Factors and reasons associated with low COVID-19 vaccine uptake among highly hesitant communities in the US

Am J Infect Control. 2022 Mar;50(3):262-267. doi: 10.1016/j.ajic.2021.12.013. Epub 2022 Jan 5.


Background: The inability to achieve high COVID-19 vaccination rates can continue to have serious harm to our communities. Vaccine hesitancy is a major barrier towards high vaccination rates. We evaluated the relationship between COVID-19 vaccine uptake and vaccine hesitancy, and then examined whether community factors were associated with COVID-19 vaccine uptake and hesitancy.

Methods: We constructed and evaluated a cross-sectional, county-level dataset that included the levels of vaccination uptake and vaccine hesitancy, and population characteristics based on those included in the CDC's Social Vulnerability Index.

Results: Across 3142 US counties, vaccine hesitancy was significantly and negatively correlated with vaccine uptake rates (r = -0.06, P value <.01). The 2 predictors associated with a low vaccination level within highly hesitant communities were: no high school education (OR:0.70, P value <.001), and concern on vaccine availability and distribution (CVAC) (OR:0.00, P value <.001). The most common reason driving vaccine hesitancy was lack of trust in COVID-19 vaccines (55%), followed by concerns around side effects of the vaccine (48%), and lack of trust in government (46%).

Conclusions: COVID-19 vaccine hesitancy is a public health threat. Our findings suggest that low education levels are a major contributor to vaccine hesitancy and ultimately vaccination levels. Since education levels are not easily modifiable, our results suggest that policymakers would be best served by closing knowledge gaps to overcome negative perceptions of the vaccine through tailored interventions.

Keywords: Education; Health Services Research; Public Health; Vaccination.

MeSH terms

  • COVID-19 Vaccines
  • COVID-19* / prevention & control
  • Cross-Sectional Studies
  • Humans
  • SARS-CoV-2
  • Vaccination
  • Vaccines*


  • COVID-19 Vaccines
  • Vaccines