COVID-19 Vaccination Intent in Adults in Puerto Rico is High, but Concerns Remain

Older male getting the COVID-19 vaccine at the University of Puerto Rico, Medical Sciences Campus. Photo credit: Emma Fernandez

Vaccine hesitancy is critical to understand because the control of the COVID-19 pandemic primarily relies on mass vaccination and achieving herd immunity. Hesitancy toward COVID-19 vaccination is greater among people from racial and ethnic minority communities and individuals of low socioeconomic status. This is particularly important for individuals in Puerto Rico (PR), given that the COVID-19 pandemic has influenced the ongoing economic crisis on the island by exacerbating socioeconomic and health inequalities. A recent study supported by NIMHD identified factors associated with COVID-19 vaccination intent among adults in PR.

In this cross-sectional study, 1,911 adults 18 years or older and living in PR completed an online survey from December 2020 to February 2021. Using the Health Belief Model as a framework, the questionnaire assessed perceptions, beliefs, and attitudes toward COVID-19 and vaccination against this disease to understand predictors of vaccination intent. This included questions related to:

  • COVID-19 susceptibility and disease severity.
  • Vaccination benefits and barriers.
  • Cues to vaccination.

Logistic regression models were performed to predict the odds of uncertainty and willingness toward vaccination and adjusted for socio-demographic, behavioral, and clinical factors.

The study investigators found that 82.5% of survey participants reported an intent to get vaccinated against COVID-19, whereas 6.5% had no intent, and 11% were unsure. Survey responders who reported no intent to get vaccinated or being unsure were more likely to be female, between the ages of 30–39 years, have lower income, and have higher levels of religiosity. Approximately 40% of participants reported concerns about vaccine safety, efficacy, and side effects. The most reported ‘cue to action’ for vaccination was receiving adequate information about the COVID-19 vaccine.

The main reasons for vaccination unwillingness and uncertainty included concerns over vaccine safety, efficacy, novelty, rigor of testing, and lack of trust in what the government says about COVID-19. The investigators reported that lower perceived susceptibility and severity to COVID-19 were associated with higher odds of unwillingness and uncertainty concerning vaccination. For example, disagreeing with the statement “getting COVID-19 is currently a possibility for me” was associated with three times the odds of vaccination unwillingness and uncertainty. Similar findings were also observed when respondents disagreed with the statement “I am afraid of getting COVID-19”.

Higher odds of vaccination unwillingness and uncertainty were also associated with respondents:

  • Not perceiving benefits from the vaccine.
  • Taking the vaccine only if many in the public take it.
  • All of the three vaccination barriers evaluated (concerns with safety, efficacy, and side effects).

In summary, vaccination intent was over 80% among adults in PR. Vaccination barriers, including concerns over vaccine safety, efficacy, and side effects, among adults in Puerto Rico need to be addressed through education campaigns and future interventions. These campaigns and interventions should incorporate non-government groups for delivery and implementation to enhance COVID-19 vaccine uptake in Puerto Rico.

We would like to acknowledge Andrea López-Cepero, Ph.D., and Emma Fernández-Repollet, Ph.D., for their contributions toward this Spotlight.


López-Cepero, A., Cameron, S., Negrón, L. E., Colón-López, V., Colón-Ramos, U., Mattei, J., Fernández-Repollet, E., & Pérez, C.M. (2021). Uncertainty and unwillingness to receive a COVID-19 vaccine in adults residing in Puerto Rico: Assessment of perceptions, attitudes, and behaviors. Human Vaccines & Immunotherapeutics, doi: 10.1080/21645515.2021.1938921.

Page updated January 14, 2022