¹Bridge Quality Enhancement Research Initiative Program, Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, Massachusetts
²Section of General Internal Medicine, Boston University School of Medicine, Boston, Massachusetts
³Office of Analytics and Performance Integration, Survey of Healthcare Experiences of Patients, Veterans Health Administration, Washington, District of Columbia
⁴Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, Massachusetts
⁵Bridge Quality Enhancement Research Initiative Program, Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Jamaica Plain, Massachusetts
⁶Bridge Quality Enhancement Research Initiative Program, Center for Innovation to Implementation, VA Palo Alto Healthcare System, Menlo Park, California
⁷Center for Primary Care and Outcomes Research, Stanford University School of Medicine, Stanford, California
⁸Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, California
⁹Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, Rhode Island

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Key Points

Question What are veterans’ attitudes and intentions associated with COVID-19 vaccination?

Findings In this survey study of 1178 US veterans in March 2021, 71% of veterans reported being vaccinated against COVID-19. Fears about side effects and worry about the newness of vaccines were the primary reasons given for not getting vaccinated, reflecting vaccine skepticism and deliberation.

Meaning These findings suggest that targeting veterans’ concerns around the adverse effects and safety of COVID-19 vaccines through conversations with trusted Veterans Health Administration health care practitioners is key to increasing vaccine acceptance.

Abstract

Importance Compared with the general population, veterans are at high risk for COVID-19 and have a complex relationship with the government. This potentially affects their attitudes toward receiving COVID-19 vaccines.

Objective To assess veterans’ attitudes toward and intentions to receive COVID-19 vaccines.

Design, Setting, and Participants This cross-sectional web-based survey study used data from the Department of Veterans Affairs (VA) Survey of Healthcare Experiences of Patients’ Veterans Insight Panel, fielded between March 12 and 28, 2021. Of 3420 veterans who were sent a link to complete a 58-item web-based survey, 1178 veterans (34%) completed the survey. Data were analyzed from April 1 to August 25, 2021.

Exposures Veterans eligible for COVID-19 vaccines.

Main Outcomes and Measures The outcomes of interest were veterans’ experiences with COVID-19, vaccination status and intention groups, reasons for receiving or not receiving a vaccine, self-reported health status, and trusted and preferred sources of information about COVID-19 vaccines. Reasons for not getting vaccinated were classified into categories of vaccine deliberation, dissent, distrust, indifference, skepticism, and policy and processes.

Results Among 1178 respondents, 974 (83%) were men, 130 (11%) were women, and 141 (12%) were transgender or nonbinary; 58 respondents (5%) were Black, 54 veterans (5%) were Hispanic or Latino, and 987 veterans (84%) were non-Hispanic White. The mean (SD) age of respondents was 66.7 (10.1) years. A total of 817 respondents (71%) self-reported being vaccinated against COVID-19. Of 339 respondents (29%) who were not vaccinated, those unsure of getting vaccinated were more likely to report fair or poor overall health (32 respondents [43%]) and mental health (33 respondents [44%]) than other nonvaccinated groups (overall health: range, 20%-32%; mental health: range, 18%-40%). Top reasons for not being vaccinated were skepticism (120 respondents [36%] were concerned about side effects; 65 respondents [20%] preferred using few medications; 63 respondents [19%] preferred gaining natural immunity), deliberation (74 respondents [22%] preferred to wait because vaccine is new), and distrust (61 respondents [18%] did not trust the health care system). Among respondents who were vaccinated, preventing oneself from getting sick (462 respondents [57%]) and contributing to the end of the COVID-19 pandemic (453 respondents [56%]) were top reasons for getting vaccinated. All veterans reported the VA as 1 of their top trusted sources of information. The proportion of respondents trusting their VA health care practitioner as a source of vaccine information was higher among those unsure about vaccination compared with those who indicated they would definitely not or probably not get vaccinated (18 respondents [26%] vs 15 respondents [15%]). There were no significant associations between vaccine intention groups and age (χ²₄ = 5.90; P = .21) or gender (χ²₂ = 3.99; P = .14).

Conclusions and Relevance These findings provide information needed to develop trusted messages used in conversations between VA health care practitioners and veterans addressing specific vaccine hesitancy reasons, as well as those in worse health. Conversations need to emphasize societal reasons for getting vaccinated and benefits to one’s own health.

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Article Information

Accepted for Publication: September 2, 2021.

Published: November 3, 2021. doi:10.1001/jamanetworkopen.2021.32548

Corresponding Author: A. Rani Elwy, PhD, Bridge Quality Enhancement Research Initiative Program, Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, 200 Springs Rd (Mailstop 152), Bedford, MA 01730 (rani.elwy@va.gov).

Author Contributions: Drs Elwy and Meterko had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Jasuja, Meterko, Carbonaro, Clayman, LoBrutto, Midboe, Asch, Gifford, McInnes, Elwy.

Acquisition, analysis, or interpretation of data: Jasuja, Meterko, Bradshaw, Carbonaro, Clayman, Miano, Maguire, Midboe, Asch, Gifford.

Drafting of the manuscript: Jasuja, Meterko, Bradshaw, Carbonaro, LoBrutto, Elwy.

Critical revision of the manuscript for important intellectual content: Jasuja, Meterko, Bradshaw, Carbonaro, Clayman, Miano, Maguire, Midboe, Asch, Gifford, McInnes.

Statistical analysis: Meterko, Bradshaw, Carbonaro.

Obtained funding: Midboe, Gifford, McInnes, Elwy.

Administrative, technical, or material support: Carbonaro, Clayman, LoBrutto, Miano, Maguire, Midboe, Gifford, Elwy.

Supervision: Clayman, Asch, Gifford, McInnes, Elwy.

Conflict of Interest Disclosures: None reported.

Funding/Support: This project was funded by grant No. QUE 20-017 from the Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development, Quality Enhancement Research Initiative.

Role of the Funder/Sponsor: The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

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Attitudes and Intentions of US Veterans Regarding COVID-19 Vaccination

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