Vaccine Hesitancy among Older Adults, with Implications for COVID-19 Vaccination and Beyond

Many older adults face the decision of whether to receive a vaccine with ease: they choose to get all recommended vaccines, or they refuse vaccines entirely. Others, however, find the decision more complex and make it on a case-by-case basis. Experts consider this middle group of adults, who selectively choose which vaccines to accept, to be “vaccine hesitant.” 

This report explores vaccine hesitancy among U.S. adults ages 50 and older, the attitudes that drive vaccine hesitancy, and the relationship between hesitancy toward the influenza vaccine and hesitancy toward COVID-19 vaccines. It concludes that vaccine hesitancy is widespread in this group and that attitudes towards other vaccines may prove valid indicators of acceptance of the COVID-19 vaccine.   

Wide Spectrum of Vaccination Behavior

A recent AARP survey asked older adults the extent to which they get the vaccines recommended to them by their health care provider. Responses identified four types of vaccine behavior – gets all, gets most, gets a few, and gets none – that fall along a vaccine acceptance continuum. 

At one end of the continuum is the largest group: nearly half of adults ages 50 and older (45 percent) who get all of the vaccines recommended to them. While this “gets all” behavior is the most common, there is some variation. Black adults ages 50 and over are less likely (33 percent get all) than their White (47 percent get all) or Hispanic (40 percent get all) counterparts to get all vaccines. Moreover, the likelihood of getting all recommended vaccines increases with an individual’s level of income and education.    

At the other end of the continuum is the smallest group: the 11 percent of adults age 50 and older who get none of the vaccines recommended to them. This group had varying levels of education and income and diverse racial and ethnic identities, suggesting that negative attitudes toward vaccines spans demographic differences. 

In the middle of the continuum are two groups who comprise the 44 percent of older adults who are vaccine hesitant; they get some but not all of the vaccines recommended. Those in the larger of the two groups get most vaccines recommended by their health care provider (29 percent) and the smaller group consists of individuals who get only a few (15 percent). Additionally, Black (54 percent) and Hispanic (48 percent) older adults fall into these two groups at higher rates than their White (41 percent) counterparts.

What is Driving Vaccine Hesitancy among Older Adults?

Behind the vaccination behavior of older adults are a number of motivating factors, and the AARP survey isolated several. Among respondents who reported being unlikely to get a flu vaccine this year (2020): 40 percent indicated concern with the vaccine’s side effects; 26 percent were uncertain about the vaccine’s effectiveness; 32 percent also indicated that they were in good health and didn’t see the need to get the vaccine. The data also reveal substantial differences by racial and ethnic group. 

COVID-19: Facing the Decision to Accept a New Vaccine

It appears that previous vaccine behavior may be a valid indicator of likely COVID-19 vaccine acceptance. The AARP survey, which was fielded prior to the authorization of the COVID-19 vaccines, showed that 65 percent of adults ages 50 and older were likely (37 percent very likely, 28 percent somewhat likely) to get a COVID-19 vaccine when it becomes available. This high rate is consistent with the recent flu vaccination rates of older adults (47 percent), although we will not know the full extent of the COVID-19 vaccine uptake for some time.

It also appears that the factors driving hesitancy toward COVID-19 vaccines resemble the factors driving hesitancy toward the flu vaccine. The AARP survey asked older adults who indicated that they were unlikely to get a COVID-19 vaccine what factors were driving their decision. They most often cited worry about the vaccine’s side effects, though with greater frequency (59 percent), and indicated concern with the vaccine’s effectiveness (29 percent) as a top factor. In addition, respondents frequently noted the perceived risks of the COVID-19 vaccine (52 percent) as well as a distrust in the government (47 percent) as key factors.