Survey on COVID-19 Vaccine Hesitancy

Question Title

* 1. Do you plan on being immunized with the COVID-19 vaccine when it becomes widely available?

Yes

Unsure

Question Title

* 2. Are you concerned about the safety and efficacy of the COVID-19 vaccine?

Yes

Need more information on the safety and efficacy of Covid-19 before a decision is made as to whether the receive it.

Question Title

* 3. Does your staff want to receive the COVID-19 vaccine when it becomes widely available?

Yes

Some do, some don’t

Unsure

Question Title

* 4. Is your staff concerned about the safety and efficacy of the COVID-19 vaccine?

Yes

They need more information on the vaccine before they make a decision as to whether the receive it.

Question Title

* 5. Are your patients asking questions about the safety and efficacy of the vaccine?

Yes

Question Title

* 6. Can you estimate what percent of your patients are likely to get the vaccine?

Less that 25%

25-50%

50-75%

75-100%

Question Title

* 7. What do you view as the biggest obstacle in getting New Yorkers vaccinated?
Choose all that apply.

Having an adequate supply of vaccine

Getting the public to understand that others may be prioritized over them

Vaccine hesitancy

Other (please specify)

Question Title

* 8. Messaging: What do you recommend as the most effective messaging means of communication for those patients who are hesitant to get the vaccine?
Choose all that apply.

Immunizing myself and informing the patient that I have received it

A prepared script on the importance of getting the vaccine with an explanation of its safety

Brochures and Flyers that can be distributed to patients

A state campaign on the importance of being immunized for COVID-19

Question Title

* 9. Vaccine Distribution: Along with traditional immunizers, the state will be directing and supervising regional and local Points of Distribution (PODs) to administer vaccinations, the size and set-up of these PODS will vary according to geographic area, vaccine supply and other factors.

What should the state be considering regarding the credibility and acceptance of these efforts, as well as in terms of their effective and efficient operations? Choose all that apply.

Individuals may not be able to travel to these locations

Safety concerns regarding COVID-19 spread due to the number of people that will be at a POD

Individuals may not be accepting of “just anyone” giving them the vaccine

Language barriers

Screening of individuals for any medical contraindications

Other (please specify)

Question Title

* 10. Access: What are you most concerned about as it related to the equitable access to the vaccine?

Language barriers

Concerns about the safety/efficacy of the vaccine

Supply

Other (please specify)

Question Title

* 11. What county are you in?

Albany

Allegany

Broome

Cattaraugus

Cayuga

Chautauqua

Chemung

Chenango

Clinton

Columbia

Cortland

Delaware

Dutchess

Erie

Essex

Franklin

Fulton

Genesee

Greene

Hamilton

Herkimer

Jefferson

Lewis

Livingston

Madison

Monroe

Montgomery

Nassau

New York City

Niagara

Oneida

Onondaga

Ontario

Orange

Orleans

Oswego

Otsego

Putnam

Rensselaer

Rockland

Saratoga

Schenectady

Schoharie

Schuyler

Seneca

St Lawrence

Steuben

Suffolk

Sullivan

Tioga

Tompkins

Ulster

Warren

Washington

Wayne

Westchester

Wyoming

Yates

Question Title

* 12. What is the size of your practice?

1 -5

6 -10

11 - 20

21 - 45

46 or over

Health system-employed

Question Title

* 13. What is your speciality?

Anesthesiology

Cardiology

Cosmetic Surgery

Dermatology

Emergency Medicine

Endoscopy

Family Practice

General Surgery

Gastroenterology

Internal Medicine

Neurology

Neurosurgery

OB-GYN

Oncology

Ophthalmology

Orthopedic Surgery

Otolaryngology

Pain Management

Pathology

Pediatric Care

Physical Medicine and Rehabilitation

Plastic Surgery

Psychiatry

Radiology

Rheumatology

Thoracic Surgery

Urology

Vascular Surgery

Other (please specify)

Survey on COVID-19 Vaccine Hesitancy

Question Title

* 1. Do you plan on being immunized with the COVID-19 vaccine when it becomes widely available?

Question Title

* 2. Are you concerned about the safety and efficacy of the COVID-19 vaccine?

Question Title

* 3. Does your staff want to receive the COVID-19 vaccine when it becomes widely available?

Question Title

* 4. Is your staff concerned about the safety and efficacy of the COVID-19 vaccine?

Question Title

* 5. Are your patients asking questions about the safety and efficacy of the vaccine?

Question Title

* 6. Can you estimate what percent of your patients are likely to get the vaccine?

Question Title

* 7. What do you view as the biggest obstacle in getting New Yorkers vaccinated? Choose all that apply.

Question Title

* 8. Messaging: What do you recommend as the most effective messaging means of communication for those patients who are hesitant to get the vaccine? Choose all that apply.

Question Title

Question Title

* 10. Access: What are you most concerned about as it related to the equitable access to the vaccine?

Question Title

* 11. What county are you in?

Question Title

* 12. What is the size of your practice?

Question Title

* 13. What is your speciality?

* 7. What do you view as the biggest obstacle in getting New Yorkers vaccinated?
Choose all that apply.

* 8. Messaging: What do you recommend as the most effective messaging means of communication for those patients who are hesitant to get the vaccine?
Choose all that apply.