Multilevel determinants on COVID-19 booster intention among Americans.

The pandemic has disrupted public health and social well-being for more than two years. With the vaccine efficacy waning over time and the spread of new variants, a booster becomes increasingly imperative. This study investigates predictors of the American public's COVID-19 booster intention. A national survey was conducted from September 23rd to October 31st, 2021, on a representative sample. The survey data is merged with state-level indicators of vaccination rate, case rate, political context, and economic recovery. Multilevel regression modeling is adopted for statistical estimation. Results show that a higher proportion of vaccinated people in the network is positively related to one's chance of getting the booster (β = 0.593, p = 0.000). In comparison, a higher proportion of infected people in the network is negatively related to one's intention to become boosted (β = -0.240, p = 0.039). Additionally, the higher educated (β = 0.080, p = 0.001) and older (β = 0.004, p = 0.013) were more likely to say they would get the booster than their counterparts. Meanwhile, the odds of people taking the COVID-19 booster decrease by 3.541 points (p = 0.002) for each unit increase in the case rate at the state level. This study articulates that individual intention to take the booster is a function of their personal characteristics and is also rooted in social networks. These findings contribute to the literature and have policy implications. Knowledge of the profiles among people who intend to take/refuse the booster provides essential information to leverage certain factors and maximize booster uptake to mitigate the pandemic's devastating impact.