Journal Article

Anti-vaccine attitudes and COVID-19 vaccine status at the end of the U.S. public health emergency

Choi, Jasmin, Lynch, Kathleen, Choe, Karen, Chang, Virginia W., McKnight, Courtney, Feelemyer, Jonathan, Yang, Lawrence H., Jarlais, Don Des

2025

Overview

Despite the end of the federal COVID-19 public health emergency in May 2023, COVID-19 prevention remains a priority. This study investigates how public vaccination attitudes and perceived COVID-19 risks relate to vaccination status, aiming to identify factors associated with COVID-19 vaccination post-emergency. An online survey was conducted from April to May 2023 among a non-representative, nationally-based sample of MTurk workers. The primary outcome was COVID-19 vaccination status. Variables examined included anti-vaccine attitudes, health status, COVID-19 experiences, and sociodemographic factors. We created a composite measure of anti-vaccine attitudes from 15 items with three levels. Bivariate tests of association and multivariable logistic regression were performed. A final sample of 989 adults were included in this analysis. In our multivariable model, individuals with higher anti-vaccine attitudes were less likely to be vaccinated against COVID-19 compared to those with low anti-vaccine attitudes (OR = 0.10, 95 % CI 0.04, 0.25). Those who identified as LGBQ+ (OR = 2.55, 95 % CI 1.32, 4.94), had chronic conditions (OR = 2.94, 95 % CI 1.43, 6.01) and had felt stigmatized from COVID-19 infections (OR = 3.33, 95 % CI 1.47, 7.58) were more likely to be vaccinated, even after adjusting for anti-vaccine attitudes. News source, perceived risk of contagion by contact, and long COVID-related factors were not significantly associated with vaccination status in the multivariable model. Our findings highlight the persistent relationship between anti-vaccine attitudes and vaccination status in the “post-pandemic” era. Beyond vaccine attitudes, sexual orientation, chronic conditions, and stigmatization experiences may influence perceived need for protection. Stigma can sometimes reinforce social norms driving vaccination, but this effect is nuanced, particularly with anti-vaccine attitudes. To promote vaccine uptake, interventions should prioritize community support, counter misinformation, and enhance vaccine literacy. Building trust among vulnerable populations is essential, rather than relying on public health messaging that may reinforce social stigma.

• Publisher: Elsevier Ltd,Elsevier Limited
• Subject: Adult / Allergy and Immunology / Anti-vaccine / At risk populations / Attitudes / Bivariate analysis / Chronic conditions / Chronic illnesses / Community involvement / COVID-19 / COVID-19 - epidemiology / COVID-19 - prevention & control / COVID-19 - psychology / COVID-19 infection / COVID-19 vaccines / COVID-19 Vaccines - administration & dosage / Disease transmission / Ethnicity / False information / Female / Health Knowledge, Attitudes, Practice / health status / Health surveillance / Human papillomavirus / Humans / Immunization / literacy / Long COVID / Male / Middle Aged / misinformation / Pandemics / Public Health / Public health emergency / regression analysis / risk / Risk perception / SARS-CoV-2 - immunology / Sexual behavior / social stigma / Sociodemographics / Stigma / surveys / Surveys and Questionnaires / United States - epidemiology / vaccination / Vaccination - psychology / Vaccination - statistics & numerical data / Vaccination Hesitancy - psychology / Vaccine / Vaccine hesitancy / Vaccines / Young Adult