# Lingering Hesitancy: Persistent Uncertainty About the COVID-19 Vaccines Among Previously Vaccinated Individuals

## TL;DR

This study explores why some people who already received the COVID-19 vaccine still have concerns, showing how sociocultural factors and mistrust influence their hesitancy toward future doses.

## Contribution

The paper introduces the concept of 'lingering hesitancy' and identifies sociocultural and trust-related factors influencing it among previously vaccinated individuals.

## Key findings

- Conservative and urban respondents showed higher negative attitudes and safety concerns about the vaccine.
- Mistrust in government and institutions mediated hesitancy among Black/African American and conservative respondents.
- Trusted messengers are crucial for improving confidence in routine vaccinations.

## Abstract

•Previously vaccinated individuals have varying perceptions of the COVID-19 vaccines.•Persistent concerns about a vaccine could influence future vaccination decisions.•Sociocultural context plays a role in the development of lingering hesitancy.•Mistrust mediates the relationship between context and lingering hesitancy.•Trusted messengers are essential for boosting confidence in routine vaccinations.

Previously vaccinated individuals have varying perceptions of the COVID-19 vaccines.

Persistent concerns about a vaccine could influence future vaccination decisions.

Sociocultural context plays a role in the development of lingering hesitancy.

Mistrust mediates the relationship between context and lingering hesitancy.

Trusted messengers are essential for boosting confidence in routine vaccinations.

Routine vaccination is an important public health measure to prevent severe illness from COVID-19. Although the determinants of vaccine hesitancy have been explored in prior research, limited information is available on the varying perceptions of the COVID-19 vaccines among previously vaccinated individuals. This study investigates how individuals previously vaccinated against COVID-19 might develop hesitancy toward future doses, a concept that the authors define as lingering hesitancy.

The authors conducted an online cross-sectional survey with 560 vaccinated respondents in 6 urban Chicago community areas (n=440) and Stephenson County, a rural county in Northern Illinois (n=120), between December 2021 and April 2022. The authors explored the role of an individual’s sociocultural context (i.e., urban/rural setting, political affiliation, and race/ethnicity) in developing lingering hesitancy. Lingering hesitancy was operationalized using 2 constructs: (1) negative COVID-19 vaccine attitudes and (2) COVID-19 vaccine safety concerns. The authors also investigated whether mistrust in the government and institutions as well as barriers to accessing the COVID-19 vaccines mediate the relationship between context and lingering hesitancy.

The authors found significantly higher negative attitudes toward the COVID-19 vaccines and higher safety concerns among conservative versus liberal respondents (b=0.37, p<0.001; b=0.21, p<0.01, respectively) and among urban versus rural residents (b=0.45, p<0.001; b=0.37, p<0.001). Black/African American participants reported higher vaccine safety concerns than White participants (mean=2.6 vs 2.4, p<0.05). A significant portion of lingering hesitancy among conservative and Black/African American respondents was mediated by mistrust in the government and institutions. Barriers partially mediated vaccine safety concerns among Hispanic respondents.

Most public health efforts aimed at COVID-19 vaccine outreach and messaging have focused on increasing vaccine uptake, thereby targeting unvaccinated individuals. As the focus shifts toward annual COVID-19 vaccinations, it is essential to consider lingering hesitancy among those who have received previous vaccine doses. This article provides a framework for implementing vaccine-messaging campaigns that increase confidence and build trust in routine vaccinations.