Consumer sentiment around vaccines continues to shift as the pandemic evolves. Our survey studied what worked and what did not, in terms of vaccine deployment strategies, and the lessons learned can be applied to future vaccination programs.

Executive summary

As of November 2021, 30% of the US adult population is not fully vaccinated against COVID-19.¹

Health care, government, and life science organisations had a sharp learning curve to determine deployment strategies that ensured supply was accessible and equitable, in addition to assuring consumer confidence that the vaccines are effective and safe. Consumer sentiment around vaccines has shifted and continues to shift as the pandemic evolves. It has been almost a year since the first COVID-19 vaccine became available. What have we learned about consumer perspectives on vaccines that can be applied going forward to vaccination in general?

• Former deliberators—currently vaccinated, but were formerly uncertain
• Want the vaccine, but not yet vaccinated—those who want the vaccine but haven’t received it yet
• One dose but not the second—those who got the first dose but have not scheduled the second shot
• Unvaccinated and "on the fence"—those who have not decided yet if they want the vaccine
• Only if required—unvaccinated and do not want the vaccine, but will if required
• Never/refuse—unvaccinated and say they would never get the vaccine
• Fully vaccinated and were never uncertain

We found that:

• Across all income levels, access, scheduling, and convenient hours are still barriers to vaccination for those who want the vaccine.
  • Transportation issues are barriers to vaccination for one in five respondents who want the vaccine. This is higher among lower-income individuals: 26% of consumers with a household income less than US$25,000 per year cited inability to get to a vaccine site because of transportation issues.
• Trusted sources on public health information and where individuals went for COVID-19 information varies by demographics and vaccine status.
  • Trusted sources: Although doctors were the most trusted source for public health information for all races/ethnicities, Asian (68%), white (66%), and Hispanic (63%) respondents were more likely than Black (54%) respondents to say so.
  • Where they went for information: Unvaccinated respondents (“never/refuse” and “only if required”) were more likely to go to their friends/family for information (No. 1 source) versus their doctors (No. 2 source). Doctors were the most used source for all other vaccine cohorts
• Personal relationships between family/friends and doctors matter in our digitised world and we should empower those relationships.
  • More than half (59%) of former deliberators say they got vaccinated because of family and friends compared to only 5% who said they were motivated by an incentive, like free tickets, meals, or paid time off.
  • Key groups may be influenced to get vaccinated by family or friends. For example, when seeking out information on COVID-19:
    • Black and Hispanics respondents reported nearly equal rates of going to their friends and family as they did to their doctor for information.
    • More unvaccinated and unwilling (“never/refuse” and “only if required”) are going to their friends for information than their doctors.
    • Generation Z consumers are going to their friends and family as their top source, at a higher rate than their doctor.
• More consumers may be swayed than originally thought. Opportunities to improve vaccination adoption include:
  • Offering the vaccine where they already are (go where the people are) :
    • If “their” doctor offered it at a routine visit, 56% of “on the fence/unvaccinated”, 43% of “only if required,” and 17% of “refusers” say they are likely to get vaccinated.
    • If a vaccine was offered at place they were already shopping, 48% of “on the fence/unvaccinated”, 33% of “only if required,” and 15% of “never/refuse” say they are likely to get vaccinated.
• Use friends and family as messengers for information and personal experiences with the vaccine.
  • Of those who want to get vaccinated, 34% said learning someone they trust got it, and 28% said conversations with a trusted person are motivating them to get vaccinated.
  • Forty-four percent (44%) of those who want the vaccine are motivated to protect family and friends.
• Address anxieties and fears with compassion along with facts; meeting consumers where they are regarding information about side effects, immunity, and effectiveness.
  • The top three factors that could influence the “on the fence and unvaccinated” are related to safety and information

Findings

Access, scheduling, and convenient hours are still barriers to vaccination

Access issues, like transportation or convenient hours, have always been barriers preventing many from receiving health care treatment. With vaccines, particularly the COVID-19 vaccine, it is no different. Through our survey, we found that across all income levels, access, scheduling, and convenient hours are still barriers for those who want the vaccine (figure 1).

For those who are unvaccinated, but want the vaccine, transportation issues were cited as a top concern among all consumers, however this was particularly true for low-income consumers. Over a quarter (26%) of consumers with a household income less than US$25,000 per year cited inability to get to a vaccine site because of transportation issues. Difficulty scheduling was also a top barrier for all consumers across income levels but was listed as the biggest barrier for consumers making over US$100,000 per year.

We also found that access issues remain a top barrier for racially and ethnically diverse consumers, and those living with disabilities. Over a third (33%) of unvaccinated Hispanic consumers who want the vaccine cited inconvenient hours as a top reason they not been vaccinated. Additionally, 23% of Asian consumers and 21% of Hispanic consumers that are unvaccinated, but want the vaccine, cited inability to gain access due to disabilities.

Trusted voices: Whom do consumers say they trust and where do they go to for information on COVID-19?

The COVID-19 pandemic and racial unrest in 2020 that grew following the tragic deaths of George Floyd, Breonna Taylor, and so many others spurred health care and life sciences organisations to talk openly about the role they may have played in the loss of trust with some patients and communities—both historically and currently. Consumer and community trust in the health system, health care professionals, and the wider vaccine research community is an integral part of vaccine acceptance.² However, trustworthy sources remains a top barrier. According to the Kaiser Family Foundation, 38% of unvaccinated adults listed mistrust of the government as a top reason why they did not get vaccinated.³ Similarly, our findings found appointed or elected federal officials, and state or local political officials were the least trusted sources for public health information.

Consumers say they trust their doctors for accurate public health information

Considering the amount of mistrust in the health care system, identifying trusted sources is essential to get more consumers accurate and safe information on public health issues.

Overall, survey respondents selected their personal doctor as being the most trusted source of accurate and up-to-date information about public health issues (figure 2). This is also in alignment with public data.⁴ Next, consumers said they trust health insurance companies and health departments (local, state, and federal at similar rates for extreme trust).

Where trust varies

By race ethnicity:

• Although doctors were the most trusted source for all races/ethnicities, Asian (68%), white (66%), and Hispanic (63%) respondents were more likely than Black (54%) respondents to say so (figure 3).
• Appointed or elected federal officials were the least trusted sources across racial and ethnic groups. However, they were more trusted amongst consumers who identified as Black (26%), Asian (26%), and Hispanic (28%), compared to only 19% of white consumers.

By generation:

Although personal doctors were the most trusted source for all generations, younger generations were less likely than older ones to say so (figure 4). Other differences include:

• About 15% more seniors had “extreme trust” in their doctor compared with Generation Z and millennials.
• Federal health agencies, like the CDC and NIH, were more trusted among younger generations, Generation Z and millennials than baby boomers and Seniors.
• Younger generations were twice as likely to trust appointed or elected federal officials compared with baby boomers.

By income:

The top two sources for public health information were personal doctors and health insurance companies. However, there were some variances across income levels:

• Consumers with a household income of US$100,000 or were, on average, more trusting of each source. Additionally, half of all consumers making over US$100,000 per year had an equal level of “extreme trust” in their health insurance company, local or county health department, federal public health officials, and state health department
• Local or county health departments were the third most trusted source for consumers with a household income less than US$49,000 (36%) and between US$50,000-US$99,000 (39%). 
• State health departments were the third most trusted source for consumers with a household income above US$100,000 (51%).

Where did people go for information about COVID-19? Their personal doctor and friends and family top the list

Although we saw some differences by race/ethnicity across the board, consumers selected their doctor and friends as the top places they went to for information on COVID-19 (figure 5).

Friends, family, and doctors:

• Black and Hispanic respondents reported nearly equal rates of going to their friends and family as they did to their doctor for information, whereas white and Asian respondents were more likely to go to their doctor.
• Generation Z consumers reported friends and family as the top source of information (39%), compared with all other generational groups who selected their doctor as their top source for information.
• The “unvaccinated and only if required” group selected their friends and family as their top source of information (39%), while other groups chose their doctor as their top source of information.
• The “on the fence and unvaccinated” who live in urban areas utilised friends and family as the top source for information (44%).

Differences in the level of trust versus where consumers went for information

Consumers’ level of trust and where they got their information varied (figure 6). As shown above, doctors were the most trusted among all consumers for public health information, as well as the top source for COVID-19 information. In contrast, cable news was the fourth most popular source of COVID-19 information, despite being ranked eighth as a trusted source of public health information (in reply to an earlier question in the survey).

Additionally, consumers ranked health plans and pharmaceutical companies higher than cable news on trust (41%, 28%, and 23%, respectively), but actually used them less for information (17%, 12%, and 23%, respectively).

More consumers can be swayed than originally thought: Opportunities to convince the unvaccinated

Use friends, family, and personal doctors for information, experiences, and offering the vaccine

Our survey results suggest that personal doctors could be used to get more people vaccinated by offering in routine visits or helping people get scheduled.

For example:

• Seventy-five percent of consumers said they are just as likely or more likely to visit their doctor since COVID-19. However, of the vaccinated consumers only 11% said their doctor or a nurse offered the COVID-19 vaccine during a routine visit. While doctors’ offices were largely excluded during the initial vaccine distribution,⁵ which focused more on mass vaccination sites, they play a key role in reaching many Americans who have not yet been vaccinated.⁶ 
• Of all consumers who are not yet fully vaccinated, 34% said they were likely to get it if it was offered during a routine visit.
• This was particularly true for consumers who only received one dose and have not scheduled the second, and those who plan to get it but have not yet done so. Consider: Seventy percent of those who only received one dose and 73% of those who have not been vaccinated but plan to said they would be “extremely likely” to get vaccinated if it was offered during a routine visit.

Our survey results suggest that consumers implicitly trust each other when it comes to vaccine behaviors, highlighting that friends and family could be more influential motivators for change. Among our various cohorts, we found that conversations and experiences of family and friends are motivators. For example, friends/family:

•  Influenced consumers to get vaccinated
  • “Wanting to protect friends/family” was the number onereason former deliberators got vaccinated (47%).
  • “Conversations with friends/family” convinced many to get vaccinated. This was reported as one of the top motivators by consumers who are now fully vaccinated (25%), vaccinated but deliberated (27%), and received one dose (32%).
•  Can motivate those who are not vaccinated but plan to get it
  • “Wanting to protect friends/family” is the number one motivator (44%), followed by seeing others get the vaccine safely (43%)for those who want the vaccine but have not yet gotten it.
  • Learning someone they trust got it (34%) and conversations with a trusted person (28%) are also motivating this group to get vaccinated.
• Are the most used information sources on COVID-19 for the unvaccinated
  • “Refusers” and “only if required” are going to their friends/family as the top source for information on COVID-19; even at higher rates than going to their doctors. For example, refusers went to their friends (30%) versus their doctors (25%) and “only if required” (39% to friends versus 37% to their doctor).

Consumers may be willing to share their stories with other unvaccinated consumers to protect their friends and family, and those who are unvaccinated seek information from friends and family. Elevating the stories of consumers can foster vaccine acceptance in those who may be hesitant or resistant. One potential way to do this is by developing an ambassador program comprising of community members in partnership with local trusted leaders (see sidebar, “Trusted voices in communities”).

Offering convenient vaccination schedules and appointments could sway a portion of the unvaccinated

Some news and campaigns have dismissed the consumers who say they “refuse” to get the vaccine, but we found that there are at least 15% of those consumers who would get vaccinated in various very convenient scenarios. For example, if “their” doctor offered it at a routine visit, 56% of "on the fence," 43% of “only if required,” and 17% of “refusers” say they are likely to get vaccinated (figure 7).

The other top responses for what could make the unvaccinated change their minds were all related to reaching out to people where the:

• Vaccine was offered where they were already shopping
• Mobile vaccine clinic came to their neighborhood
• Vaccine site with walk-ins was available
• Nurse or trusted health care provider visited their neighborhood

Addressing anxieties and fears with facts; meeting consumers where they are regarding information about side effects, immunity, and effectiveness

Many campaigns and media focus on the safety of the vaccines, but we found that some among those unvaccinated are still seeking credible and reliable facts. Consider the finding that the top three factors that could influence the “on the fence and unvaccinated” are related to safety and information (figure 8).

Seventy-nine percent of “on the fence and unvaccinated” consumers said more reliable safety information would somewhat or very much influence them to get vaccinated, and 74% said when there is a new vaccine that feels safer than what is available now.

In addition, fears are pulling back those who want the vaccine but still haven’t got it. Among those who want the vaccine but are on the fence, safety concerns include:

• Fear of side effects: Just fearing a reaction; waiting for the vaccine to be safer; unsure of the side effects.
• Pregnancy-related fears: Pregnant and didn't trust it; pregnant and concerned that a vaccine may affect the pregnancy if I reacted badly to it.
• Waiting for evidence: Giving it time to watch the research; waiting for FDA approval; waiting to see if any issues would occur with the vaccines; still a little hesitant; skeptical.

Conclusion

The Deloitte survey of US consumers debunks many of the common conceptions about how to motivate consumers who are unvaccinated. The lessons learned from this survey have an impact not only on the current COVID-19 pandemic, but also boosters and other public health campaigns going forward. Life sciences, health care, and government agencies are all trying various methods to increase vaccine distribution and adoption. They should take note of why consumers are making the decisions they are with regard to vaccines. These are helpful lessons: Make it convenient, involve personal doctors, encourage people to convince a friend or family member, and give that person a ride.

Deloitte's Life Sciences & Health Care Consulting Services

Innovation starts with insight and seeing challenges in a new way. Amid unprecedented uncertainty and change across the industry, stakeholders are looking for new ways to transform the journey of care. Deloitte’s US Life Sciences & Health Care practice helps clients transform uncertainty into possibility and rapid change into lasting progress. Comprehensive audit, advisory, consulting, and tax capabilities can deliver value at every step, from insight to strategy to action. Learn more.

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