More than three-quarters of American adults did not get a coronavirus vaccine last season, a number that health experts warn could rise this year amid new recommendations from the US government.
The Covid vaccine was initially popular. About 75% of Americans had received at least one dose of the first versions of the vaccine by early 2022, according to data from the Centers for Disease Control and Prevention. But only about 23% of American adults received a coronavirus vaccine during the 2024-25 virus season, well below the 47% of American adults who got a flu shot. Vaccination rates for influenza, measles and tetanus are also falling.
However, Covid remains a serious, potentially fatal health risk, recorded as the leading cause of death on around 31,400 death certificates last year. By comparison, the flu killed about 6,500 people, and pneumonia, a common complication of the flu, killed an additional 41,600, according to CDC data.
As millions of Americans decide whether to get a coronavirus vaccine this season, public health researchers worry that vaccination rates will drop further, especially because Hispanic and black Americans and those under 30 have lower rates, exposing them to serious complications like long-term covid. Under the Trump administration and Health and Human Services Secretary Robert F. Kennedy Jr., the federal government has scaled back its coronavirus vaccine recommendations, leading to a raft of rules on pharmacy access, with Americans living in Republican states often facing more hurdles.
“There’s a lot of misinformation floating around about Covid,” said Alein Haro-Ramos, assistant professor of health, society and behavior at the University of California-Irvine. “Vaccine hesitancy will increase.”
In August, the FDA limited approval for Covid vaccines to people age 65 and older and to adults and children with at least one underlying condition that puts them at high risk for serious complications from the coronavirus.
A month later, the CDC’s Advisory Committee on Immunization Practices voted in favor of “shared clinical decision making” on the vaccine, withdrawing the recommendation that all adults be vaccinated. The committee advised doctors to stress to adults under 65 and children that the benefits of the vaccine are greater for those with underlying conditions.
The guidelines are disputed by infectious disease experts, who say most adults and children should get both flu and Covid vaccines, which are safe, effective and prevent serious illness. Several independent medical organizations, such as the American Academy of Family Physicians and the American Academy of Pediatrics, have reiterated their support for the widespread adoption of Covid vaccines.
More than a dozen states have taken steps to ensure most people can get a Covid vaccine at the pharmacy without a prescription, with many states linking their policies to advice from medical organisations. And many of those states require insurers to cover the vaccines at no cost, according to a KFF analysis. In many other states, led primarily by Republicans, pharmacy access to vaccines may require a prescription.
Among the most commonly cited reasons for Covid vaccine hesitancy are fears of side effects, long-term health consequences and vaccine effectiveness, and mistrust of pharmaceutical companies and government officials, according to a 2024 review of multiple studies published in the journal Vaccines.
Reluctance to get vaccinated against Covid in the 2024-25 virus season was higher among Latinos, African-Americans, men, the uninsured and people living in Republican states, CDC data show.
Latino adults were significantly less likely than adults from most other racial and ethnic groups to receive a Covid vaccine last season, with a vaccination rate of about 15%.
Some of this may be due to age: A disproportionate share of Latinos are young. But public policy actions can also be a factor. The first Trump administration, for example, linked Medicaid to the “public charge,” a rule that allows the federal government to deny an immigrant a green card or visa based on his reliance on taxpayer-funded programs. Some Latinos may be afraid to sign up for social services even after the Biden administration reversed those Trump initiatives.
Haro-Ramos co-authored a study published in 2024 that found that many Latinos were hesitant to get vaccinated because of fears about their immigration status and that health discrimination, such as denial of care or delays, increased their hesitancy about vaccines.
“Do you trust the health care system, in general? Do you want to give your information — your name, your address?” Haro-Ramos said. “Trust is critical.”
Haro-Ramos said the problem has likely worsened since her study was published. The Trump administration revealed this summer that it would give the personal information of Medicaid enrollees to Immigration and Customs Enforcement. Many Latinos are canceling doctor’s appointments to avoid a potential confrontation with immigration enforcement officials.
“People avoid leaving their homes at all costs,” Haro-Ramos said.
Janani Rajbhandari-Thapa, an associate professor at the University of Georgia’s College of Public Health, recently co-authored a study on Covid vaccination in nearly 1,500 African-Americans living in south Georgia. The study found that participants were more likely to listen to their health care providers than their leaders or colleagues when seeking vaccination advice.
More than 90% of those studied had received at least one dose of the vaccine, but those who were unvaccinated were more likely to agree with false statements linking vaccines to miscarriages, to parts remaining in the body for a long time, or even to the conspiracy of implanting a computer chip in the body.
“Clinicians are the ones who can get the messages about vaccination — that these are myths,” Rajbhandari-Thapa said.
Although hospitalization and death rates have fallen dramatically since the worst days of the pandemic, deadly complications related to the coronavirus remain more common among the elderly. About 89 percent of coronavirus deaths in the U.S. last year were among people 65 and older, compared with about 81 percent of flu and pneumonia deaths.
As the pandemic recedes, young people have developed a sense of invincibility. Only 11% of Americans aged 18 to 29 received a vaccine during the 2024-25 virus season, the lowest vaccination rate among adult age groups. This is well below the 70% of young adults who received at least one dose of the initial Covid vaccines by November 2023.
While many people get the coronavirus after receiving a vaccine, because the vaccine’s ability to prevent infection wears off fairly quickly, some people misunderstand the vaccine’s purpose, said Otto Yang, an infectious disease specialist at UCLA Health.
“They think, ‘Well, the vaccine didn’t prevent me from getting Covid, so the vaccine didn’t work,'” Yang said. “And what they don’t see is that the vaccine prevented them from getting seriously ill, which is ultimately the most important thing.”
And the vaccine may help prevent long-term Covid, which is a problem for all ages, Yang said. A recent Northwestern University study found that younger adults suffer worse long-term Covid symptoms than older adults.
Ultimately, Yang said, it’s not a solid choice to get a flu shot but forgo a Covid shot, as both are safe, effective and prevent serious illness. It is clear, he added, that people with weakened immune systems and those at higher risk should get a Covid vaccine. The decision is “a little less clear” for others, but “probably most adults should be vaccinated, just as recommended for the flu shot, and most children as well.”
