vaccine. Respondents articulated concern with a lack of knowledge about the COVID-19 vaccine, particularly related to vaccine safety. This finding is consistent with emerging literature specific to COVID-19 [28,29] and is also consistent with research on vaccines for other preventable diseases [30,31]. The qualitative analysis in this paper provided more of a nuanced understanding that adds to the prior literature. Respondents expressed concern over the speed of the development, testing, and approval process. Our findings are consistent with the growing literature on vaccine hesitancy, in which the approval process for vaccines is an important contributing factor for the trust or mistrust in vaccines [32–34], and this article makes an important contribution as the first qualitative study highlighting participant concerns related to the approval process for COVID-19 vaccines in their own words. Respondents described their reluctance to be among the first recipients of the COVID19 vaccine. Although the desire to not be among the first vaccinated likely involves multiple factors, respondents expressed their reticence, linking safety concerns to concerns related to the clinical testing and approval process. While other research has demonstrated hesitancy related to being part of the initial vaccine deployment [35], this is the first qualitative article to document this in the participants’ own words. Respondents reported concerns about the people, governmental entities, and corporations involved in developing, authorizing, and distributing a COVID-19 vaccine. They described their suspicion that the political and economic systems involved in the development would affect the safety and/or efficacy of the COVID-19 vaccine. Distrust in public institutions is also well-described in the literature, with strong associations between the distrust of organizations, such as the CDC or the World Health Organization (WHO), and vaccine hesitancy [29,36]. Our findings are consistent with research demonstrating that the political landscape for vaccinations is critical for its impact on individual thoughts and feelings, as well as vaccine behaviors [32,37]. Our findings are consistent with research about the effects of the politicization of health issues generally [38], as well as newlypublished findings regarding the role of politics in the COVID-19 pandemic [39]. Our findings contribute to burgeoning literature that links vaccine attitudes to the social and political aspects of the vaccine authorization and approval processes and is one of the first qualitative articles to do so. Finally, some respondents described concerns with the COVID-19 vaccine as part of their concerns with vaccines in general. Respondents who expressed this concern focused on personal experiences with other vaccinations, such as the influenza vaccination. The experience of individuals or of people in close social proximity is suggested in prior research on vaccine hesitancy drivers [35]. These findings, alongside emerging literature on vaccine hesitancy in minority communities, demonstrate that reasoning by analogy with other vaccines is an important feature of individual thoughts and feelings and may be a major driver for vaccine-hesitant persons [35]. Other respondents focused on the economic, political, and juridico-legal context of vaccinations in general. These respondents placed particular emphasis on the profit motives of pharmaceutical companies and related to the fears of being forced to be vaccinated by government actors or through legislation. Distrust in corporate actors and pharmaceutical companies related to profit motives is also supported in the literature [40]. Int. J. Environ. Res. Public Health 2021, 18, 8690 7 of 9 5. Limitations and Future Research There are some limitations to this study. Digital data collection methodologies allow for a larger number of respondents and greater anonymity for respondents; however, this method for qualitative data capture does not allow for follow-up questions or clarifying probes. Digital survey methods may also introduce related biases, as potential participants may not have easy access to the survey or face other limitations on participation. Another limitation is that non-probabilistic samples may not be generalizable to other populations. Additional research is needed to explore the ways in which individual thoughts and feelings about vaccines are related to social networks and vaccine epistemologies. Further research is needed to understand how individuals identify trustworthy sources of information, how trusted messages are constructed, and what additional methods may be necessary in order to fill the information gap for vaccine-hesitant populations. 6. Conclusions This study suggests that vaccine hesitancy related to the COVID-19 vaccine is both multi-dimensional and complex. Respondents viewed the COVID-19 vaccine as a risk, and vaccine hesitancy was linked to social, political, and economic processes related to vaccine production. The stakes are high for understanding the nuances of vaccine hesitancy, as a poor and disproportionate vaccine uptake will worsen the existing social and economic challenges, widen the health disparities gap, and diminish the efforts of equitable vaccine allocation. The results from this study are important for COVID-19 vaccination efforts and will improve efforts to understand the