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Risk of disease and willingness to vaccinate in the United States: A population-based survey.
PLoS Med. 2020 10; 17(10):e1003354.PM

Abstract

BACKGROUND

Vaccination complacency occurs when perceived risks of vaccine-preventable diseases are sufficiently low so that vaccination is no longer perceived as a necessary precaution. Disease outbreaks can once again increase perceptions of risk, thereby decrease vaccine complacency, and in turn decrease vaccine hesitancy. It is not well understood, however, how change in perceived risk translates into change in vaccine hesitancy. We advance the concept of vaccine propensity, which relates a change in willingness to vaccinate with a change in perceived risk of infection-holding fixed other considerations such as vaccine confidence and convenience.

METHODS AND FINDINGS

We used an original survey instrument that presents 7 vaccine-preventable "new" diseases to gather demographically diverse sample data from the United States in 2018 (N = 2,411). Our survey was conducted online between January 25, 2018, and February 2, 2018, and was structured in 3 parts. First, we collected information concerning the places participants live and visit in a typical week. Second, participants were presented with one of 7 hypothetical disease outbreaks and asked how they would respond. Third, we collected sociodemographic information. The survey was designed to match population parameters in the US on 5 major dimensions: age, sex, income, race, and census region. We also were able to closely match education. The aggregate demographic details for study participants were a mean age of 43.80 years, 47% male and 53% female, 38.5% with a college degree, and 24% nonwhite. We found an overall change of at least 30% in proportion willing to vaccinate as risk of infection increases. When considering morbidity information, the proportion willing to vaccinate went from 0.476 (0.449-0.503) at 0 local cases of disease to 0.871 (0.852-0.888) at 100 local cases (upper and lower 95% confidence intervals). When considering mortality information, the proportion went from 0.526 (0.494-0.557) at 0 local cases of disease to 0.916 (0.897-0.931) at 100 local cases. In addition, we ffound that the risk of mortality invokes a larger proportion willing to vaccinate than mere morbidity (P = 0.0002), that older populations are more willing than younger (P<0.0001), that the highest income bracket (>$90,000) is more willing than all others (P = 0.0001), that men are more willing than women (P = 0.0011), and that the proportion willing to vaccinate is related to both ideology and the level of risk (P = 0.004). Limitations of this study include that it does not consider how other factors (such as social influence) interact with local case counts in people's vaccine decision-making, it cannot determine whether different degrees of severity in morbidity or mortality failed to be statistically significant because of survey design or because participants use heuristically driven decision-making that glosses over degrees, and the study does not capture the part of the US that is not online.

CONCLUSIONS

In this study, we found that different degrees of risk (in terms of local cases of disease) correspond with different proportions of populations willing to vaccinate. We also identified several sociodemographic aspects of vaccine propensity. Understanding how vaccine propensity is affected by sociodemographic factors is invaluable for predicting where outbreaks are more likely to occur and their expected size, even with the resulting cascade of changing vaccination rates and the respective feedback on potential outbreaks.

Authors+Show Affiliations

Department of Politics and Philosophy, University of Idaho, Moscow, Idaho, United States of America.Department of Mathematics, University of Idaho, Moscow, Idaho, United States of America.Department of Politics and Philosophy, University of Idaho, Moscow, Idaho, United States of America.Department of Political Science, The University of Utah, Salt Lake City, Utah, United States of America.Department of Biology, University of Idaho, Moscow, Idaho, United States of America.

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

33057373

Citation

Baumgaertner, Bert, et al. "Risk of Disease and Willingness to Vaccinate in the United States: a Population-based Survey." PLoS Medicine, vol. 17, no. 10, 2020, pp. e1003354.
Baumgaertner B, Ridenhour BJ, Justwan F, et al. Risk of disease and willingness to vaccinate in the United States: A population-based survey. PLoS Med. 2020;17(10):e1003354.
Baumgaertner, B., Ridenhour, B. J., Justwan, F., Carlisle, J. E., & Miller, C. R. (2020). Risk of disease and willingness to vaccinate in the United States: A population-based survey. PLoS Medicine, 17(10), e1003354. https://doi.org/10.1371/journal.pmed.1003354
Baumgaertner B, et al. Risk of Disease and Willingness to Vaccinate in the United States: a Population-based Survey. PLoS Med. 2020;17(10):e1003354. PubMed PMID: 33057373.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Risk of disease and willingness to vaccinate in the United States: A population-based survey. AU - Baumgaertner,Bert, AU - Ridenhour,Benjamin J, AU - Justwan,Florian, AU - Carlisle,Juliet E, AU - Miller,Craig R, Y1 - 2020/10/15/ PY - 2019/09/02/received PY - 2020/09/11/accepted PY - 2020/10/15/entrez PY - 2020/10/16/pubmed PY - 2020/12/22/medline SP - e1003354 EP - e1003354 JF - PLoS medicine JO - PLoS Med VL - 17 IS - 10 N2 - BACKGROUND: Vaccination complacency occurs when perceived risks of vaccine-preventable diseases are sufficiently low so that vaccination is no longer perceived as a necessary precaution. Disease outbreaks can once again increase perceptions of risk, thereby decrease vaccine complacency, and in turn decrease vaccine hesitancy. It is not well understood, however, how change in perceived risk translates into change in vaccine hesitancy. We advance the concept of vaccine propensity, which relates a change in willingness to vaccinate with a change in perceived risk of infection-holding fixed other considerations such as vaccine confidence and convenience. METHODS AND FINDINGS: We used an original survey instrument that presents 7 vaccine-preventable "new" diseases to gather demographically diverse sample data from the United States in 2018 (N = 2,411). Our survey was conducted online between January 25, 2018, and February 2, 2018, and was structured in 3 parts. First, we collected information concerning the places participants live and visit in a typical week. Second, participants were presented with one of 7 hypothetical disease outbreaks and asked how they would respond. Third, we collected sociodemographic information. The survey was designed to match population parameters in the US on 5 major dimensions: age, sex, income, race, and census region. We also were able to closely match education. The aggregate demographic details for study participants were a mean age of 43.80 years, 47% male and 53% female, 38.5% with a college degree, and 24% nonwhite. We found an overall change of at least 30% in proportion willing to vaccinate as risk of infection increases. When considering morbidity information, the proportion willing to vaccinate went from 0.476 (0.449-0.503) at 0 local cases of disease to 0.871 (0.852-0.888) at 100 local cases (upper and lower 95% confidence intervals). When considering mortality information, the proportion went from 0.526 (0.494-0.557) at 0 local cases of disease to 0.916 (0.897-0.931) at 100 local cases. In addition, we ffound that the risk of mortality invokes a larger proportion willing to vaccinate than mere morbidity (P = 0.0002), that older populations are more willing than younger (P<0.0001), that the highest income bracket (>$90,000) is more willing than all others (P = 0.0001), that men are more willing than women (P = 0.0011), and that the proportion willing to vaccinate is related to both ideology and the level of risk (P = 0.004). Limitations of this study include that it does not consider how other factors (such as social influence) interact with local case counts in people's vaccine decision-making, it cannot determine whether different degrees of severity in morbidity or mortality failed to be statistically significant because of survey design or because participants use heuristically driven decision-making that glosses over degrees, and the study does not capture the part of the US that is not online. CONCLUSIONS: In this study, we found that different degrees of risk (in terms of local cases of disease) correspond with different proportions of populations willing to vaccinate. We also identified several sociodemographic aspects of vaccine propensity. Understanding how vaccine propensity is affected by sociodemographic factors is invaluable for predicting where outbreaks are more likely to occur and their expected size, even with the resulting cascade of changing vaccination rates and the respective feedback on potential outbreaks. SN - 1549-1676 UR - https://www.unboundmedicine.com/medline/citation/33057373/Risk_of_disease_and_willingness_to_vaccinate_in_the_United_States:_A_population_based_survey_ L2 - https://dx.plos.org/10.1371/journal.pmed.1003354 DB - PRIME DP - Unbound Medicine ER -