68（0.02），p<0.001，部分 η2=0.12）是疫苗犹豫的主要决定因素。右翼政治派别（β（SE）=0.32（0.02），p<0.001，部分 η2=0.03）、更高的风险倾向（β（SE）=0.24（0.02），p<0.001，部分 η2=0.03）和 COVID-19 大流行对心理健康影响较小（β（SE）=0.20（0.01），p<0.001，部分 η2=0.03）是主要的社会人口统计学和心理决定因素。其他社会人口统计学决定因素包括年龄较小、女性、种族和就业状况。缺乏疫苗信心和自满分别解释了疫苗犹豫的 38%和 21%的方差；而社会人口统计学和心理决定因素分别解释了疫苗犹豫的 13%和 11%的方差。
针对增强公众对疫苗的信心并强调 COVID-19 的风险和严重性的有针对性和量身定制的公共卫生干预措施可能会解决 COVID-19 疫苗犹豫问题。可能需要针对特定的边缘化和服务不足的群体开展工作，以促进疫苗信心。
