COVID-19 Pro-Vaccine, Vaccine-Hesitant, and Anti-Vaccine Attitudes and Beliefs Among US Young Adults during the Pandemic

Background and Purpose: Opinions on vaccination are highly variable, ranging from favorable to staunchly opposed. Vaccination has become an increasingly polarized issue, with the COVID-19 pandemic as a poignant example. Thus, it is crucial to identify the underlying factors and reasoning behind vaccine uptake. Using qualitative thematic analysis, this study aims to identify unique beliefs, motivations, contextual factors, and emotions that influenced COVID-19 vaccine uptake. Some of these findings could potentially be applied to other vaccines, contributing to current and future vaccination efforts.

Methods: The analysis focused on 1,898 US young adults aged 18-30 years old who responded to one of two open-ended COVID-19 vaccine questions from the COVID-19 Adult Resilience Experiences Study (CARES) online survey. 1,713 respondents indicated that they were vaccinated and were asked to describe their decision. 185 respondents were not planning to get the vaccine and were asked to describe their decision. Two independent reviewers performed inductive open coding using Microsoft Excel in which unique codes were assigned to each quote based on the ideas, concepts, or emotions expressed. There was no limit to the number of codes that could be assigned to each quote. Following open coding, the two reviewers performed axial coding along with a third reviewer to group the initial codes into distinct themes.

Results: Overall, there were three major attitudes: pro-vaccine, vaccine-hesitant, and anti-vaccine. There were five major pro-vaccine themes: “Trust in Institutions” (trust in government and public health), “Instinctive Choice” (obvious decision, got vaccinated immediately), “Compliance with Requirements” (school/work mandates), “Health-protective Motivations” (pre-existing health conditions that increase risk, preventing severe symptoms or death), and “Social Restoration Through Responsible Actions” (Return to “normal”, protecting self and others, herd immunity). Next, there was one major vaccine-hesitant theme: “Fear of the Unknown” (rushed development, unclear side effects, waiting for more evidence). Finally, there were five anti-vaccine themes: “Spiritual and Naturalistic Frameworks” (against religious beliefs, unnatural ingredients, maintain “clean” lifestyle), “Distrust in Institutions and Conspiracies” (distrust in governments, assuming ulterior motives, conspiracy theories), “Skepticism About Vaccine Efficacy and Safety” (not safe, rushed development process, lack of efficacy), “Fatalism” (will contract COVID-19 regardless, vaccine doesn’t always work), and “Individual Autonomy and Liberty” (against mandates, freedom of choice).

Conclusions and Implications: A key distinction between pro-vaccine and anti-vaccine attitudes was the contrast between collectivist and individualist motivations. Pro-vaccine respondents often focused on protecting others and fulfilling social responsibilities, whereas anti-vaccine respondents focused more on personal freedoms and autonomy. Vaccine-hesitant respondents often expressed fear of uncertainty regarding vaccine development. These findings highlight the need for clear, transparent communication about scientific evidence behind vaccine development and the community benefits of vaccines. Considering the influence of spiritual and naturalistic beliefs among anti-vaccine individuals, vaccine outreach could benefit from engaging trusted figures within those communities, offering messages that resonate with their values while addressing misinformation. Future research should explore methods for bridging collectivist motivations with individualistic motivations to further expand vaccine uptake.