COVID-19 Booster Rates Low Among US Veterans, Study Finds


Fewer than half of eligible veterans enrolled in the Veterans Health Administration have received their COVID-19 booster.

COVID-19 booster rates remain low among US veterans despite eligibility, according to a study recently published in JAMA Network Open. Younger, rural, American Indian or Alaska Native, and homeless populations had the lowest booster rates and greatest risk of COVID-19 related-illness, hospitalization, and mortality, according to the study.

Of 6,173,062 US veterans enrolled in the Veterans Health Administration (VHA), 64% completed primary COVID-19 vaccination, making them eligible to receive a booster. Researchers investigated the association of demographic, clinical, and social determinants of health with COVID-19 booster completion to identify vulnerable subpopulations.

Using the VHA electronic health record (EHR), researchers constructed a retrospective cohort of 3,578,627 veterans. Data from December 11, 2020, when the first emergency use authorization approval and first COVID-19 vaccinations in the VHA occurred, through February 8, 2022, were included in the analysis.

Participants had at least 1 VHA outpatient visit and were eligible for the first COVID-19 booster based on CDC-specified intervals from primary series completion. Data on receipt of the first COVID-19 booster after primary vaccination within or outside the VHA were used for analyses.

Of the 3,578,627 eligible VHA enrollees, the mean (SD) age was 65.9 (15.1) years. The cohort was 8.8% female and 91.2% male.

Self-reported race and ethnicity information from the EHR indicated that 65.6% of the cohort were non-Hispanic White, 18.3% were non-Hispanic Black or African American, 7.1% were Hispanic, 5.5% were of unknown race or ethnicity, 1.4% were Asian, 0.7% were Native Hawaiian or another Pacific Islander, and 0.6% were American Indian or Alaska Native.

Fewer than half (39.8%) of eligible veterans in this cohort received a booster. The lowest booster rates were observed among veterans aged 18 to 34 years compared to veterans 85 years of age or older.

Veterans who were not assigned to a primary care team, those who lived in a rural residence, or who reported housing and/or food insecurity were less likely to receive a booster. Researchers found that veterans from the East South-Central region had the lowest booster rates compared with those from New England.

Black or African American veterans were found to have the highest booster rates, 44.3%, likely due to the VHA system having fewer barriers to access, according to the study. In contrast, American Indian or Alaska Native veterans had the lowest booster rate of 35.4%.

Overall, these findings demonstrate low booster rates in a population with primary vaccination, meaning increased susceptibility to COVID-19-related illness, hospitalization, and mortality.

The authors recommend outreach to subpopulations at the greatest risk, including younger, rural, American Indian or Alaska Native, and homeless populations. They encourage primary care clinicians to engage unvaccinated and unboosted patients in conversations about COVID-19, suggesting that this may mitigate residual disparities.

The study has some limitations, with the authors acknowledging that the results may not generalize to nonveteran populations. Additionally, the VHA EHR may not capture all community-administered boosters.


Seal K H, Bertenthal D, Manuel J K, Pyne J M. Association of demographic, clinical, and social determinants of health with COVID-19 vaccination booster dose completion among US veterans. JAMA Netw Open. 2022;5(7)e:2222635. Published July 19, 2022. Accessed July 22, 2022.

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