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.
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?
Deloitte conducted a nationally representative study of 3,000 US adults (18 and older), which included an oversample of 1,200 non–fully-vaccinated individuals. The national sample is representative of the US census with respect to age, gender, race/ethnicity, income, geography, and insurance source. We explored the sentiments of various consumer cohorts by vaccine status including:
We found that:
The Deloitte Center for Health Solutions (DCHS) conducted an online nationally representative survey of 3,000 US adults (18 and older) about their experiences and attitudes related to vaccines and their health. The 3,000-person sample included an oversample of 1,200 consumers who were not fully vaccinated. The survey was administered from August 13 to August 27, 2021, and the sample is representative of the US census with respect to age, gender, race/ethnicity, income, and geographic region.
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.
Of those who did get the shot, some said they did so because of easy scheduling and/or assistance with it.
• Twenty-five percent said “someone else helped set up an appointment.” For example, the local clinic or a nurse made the appointment for them.
• Thirty percent cited “user-friendly scheduling.” For example, the county sent an email with dates and times available for vaccination.
Reminders and follow-ups could also help. We know appointment reminders are effective in getting consumers to attend regular doctor, dentist, and other appointments. We found that 52% of those who missed their appointments did not receive a communication to reschedule from the vaccine site.
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.
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).
By race ethnicity:
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:
The top two sources for public health information were personal doctors and health insurance companies. However, there were some variances across income levels:
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:
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).
By generation: Younger generations (Gen Z and millennials) versus older generations (boomers and Seniors)
By race ethnicity:
By rural/urban among the never/refuse group:
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.
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:
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”).
An academic medical centre created a cultural ambassador programme comprising of community-based partnership with churches and trusted leaders to address the need for diverse representation in clinical trials. The ambassadors engage in advocacy and education efforts in the community, serve as bidirectional partners, and build trust-based relationships with community members. This program has sucessfully enabled engagement and enrollment of diverse community members in clinical trials for over 10 years. A similar model could be deployed for vaccines to enable storytelling and education between vaccinated and unvaccinated consumers and stakeholders.
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:
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:
Counties and states across the United States have instated various incentives with the hope of driving vaccination rates. Incentives include lottery tickets, gift cards, tickets to sporting events or aquariums, food and drink, and even a TikTok contest to target those aged 13–29.7 However, incentives were not a major motivating factor for those who got vaccinated in our survey. Of the vaccinated consumers, only 5% said they were motivated by an incentive, such as free tickets, meals, or paid time off.
However, among those consumers who got incentives—it’s important to continue offering them for follow-up doses and, potentially, boosters. In our survey, of the consumers who received one dose and not the second, 18% said they did not get the second because they were offered an incentive for the first dose but not the second.
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.
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