COVID-19 vaccine decision-making in remote Alaska between November 2020 and November 2021

Abstract

Vaccine hesitancy is an ongoing barrier to achieve sufficient COVID-19 vaccination coverage. Although there are many studies globally of vaccine hesitancy based on large survey samples, there are fewer in-depth qualitative studies that explore vaccine hesitancy and acceptance as a spectrum of decision-making. In this paper, we begin to describe vaccination decision-making among 58 adults living in remote Alaska based on three waves of online surveys and follow-up semi-structured interviews conducted between November 2020 and November 2021. The survey question of intention was not a predictor of adoption for about one third of the interviewees who were unvaccinated when they took the survey (n=12, 35%). Over half of all interviewees (n=37, 64%) had vaccine-related concerns, including 25 vaccinated individuals (representing 57% of vaccinated interviewees). Most interviewees reported that they learned about COVID-19 vaccines through interpersonal interactions (n=30, 52%) and/or a variety of media sources (n=29, 50%). The major facilitators of acceptance were trust in the information source (n=20, 48% of the 42 who responded), and learning from the experiences of family, friends, and the broader community (n=12, 29%). Further, trust and having a sense of agency appears to be important to interviewee decision-making, regardless of vaccination status and intention.

KEYWORDS:

• COVID-19
• vaccine hesitancy
• vaccine acceptance
• Alaska
• Alaska native

List of abbreviations

CDC	=	Centers for Disease Control and Prevention
COVID-19	=	Coronavirus disease 2019
SARS-CoV-2	=	Severe acute respiratory syndrome coronavirus 2
WHO	=	World Health Organization

Acknowledgments

This project would not be possible without the direction and input of individuals from across Alaska. Quyanaqpak to our interviewees, and to the community leaders and individuals who advised us on developing this study. Many thanks especially to the Northwest Arctic Borough Mayor Lucy Nelson and COVID-19 Taskforce, who allowed Eichelberger to sit in on meetings to learn about the pandemic’s impacts and responses in remote Northwestern Alaska. We also thank the Alaska Native Tribal Health Consortium Indigenous Research Committee, and the Health Research Review Committee for their insightful comments and direction. Lastly, we want to express our gratitude to the late Paul Farmer, whose dedication to health equity and contributions to public health continue to inspire us.

Disclosure statement

No potential conflict of interest was reported by the authors.

Authors’ contributions

Eichelberger led the analysis, literature review, and writing, based on master codes developed by Fried (reported in Hahn, et al 2022). Hansen conducted literature reviews and was a major contributor to the writing. Fried and Hansen calculated population characteristics. All authors assisted in interpretation of data, paper framing, and writing the manuscript. All authors read, provided content, and approved the final manuscript.

Availability of data and materials

The datasets generated and/or analysed during the current study are not publicly available. Any release of data from this project must be formally requested from and approved by appropriate Tribal leadership.

Ethics approval and consent to participate

All study methods were reviewed and approved by the Alaska Area Institutional Review Board, as well as the Alaska Native Tribal Health Consortium Health Research Review Committee. We conducted informed verbal consent with participants prior to conducting each interview. This paper was reviewed by the Alaska Native Tribal Health Consortium Health Research Review Committee, who provided feedback that we incorporated into the final draft. All errors are our own.

Additional information

Funding

This work was supported by the National Science Foundation (NSF) Office of Polar Programs under 2033192. The NSF had no role in the design of the study and collection, analysis, interpretation of data, nor in writing the manuscript.