Strategies that make vaccination easy and promote autonomy could increase COVID-19 vaccination in those who remain hesitant

The COVID-19 vaccination campaign in the US has been immensely successful in vaccinating those who are receptive, further increases in vaccination rates however will require more innovative approaches to reach those who remain hesitant, deliberative or indifferent. Phenomena such empty mass vaccination sites and wasted vaccine doses in some regions suggest that in addition to dispelling misinformation and building trust, developing more person-centered vaccination strategies, that are modelled on what people want could further increase uptake. To inform vaccine distribution strategies that are aligned with public preferences for COVID-19 vaccination campaign features we conducted a survey and discrete choice experiment among a representative sample of 2,895 people in the US, between March 15 and March 22, 2021. We found that on average the public prioritized ease, preferring single to two dose vaccinations, vaccinating once rather than annually and reduced waiting times at vaccination sites - for some these were the primary preference drivers. Vaccine enforcement reduced overall vaccine acceptance, with a trend of increasing ‘control aversion’ with increasing vaccine hesitancy, particularly among those who were young, Black/African American or Republican. These data suggest that making vaccination easy and promoting autonomy by offering the public choices of vaccination brands and locations may increase uptake, and that vaccine mandates could compromise autonomy and increase control aversion in those who are hesitant - reducing vaccination in such groups and potentially undermining the goals of COVID-19 vaccination campaigns. Significance DCE’s are a novel tool in public health that allow examination of preferences for a product, service or policy, identifying how the public prioritizes personal risks and cost in relation to health behaviors. Using this method to establish preferences for COVID-19 vaccination campaign strategies, our results suggest that: firstly, vaccination should be made as easy as possible for the public, second, that individuals should be offered choices of vaccine brand and vaccination location, and third, that vaccine enforcement could activate ‘control aversion’ in the public and particularly in those who are most hesitant – potentially causing these groups to double down on vaccine resistance, a scenario which would impede the success of vaccination programs in the US. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This study was supported by funds from the Barnes Jewish Hospital in St. Louis, MO. I Eshun-Wilson and A Mody are supported by the NIH (KL2 TR002346). ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The study was approved by the Washington University institutional review board and was exempted from a formal consent process, participants were provided with an introductory information sheet as part of the online survey. All necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Yes On publication the data will be made available in supplementary materials for the journal