AI Meets Attitudes: Cross-Sectional Quantitative Study of COVID-19 Vaccine Hesitancy in Alaska's Diverse Communities

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 challenges create complex dynamics for vaccine uptake. Objective: This study uses machine learning on survey data to identify key sociodemographic 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 extreme gradient boosting, random forest, and K-nearest neighbors models for both regression and classification, and interpreted classification results via Shapley Additive Explanations values. Results: Analysis of 720 respondents showed that in Alaska, 1.8% (13/720) of surveyed individuals completed the full primary vaccination series (doses 1-3) and received all 3 booster doses. A vaccination rate of 63.47% (at least 1 dose), with Pfizer preferred over Moderna. A total of 34% (238/720) of participants reported receiving the first dose of the COVID-19 vaccine, 43% (310/720) received the second dose, 18% (130/720) received a third dose, 22% (158/720) received the first booster, 13% (94/720) received the second booster, and only 4% (29/720) 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 lesbian, gay, bisexual, and transgender individuals showed the lowest. Trust in the health care system was the strongest predictor, confirmed by machine learning analyses. Conclusions: Focusing on a geographically and demographically distinct US 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 United States, underscoring the importance of culturally tailored, trust-centered interventions to promote vaccine uptake and health equity.