Too many Americans are not getting vaccinated, presenting a very real threat to public health as herd immunity is eroded. Much of the recent scholarship in vaccine refusal and hesitancy focuses on parental decision making about childhood vaccines. Yet with only about 44 percent of adults receiving a flu shot, and lower rates for other vaccines such as TDAP and pneumonia, understanding decision-making related to adult immunization is critical to increase vaccine uptake in adults. Together with her colleagues, family science Professor Sandra Quinn, senior associate director of the Maryland Center for Health Equity, has just published results from one of the first studies looking at vaccine hesitancy in adults for themselves, not their children. Their main findings suggest that exploring vaccine hesitancy among adults may be a useful approach to understanding the persistence of racial/ethnic disparities in vaccine acceptance between African American and white adults, and identifying strategies to improve vaccine uptake.
[Dr. Sandra Quinn]
Dr. Quinn et al. found that there is a continuum of behavior ranging from never-takers to sometimes-takers to always-takers, with significant differences between African American and whites. They compared their findings to the Three Cs framework: Complacency, Convenience, and Confidence, and found that complacency contributed to low vaccine acceptance for both races. For sometimes-takers and always-takers, convenience contributed to vaccine uptake, yet never-takers described different reasons for their avoidance. These reasons differed by race. For example, African Americans cited cost as a barrier. Additionally, there were racial differences in trust and confidence that impacted the decision-making process.
Complacency and confidence were found to impact vaccine behavior both positively and negatively, and these two factors often affected behavior more profoundly than convenience. This understanding can help public health workers to influence vaccine uptake. For example, someone may be complacent about getting a flu vaccine, but if the vaccine is offered within the workplace, the convenience may overcome the complacency. By addressing some of the factors that negatively impact confidence in the vaccine, strategic health communication may help to overcome lack of confidence. Additionally, public health professionals can work with other partners to broaden delivery of the vaccine by enhancing convenience and increasing passive acceptance of the vaccine.
The article, Exploring the Continuum of Vaccine Hesitancy Between African American and White Adults: Results of a Qualitative Study, was published in the December issue of PLOS Current Outbreaks.