Study Results Show COVID-19 Vaccination Uptake Is Suboptimal Among Veterans


Findings indicate that primary vaccines can be improved among younger, rural-dwelling individuals.

COVID-19 vaccination coverage among US veterans through June 2022 was suboptimal, according to the results of a study published in JAMA Network Open.

Findings indicated that primary vaccination can be improved among younger, rural-dwelling veterans and greater uptake of booster vaccination among all veterans is needed.

It is estimated that only approximately 77% of adults in the United States had completed primary vaccination by July 2022, despite national efforts to encourage COVID-19 vaccination. Of these, just 51% had received a first booster dose.

The Veterans Health Administration (VHA) provides comprehensive care to more than 9 million enrolled veterans in the United States and worked closely with the CDC and other federal partners to quickly deliver COVID-19 vaccines to veterans following initial Emergency Use Authorization.

Investigators conducted a retrospective cohort study to describe incidence and patient characteristics associated with primary, first booster, and second booster COVID-19 vaccination among VHA enrollees between December 2020 and June 2022.

“The VHA affords an opportunity to evaluate vaccine uptake in different patient groups and promote equitable access to preventive care,” the authors wrote.

The study assessed US veterans receiving care in VHA medical centers and outpatient clinics as of December 1, 2020, including all VHA enrollees with inpatient, outpatient, or telehealth encounters in VHA, as well as primary-care physician appointments in the preceding 24 months.

Of the 5,632,413 veterans in the study, 90.4% were male, with a median age of 66 years. A total of 1,032,334 veterans were Black, 448,714 were Hispanic, and 4,202,173 were White.

Through June 2022, cumulative incidences were 69.0% for primary vaccination, 42.9% for first booster, and 9.3% for second booster.

The findings showed cumulative incidence for primary vaccination increased with increasing age, from 46.9% (95% CI, 46.8%-47.0%) among veterans aged 18 to 49 years to 82.9% (95% CI, 82.8%-83.0%) among veterans aged 80 to 84 years.

More Black veterans completed primary vaccination (71.7%; 95% CI, 71.6%-71.8%) than White veterans (68.9%; 95% CI, 68.9%-69.0%).

Following observation of early disparities in vaccination coverage among US racial and ethnic and racial minorities, efforts were undertaken to reduce this gap, the authors said.

However, this study found that thr incidence of vaccination has remained lower for indigenous groups.

Continued support and targeted outreach for COVID-19 within VHA remain important to reduce these disparities, according to the authors.

Investigators found that more urban-dwelling veterans completed primary vaccination (70.9%; 95% CI, 70.9%-71.0%) compared with highly rural-dwelling veterans (63.8%; 95% CI, 63.4%-64.1%).

Other factors independently associated with higher likelihood of both primary and booster vaccination included Asian or Black race, female sex, Hispanic ethnicity, and lack of prior SARS-CoV-2 infection.

Individuals with a greater burden of underlying medical conditions had a slightly higher likelihood of primary vaccination but slightly lower likelihood of booster vaccination, despite their increased risk of severe COVID-19 outcomes.

Overall, COVID-19 primary and booster vaccination remained underused through June 2022 in this cohort study of US veterans, similar to trends observed in the general US population.

Although greater uptake of booster vaccination among all veterans is needed,targeted outreach could particularly benefit vaccination rates among indigenous groups, individuals with a high burden of underlying conditions, and young, rural-dwelling veterans, the authors said.


Bajema KL, Rowneki M, Berry K, et al. Rates of and factors associated wWith primary and booster COVID-19 vaccine receipt by US veterans, December 2020 to June 2022. JAMA Netw Open. 2023;6(2):e2254387. doi:10.1001/jamanetworkopen.2022.5438

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