Lingering Hesitancy: Persistent Uncertainty About the COVID-19 Vaccines Among Previously Vaccinated Individuals

Routine vaccination is an important public health measure to prevent severe illness from COVID-19. Although the determinants of vaccine hesitancy have been explored in prior research, limited information is available on the varying perceptions of the COVID-19 vaccines among previously vaccinated individuals. This study investigates how individuals previously vaccinated against COVID-19 might develop hesitancy toward future doses, a concept that the authors define as lingering hesitancy.

The authors conducted an online cross-sectional survey with 560 vaccinated respondents in 6 urban Chicago community areas (n=440) and Stephenson County, a rural county in Northern Illinois (n=120), between December 2021 and April 2022. The authors explored the role of an individual's sociocultural context (i.e., urban/rural setting, political affiliation, and race/ethnicity) in developing lingering hesitancy. Lingering hesitancy was operationalized using 2 constructs: (1) negative COVID-19 vaccine attitudes and (2) COVID-19 vaccine safety concerns. The authors also investigated whether mistrust in the government and institutions as well as barriers to accessing the COVID-19 vaccines mediate the relationship between context and lingering hesitancy.

The authors found significantly higher negative attitudes toward the COVID-19 vaccines and higher safety concerns among conservative versus liberal respondents (b=0.37, p<0.001; b=0.21, p<0.01, respectively) and among urban versus rural residents (b=0.45, p<0.001; b=0.37, p<0.001). Black/African American participants reported higher vaccine safety concerns than White participants (mean=2.6 vs 2.4, p<0.05). A significant portion of lingering hesitancy among conservative and Black/African American respondents was mediated by mistrust in the government and institutions. Barriers partially mediated vaccine safety concerns among Hispanic respondents.

Most public health efforts aimed at COVID-19 vaccine outreach and messaging have focused on increasing vaccine uptake, thereby targeting unvaccinated individuals. As the focus shifts toward annual COVID-19 vaccinations, it is essential to consider lingering hesitancy among those who have received previous vaccine doses. This article provides a framework for implementing vaccine-messaging campaigns that increase confidence and build trust in routine vaccinations.