A Population Level Study on the Determinants of COVID-19 Vaccine Hesitancy at the U.S. County Level

Multiple COVID-19 vaccines were proven to be safe and effective in curbing severe illness, but despite vaccine availability, uptake rates were relatively low in the United States (U.S.), primarily due to vaccine hesitancy. To better understand factors associated with COVID-19 vaccine hesitancy in the U.S., our study provides a comprehensive, data-driven population-level statistical analysis at the county level. We find that political affiliation, as determined by the proportion of votes received by the Republican candidate in the 2020 presidential election, has the strongest association with COVID-19 vaccine hesitancy. The next strongest association was median household income, which has a negative association. The percentage of Black people and the average number of vehicles per household are also positively associated with vaccine hesitancy. In contrast, COVID-19 infection rate, percentage of Hispanic people, postsecondary education percentage, median age, and prior non-COVID-19 childhood vaccination coverage are other factors negatively associated with vaccine hesitancy. Unlike previous studies, we do not find significant relationships between cable TV news viewership or Twitter misinformation variables with COVID-19 vaccine hesitancy. These results shed light on some factors that may impact vaccination choice in the U.S. and can be used to target specific populations for educational outreach and vaccine campaign strategies in efforts to reduce vaccine hesitancy.