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Unvaccinated for COVID-19 but Willing: Demographic Factors, Geographic Patterns, and Changes Over Time

Publication Date
Trini Beleche, Allison Kolbe, Laina Bush, and Benjamin D. Sommers

As of August 4, 2021, 70.1 percent of U.S. adults have received at least one dose of a COVID-19 vaccine. However, vaccine coverage varies dramatically across the country, with vaccine coverage being less than 40 percent in a third of U.S. counties. Despite a sufficient supply of COVID-19 vaccines, daily vaccinations have dwindled in recent months. While vaccine hesitancy may contribute to low local vaccination rates, a portion of U.S. adults indicate they may be willing to be vaccinated but have not yet received the vaccine. This suggests that outreach and efforts to improve access to COVID-19 vaccines may be beneficial in trying to increase vaccination rates. To support state and local communication and outreach efforts, this analysis explores data on unvaccinated adults who express a willingness to be vaccinated against COVID-19 (whom we refer to in this report as “unvaccinated but willing”) among different geographic areas and sociodemographic groups. Additionally, this analysis models which factors are associated with being unvaccinated but willing and examines changing trends over time.

This analysis does not attempt to include all potential variables that may impact the decision to vaccinate. Thus, our estimates should be used with caution when attempting to generalize beyond the factors examined. Furthermore, although the patterns are similar to CDC vaccine administration data, the Household Pulse Survey tends to overestimate vaccination rates, which suggests that unvaccinated adults are underrepresented and that our estimates are underestimated. These and other limitations are further discussed in the Issue Brief.

Estimated Percent of Unvaccinated but Willing and Vaccine Coverage by County

This image is a map of U.S. counties showing the estimated percent of adults who are unvaccinated but willing to vaccinate as well as the percent of the population aged 12 and over who are fully vaccinated in each county.  Counties in the Southeast, particularly those in Louisiana, Arkansas, Tennessee, Mississippi, and Georgia, tended to have high estimates of unvaccinated but willing as well as low vaccination rates.  Conversely, counties in the Northeast, upper Midwest, and the West Coast tended to have high vaccination rates and low estimates of unvaccinated but willing.  Scattered counties in parts of the West, Alaska, and Northeast have both high vaccination coverage and high estimates of unvaccinated but willing.
Notes: Willing is defined as those who responded, “unsure”, “probably” or “definitely” about their intent to receive COVID-19 vaccine. Counties in dark gray are missing vaccination data. Vaccination coverage is defined as the percent of the population aged 12+ that is fully vaccinated. Systematic missing data in some states may result in underestimation of vaccine coverage. Colors correspond to tertiles for each variable (i.e., divided such that a third of counties appear in each group). Tertiles for the percent fully vaccinated correspond to 0-34.8%, 34.8-45.8%, and 45.8-99.9%. Tertiles for the percent unvaccinated but willing to vaccinate correspond to 0-7%, 7-9.2%, and 9.2-24.7%. The Household Pulse Survey overestimates vaccination coverage relative to actual vaccination rates. Currently, approximately 70% of U.S. adults have received at least one dose of the COVID-19 vaccine. Therefore, our estimates of the unvaccinated but willing population are likely underestimated.

Source: ASPE analysis of Household Pulse Survey for June 23-July 5, 2021.


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