More than three-quarters of American adults didn’t get a covid shot last season, a figure that health care experts warn could rise this year amid new U.S. government recommendations.
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, Centers for Disease Control and Prevention data shows. But only about 23% of American adults got a covid shot during the 2024-25 virus season, well below the 47% of American adults who got a flu shot. The vaccination rates for flu, measles, and tetanus are also going down.
Yet covid remains a serious, potentially deadly health risk, listed as the primary cause of death on roughly 31,400 death certificates last year. By comparison, flu killed about 6,500 people and pneumonia, a common complication of the flu, killed an additional 41,600, CDC data shows.
As millions of Americans decide whether to get a covid shot this season, public health researchers worry vaccination rates will slide further, especially because Hispanic and Black Americans and those under 30 have lower rates, exposing them to serious complications such as long covid. Under the Trump administration and Health and Human Services Secretary Robert F. Kennedy Jr., the federal government has narrowed its recommendations on the covid vaccine, leading to a hodgepodge of rules on pharmacy access, with Americans living in Republican states often facing more barriers to getting a shot.
“A lot of misinformation is going around regarding covid,” said Alein Haro-Ramos, an assistant professor of health, society, and behavior at the University of California-Irvine. “Vaccine hesitancy is going to increase.”
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In August, the FDA narrowed approval for covid vaccines to those 65 or older and to adults and children with at least one underlying condition that puts them at high risk for serious complications from covid.
A month later, the CDC’s Advisory Committee on Immunization Practices voted to recommend “shared clinical decision-making” on the vaccine, pulling back from advising all adults to get vaccinated. The committee advised doctors to emphasize to adults under 65 and children that the benefits of the vaccine are greatest for those with underlying health conditions.
The guidance is rebutted by infectious disease experts who say most adults and children should get both the flu and covid vaccines, which are safe, effective, and prevent serious illness. Several independent medical organizations like the American Academy of Family Physicians and the American Academy of Pediatrics have reiterated their support for broad adoption of covid vaccines.
More than two dozen states have taken steps to ensure most people can get a covid shot at the pharmacy without a prescription, with many states tying their policies to the advice given by medical organizations. And many of those states require insurers to cover vaccines at no cost, according to a KFF analysis. In several other states, predominantly Republican-led, pharmacy access to vaccines may require a prescription.
Among the most commonly cited reasons for covid vaccine hesitation are fears about side effects, long-term health consequences, and the effectiveness of the vaccine, and mistrust of pharmaceutical corporations and government officials, according to a 2024 review of multiple studies, published in the journal Vaccines.
Covid vaccine hesitancy in the 2024-25 virus season was higher among Latinos, African Americans, men, uninsured people, and people living in Republican-leaning states, CDC data shows.
Latino adults were significantly less likely than adults from most other racial and ethnic groups to get a covid shot last season, with a vaccination rate around 15%.
Some of that may be due to age: A disproportionate share of Latinos are young. But public policy actions may also be a factor. The first Trump administration, for example, tied Medicaid to “public charge,” a rule allowing the federal government to deny an immigrant a green card or visa based on their dependence on taxpayer-funded programs. Some Latinos may be afraid to sign up for social services even after the Biden administration reversed those first-term Trump actions.
Haro-Ramos co-authored a study published in 2024 that found many Latinos were hesitant to get vaccinated because of fears about their immigration status, and that experiencing health discrimination, like care denials or delays, increased their vaccine hesitancy.
“Do you trust the health care system, broadly speaking? Do you want to provide 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 appointments to head off possible confrontation with immigration enforcement officials.
“People are avoiding leaving their homes at all costs,” Haro-Ramos said.
Janani Rajbhandari-Thapa, an associate professor at the University of Georgia College of Public Health, recently co-authored a study of covid vaccination among 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 faith leaders or co-workers when seeking advice on getting vaccinated.
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 that tied vaccines to miscarriages, to components’ remaining in the body for a long time, or even to the conspiracy that they implant a computer chip in the body.
“It’s the clinicians who can take the messages about vaccination — that these are myths,” Rajbhandari-Thapa said.
Even though covid hospitalization and death rates have fallen dramatically since the worst days of the pandemic, fatal complications related to covid remain most common among older people. Around 89% of U.S. covid deaths last year were among people 65 and older, compared with about 81% of flu and pneumonia deaths.
As the pandemic falls into the rearview, young people have developed a sense of invincibility. Only 11% of Americans ages 18 to 29 received a vaccine during the 2024-25 virus season, the lowest vaccination rate among adult age groups. That’s far below the 70% of young adults who got at least one dose of the initial covid vaccines by November 2023.
While many people get covid after receiving a covid shot, because the vaccine’s ability to prevent infection wears off pretty fast, some misunderstand the purpose of the shot, 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’re not seeing is that the vaccine prevented them from getting severely ill, which is ultimately the most important thing.”
And the vaccine can help prevent long covid, which is a problem for all ages, Yang said. A recent Northwestern University study found that younger adults suffer worse symptoms of long covid than older adults.
Ultimately, Yang said, it is not a consistent choice to get a flu vaccine but forgo a covid vaccine, since both are safe, effective, and prevent serious illness. It is clear, he added, that people with compromised immune systems and those at higher risk should get a covid shot. The decision is “a little bit less clear” for others, but “probably most adults should be getting vaccinated, just like it’s recommended for the flu vaccine, as well as most children.”
Phillip Reese is a data reporting specialist and an associate professor of journalism at California State University-Sacramento.
