KFF COVID-19 Vaccine Monitor: November 2021

The KFF COVID-19 Vaccine Monitor is an ongoing research project tracking the public’s attitudes and experiences with COVID-19 vaccinations. Using a combination of surveys and qualitative research, this project tracks the dynamic nature of public opinion as vaccine development and distribution unfold, including vaccine confidence and acceptance, information needs, trusted messengers and messages, as well as the public’s experiences with vaccination.

Key Findings

• As 2021 comes to an end and the country faces another new variant and rising infection rates, a majority of the public now say they are frustrated about the status of COVID-19 vaccinations in the U.S., and the share who say they are optimistic has decreased eighteen percentage points since January. At the same time, the share of fully vaccinated adults who report receiving a booster dose has more than doubled in the last month, with one-fourth of fully vaccinated adults (16% of all adults) reporting receiving a COVID-19 booster dose.
• Older adults are most likely to report receiving a booster dose, with at least one-third of Black adults, Hispanic adults, and White adults over the age of 50 saying they have already received a booster dose and many more saying they plan to get a booster dose soon. This suggests that the initial concerns some Black and Hispanic adults had with the COVID-19 vaccine may have dissipated. Yet, among those who are fully vaccinated, younger Black adults seem slightly more hesitant to get a booster dose with three in ten younger Black adults saying they will not get an additional shot, compared to one in eight younger Hispanic adults and White adults.
• Partisanship continues to play an outsized role in initial vaccination uptake as well as intention to get a booster dose. Four in ten Republicans remain unvaccinated and smaller shares of vaccinated Republicans – especially older Republicans – report receiving a booster dose. Seven in ten unvaccinated adults say they aren’t confident that the vaccines are safe for all adults.
• Roughly one-third (36%) of those who are pregnant or trying to become pregnant remain unvaccinated. One reason why this population may be less likely to get vaccinated is because nearly six in ten (57%) say they are not confident the COVID-19 vaccines are safe for pregnant women.
• Three in ten workers now report that their employer has required them to get the COVID-19 vaccine even as the share of the public that support the federal government requiring employers to mandate vaccines has dropped five percentage points since October. More than half of employees who work in workplaces with 100 employees or more (the size of companies covered in this federal requirement) either say their employer already requires vaccination (36%) or say they want their employer to require it (17%). Four in ten (41%) say they do not want their employer to require COVID-19 vaccination.
• Majorities of Black adults and Hispanic adults, two groups that have reported disproportionate impacts of the coronavirus throughout the pandemic, say the pandemic has had a negative impact on their ability to afford many household expenses. People in these groups are also more likely to report that they feel the government has not done enough to help either their communities or people like them.

Trends In COVID-19 Vaccination Intentions And Uptake

The latest data from the KFF COVID-19 Vaccine Monitor shows that one in four adults remain unvaccinated with one in seven (14%) continuing to say they will “definitely not” get vaccinated (a share that has held relatively steady since December 2020) and an additional 3% saying they will only do so if they are required for work, school, or other activities. Nearly three-quarters of adults say they have received at least one dose of the COVID-19 vaccine and another 2% say they will get vaccinated “as soon as possible,” similar to the shares who reported the same last month. Another 6% say they want to “wait and see” before getting a COVID-19 vaccine.

As reported previously, while majorities across all demographic groups have received a COVID-19 vaccine, there are still disproportionate shares of certain groups that remain unvaccinated. A recent KFF analysis found partisanship is now the strongest self-identifying predictor of being unvaccinated and a quarter of Republicans (26%) continue to say they will “definitely not” get a COVID-19 vaccine, similar to the shares of uninsured adults and White Evangelical Christians who say the same. There are also gaps in vaccine uptake between college graduates and those without a college degree (83% vs. 68%) and age groups, with 89% of adults 65 and older reporting receiving a COVID-19 vaccine compared to 67% of adults 18-29 years old. At least two-thirds of Hispanic adults, Black adults, and White adults report receiving a vaccine.

Vaccine Boosters Eligibility And Uptake

The share of fully vaccinated adults who report receiving a booster dose has more than doubled in the last month with now nearly one-fourth of fully vaccinated adults (23%, or 16% of all adults) saying they have already received a booster dose. The survey was in the field at the time the U.S. Food and Drug Administration (FDA) announced Emergency Use Authorization for all adults to get a Pfizer-BioNTech or Moderna COVID-19 vaccine booster shot on November 19, 2021 and while many states expanded eligibility for COVID boosters. Nearly four in ten fully vaccinated adults say they will “definitely get” a booster when the FDA and CDC recommend it for people like them with another one in five (19%) saying they will “probably get” the booster dose. About one in four vaccinated adults say they will either “probably not get” or “definitely not get” a booster dose of the COVID-19 vaccine.

Similar to the role that partisanship has played in initial COVID-19 vaccines, the survey finds the share of fully vaccinated Democrats (32%) reporting receiving a booster dose outpaces both independents (21%) and Republicans (18%). Democrats also are more likely than independents or Republicans to report they will “definitely” get a booster once eligible, 43% compared to 32% and 32%, respectively. Three in ten (31%) fully vaccinated Republicans say they will definitely not or probably not get a booster if the FDA and CDC recommend it for people like them, compared to 38% last month.

Looking at adults ages 50 and older, the group that was eligible for a booster dose earlier than the total adult population, partisanship is playing an outsized role in vaccinated adults’ intentions to get a booster. More than four in ten fully vaccinated Democrats ages 50 and older say they have already gotten a booster dose (44%), compared to one-third of independents (34%) and a quarter of Republicans (24%) of the same age group. On the other hand, at least one-third of Black (33%), Hispanic (36%), and White adults (37%) ages 50 and older say they have received a booster dose.

Majorities of fully vaccinated adults across racial and ethnic identity groups, regardless of age, say they have either already gotten a booster shot or they will get a booster dose, suggesting that the initial concerns some Black and Hispanic populations had with the COVID-19 vaccine have been addressed and may not stop them from receiving a booster dose. Yet, among those who are fully vaccinated, younger Black adults (67%) lag behind their Hispanic (81%) and White (78%) counterparts in terms of willingness to get a booster dose with three in ten young Black adults saying they will either “probably not” (24%) or “definitely not” (6%) get an additional shot (compared to one in eight young Hispanic or White adults).

Why Adults remain unvaccinated?

The safety of the COVID-19 vaccines remain a concern among the unvaccinated population with seven in ten saying they are either “not too confident” or “not at all confident” that COVID-19 vaccines are safe for adults. This compares to nine in ten vaccinated adults (89%) who are confident in the vaccines’ safety. Partisan gaps exist as well, but more than half of Republicans (55%) are confident in the safety of the vaccines, as are large majorities of Democrats (92%) and independents (69%).

Safety of Vaccines For Pregnant Women

Women who are pregnant or trying to become pregnant also lag in vaccine uptake with 64% saying they have gotten a COVID-19 vaccine (compared to 73% of those in the same age range who say they are not planning to become pregnant). An additional 7% say they are wanting to “wait and see” while three in ten say they will either only get if required (15%) or will definitely not get the vaccine (14%). One reason why they may be less likely to get vaccinated is because less than half of those who are pregnant or planning to become pregnant (39%) say they are either “very confident” or “somewhat confident” the COVID-19 vaccines are safe for pregnant women. Nearly six in ten (57%) say they are not confident the vaccines are safe for them.

In addition to concerns about the safety of the vaccines, unvaccinated adults continue to report being less worried about getting sick from the coronavirus. Smaller shares of unvaccinated adults are worried that either they or family member will get seriously sick from the coronavirus (18% and 38%, respectively) compared to vaccinated adults (35% and 61%).

COVID-19 Vaccine Requirements in the Workplace

In early November, the Biden administration announced that all businesses with 100 or more employees would have to require vaccines or weekly tests for all of their employees. While a federal appeals court has paused this mandate on private companies and the Occupational Safety and Health administration (OSHA) has suspended enforcement, many private businesses have already begun implementing such mandates. Roughly three in ten workers (29%) say their employer has required them to get the COVID-19 vaccine, continuing the upward trend of workers who reported an employer mandate in the Vaccine Monitor (9% in July, and 25% last month). Notably, more than half of employees who work in workplaces with 100 employees or more (the size of companies covered in this federal requirement) either say their employer already requires vaccination (36%) or say they want their employer to require it (17%).¹ Four in ten of those with larger employers (41%) say they do not want their employer to require COVID-19 vaccination.

While the share saying they are currently subject to an employer vaccine mandate has increased since July, more than half of all workers say their employer has not yet required them to get a COVID-19 vaccine and that they do not want their employer to require vaccination, which has remained unchanged over the past several months. Large majorities of Republicans (69%) and unvaccinated workers (86%) say they do not want their employer to require employees to get vaccinated while most Democrats and vaccinated workers say their employer has either required them to get the vaccine or say they want their employer to impose such a requirement.

Few (4%) unvaccinated adults say they have personally left a job because their employer required them to get a COVID-19 vaccine (1% of all adults). This includes small shares across partisanship and workplace size.

Support for the federal requirement on larger workplaces (at least 100 employees) to mandate vaccines or require weekly testing is largely divided by partisanship and vaccination status, less so by size of workplaces. While a large majority (86%) of Democrats support the federal requirement, it is opposed by almost eight in ten (79%) Republicans. Two-thirds of vaccinated adults (65%) also support the requirement while eight in ten unvaccinated adults (79%) oppose it.

Support for the federal government requiring larger employers to make sure their workers get vaccinated or get tested weekly has decreased by five percentage points since last month (57%).

The Pandemic’s Toll

With reports of breakthrough cases, vaccine resistance, and upcoming winter surges, the American public is now more negative about the status of COVID-19 vaccination in the U.S. than they were at the beginning of the year – before people were eligible to receive shots. Feeling “frustrated” is now the most common emotion with more than half of adults (58%) say it describes how they feel about the current status of COVID-19 vaccinations in the country. And while two-thirds of the country felt “optimistic” back in January 2021, this has decreased to 48% this month and now a larger share of the public (31%) report feeling “angry” (compared to 23% back in January). A quarter of the public remain “confused” and four in ten say they are “satisfied.”

Back in January, optimism was the most commonly reported emotion but now, frustration and optimism have switched spots – largely due to increased frustration among Republicans and to some extent, independents. In January, two-thirds of Republicans reported feeling optimistic but that has dropped to 37% in the most recent Monitor. On the other hand, larger shares of Republicans now report feeling “frustrated” than they did back in January (68% compared to 42%). Similarly, a larger share of independents now report feeling frustrated (60%) and a smaller share report feeling optimistic (44%). Majorities of Democrats continue to say they feel both “optimistic” (60%) and “frustrated” (55%).

Many Say Government Is Not Doing enough To Help Key Groups

In addition to feelings about the status of COVID-19 vaccinations in the U.S., half of adults think the government has not done enough to help small businesses (48%) and lower-income people (48%) during the coronavirus pandemic. Four in ten think the government has “not done enough” to help three groups also disproportionately impacted by the pandemic – Black people (41%), rural residents (41%), and Hispanic people (39%). Smaller shares say the government hasn’t done enough to help people like them (32%), White people (26%) and big companies (18%). In fact, more than one-third of adults say the government has “done too much” to help big companies during the pandemic.

Early on during the pandemic, there was substantial attention on the disproportionate burden being felt on racial and ethnic minorities as well as those living in rural communities. The latest survey shows that more than four in ten Black and Hispanic adults, as well as those living in rural areas, say the government’s response to the pandemic has not done enough to help both their communities and people like them.

Overall, views of the President Biden’s handling of the coronavirus pandemic are mixed with similar shares approving (44%) and disapproving (48%). Yet, like most experiences and attitudes related to COVID-19, views are largely divided across party lines and by vaccination status. Nearly nine in ten Republicans (88%) say they disapprove of the way President Biden is handling the pandemic while 83% of Democrats approve. A larger share of independents disapprove (52%) than approve (39%). Large majorities of unvaccinated adults (79%) also disapprove of President Biden’s handling of the pandemic while a majority (56%) of vaccinated adults approve.

The Pandemic Continues to Hit Some groups Harder

More than half (53%) of adults in the U.S. continue to say the coronavirus pandemic has had a negative impact on their mental health. This is consistent with a long-term trend finding roughly half of adults report negative mental health impacts from the pandemic, which has improved only slightly as more people have gotten vaccinated against the disease. At least four in ten also report negative impacts on their relationships with family members (47%) and their ability to pay for basic necessities (43%). More than one-third (36%) also report a negative impact on their physical health.

Women and younger adults continue to report disproportionate impacts on their mental health with about six in ten of each group saying the pandemic has had a negative impact on their mental health including a quarter who say it has had a “major negative impact.” Yet, the situation may be improving slightly for women with a smaller share of them reporting a negative impact on their mental health compared to last year (71%). The share of younger adults who report a negative impact on their mental health remains relatively unchanged. At least half of White adults, Hispanic adults, and Black adults say the pandemic has had negative impact on their mental health.

Black and Hispanic adults continue to report disproportionate personal economic impacts of the COVID-19 pandemic with more than half of both groups (56% and 52%, respectively) saying the pandemic has a negative impact on their ability to pay for basic necessities (compared to 37% of White adults). This includes nearly half of older Black and Hispanic adults (45%, for both groups) compared to three in ten White adults ages 50 and older. Black and Hispanic adults report no improvement with their household finances, with similar shares this year compared to last year reporting the pandemic has had a negative impact on their ability to pay for basic necessities.