# Factors contributing to COVID-19 vaccine hesitancy in Veterans later in the pandemic

## TL;DR

This study explores why some U.S. military Veterans remained hesitant about the COVID-19 vaccine more than a year after it became available.

## Contribution

The study identifies demographic and attitudinal factors linked to vaccine hesitancy among Veterans later in the pandemic.

## Key findings

- Unvaccinated Veterans were more likely to be female, older, and live in rural areas.
- Unvaccinated Veterans reported lower trust in vaccine safety and less information about the vaccine.
- High levels of trust in VA healthcare providers were observed among both vaccinated and unvaccinated Veterans.

## Abstract

Vaccine hesitancy remains a significant public health concern despite the widespread availability of vaccines. Little is known about factors influencing hesitancy among U.S. military Veterans later in the pandemic. The goal of this study was to identify factors contributing to COVID-19 vaccine acceptance and hesitancy among U.S. military Veterans more than one year after vaccine availability.

This study was part of the COVID-19 Vaccine Acceptance Study (CoVAcS) conducted across ten Veterans Affairs Health Care Systems from February 2022 to April 2023. CoVAcS delivered motivational interviewing-informed training to healthcare providers and staff. Unvaccinated (N = 83) and recently vaccinated (N = 140) Veterans were surveyed using items from the Centers for Disease Control and Prevention Vaccine Confidence Survey. Univariable and multivariable logistic regression analyses were conducted.

Compared to recently vaccinated Veterans in univariable analyses, unvaccinated Veterans were older, more likely female, reported higher household income, more likely from a rural residence, did not receive recent seasonal influenza vaccine, and were less likely to screen positive for anxiety or depression. Univariable results also demonstrated high levels of trust in VA healthcare providers and staff and in the VA healthcare system among unvaccinated and recently vaccinated Veterans. In addition, 67.5% of unvaccinated Veterans reported not having enough information about COVID vaccines. In multivariable analyses, unvaccinated Veterans were more likely to be female and live in a rural area. They were also less likely to believe the COVID-19 vaccine is safe, trust the seasonal flu vaccine, or screen positive for anxiety compared to recently vaccinated Veterans.

Results from this study suggest that demographic factors associated with Veteran vaccine hesitancy should be assessed over time to increase provider awareness and focus patient communication and outreach efforts. Unvaccinated Veterans indicated a need for more information about the COVID-19 vaccine. Autonomy-supportive and collaborative communication strategies such as motivational interviewing may help providers better understand patient perspectives on vaccine safety, as well as the barriers and potential benefits to vaccination.

ClinicalTrials.gov, TRN: NCT05027464, Registration Date: 30 August 2021.