Understanding vaccine willingness in post-COVID America: Key determinants and demographic differences

The COVID-19 vaccine played a key role in ending the pandemic and reshaped public attitudes-some gained trust due to its rapid success, while others became more hesitant. Understanding what drives vaccine uptake, especially in diverse populations, is vital for future public health efforts. In 2024, an online survey with 2352 participants used discrete choice experiments to explore factors influencing willingness to vaccinate during a hypothetical epidemic. Participants were asked if they would like to uptake a vaccine during a hypothetical epidemic under conditions varied by the infectious disease's contagiousness and mortality; the effectiveness, safety, and price of the vaccine; and vaccination rates among inner and outer social circles. Participants were also asked about demographics, health conditions, social support, personal impact of the COVID-19 pandemic, and neighborhood characteristics. Conditional logit regression models and logistic regression models were used to examine how vaccine willingness is associated with various characteristics. A total of 2352 participants completed the online survey. In this sample, 45.7 % were 60 + years old; 60.4 % were females. Approximately 70 % had at least a high school education, and 73 % lived in urban areas. The results indicate that vaccine uptake willingness is associated with the high effectiveness and safety of a vaccine, while higher costs of vaccine deter uptake. Greater vaccination rates in outer networks boost willingness, except when the disease spreads slowly but has high mortality. When the infectious disease has high mortality, the vaccine's effectiveness is prioritized over safety. Willingness also varies by demographics and other individual characteristics, with prior COVID-19 experience associated with higher willingness to vaccine uptake. To promote vaccine uptake for future epidemics, campaigns may emphasize a vaccine's effectiveness in high-risk situations and safety in low-risk ones, target outer social networks, and use culturally tailored outreach to address mistrust.