JMIR Publications

ABSTRACT

Background:

In 2019, the World Health Organization declared the reluctance to vaccinate despite the availability of vaccination services as one of the top 10 threats to global health. Since the novel coronavirus (COVID-19) emerged in late 2019, COVID-19 vaccination specifically has been deemed a critical public health priority. In early 2021, self-reported reluctance to vaccinate among military personnel might have been considered a significant threat to national security. Unlike the flu, TDAP, smallpox, and other vaccines, which are routine and a required aspect of force readiness, the newly developed COVID-19 vaccine was initially optional to members of the US military, before becoming mandatory for a period, and finally being declared optional again on January 10, 2023. Having a choice architecture that makes COVID-19 vaccination optional, rather than required, for military personnel could inadvertently undermine military readiness if vaccination uptake does not reach an acceptable threshold.

Objective:

The purpose of this observational study was to examine Marines’ self-reported reasons for planning to decline the COVID-19 vaccine to understand their barriers to vaccination.

Methods:

As the vaccination became available to one company of Fleet Antiterrorism Security Team (FAST) Marines in early 2021, company command required those planning to decline vaccination to write an essay with up to five reasons for their choice. These essays provide the data for this study. Qualitative descriptive analysis was used to thematically categorize FAST Marines’ written reasons for planning to decline the COVID-19 vaccine into a codebook. Interrater agreement was very good (κ = 0.81).

Results:

A troop of 47 Marines provided 235 reasons why they planned to decline the COVID-19 vaccine. Most frequent reasons were difficulty understanding health information (45%), low estimates of risk (14%), and fear of physical discomfort (12%). Resulting interventions directly targeted Marines’ self-reported reasons by reducing barriers (e.g., normalized getting the vaccine), increasing vaccine benefits (e.g., improved access to base gyms and recreational facilities), and increasing non-vaccine friction (e.g., required in writing five reasons for declining the vaccine).

Conclusions:

Understanding the barriers military personnel experience toward COVID-19 vaccination remains critical despite the success of COVID-19 vaccination experienced to date. Insights from subpopulations like FAST Marines can enhance our ability to identify appropriate barriers and intervention techniques to influence COVID-19 vaccination behaviors.