Nearly 7 million Americans might not get a COVID-19 vaccine because they don’t know it’s free

March 10, 2021, 9:30 PM UTC

A new U.S. Census survey found that 6.9 million U.S. residents don’t plan to get vaccinated against COVID-19 because they’re mistakenly concerned about the cost of the shot. In reality, the U.S. government is paying for the vaccine, making it free at the point of service to all U.S. residents—but the survey points to major shortfalls in efforts to communicate that to the public.

Those expressing misplaced worry about vaccine costs amount to slightly over 2% of the U.S. population. That might not seem dire, but it contributes to a broader wave of “vaccine hesitancy,” or unwillingness or uninterest in receiving a vaccine, that could prolong the coronavirus pandemic.

The data was gathered as part of the U.S. Census’s Household Weekly Pulse survey ending March 1. It also found that a stunning 90 million U.S. residents feel some form of vaccine hesitancy. Hesitancy can be rooted in a variety of concerns, from worries about vaccine effectiveness to fictitious “anti-vaxx” conspiracy theories. All results are statistical extrapolations from a large, randomized sample of U.S. households.

Right now, because of limited supplies of COVID-19 vaccines, there’s a rush for every available shot. But public health experts are increasingly concerned that even once supplies are plentiful, high levels of vaccine hesitancy will make it difficult to vaccinate enough Americans to fully control the COVID-19 pandemic. Dr. Anthony Fauci, now lead infectious disease expert with the White House COVID task force, estimated in December that 90% of Americans might need to be vaccinated before the pandemic can be controlled.

“Hesitancy comes in many forms,” says Dr. Jacob Reider, CEO of the Alliance for Better Health, which helps Medicaid recipients and the uninsured access health care. “A perceived financial barrier is absolutely a component of hesitancy and a reminder that we need to deeply understand why people make the decisions that they make.”

Hesitancy varies among demographic groups, with rural residents and Black Americans among those with the highest levels of skepticism. The latest Census survey, for instance, found that 3.6 million Black Americans, or just over 8%, “don’t trust COVID-19 vaccines.” That’s substantially higher than the same feeling among white (5%) or Hispanic (6%) respondents.

The Census survey does not provide race or ethnicity data specific to respondents worried about coronavirus vaccine cost. But the worry is surprisingly high among seniors, who are especially vulnerable to COVID-19. More than 282,000 Americans over 65 don’t plan to get vaccinated because of mistaken cost concerns.

An analysis of a prior Census survey by found that cost-based vaccine hesitancy was highest in Minnesota, Nevada, Pennsylvania, Virginia, and Montana. Pennsylvania may have a particular conundrum, with 60% more seniors reporting mistaken concerns about vaccine cost than in any other state.

Reider sees the widespread misperception about vaccine cost as an indictment of U.S. public health efforts: “It just means [health authorities] haven’t communicated well enough. It’s on us to make sure the information is available. It’s not self-evident.”

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