JMIR Publications

ABSTRACT

Background:

Individuals seek health information online to guide their health decision-making. Factors like anxiety, worry, and perceptions of insufficient knowledge about a topic motivate information seeking. These factors converged during the COVID-19 pandemic and were linked with COVID-19 vaccination decision-making. Research shows that online search relevant to COVID-19 were associated with subsequent vaccine uptake. However, less is known about COVID-19 vaccine intent search (which assesses vaccine availability, accessibility, and eligibility) as a signal of vaccine readiness

Objective:

This study investigated the relationship between COVID-19 vaccine readiness—a composite measure of COVID-19 vaccination intent and uptake—and COVID-19 vaccine intent relative search volume on Google in each United States (U.S.) county between January 2021 and April 2023—a time during which those with primary COVID-19 vaccinations increased from under 57,000 to over 230 million.

Methods:

We compiled panel data from several publicly available data sources in all U.S. counties between January 2021 and April 2023. We estimated a random effects generalized least squares regression model with time-fixed effects to assess the relationship between county-level COVID-19 vaccine readiness and COVID-19 vaccine intent relative search volume. We controlled for health care capacity, per capita COVID-19 cases and vaccination doses administered, and sociodemographic indicators.

Results:

The county-level proportions of unvaccinated adults who reported that they would wait and see before getting a COVID-19 vaccine was positively associated with COVID-19 vaccine intent relative search volume (P=.003). The county-level proportions of vaccine enthusiast adults—adults who indicated they were either already vaccinated with a primary COVID-19 vaccine series or planned to complete the vaccine series soon—was negatively associated with COVID-19 vaccine intent relative search volume (P <.001). However, vaccine intent search was higher in high wait and see counties and lower in high vaccine enthusiast counties. Results showed statistically significant associations between COVID-19 vaccine intent relative search volume and the presence of public health research facilities (P=.001), lagged monthly change in COVID-19 cases per capita (P<.001), and lagged monthly change in COVID-19 vaccination doses per capita (P<.001).

Conclusions:

During this period of steep increase in COVID-19 vaccination, online search may have signaled differences in county-level COVID-19 vaccine readiness. More vaccine intent search occurred in high wait-and-see counties, whereas less vaccine intent search occurred in high vaccine enthusiast counties. Considering previous research that identified a relationship between vaccine intent search and subsequent vaccine uptake, these findings suggest that vaccine intent search aligned with people’s transition from wait and see to vaccine enthusiasts. The findings also suggest that online search trends may signal localized changes in information-seeking and decision-making antecedent to vaccine uptake. Findings may inform efforts to educate the public during an evolving public health crisis to provide the information needed to make health decisions.