Concerns regarding the safety of the COVID-19 vaccines is an emerging problem, both in the United States and abroad. The World Health Organization has developed this the Vaccine Hesitancy Scale, to identify the roots of vaccine hesitancy. Thus, this survey will be used in Georgia Public Health District 4 to better understand the causes of vaccine hesitancy in our community. Your time is much appreciated in completing this survey! 

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* 1. What is your age?

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* 2. Which race/ethnicity best describes you? (Please choose only one.)

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* 3. What is your gender?

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* 6. What county do you live in?

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* 7. When a vaccine for the coronavirus becomes publicly available, will you get vaccinated?

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* 8. If you answered "no" or "maybe" to question 7, please expand on why.

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* 9. Rate the following statement: The COVID-19 Vaccine is safe and effective.

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* 10. Have you ever been reluctant or hesitant to get a vaccination?

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* 11. If Yes, What was/were the reason(s)? (Check all that apply)

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* 12. Have any of the following prevented you from getting immunized?

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* 13. Have you ever received or heard negative information about vaccines?

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* 14. If yes, did you still get vaccinated after you heard the negative information?

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* 15. Who do you trust the most for vaccine information?

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* 16. Rate the following statement:  The government is making decisions in your best interest with respect to what vaccines are provided.

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* 17. Will you not receive vaccinations due to religious or cultural reasons?

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* 18. Do you trust vaccine manufacturers to provide safe and effective vaccines?

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* 19. Do you think governments are “pushed” by politicians to recommend certain vaccines?

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* 20. Additional comments.

0 of 20 answered
 

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