Compliance, procrastination and refusal: American COVID-19 vaccination trust and value orientation

INTRODUCTION: COVID-19 vaccine hesitancy studies, most of which were completed prior to the release of the vaccine, speculated on factors that might influence inoculation intention when a vaccine was introduced. This paper examines actual vaccination decisions among US residents after COVID-19 vaccines were approved, with a focus on trust in vaccine effectiveness, increased trust in government pandemic response, and individual-versus-collective value orientation. METHOD: The data set was from the Kaiser Family Foundation COVID-19 Vaccine Monitor, a nationally representative sample reflecting the opinions of 1,519 American adults aged 18 and above. Data were collected in September 2021—approximately nine months after the first COVID-19 vaccines were approved for distribution. Indicators of trust in vaccine effectiveness included individual opinions regarding breakthrough infections and vaccine boosters. Increased trust in government indicated approval of official COVID-19 responses, and value orientation denoted respondent emphasis on personal choice versus protecting the health of others. We established three categories of a vaccine hesitancy-dependent variable: none, some, and full rejection. A multinomial regression analysis was employed to compare vaccine hesitancy in three pairs of contrasting groups. RESULTS: While we noted distinct patterns in decision-making factors for each of the contrasting pairs, we also observed strong effects for trust in vaccine effectiveness and value orientation on vaccine decisions across all three. Both effects were more substantial than those associated with three control variables—social-demographic characteristics, political party affiliation, and health risk. CONCLUSION: Our findings suggest that in order to increase vaccination rates, policymakers and influencers should focus on reducing individual scepticism over breakthrough infections and vaccine boosters, and on influencing a value orientation shift from personal choice to social responsibility.