New study shows women, younger people, and the socially vulnerable less likely to get vaccinated for COVID-19

A three-year observational study revealed that certain patient characteristics were associated with vaccine hesitancy, but that trusting your doctor makes all the difference

If you were born in the U.S., you likely received 20 to 30 vaccinations by age two. These routine immunizations protect young immune systems from deadly diseases like hepatitis B and tetanus. However, in 2022, over half a million fewer pre-K and kindergarten-age children were vaccinated compared to 20191. So why is the U.S. facing a crisis of distrust in modern vaccines?

Prominent anti-vaccine advocate Robert F. Kennedy Jr., leader of the Department of Health and Human Services, has spent years sowing doubt about COVID-19 vaccines, claiming black people should have separate vaccine schedules, and reiterating the disproven claim that vaccines cause autism. As national leaders reinforce medical misinformation, the heightened vaccine skepticism seen during the COVID-19 pandemic will continue to grow, researchers say.

In a new study published in Vaccine on Feb. 27, scientists set out to figure out why people don’t get vaccinated. The study surveyed hospitalized patients in two groups: one pre-pandemic group about influenza vaccine hesitancy, and the second about COVID-19 hesitancy during the pandemic. Some patients had received these vaccines, while others did not. Patient characteristics like age, race, insurance type, education level, and U.S. census region were recorded and assessed for association with vaccination status.

“People want to trust in [federal health] agencies, which is going to be really hard right now. The flu campaign through the CDC has been taken down. Trust is eroding faster than we ever thought, and I don't think we’re going to see the curve broken until there's a serious health issue,” says Jeffrey Lazarus, professor of global health at CUNY and co-author of the Lancet’s COVID-19 Commission.

“in a year, I think we’re going to see a lot more serious cases of influenza,” —Jeffrey Lazarus

When asked their primary reasons for not getting vaccinated against COVID-19, personal beliefs were the top motivators: that the vaccine wasn’t important for their health, and that it was dangerous. According to study researcher Akram Khan, the politicization of the COVID-19 pandemic played a key role in fueling safety concerns.

Results also showed that prior influenza vaccinations were associated with COVID-19 vaccinations, and health care provider recommendations played a major role in vaccine acceptance.

“We found if the patient’s health care provider was able to convince the patient to get vaccinated every year for influenza, it was much more likely for the patient to get vaccinated against pandemic,” said Khan.

An analysis of patient characteristics in the COVID-19 survey groups showed that younger people, patients living in the Midwest or Southern U.S., and women were less likely to get vaccinated. Women and pregnant people are an important vaccine demographic, as they make choices not only for themselves, but for their newborns. Some vaccines are recommended for babies before they are born, and these potentially life-saving immunizations can only be given at the mother’s discretion.

In the influenza group, chronic medical conditions and current smoker status were most closely associated with hesitancy. One characteristic was closely associated with vaccine hesitancy across both groups: a higher social vulnerability index, or patients who had lower socioeconomic status, were a part of racial or ethnic minorities, or had poor housing quality.  

Khan believes that the results showed a need for targeted vaccine education for patients and health care providers alike.

“My fear is if we have a big avian bird flu pandemic and half the country believes they will be hurt by [a bird flu vaccine]. We need to make sure the socially vulnerable are educated and given access to the vaccine, and educating them now is so important,” Khan says.

But the road to widespread vaccine acceptance through national education efforts is more complicated than ever. As CDC resources and medical research funding get slashed by the new Trump administration, medical experts fear that doubts about vaccine safety and efficacy will stretch beyond newer technologies like the COVID-19 mRNA vaccine.

“Trust in federal health recommendations is eroding faster than we ever thought. We may not see [the effects of it] this year, but maybe in a year, I think we’re going to see a lot more serious cases of influenza. Even without CDC resources, we can watch these trends through death certificates,” said Jeffrey Lazarus.

Conducting broad studies like this one, which surveyed 13,275 patients across 21 hospitals in 18 states as part of the CDC’s IVY surveillance program, will be less likely as federal health agency employees and research grants continue to be cut. CDC data, a cornerstone of national public health infrastructure, is being rewritten to suit the political ideologies of President Trump. A new banner atop the CDC’s social vulnerability index page, a key measurement in this study, reads “This page does not reflect biological reality and therefore the Administration and this Department rejects it.” 

Immunization efforts worldwide have saved an estimated 154 million lives, but as the U.S. shuts itself off from global health institutions like the WHO, disseminating trustworthy medical recommendations about vaccines to the national public will be a real challenge, researchers say.

One of the best ways to combat vaccine-related misinformation and encourage patients to receive both routine and novel vaccinations is to strengthen the health care provider-patient relationship, study results showed.

“Younger people and people with certain political backgrounds are less likely to get vaccinated. We need to focus on this population, build their trust in their health care providers’ [recommendations], and educate the providers themselves,” says Khan.

Reflecting on his research and on the current state of vaccine acceptance in the U.S., Khan says “this may be our best hope.”