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Vaccine Hesitancy Persists Despite Understanding Vaccination Effectiveness, Survey Finds
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Survey reveals gaps in vaccination intentions for flu, COVID-19, respiratory syncytial virus, and pneumococcal disease.
A recent survey by the National Foundation for Infectious Diseases (NFID) highlights a significant gap between US adults' beliefs in the effectiveness of flu, COVID-19, respiratory syncytial virus (RSV), and pneumococcal vaccines and their intentions to get vaccinated this season.1
“Survey findings highlight the need for greater awareness about the risks of respiratory diseases as well as the safety and benefits of vaccines, both in terms of preventing infections and reducing the risk of hospitalization or death,” wrote the authors of the study. “Health care professionals remain the most trusted source of information about vaccines and play a critical role in protecting public health by providing clear, consistent, and strong vaccine recommendations.”
The survey was conducted at the University of Chicago from August 8 to 12, 2024. A total of 1160 adults aged 18 years and older across the 50 states and the District of Columbia completed the survey, with 1130 responses collected online and 30 by telephone.
Attitudes on Respiratory Diseases and Vaccination
The survey revealed that fewer than 1 in 5 US adults are concerned about themselves or a family member contracting a respiratory infection this fall and winter. Specifically, 16% expressed concern about RSV, 17% about flu, 17% about pneumococcal disease, and 20% about COVID-19. Notably, concern about COVID-19 has steadily declined over the years, with only 20% of respondents expressing concern in 2024, compared with 23% in 2023 and 34% in 2022. However, adults with chronic health conditions are roughly twice as likely to worry about contracting flu, COVID-19, RSV, or pneumonia compared with those without such conditions.
Despite recommendations for flu and COVID-19 vaccinations for everyone aged 6 months and older, only 38% of US adults plan to get a flu vaccine, and just 26% plan to get the updated COVID-19 vaccine. Similarly, among those eligible for RSV and pneumococcal vaccines, only 21% and 24%, respectively, plan to get vaccinated.
The primary reasons for vaccine hesitancy include concerns about side effects, general distrust of vaccines, fear of getting sick from the vaccine, or beliefs that the vaccines are not highly effective. These attitudes underscore a need for enhanced education and outreach to improve vaccination uptake, especially among vulnerable populations.
RSV
RSV is a significant cause of respiratory illness and hospitalization in older adults in the United States, particularly during the fall and winter. As of spring 2024, 20% to 25% of US adults aged 60 years and older were estimated to have received the RSV vaccine.2
On June 26, 2024, the CDC’s Advisory Committee on Immunization Practices (ACIP) updated its recommendations that all adults aged 75 years and older, and adults aged 60 to 74 years who are at increased risk for severe RSV disease should receive a single dose of the RSV vaccine (Arexvy [GSK], Abrysvo [Pfizer], or mResvia [Moderna]).
Among those who are committed to vaccination, 21% say they “definitely will,” 17% “probably will,” and 18% remain “uncertain.” 1 The most cited reasons for deciding to get the RSV vaccine include personal protection (72%), avoiding severe complications such as hospitalization or death (61%), a recommendation from their doctor (59%), and protecting their family (58%).
For the 26% of eligible adults who do not plan to receive the RSV vaccine, concerns about side effects (45%) and getting sick from the vaccine (38%) were the top reasons for hesitancy. Additionally, distrust of vaccines in general (38%) and the absence of a doctor's recommendation (24%) further contributed to their decision not to get vaccinated.
Role of Health Care Professionals
Additionally, a large majority of US adults (75%) place significant trust in doctors, nurses, and pharmacists when it comes to vaccine information, underscoring the importance of health care providers in vaccine education and outreach efforts. Trust in public health institutions, while still substantial, is somewhat lower, with 55% of adults expressing trust in the CDC and 51% trusting state and local health departments.
Masking Behaviors
The data showed a declining trend in mask use during the fall and winter seasons, particularly in health care settings. Only 19% of US adults plan to wear a mask when visiting a doctor’s office, pharmacy, or hospital, while nearly half (49%) will do so only if required. Interestingly, there are notable disparities in masking preferences across racial and ethnic groups. Black adults (38%) and Hispanic adults (23%) are more likely to wear masks in health care environments compared with White adults (13%), reflecting differences in perceived risk or precautionary behaviors among these groups.
The survey findings emphasized the critical need to dispel misconceptions about flu, COVID-19, RSV, and pneumococcal disease, while increasing awareness around the importance of prevention. Health care professionals, as the most trusted source of vaccine information, are uniquely positioned to educate patients and provide strong vaccine recommendations, while safe and effective vaccines are readily available in the United States to protect against these diseases.
References
1. 2024 national survey: Attitudes and behaviors about influenza, COVID-19, respiratory syncytial virus, and pneumococcal disease. September 25, 2024. Accessed September 30, 2024. https://www.nfid.org/resource/2024-national-survey-attitudes-and-behaviors-about-influenza-covid-19-respiratory-syncytial-virus-and-pneumococcal-disease/
2. Steinzor P. Updated ACIP guidelines: RSV vaccine for adults aged 60 years and older. AJMC. August 7, 2024. Accessed September 30, 2024. https://www.ajmc.com/view/updated-acip-guidelines-rsv-vaccine-for-adults-aged-60-years-and-older
