AI Meets Attitudes: Decoding COVID-19 Vaccine Hesitancy in Alaska’s Diverse Communities (Preprint)

BACKGROUND The global COVID-19 vaccine rollout faces challenges from persistent hesitancy, especially in rural and underserved regions. Alaska’s unique geographic, cultural, and infrastructural barriers create complex vaccine uptake dynamics. OBJECTIVE This study uses advanced machine learning on survey data to identify key socio-demographic and attitudinal predictors of hesitancy, informing targeted public health strategies. METHODS This study surveyed 720 Alaska adults, selected via targeted sampling to capture diverse COVID-19 vaccine attitudes across demographics and regions. A structured questionnaire assessed hesitancy through 17 indicators. We applied XGBoost, Random Forest, and KNN models for both regression and classification, and interpreted classification results via SHAP values. RESULTS Analysis of 720 respondents showed that in Alaska, 1.8% of surveyed individuals completed the full primary vaccination series (doses 1–3) and received all three booster doses. 63.47% vaccination rate (at least one dose), with Pfizer preferred over Moderna. A total of 34% of participants reported receiving the first dose of the COVID-19 vaccine, 43% received the second dose, 18% received a third dose, 22% received the first booster, 13% received the second booster, and only 4% received a third booster. Geographic data revealed higher uptake in urban centers and variability in rural areas. Young adult males exhibited the highest hesitancy, while LGBT individuals showed the lowest. Trust in the healthcare system was the strongest predictor, confirmed by machine learning analyses. CONCLUSIONS Focusing on a geographically and demographically distinct U.S. population, this study advances the scientific understanding of vaccine hesitancy while informing context-sensitive public health strategies. The findings offer actionable evidence to guide targeted communication, equitable outreach, and data-driven policy in Alaska and similarly underserved regions across the Americas, underscoring the importance of culturally tailored, trust-centered interventions to promote vaccine uptake and health equity. CLINICALTRIAL NA