Exploring COVID-19 Vaccine Decision Making: Insights from 'One-Shot Wonders' and 'Booster Enthusiasts'

Within the USA, the uptake of the updated COVID-19 vaccines is suboptimal despite health authority recommendations. This study used qualitative methods to examine factors influencing COVID-19 vaccine decision making and the effects of anxiety and depression on these decisions within the CHASING COVID Cohort (C3). Between October and December 2023, we conducted 25 interviews with participants from 16 different US states, 14 of whom endorsed recent symptoms of anxiety and/or depression. Using grounded theory methodology for coding and thematic analysis, we categorized participants into "One-Shot Wonders" and "Booster Enthusiasts". Our findings indicate that the US COVID-19 vaccination environment has shifted from active promotion to a notable absence of COVID-19 discussions, leading to reduced worry about infection and severe illness, diminished perception of the benefits of the vaccine on personal and community levels, and fewer cues to action. Initially influential factors like family, personal experiences, and physician recommendations lost impact over time. Although the relationship between symptoms of depression and anxiety and vaccination was not prominent, one case highlighted a direct relationship. The study emphasizes the importance of timely and accurate public health messaging adaptable to individuals' needs and misconceptions, highlighting the need for dynamic communication strategies in future initiatives with rapidly changing landscapes.