COVID-19 Vaccine Hesitancy in a US Public University Cohort

COVID-19 is a threat to university reopening. Universities are sites of dense human contact, congregate living, and heterogenous mixing patterns that may increase risk of viral transmission within and between social groups. Understanding attitudes toward vaccine uptake is critical to strategic reopening. At the University of Washington, we conducted a prospective observational study of SARS-CoV-2 surveillance in faculty, staff, and students (n=17,994) between 09-Sep-2020 and 27-Jan-2021. Demographic characteristics and attitudes toward vaccination were collected at baseline and followed-up among the same cohort. Participants were asked to complete daily electronic check-ins (email or text) to assess symptoms and risk factors. At baseline, 14,353 (79.8%) were vaccine receptive and 3,641 (20.2%) were vaccine hesitant (responded that when the COVID-19 vaccine becomes available to them, they would not plan to get vaccinated, or were uncertain).

Of the 3,641 who were vaccine hesitant at baseline, 2,360 (64.8%) participants were followed-up to reassess attitudes in the time period after FDA Emergency Use Authorization (EUA) of two SARS-CoV2 vaccines using mRNA formulations (Pfizer, Moderna). Among the 2,360 who were followed-up, 649 (27.5%) were hesitant at follow-up (continued hesitancy). In an analysis using multivariate regression, we observed that continued hesitancy was relatively more common among Black (PR 1.97, 95% CI 1.52-2.54) and Asian (PR 1.56, 95%CI 1.31-1.85) respondents than among Whites; persons who reported non-receipt of prior year’s influenza vaccine (PR 1.73, 95%CI 1.49-2.01); and residence outside Seattle city limits (PR 1.52, 95%CI 1.27-1.84). Faculty status was associated with a lower likelihood of continued hesitancy (PR 0.45, 95%CI 0.25-0.82, compared to students). Students in Greek congregate living were somewhat more likely to remain hesitant than those living off-campus (PR 1.29, 95%CI 0.99-1.78).

In this cohort of university staff, students, and faculty, continued vaccine hesitancy after vaccine EUA was relatively more common in persons at higher risk for COVID-19 infection and transmission. Understanding hesitancy patterns is important for university reopening and campus public health planning.