A Population Level Study on the Determinants of COVID-19 Vaccine Hesitancy at the U.S. County Level

Multiple COVID-19 vaccines were proven to be safe and effective in curbing severe illness, but despite vaccine availability, uptake rates were relatively low in the United States (U.S.), primarily due to vaccine hesitancy. To better understand factors associated with COVID-19 vaccine hesitancy in the U.S., our study provides a comprehensive, data-driven population-level statistical analysis at the county level. We find that political affiliation, as determined by the proportion of votes received by the Republican candidate in the 2020 presidential election, has the strongest association with COVID-19 vaccine hesitancy. The next strongest association was median household income, which has a negative association. The percentage of Black people and the average number of vehicles per household are also positively associated with vaccine hesitancy. In contrast, COVID-19 infection rate, percentage of Hispanic people, postsecondary education percentage, median age, and prior non-COVID-19 childhood vaccination coverage are other factors negatively associated with vaccine hesitancy. Unlike previous studies, we do not find significant relationships between cable TV news viewership or Twitter misinformation variables with COVID-19 vaccine hesitancy. These results shed light on some factors that may impact vaccination choice in the U.S. and can be used to target specific populations for educational outreach and vaccine campaign strategies in efforts to reduce vaccine hesitancy. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This study did not receive any funding. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. 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, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes The data utilized in the study, along with the corresponding code, have been published on GitHub: [https://github.com/CSSEGISandData/covid19\_vaccine\_hesitancy_study][1]. However, in compliance with the redistribution rules of Nielsen, the cable TV viewership data was excluded from the shared dataset. [https://github.com/CSSEGISandData/covid19\_vaccine\_hesitancy_study][1] [1]: https://github.com/CSSEGISandData/covid19_vaccine_hesitancy_study