Convenience, Effectiveness Prove Significant Attributes in Vaccine Uptake Decisions


US adults have a slightly stronger preference for fewer adverse events in relation to pediatric COVID-19 vaccination, study results show.

According to the preferences of US adults, vaccine effectiveness is a significant attribute of adult and pediatric COVID-19 vaccination, according to the results of a study published in JAMA Network Open.

However, US adults have a slightly stronger preference for fewer rare adverse events (AEs) in relation to pediatric COVID-19 vaccination.

As COVID-19 vaccination rates in the United States remain below optimal levels, patient preferences for different attributes of vaccine products and the vaccination experience can be important in determining vaccine uptake decisions.

Although additional authorizations have expanded COVID-19 vaccination to younger ages, vaccination coverage for adolescents lags behind coverage for adults.

To assess preferences for attributes of adult and pediatric COVID-19 vaccination among US adults, investigators performed a discrete-choice analysis using an online survey of a national panel of US adults conducted in May and June 2021.

The discrete-choice analysis was used to measure the relative value of each attribute in the decision to choose a COVID-19 vaccination option for adults or children.

Investigators used 6 attributes to describe hypothetical vaccination options: mild side effects, number of doses, rare AEs, regulatory approval, time required for vaccination, and vaccine effectiveness.

Findings of previous studies of vaccine-preventable outcomes indicated higher values for averting illness in children compared with adults. Additionally, other vaccination preference studies have documented risk of AEs as 1 of many concerns related to increasing rates of vaccine hesitancy for parents.

“Higher values for averting illness in children would predict higher rates of vaccination for children, but given the emergency use authorization approval status and extensive literature on increasing visibility of vaccine hesitancy for routine childhood vaccination and influenza among parents pre-COVID-19, our hypothesis was that preferences would differ between adult and child vaccination for mild side effects, rare adverse events, and number of doses,” the authors wrote.

In this study, respondents chose between hypothetical vaccination profiles or no vaccination. Additional survey questions asked about COVID-19 illness experience, COVID-19 risk factors, opinions about the risk of COVID-19, vaccination beliefs, and vaccination status.

A total of 1040 adults responded to the online survey. Participants reflected characteristics of the adult US population, except with 610 (59%) of participants being female, which is higher than 51% for the US adult population at large.

Although all attributes were significant for both adult and child vaccination for those who selected vaccination for themselves, participants indicated that vaccine effectiveness (95% vs 60%) was the most significant attribute (β, 9.59 [95% CrI, 9.20-10.00] vs β, 0.41 [95% CrI, 0-0.80]).

Respondents also preferred fewer common AEs, 1 dose, fewer rare AEs, FDA approval, and less waiting time, but these attributes had less influence on their choices.

Results were similar when framing the question as an adult or child vaccination. However, there was a slightly stronger preference for fewer rare AEs for children, supporting the results of previous studies.

Subgroup analyses by COVID-19 attitudes or behaviors showed similar results with those who did not intend to vaccinate placing a higher weight on no risk of AEs for both adults and children compared with those who intended to vaccinate.

Investigators identified 4 groups of respondents through latent class analysis: individuals sensitive to convenience, individuals sensitive to regulatory and safety status, individuals who carefully considered all attributes in making their choices, and individuals who rejected the vaccine. These classes were identified for both adult and child vaccination frames.

The identification of these 4 distinct preference groups provides new information to guide communications to support vaccine decision making.

“In particular, the group that prioritize convenience [less time required for vaccination and fewer doses] may present an opportunity to create actionable strategies to increase vaccination uptake for both adult and pediatric populations,” the authors wrote.

They suggested the implementation of strategies that provide even more convenient vaccination access, such as door-to-door vaccination, drive-through clinics, neighborhood pop-ups, or school-located clinics, could improve vaccination coverage. Increased availability of vaccination at mass vaccination sites and pharmacies provides opportunities for increasing vaccine uptake.

The authors encourage future studies explore the characteristics of this group including predicted uptake for convenience-based vaccination strategies.


OliverSE, GarganoJW, MarinM,et al. The advisory committee on immunization practices’ interim recommendation for use of Pfizer-BioNTech COVID-19 vaccine—United States, December 2020.MMWR Morb Mortal Wkly Rep. 2020;69(50):1922-1924.

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