KFF COVID-19 Vaccine Monitor: April 2021

The KFF COVID-19 Vaccine Monitor is an ongoing research project tracking the public’s attitudes and experiences with COVID-19 vaccinations. Using a combination of surveys and qualitative research, this project tracks the dynamic nature of public opinion as vaccine development and distribution unfold, including vaccine confidence and acceptance, information needs, trusted messengers and messages, as well as the public’s experiences with vaccination.

Key Findings

• With eligibility for COVID-19 vaccination now open to all adults in the U.S., the latest KFF COVID-19 Vaccine Monitor shows that while the pace of vaccine uptake has continued rapidly over the past month, enthusiasm may be reaching a plateau. The share of adults who say they’ve gotten at least one dose of a vaccine or intend to do so as soon as possible inched up from 61% in March to 64% in April, while the share who want to “wait and see” before getting vaccinated – a group that had been steadily decreasing in size since over several months – remained about the same in April (15%) compared to March (17%). Among Republicans, a group that has been slower to embrace the vaccine, over half now say they’ve gotten at least one dose or will do so as soon as they can. The share of Republicans who say they will “definitely not” get vaccinated decreased from 29% in March to 20% in April but remains substantially larger than the share among Democrats or independents.
• In the wake of news about blood clots possibly linked to the Johnson & Johnson COVID-19 vaccine and the subsequent pause in the use of this vaccine, less than half the public expresses confidence in the safety of the Johnson & Johnson vaccine, and concerns about potential side effects have increased among those not yet vaccinated, especially women. Hispanic women are particularly likely to say that the news of these blood clots caused them to rethink their vaccination decision. Despite this, the trajectory of vaccine uptake and enthusiasm does not appear to have slowed disproportionately among women over the past month. Two-thirds (66%) of women say they’ve been vaccinated or will do so as soon as possible, compared to 63% of men.
• Among those who are open to getting vaccinated but have not yet tried to get an appointment, reasons range from safety concerns to logistical barriers to questions about eligibility, and vary widely by vaccination intention. Those who say they want the vaccine as soon as possible mainly cite logistical concerns and information needs; those in the wait and see group mainly express safety concerns or a lack of research, and those who say they’ll get the vaccine only if required mainly say they don’t feel they want or need the vaccine. By contrast, when those who say they will “definitely not” get vaccinated are asked if there is anything that might change their mind, the answer is a resounding “no.”
• While side effects and safety top the list of concerns for those who haven’t gotten vaccinated for COVID-19, we continue to find that lack of information and access are barriers for some individuals, particularly people of color. For example, Black and Hispanic adults are more likely than White adults to be concerned about having to miss work due to side effects, having to pay out-of-pocket for the COVID-19 vaccine (even though it is free), or not being able to get the vaccine from a place they trust. In addition, 45% of Hispanic adults say they don’t have enough information about when they can get vaccinated and a similar share are not sure whether they are currently eligible to receive the vaccine in their state (even though eligibility is now open to all U.S. residents).
• About half of young adults ages 18-29 say they’ve already gotten at least one dose of a COVID-19 vaccine or will do so as soon as possible, but about a quarter say they still want to “wait and see” how the vaccine is working, higher than any other age group. Peer networks may play a role in encouraging vaccine uptake among young adults; those who say at least half of their close friends are vaccinated are much more enthusiastic about getting vaccinated themselves compared to those who say just a few or none of their friends have gotten a shot. In addition, young adults may be more receptive than older adults to vaccination requirements in order to travel or attend large gatherings.
• As the U.S. awaits authorization of a COVID-19 vaccine for use in children under age 16, three in ten parents of children ages 12-15 say they will get their child vaccinated as soon as a vaccine is available, one quarter say they will wait a while to see how the vaccine is working, 18% plan to get their child vaccinated if their school requires it, and nearly a quarter say they will definitely not get their child vaccinated. Perhaps unsurprisingly, parents’ intentions for vaccinating their kids largely line up with their own intentions for getting the COVID-19 vaccine themselves.

Trends In COVID-19 Vaccination Intentions

With eligibility for COVID-19 vaccination now open to all adults in the U.S., the latest KFF COVID-19 Vaccine Monitor reports that a majority of adults now say they have already gotten at least one dose of the vaccine (56%), up from 32% in March. At the same time, the share of ready and willing adults who have not yet gotten vaccinated but say they intend to do so as soon as they can has fallen to 9% from 30% in March when many adults were still not eligible for vaccination. Overall, the total enthusiastic group (those who say they’ve already been vaccinated or will get it as soon as possible) inched up only slightly from 61% in March to 64% in April, while the share of adults who say they want to “wait and see” appears to have plateaued at 15%, similar to the 17% who said the same in March. The shares of the public who say they will get the vaccine only if they are required to do so for work, school, or other activities (6%) or say they will “definitely not” get the vaccine (13%) have stayed about the same since January.

Enthusiasm for getting the COVID-19 vaccine has continued to inch upward across racial and ethnic groups, but at a slower pace than in previous months. About six in ten Black (59%) adults and two-thirds of Hispanic (64%) and White (66%) adults now say they’ve either gotten at least one dose of the vaccine or will get it as soon as they can. At the same time, Black and Hispanic adults remain somewhat more likely than White adults to say they want to “wait and see” before getting vaccinated (19%, 18%, and 13%, respectively).

Among older adults, similar shares across racial and ethnic groups say that they have received at least one dose of a COVID-19 vaccine (roughly eight in ten among ages 65 and over and roughly six in ten among ages 50-64). However, among younger adults (those under age 50), a larger share of White adults (50%) compared to Black and Hispanic adults (36% each) say they’ve already gotten vaccinated. Fewer White adults under the age of 50 say they will “wait and see” (16% compared to 24% of both Black and Hispanic adults in this age range).

Among partisans, enthusiasm for getting the COVID-19 vaccine remains highest among Democrats but may have reached a plateau among this group. Eight in ten Democrats say they’ve already gotten at least one dose of the vaccine or will get it as soon as possible, virtually unchanged from the share who said so last month (79%). Increasing enthusiasm among independents may also be slowing down, with six in ten (59%) now saying they’ve gotten at least one dose or will do so as soon as they can, similar to the 57% who said so in March.

While the growth in vaccine enthusiasm appears to have slowed among independents and Democrats, it has continued to increase among Republicans, with a majority (55%) now saying they have either received at least one dose of the vaccine or intend to do so as soon as possible. One in five Republicans (20%) say they will “definitely not” get vaccinated, down from 29% last month but still substantially larger than the share among independents (13% and Democrats (4%).

Across key demographic groups, at least half of adults say they have already gotten at least one dose of the vaccine or will get it as soon as it is available to them. Older adults, Democrats, and college graduates remain the most enthusiastic about getting the vaccine, with at least seven in ten indicating they’ve gotten at least one shot. Roughly one-quarter (24%) of young adults ages 18-29 say they still want to “wait and see” before getting vaccinated, as do about one in five Black adults (19%), adults without a college degree (19%), political independents (19%), urban residents (19%), and Hispanic adults (18%).

Among older adults, similar shares across racial and ethnic groups say that they have received at least one dose of a COVID-19 vaccine (roughly eight in ten among ages 65 and over and roughly six in ten among ages 50-64). However, among younger adults (those under age 50), a larger share of White adults (50%) compared to Black and Hispanic adults (36% each) say they’ve already gotten vaccinated. Fewer White adults under the age of 50 say they will “wait and see” (16% compared to 24% of both Black and Hispanic adults in this age range).

Notably, about one in five Hispanic adults ages 18-49 (18%) and ages 50-64 (20%) say they have not yet been vaccinated but intend to do so as soon as possible, suggesting a possible barrier to access for these groups.

Confidence and Concerns Following Johnson & Johnson Vaccine Safety Review

On April 13^th, the U.S. Food and Drug Administration (FDA) and the U.S. Centers for Disease Control (CDC) recommended a temporary pause on the use of Johnson & Johnson’s Covid-19 vaccine following reports of rare blood clots. Ten days later, after both agencies conducted a safety review, the FDA and CDC recommended that the use of the Johnson & Johnson vaccine should resume. The latest KFF COVID-19 Vaccine Monitor (which was fielded just after the pause began and remained in the field after the pause was lifted) finds that while overall confidence in safety of the COVID-19 vaccines currently available in the U.S. is high, less than half say they are at least somewhat confident the Johnson & Johnson vaccine is safe (46%), compared to nearly seven in ten who say the same about the Moderna and Pfizer vaccines (69% each)¹. Fifteen percent say they are “very confident” that the Johnson & Johnson vaccine is safe, less than half the share who say the same about the Moderna and Pfizer vaccines, or the COVID-19 vaccines overall.

Confidence in the COVID-19 vaccines overall – and in each of the specific vaccines – is lower among those who have not yet been vaccinated than it is among those who have already received the vaccine and varies by vaccination intention. Among those who want to “wait and see” before getting the vaccine, slight majorities say they are confident that the Pfizer vaccine (55%) and Moderna vaccine (53%) are safe, compared to 28% who say the same of the Johnson & Johnson vaccine. There is less variation in confidence levels across the different vaccines among those in the “only if required” group, while those who say they will “definitely not” get vaccinated express very little confidence in the safety of any of the COVID-19 vaccines.

Most adults (78%) say they have heard or read at least a little about some rare cases in which a small number of individuals developed blood clots within two weeks of getting the Johnson & Johnson COVID-19 vaccine. Among those who have not yet been vaccinated, the large majority either say the news “has not changed their mind about getting vaccinated” (56%) or say they have “not heard or read anything at all” about these cases (21%). However, about one in five unvaccinated adults say the news caused them to change their mind about getting a COVID-19 vaccine, including 9% who say it made them less likely to want the Johnson & Johnson vaccine but didn’t change their minds about the other vaccines, 7% who say it made them less likely to want any COVID-19 vaccine, and 4% who say it changed their thoughts about the vaccines in some other way.

Most of the blood clot cases reported occurred among women, and we find a larger share of unvaccinated women (83%) than unvaccinated men (73%) say they have heard or read at least a little about this news. In addition, unvaccinated women are less likely than unvaccinated men to say they are confident in the safety of the Johnson & Johnson vaccine (21% vs. 32%), though there is no significant gender difference in confidence of the safety of COVID-19 vaccines overall.

Notably, 39% of unvaccinated Hispanic women say they heard the news and it caused them to change their mind about the vaccine, including 15% who say it made them less likely to want the Johnson & Johnson vaccine and 18% who say it made them less likely to want any COVID-19 vaccine.

The Monitor also finds indications that concerns about side effects from the vaccines overall have increased in the wake of the Johnson & Johnson pause, particularly among women. Among those who are not yet convinced to get the vaccine right away (those who want to wait and see, will get vaccinated only if required, or will definitely not get vaccinated), 81% say they are concerned they might experience serious side effects from the vaccine, up from 70% last month. Among women within this group, concern increased by 15 percentage points, from 77% in March to 92% in April.

Despite what appear to be heightened concerns about safety and side effects among women, the trajectory of vaccine uptake and enthusiasm does not appear to have slowed significantly among women over the past month. Two-thirds (66%) of women say they’ve been vaccinated or will do so as soon as possible, compared to 61% in March. Among men, 63% now say they’ve gotten vaccinated or are eager to do so, compared to 62% in March.

In addition, despite these concerns about the Johnson & Johnson vaccine, a one-dose vaccine still has an appeal for many people. Three in ten unvaccinated adults (29%), including 45% of those in the “wait and see” category say they would be more likely to get the vaccine if they only needed one dose.

What Is Keeping People From Getting Vaccinated?

Most unvaccinated adults, including a majority of those who say they will get the vaccine as soon as they can, have not yet attempted to make an appointment for a vaccine, despite all adults in the U.S. now being eligible. Twelve percent of those who have not received a COVID-19 vaccine say they have tried to make an appointment to get vaccinated, including 38% of those who say they want the vaccine as soon as possible, 8% of those in the “wait and see” group, and 6% of those who say they’ll get the vaccine only if required. Majorities across all these groups say they have not yet tried to make an appointment.

When those who indicate some willingness to get vaccinated (saying they’ll get the vaccine as soon as they can, will wait and see, or will get it if required) are asked to say in their own words the main reason why they have not tried to get an appointment, reasons range from safety concerns to logistical barriers to questions about eligibility, and vary widely by vaccination intention.

Among the group that says they want the vaccine as soon as possible, logistical concerns and information needs top the list of reasons for not making an appointment, including being too busy or not having time to try to get an appointment (14%) and not being able to take the time off work (12%). Another 9% of this group say they just haven’t gotten around to it, 8% say they are not sure about their eligibility or whether they have the right documentation, and 7% express a general lack of information about how to get vaccinated.

Among those who want to wait and see before getting vaccinated, one-fourth (23%) say they haven’t tried to get an appointment yet because they are waiting until more people have gotten the vaccine. Others in this group say they are concerned about the safety or side effects of the vaccine (14%) or that the vaccine is too new or there is not enough research available (9%), while 8% say they just generally don’t want or need the vaccine.

Among those who say they’ll get the vaccine only if required, the largest share says they haven’t made an appointment because they don’t want or need the vaccine (26%), while one in ten cite concerns about safety or side effects and 6% feel the vaccine is too new or hasn’t been researched enough.

Table 1: Top reasons why individuals have not tried to get a COVID-19 Vaccine appointment by vaccination intention (Open-end)
As soon as possible		Wait and see		Only if required
Busy/didn’t have time/schedule conflict	14%	Want to wait until more people have gotten it	23%	Don’t want it/need it (general)	26%
Can’t take time off work/conflicts with work hours	12%	Concerned about safety and/or side effects	14%	Concerned about safety and/or side effects	10%
Just haven’t gotten around to it	9%	Vaccine is too new/not enough research	9%	Vaccine is too new/not enough research	6%
Don’t have proper documentation/not sure if eligible	8%	Don’t want it/need it (general)	8%	Already had COVID	5%
Lack of information about how to get the vaccine	7%	Waiting for medical reason	6%	Don’t have proper documentation/not sure if eligible	4%

 

In contrast to the range of barriers and concerns cited by those who are at least somewhat open to getting vaccinated, when those who say they will “definitely not” get a COVID-19 vaccine are asked if there is anything that might convince them to change their mind, the answer is overwhelmingly “no,” with 72% providing this response. Seven percent of this group say that more research on the vaccines might convince them to change their minds, while the remainder gave a range of other response.

Other Concerns And Barriers To Vaccination

While vaccine side effects and safety continue to be the top concerns among those who have not yet been vaccinated (cited as concerns by 76% and 70%, respectively), there are a range of other concerns that vary by vaccination intention. For example, six in ten (59%) of those not yet vaccinated (rising to 72% of the “definitely not” group) are concerned that they might be required to get the COVID-19 vaccine even if they don’t want to. About half (48%) of those ages 18-49 (rising to 66% among the “definitely nots”) are concerned that the COVID-19 vaccine might negatively impact their fertility in the future. Many express work-related concerns, including half (48%)  who say they are concerned they might miss work if the vaccine side effects make them feel sick and one in five who say they are concerned they may need to time off work to go and get the vaccine. One-third (32%) are concerned that they might have to pay an out-of-pocket cost to get vaccinated, even though the vaccine is available for free to all U.S. adults. Other concerns include being required to provide a social security number or government-issued identification to get vaccinated (34%), not being able to get the vaccine from a trusted place (32%), or that it will be difficult to  travel to a vaccination site (15%).

Many concerns about COVID-19 vaccination are expressed at higher rates by people of color compared to White adults. For example, nearly six in ten Hispanic adults (58%) under age 50 say they are concerned that the vaccine may negatively impact their future fertility, compared to 42% of White adults in this age range. In addition, potential access-related barriers to vaccination are more commonly expressed as concerns by Black and Hispanic adults compared to White adults. More than half (55%) of unvaccinated Black adults and almost three-quarters (64%) of Hispanic adults are concerned about having to miss work due to vaccine side effects compared to four in ten White adults (41%). Larger shares of Black and Hispanic adults compared to White adults also express concern about not being able to get the vaccine from a place they trust, having to pay an out-of-pocket cost to get vaccinated, and having difficulty traveling to a vaccination site.

In addition to these concerns, lack of information is still a barrier to getting a COVID-19 vaccine for many adults, particularly people of color. Three in ten unvaccinated adults overall, rising to 42% of Hispanic adults, say they are not sure whether they’re currently eligible to get a vaccine in their state, even though eligibility is now open to all U.S. adults. In addition, one in five unvaccinated adults overall (29% of Hispanic adults) say they don’t have enough information about where to get a COVID-19 vaccine and 26% (45% of Hispanic adults) say they don’t have enough information about when they can get one.

Incentives And Requirements That Might Increase Vaccination Uptake

In addition to understanding and addressing people’s concerns about the vaccines, there are various incentives, conveniences, and requirements that may be effective at encouraging some people to get vaccinated. Three in ten unvaccinated adults who are not yet ready to get the vaccine right away, including nearly half of those who want to “wait and see,” say they would be more likely to get the vaccine if it was offered to them at a place they normally go for health care or if they only needed to get one dose. At least a quarter of those who are not yet ready to get the vaccine right away, including substantial shares of those in both the “wait and see” and “only if required” groups say they would be more likely to get vaccinated if it was required to fly on an airplane, to attend large gatherings such as sporting events or concerns, or for international travel.

Employer policies and incentives could also play a role in increasing COVID-19 vaccination uptake. About three in ten (28%) of employed adults who are not yet ready to get vaccinated, including nearly half (47%) in the “wait and see” group, say they would be more likely to get vaccinated if their employer gave them paid time off to get vaccinated and recover from any side effects. About a quarter overall and four in ten (39%) in the “wait and see” group say they would be more likely to get vaccinated if their employer offered a financial incentive of $200, while two in ten overall and about a third (32%) of those who want to “wait and see” say they would be more likely to get the vaccine if their employer arranged for a  medical provider to administer it at their workplace.

Vaccine Misinformation

The latest KFF Vaccine Monitor also finds that a majority of adults (54%) either believe some common misinformation about the COVID-19 vaccines or are unsure whether these things are true or false. About one in four believe or are unsure whether you can get COVID-19 from the vaccine and one in five believe or are unsure whether those who have already had COVID-19 should not get vaccinated, whether the vaccines contain fetal cells, have been shown to cause infertility, or that the vaccine can change your DNA. Among younger adults ages 18 to 29, four in ten (42%) say they have heard that the COVID-19 has been shown to cause infertility, and about one in four either are unsure if that is true (22%) or believe that is true (5%).

Belief in or uncertainty towards vaccine misinformation is highest among those most reluctant to get the vaccine. Eight in ten (81%) of adults who say they will “definitely not” get the vaccine believe or are unsure about at least one common COVID-19 vaccine myth, as do 75% of those who say they will only get the vaccine if required. In addition, vaccine misinformation appears to be wide-reaching, as even among those who have already been vaccinated 43% believe or are uncertain about at least one common vaccine myth, as do half of those who say they want the vaccine as soon as possible.

A larger share of women (58%) than men (50%) believe or be unsure about at least one common myth surrounding the COVID-19 vaccine. Likewise, younger adults are more likely than those 65 and older to believe or be unsure about a vaccine myth. Across partisans, majorities of Republicans (58%) and independents (56%) believe or are unsure about at least one vaccine myth, compared to a smaller share of Democrats (43%).

Young Adults and Vaccine Uptake

Though they are at lower risk of complications from COVID-19, many experts believe vaccine uptake among young adults will be needed in order to achieve herd immunity. Young adults ages 18 to 29 are the least likely to say they’ve already been vaccinated or intend to do so as soon as possible, and about one-quarter (24%) say they want to “wait and see” before they get the COVID-19 vaccine. In addition, half of younger adults say “just a few” or “none” of their close friends have been vaccinated, including one in five 18-29 year-olds who say none of their close friends are vaccinated and a further 31% say only a few of their friends have gotten the vaccine.

For young adults, peer influences may have a big effect on vaccination decisions. Among young adults ages 18-29, a large majority (77%) of those who say at least half of their close friends have been vaccinated report having already received at least one dose of a COVID-19 vaccine themselves (68%) or say they want to as soon as they can (9%). Among those who say just a few or none of their friends have been vaccinated, a much smaller share say they’ve already been vaccinated or intend to do so as soon as possible (32%), while three in ten (29%) say they will “wait and see,” one in five (19%) say they will get vaccinated only if required, and 17% say they will “definitely not” get the vaccine.

Compared to those in other age groups, young adults may be particularly motivated by requirements and conveniences to encourage COVID-19 vaccine uptake. About four in ten young adults ages 18 to 29 who are not yet ready to get the vaccine right away say they would be more likely to get vaccinated if it was offered at a place they normally go for health care (43%) or if they only needed to get one dose of the vaccine (37%). Among requirements, about four in ten young adults in this group say they would be more likely to get vaccinated if it was required to fly on an airplane (40%), to attend large gatherings (39%), or for international travel (38%).

COVID-19 Vaccinations for Children

While the Pfizer COVID-19 vaccine is already authorized for use in children ages 16-17, there is currently no vaccine available in the U.S. for children ages 15 and under. Earlier this month, Pfizer requested that the FDA extend their emergency use authorization for their COVID-19 vaccine for use in children between the ages of 12 and 15 following promising clinical trials, and FDA authorization is expected as soon as next week. Over the last month, Pfizer and Moderna have started testing their COVID-19 vaccines in children between the ages of 6 months and 12 years old.

Around three in 10 (29%) parents of children under age 18 say they’ll get their child vaccinated “right away” once a COVID-19 vaccine is authorized and available for their child’s age group. An additional one third (32%) say they’ll wait awhile to see how the vaccine is working before getting their child vaccinated. One-third say they will only get their child vaccinated if their school requires it (15%) or they definitely won’t get their child vaccinated (19%).

Among parents who have at least one child between the ages of 12-15, responses are similar: 30% say they’ll get their child vaccinated right away, 26% will wait to see how it’s working, 18% will vaccinate only if their child’s school requires it, and 23% say they will definitely not get their child vaccinated. Among parents who have at least one child ages 16-17 (for whom the Pfizer vaccine is already approved), thirty-one percent report wanting to get them vaccinated right away and another 8 percent say their child is already vaccinated, while almost quarter say they will definitely not get them vaccinated.

Across racial and ethnic groups, at least half of parents say they will get their child vaccinated for COVID-19 as soon as a vaccine is authorized for children (25% of Black parents, 31% of Hispanic parents, 30% of White parents) or that they will wait a while to see how it is working (25% of Black parents, 36% of Hispanic parents, 31% of White parents). A smaller share of Hispanic parents (10%) compared to Black parents (29%) and White parents (22%) say they will “definitely not” get their child vaccinated.

Parents’ intentions for vaccinating their children against COVID-19 largely line up with their own vaccination experiences and intentions. Among parents who have already received at least one dose of the vaccine or want it as soon as possible, three-fourths say they will either get their children vaccinated right away (48%) or will wait a while to see how it’s working (29%). Among parents who are still in “wait and see” mode when it comes to their own vaccination, 63% say they will also wait and see before getting their child vaccinated. Similarly, about six in ten (58%) of parents who say they will definitely not get vaccinated for COVID-19 themselves or will do so only if required say they will definitely not vaccinate their children.