. 2025 Feb 27:48:126806.

doi: 10.1016/j.vaccine.2025.126806. Epub 2025 Jan 30.

COVID-19 and influenza vaccine Hesitancy among adults hospitalized in the United States, 2019-2022

Akram Khan¹, Yuwei Zhu², Hilary M Babcock³, Laurence W Busse⁴, Abhijit Duggal⁵, Matthew C Exline⁶, Manjusha Gaglani⁷, Kevin W Gibbs⁸, Michelle N Gong⁹, Adit A Ginde¹⁰, David N Hager¹¹, Aluko A Hope¹², Jessica Hyde¹³, Nicholas J Johnson¹⁴, Jennie H Kwon¹⁵, Nicholas M Mohr¹⁶, Mary O'Rourke¹⁷, Ithan D Peltan¹⁸, Christopher Mallow¹⁹, Nida Qadir²⁰, Raju Reddy²¹, Basmah Safdar²², Nathan I Shapiro²³, Ine Sohn²⁴, Jay S Steingrub²⁵, Jennifer G Wilson²⁶, Adrienne Baughman²⁷, Kelsey N Womack²⁸, Jillian P Rhoads²⁹, Wesley H Self³⁰, William B Stubblefield³¹; Investigating Respiratory Viruses in the Acutely Ill (IVY) Network

Affiliations

¹ Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, Oregon Health and Sciences University, Portland, OR, USA. Electronic address: khana@ohsu.edu.
² Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA. Electronic address: yuwei.zhu@vumc.org.
³ Department of Medicine, Washington University in St. Louis, MO, USA. Electronic address: hbabcock@wustl.edu.
⁴ Department of Medicine, Emory University, Atlanta, Georgia Emory Critical Care Center, Emory Healthcare, Atlanta, GA, USA. Electronic address: laurence.w.busse@emory.edu.
⁵ Department of Critical Care, Integrated Hospital Care Institute. Cleveland Clinic, Cleveland, OH, USA. Electronic address: duggala2@ccf.org.
⁶ Department of Medicine, The Ohio State University, Columbus, OH, USA. Electronic address: Matthew.Exline@osumc.edu.
⁷ Baylor Scott and White Health, Temple and Dallas, Texas, and Texas A&M University College of Medicine, Temple, TX, USA. Electronic address: manjusha.gaglani@bswhealth.org.
⁸ Department of Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA. Electronic address: kgibbs@wakehealth.edu.
⁹ Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA. Electronic address: mgong@montefiore.org.
¹⁰ Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, USA. Electronic address: adit.ginde@cuanschutz.edu.
¹¹ Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA. Electronic address: dhager1@jhmi.edu.
¹² Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, Oregon Health and Sciences University, Portland, OR, USA. Electronic address: hopeal@ohsu.edu.
¹³ Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, Oregon Health and Sciences University, Portland, OR, USA. Electronic address: hydeje@ohsu.edu.
¹⁴ Department of Emergency Medicine and Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, WA, USA. Electronic address: nickj45@uw.edu.
¹⁵ Department of Medicine, Washington University, St. Louis, MO, USA. Electronic address: j.kwon@wustl.edu.
¹⁶ University of Iowa, Iowa City, Iowa, USA. Electronic address: nicholas-mohr@uiowa.edu.
¹⁷ Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN, USA. Electronic address: Mary.ORourke@hcmed.org.
¹⁸ Department of Medicine, Intermountain Medical Center, Murray, Utah and University of Utah, Salt Lake City, UT, USA. Electronic address: Ithan.Peltan@imail.org.
¹⁹ Department of Medicine, University of Miami, Miami, Flo Department of Medicine, University of Miami, Miami, FL, USA. Electronic address: cmallow@miami.edu.
²⁰ Department of Medicine, University of California-Los Angeles, Los Angeles, CA, USA. Electronic address: NQadir@mednet.ucla.edu.
²¹ Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, Oregon Health and Sciences University, Portland, OR, USA. Electronic address: reddyr@ohsu.edu.
²² Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT, USA. Electronic address: basmah.safdar@yale.edu.
²³ Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA. Electronic address: nshapiro@bidmc.harvard.edu.
²⁴ Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA. Electronic address: ine.sohn@vumc.org.
²⁵ Department of Medicine, Baystate Medical Center, Springfield, MA, USA. Electronic address: Jay.Steingrub@baystatehealth.org.
²⁶ Department of Emergency Medicine, Stanford University School of Medicine, Stanford, CA, USA. Electronic address: jennygwilson@stanford.edu.
²⁷ Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN, USA. Electronic address: adrienne.baughman@vumc.org.
²⁸ Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, TN, USA. Electronic address: kelsey.womack@vumc.org.
²⁹ Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, TN, USA. Electronic address: jillian.p.rhoads@vumc.org.
³⁰ Vanderbilt Institute for Clinical and Translational Research, and Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
³¹ Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.

PMID: 39884913
PMCID: PMC12229716 (available on 2026-02-27)
DOI: 10.1016/j.vaccine.2025.126806

COVID-19 and influenza vaccine Hesitancy among adults hospitalized in the United States, 2019-2022

Akram Khan et al. Vaccine. 2025.

. 2025 Feb 27:48:126806.

doi: 10.1016/j.vaccine.2025.126806. Epub 2025 Jan 30.

Authors

Affiliations

¹ Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, Oregon Health and Sciences University, Portland, OR, USA. Electronic address: khana@ohsu.edu.
² Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA. Electronic address: yuwei.zhu@vumc.org.
³ Department of Medicine, Washington University in St. Louis, MO, USA. Electronic address: hbabcock@wustl.edu.
⁴ Department of Medicine, Emory University, Atlanta, Georgia Emory Critical Care Center, Emory Healthcare, Atlanta, GA, USA. Electronic address: laurence.w.busse@emory.edu.
⁵ Department of Critical Care, Integrated Hospital Care Institute. Cleveland Clinic, Cleveland, OH, USA. Electronic address: duggala2@ccf.org.
⁶ Department of Medicine, The Ohio State University, Columbus, OH, USA. Electronic address: Matthew.Exline@osumc.edu.
⁷ Baylor Scott and White Health, Temple and Dallas, Texas, and Texas A&M University College of Medicine, Temple, TX, USA. Electronic address: manjusha.gaglani@bswhealth.org.
⁸ Department of Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA. Electronic address: kgibbs@wakehealth.edu.
⁹ Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA. Electronic address: mgong@montefiore.org.
¹⁰ Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, USA. Electronic address: adit.ginde@cuanschutz.edu.
¹¹ Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA. Electronic address: dhager1@jhmi.edu.
¹² Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, Oregon Health and Sciences University, Portland, OR, USA. Electronic address: hopeal@ohsu.edu.
¹³ Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, Oregon Health and Sciences University, Portland, OR, USA. Electronic address: hydeje@ohsu.edu.
¹⁴ Department of Emergency Medicine and Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, WA, USA. Electronic address: nickj45@uw.edu.
¹⁵ Department of Medicine, Washington University, St. Louis, MO, USA. Electronic address: j.kwon@wustl.edu.
¹⁶ University of Iowa, Iowa City, Iowa, USA. Electronic address: nicholas-mohr@uiowa.edu.
¹⁷ Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN, USA. Electronic address: Mary.ORourke@hcmed.org.
¹⁸ Department of Medicine, Intermountain Medical Center, Murray, Utah and University of Utah, Salt Lake City, UT, USA. Electronic address: Ithan.Peltan@imail.org.
¹⁹ Department of Medicine, University of Miami, Miami, Flo Department of Medicine, University of Miami, Miami, FL, USA. Electronic address: cmallow@miami.edu.
²⁰ Department of Medicine, University of California-Los Angeles, Los Angeles, CA, USA. Electronic address: NQadir@mednet.ucla.edu.
²¹ Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, Oregon Health and Sciences University, Portland, OR, USA. Electronic address: reddyr@ohsu.edu.
²² Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT, USA. Electronic address: basmah.safdar@yale.edu.
²³ Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA. Electronic address: nshapiro@bidmc.harvard.edu.
²⁴ Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA. Electronic address: ine.sohn@vumc.org.
²⁵ Department of Medicine, Baystate Medical Center, Springfield, MA, USA. Electronic address: Jay.Steingrub@baystatehealth.org.
²⁶ Department of Emergency Medicine, Stanford University School of Medicine, Stanford, CA, USA. Electronic address: jennygwilson@stanford.edu.
²⁷ Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN, USA. Electronic address: adrienne.baughman@vumc.org.
²⁸ Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, TN, USA. Electronic address: kelsey.womack@vumc.org.
²⁹ Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, TN, USA. Electronic address: jillian.p.rhoads@vumc.org.
³⁰ Vanderbilt Institute for Clinical and Translational Research, and Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
³¹ Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.

PMID: 39884913
PMCID: PMC12229716 (available on 2026-02-27)
DOI: 10.1016/j.vaccine.2025.126806

Abstract

Background: Understanding similarities and differences between hesitancy for influenza and COVID-19 vaccines could facilitate strategies to improve public receptivity toward vaccination.

Methods: We compared hesitancy for COVID-19 vaccines during the first 13 months of availability (January 2021-January 2022) with hesitancy for influenza vaccines in the 15 months prior to COVID-19 vaccine availability (October 2019-December 2020) among adults hospitalized with acute respiratory illness at 21 hospitals in the United States. We interviewed patients regarding vaccination status, willingness to be vaccinated, and perceptions of vaccine safety and efficacy. We used multivariate logistic regression to identify factors associated with vaccine hesitancy.

Results: Among 12,292 patients enrolled during the COVID-19 vaccine period, 5485 (44.6 %) were unvaccinated. Patient characteristics associated with not receiving the COVID-19 vaccine included younger age, female sex, higher BMI, lack of health insurance, absence of chronic comorbid medical conditions, no or rare influenza vaccination in prior years, higher CDC social vulnerability index (SVI), a measure of external stresses that may negatively impact health, living in the Midwest or southern US, lack of college or higher education, and not wearing a mask. Among 983 patients enrolled during the influenza vaccination period, 381(37.8 %) were unvaccinated. Characteristics associated with not receiving the influenza vaccine included no or one chronic comorbid medical condition, no or rare influenza vaccination in prior years, being a current smoker, and higher SVI. Discussion with healthcare providers was a reason for vaccination for 27.7 % (167) for influenza and 8.3 % (564) for COVID-19 and to decline vaccination for 0.5 % Ten great public health achievements-United States (2011) (2) for influenza and 2.2 % (118) for COVID-19.

Conclusions: We found that higher SVI scores and lack of prior influenza vaccination were associated with hesitancy for both COVID-19 and influenza vaccines. There were regional variations in COVID-19 vaccine acceptance and discussions with HCPs significantly influenced acceptance for both vaccines.

Keywords: COVID-19; Influenza; SARS-CoV-2; Vaccine acceptance; Vaccine hesitancy.

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Conflict of interest statement

Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

References

1. Ten great public health achievements--United States, 1900–1999. MMWR Morb Mortal Wkly Rep. 1999;48:241–3. - PubMed
1. Ten great public health achievements--United States, 2001–2010. MMWR Morb Mortal Wkly Rep. 2011;60:619–23. - PubMed
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COVID-19 and influenza vaccine Hesitancy among adults hospitalized in the United States, 2019-2022

Affiliations

COVID-19 and influenza vaccine Hesitancy among adults hospitalized in the United States, 2019-2022

Authors

Affiliations

Abstract

Conflict of interest statement

References

Publication types

MeSH terms

Substances

Grants and funding

LinkOut - more resources

Full Text Sources

Medical

Miscellaneous