Distinct differences between COVID-19 vaccine refusers and vaccine hesitant in the United States: Results from a population-based survey and latent class analysis.

PURPOSE: The vaccine refuser (VR) and vaccine hesitant (VH) populations are often conflated, despite likely differing motivations. This study characterizes these subgroups in the U.S. during the COVID-19 pandemic to inform targeted public health messaging for current and future vaccination efforts.

METHODS

We analyzed data from a probability-based, cross-sectional AmeriSpeak survey (October-November 2021) of 6515 non-institutionalized U.S. adults. Latent class analysis (LCA) identified motivational clusters, and multinomial regression assessed predictors of class membership.

RESULTS

Of 6515 respondents, 1167 were classified as VH (n = 409) or VR (n = 758). VR individuals were more likely to be White, married, and Republican (all p < 0.05). VH participants reported significantly lower medical mistrust (2.9% vs. 6.6%, p = 0.012) and less racist attitudes (3.27 vs. 3.55, p < 0.001). LCA revealed three motivational classes: Multi-issue dominant, Side-effect dominant, and Non-dominant. Class distributions differed between groups (e.g., Multi-issue: 10.8% VH vs. 21.4% VR). Race/ethnicity, gender, and marital status significantly predicted class membership (p < 0.05).

CONCLUSIONS

VH and VR individuals differ in sociodemographic traits and underlying motivations. Notably, about one-third of VRs fall within the VH spectrum. Tailoring public health messages to address specific concerns, such as side effects versus broader mistrust, may improve vaccine uptake among these distinct subgroups.