Full approval of a COVID-19 vaccine by the US Food and Drug Administration (FDA) had little impact on vaccination intentions in unvaccinated Americans, according to the findings of a survey recently published in JAMA Internal Medicine.

At the beginning of 2022, 25% of American adults were found to remain partially vaccinated or unvaccinated against COVID-19. “Lack of full FDA approval for any COVID-19 vaccine was a common rationale provided by unvaccinated Americans,” stated the study authors.

This national cross-sectional survey aimed to evaluate the vaccination intentions of unvaccinated adults in the US following the full approval of the BNT162b2 (Pfizer-BioNTech) COVID-19 vaccine, as well as the demographic associations related to these intentions. The online Qualtrics survey was completed by 535 US adults who had not received a dose of the COVID-19 vaccine before its full approval on August 23, 2021.

In order to recruit a sample that mirrored national distributions of demographic characteristics of unvaccinated Americans, the authors utilized Dynata’s Consumer Research Panel and quota-based sampling for self-reported gender, age, and race and ethnicity. The primary outcome of the survey was intentions of vaccination in response to full approval of the vaccine by the FDA. Survey respondents were placed into 1 of 3 vaccine-intention groups: acceptant, hesitant, or resistant.

Of the total respondents, only 3.6% (n=19) reported receiving their first vaccine dose after the full approval. Of the remaining respondents, 8.7% (45/516) were in the acceptant group, 47.3% (244/516) were in the hesitant group, and 43.5% (224/516) were in the resistant group.

Findings of the analysis revealed that non-Hispanic Black respondents (odds ratio [OR], 2.64; 95% CI, 1.14-6.11; P =.02) were significantly more likely to respond favorably following FDA approval, while Hispanic respondents were significantly more likely to be hesitant (OR, 2.06; 95% CI, 1.14-3.76; P =.02), but less likely to be resistant (OR, 0.52; 95% CI, 0.28-0.87; P =.04) after approval.

“This survey study’s finding of the limited impact of full FDA approval of theBNT162b2 COVID-19 vaccine for vaccination intentions should be considered when vaccine-related interventions and policies are developed during future infectious disease outbreaks,” concluded the authors.


Scherer AM, Parker AM, Gidengil CA, et al. COVID-19 vaccine uptake and intentions following US Food and Drug Administration approval of the Pfizer-BioNTech COVID-19 vaccine. JAMA Intern. Med. Published online April 11, 2022. doi:10.1001/jamainternmed.2022.0761