OBJECTIVES: Foreign-born individuals experienced disproportionate harm from the COVID-19 pandemic. Understanding early vaccine acceptance can positively affect communities of foreign-born individuals. This research aimed to explore differences in early COVID-19 vaccine acceptance between unvaccinated foreign-born and US-born individuals living in California, and whether this relationship was affected by race/ethnicity, educational attainment, and English-speaking proficiency.

METHODS: Individuals who self-identified as unvaccinated were evaluated using the 2021 California Health Interview Survey for whether they would receive a COVID-19 vaccine or not when made available. Foreign-born and US-born respondents were propensity score matched and compared on vaccine acceptance using a logistic regression model adjusted for covariates and using survey weighted procedures. Race/ethnicity, education, and English proficiency were individually interacted with birth-status in the model. Results were presented using odds ratios and average marginal effects (AME).

RESULTS: A total of 4,234,655 survey-weighted matched individuals were identified, 53.2% (N=2,251,279) of which were foreign-born. Foreign-born individuals had a higher likelihood of vaccine acceptance compared to US-born individuals (OR=2.8, 95%CI:1.16-6.83). Racial-ethnic foreign-born minorities had a non-significantly higher predicted probability of vaccine acceptance than their US-born counterparts, except for Blacks (AME=-0.1841, 95%CI:-0.380-0.012). Compared to US-born individuals, the effect of education was greatest among foreign-born individuals with <high school attainment (AME=0.291, 95%CI:0.055-0.383). The predicted probability of vaccine acceptance was non-significantly higher among foreign-born individuals with greater English proficiency; this trend was reversed for those who spoke English not well/not at all (average marginal effect:-0.0810, 95%CI:-0.429-0.266).

CONCLUSIONS: Foreign-born individuals in California had a higher likelihood of COVID-19 vaccine acceptance in 2021 compared to US-born individuals. This relationship was influenced by racial/ethnic minorities, lower educational attainment, and those who spoke English fluently/well. Future public health initiatives should target improved language equity and US-born minority communities to improve COVID-19 vaccination rates.