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Who has not been vaccinated, fully vaccinated, or boosted for COVID-19?

      Highlights

      • About 15% are unvaccinated, 17% are not fully vaccinated, and 45% are not boosted.
      • Vaccination coverage was lowest for younger age groups for all vaccination categories.
      • Booster doses were lowest among adults with lower education and income.
      • Frontline and family business workers were less likely to be vaccinated.
      • Main reasons for not being vaccinated were concerns about side effects (53.4%).

      Abstract

      We assessed COVID-19 vaccination coverage (≥1 dose, full vaccination, and booster vaccination) using a large, nationally representative survey of US households (December 29, 2021-January 10, 2022). Almost 1 in 6 adults have not been vaccinated or not been fully vaccinated, and almost one-half of fully vaccinated adults have not received a booster vaccine. All eligible individuals should receive the recommended number of vaccines to prevent further transmission of COVID-19.

      Key Words

      INTRODUCTION

      COVID-19 vaccines and booster doses have been authorized and recommended for use among adults in the United States since December 2020 and October 2021, respectively, yet many people remain unvaccinated, not fully vaccinated, or not boosted for COVID-19.

      Centers for Disease Control and Prevention. COVID-19 ACIP vaccine recommendations. Accessed December 12, 2021. https://www.cdc.gov/vaccines/hcp/acip-recs/vacc-specific/covid-19.html

      For example, as of July 1, 2022, approximately 10% of adults had not received any dose of the COVID-19 vaccine, 23% of adults were not fully vaccinated, and 49% of fully vaccinated adults have not received a booster vaccine.

      Centers for Disease Control and Prevention. COVID data tracker. Assessed March 2, 2022. https://covid.cdc.gov/covid-data-tracker/#vaccinations_vacc-total-admin-rate-pop18

      This is concerning, especially for vulnerable and high-risk populations, such as certain sociodemographic groups, essential worker groups, people in some employment categories, people with disabilities and mental health disorders, people with food insecurity, people living in some residential structures, and households with children.

      Centers for Disease Control and Prevention. People with certain medical conditions. Assessed March 2, 2022. https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-with-medical-conditions.html

      ,
      • Nguyen K.H.
      • Srivastav A.
      • Razzaghi H.
      • et al.
      COVID-19 vaccination intent, perceptions, and reasons for not vaccinating among groups prioritized for early vaccination—United States, September and December 2020.
      The recent surge in cases and hospitalizations due to new variants of COVID-19 viruses underscores the importance of achieving high and equitable vaccination coverage for preventing further transmission of COVID-19 and protecting all individuals from COVID-19 infection and severe health outcomes.

      Centers for Disease Control and Prevention. Trends in number of COVID-19 cases and deaths in the US reported to CDC, by state/territory. Assessed March 2, 2022. https://covid.cdc.gov/covid-data-tracker/#trends_dailycases

      Previous studies have examined possible reasons for nonvaccination, which include concerns about safety and side effects, wanting to ‘wait to see’ if it is safe, and mistrust of vaccines or the government.
      • Nguyen K.H.
      • Nguyen K.
      • Geddes M.
      • Allen J.D.
      • Corlin L.
      Trends in COVID-19 vaccination receipt and intention to vaccinate, United States, April to August, 2021.
      However, most studies have utilized data prior to August 2021 and to our knowledge, none have assessed uptake of the booster dose by groups with elevated risk for COVID-19 infection.
      This study assessed receipt of at least one dose of COVID-19 vaccine, full vaccination, as well as receipt of a booster vaccine, overall and by sociodemographic factors and select high risk groups using a large, nationally representative survey of US households. In addition, factors associated with each vaccination status were examined. Understanding gaps and disparities in vaccination coverage is fundamental to reducing COVID-19–related morbidity and mortality, and preventing further transmission of SARS-CoV-2 variants.

      METHODS

      Data were collected from December 29, 2021 to January 10, 2022 in the Household Pulse Survey (HPS) (sample size = 74,995, response rate = 7.2%.

      Source of the data and accuracy of the estimates for the household pulse survey – phase 3.3. Assessed March 2, 2022. https://www2.census.gov/programs-surveys/demo/technical-documentation/hhp/Phase3-3_Source_and_Accuracy_Week41.pdf

      The survey design of the HPS has been described previously.

      Fields JF, Hunter-Childs J, Tersine A, et al. Design and operation of the 2020 household pulse survey, 2020. U.S. Census Bureau. Assessed September 9, 2021. https://www2.census.gov/programs-surveys/demo/technical-documentation/hhp/2020_ HPS_Background.pdf

      This study was reviewed by the Tufts University Health Sciences Institutional Review Board and considered not to be human subjects research.
      Sociodemographic factors assessed were respondent age group (18-29, 30-39, 40-49, 50-64, ≥65 years), gender (male/female), race/ethnicity (Hispanic, non-Hispanic [NH] Asian, non-Hispanic Black, non-Hispanic white, non-Hispanic other/multiracial], educational attainment (high school equivalent or less, some college, college degree, or higher than college degree), annual household income (<$35,000, $35000-49,999, $50,000-74,999, ≥$75,000, did not report), health insurance (yes/no), prior COVID-19 infection (yes/no), and Health and Human Services region.
      Health and human services regions are defined as the following: Region 1 – Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, and Vermont; Region 2 – New Jersey, and New York; Region 3 – Delaware, District of Columbia, Maryland, Pennsylvania, Virginia, and West Virginia; Region 4 – Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina, and Tennessee; Region 5 – Illinois, Indiana, Michigan, Minnesota, Ohio, and Wisconsin; Region 6 – Arkansas, Louisiana, New Mexico, Oklahoma, and Texas; Region 7 – Iowa, Kansas, Missouri, and Nebraska; Region 8 – Colorado, Montana, North Dakota, South Dakota, Utah, and Wyoming; Region 9 – Arizona, California, Hawaii, and Nevada,; Region 10 – Alaska, Idaho, Oregon, and Washington.
      Other characteristics assessed were employment status,
      Employment status was assessed by the following question: “In the last 7 days, did you do any work for either pay or profit?” (yes/no).
      essential worker group,
      Essential worker status was assessed by the following questions: “In the last 7 days, have you worked or volunteered outside your home?” (yes/no). If respondents answered “yes,” they were asked the following question: “Since January 1, 2021, which best describes the primary location/setting where you worked or volunteered outside your home?” Based on definitions from the U.S. Department of Homeland Security's Cybersecurity and Infrastructure Security Agency's (CISA), respondents were categorized as healthcare personnel (HCP) if their response falls in one of the following three primary location/work settings: 1) healthcare (such as hospital, doctor, dentist or mental health specialist office, outpatient facility, long-term care, home health care, pharmacy, and medical laboratory), 2) social service (such as child, youth, family, elderly, disability services), or 3) death care (such as funeral home, crematory, cemetery). Respondents were categorized as school if they replied with either one of the following settings: 1) education (pre-K, K-12 school) or childcare, or 2) other education (such as business or technical school, college, university). Furthermore, respondents were categories as non-healthcare frontline essential workers if respondents replied with one of the following 8 settings: 1) first responder (such as police or fire protection, emergency relief services), 2) correctional facility (such as jail, prison, detention center, reformatory), 3) food and beverage store (such as grocery store, warehouse club, supercenters, convenience store, specialty food store, bakery, liquor store), 4) agriculture, forestry, fishing, or hunting, 5) food manufacturing facility (such as meat-processing, produce packing, food or beverage manufacturing), 6) non-food manufacturing facility (such as metals, equipment and machinery, electronics), 7) public transit (such as bus, commuter rail, subway, school bus), or 8) United States Postal Service. Respondents were categorized as “other essential workers” if they reported that they were employed in another work setting classified as “essential” during the COVID-19 pandemic. Although not specified in the survey, these categories may include workers in transportation and logistics, food service, energy, water and wastewater, shelter and housing, public safety, IT and communication, news media, public safety, public health workers, finance, legal, and others. Respondents in either HCP, frontline, or other essential worker workers were categorized as “essential workers.” For all other workers, respondents were categorized as non-essential workers if they reported other work settings not classified as “essential” or if they reported that they currently work for either pay or profit but did not work or volunteer outside the home.
      employment type,
      Employment type was assessed by the following question, “Are you employed by the government, by a private company, a nonprofit organization or are you self-employed or working in a family business?” Response options were 1) government, 2) private company, 3) non-profit organization including tax exempt and charitable organizations, 4) self-employed, or 5) working in a family business. Due to small sample sizes, respondents that work in a family business were combined with those who were self-employed.
      disability status,
      Questions on disability and functional status were derived from previously established measures: 1) Do you have difficulty seeing, even when wearing glasses? 2) Do you have difficulty hearing, even when using a hearing aid? 3) Do you have difficulty remembering or concentrating?, and 4) Do you have difficulty walking or climbing stairs? Response options were 1) no difficulty, 2) some difficulty, 3) a lot of difficulty, and 4) cannot do at all. Those who answered “a lot of difficulty” or “cannot do at all” were categorized as having the specific disability pertaining to that question (e.g., hearing disability). This produced four non-mutually exclusive groups for disability. An overall disability status variable was created for those who reported any of the four categories of disability.
      mental health symptoms,
      Questions on anxiety and depression were derived from a validated two-item Patient Health Questionnaire (PHQ-2) and the two-item Generalized Anxiety Disorder (GAD-2) scale. The questions were: 1) “Over the last 2 weeks, how often have you been bothered by … having little interest or pleasure in doing things? Would you say not at all, several days, more than half the days, or nearly every day?” 2) “Over the last 2 weeks, how often have you been bothered by … feeling down, depressed, or hopeless? Would you say not at all, several days, more than half the days, or nearly every day?” Questions from the GAD-2 were: “Over the last 2 weeks, how often have you been bothered by the following problems … Feeling nervous, anxious, or on edge? Would you say not at all, several days, more than half the days, or nearly every day?” 2) “Over the last 2 weeks, how often have you been bothered by the following problems … Not being able to stop or control worrying? Would you say not at all, several days, more than half the days, or nearly every day?” For each scale, responses were assigned a numerical value: not at all=0, several days=1, more than half the days=2, and nearly every day=3. The two responses for each scale were summed and a score equal to three or greater on the PHQ-2 was categorized as symptoms of depression (hereafter referred to as depression)

      Nonresponse bias report for the 2020 household pulse survey. Census Bureau. Accessed January 29, 2022. https://www2.census.gov/programs-surveys/demo/technical-documentation/hhp/2020_HPS_NR_Bias_Report-final.pdf

      . A sum equal to three or greater on the GAD-2 was categorized as symptoms of anxiety (hereafter referred to as anxiety). Adults who had either symptoms of anxiety or depression were categorized as having either disorder.
      oldest age of child in household [no children, <5 years, 5-11 years, 12-17 years], food insecurity (often not enough to eat, sometimes not enough to eat, enough to eat), and residential structure (single family home, townhouse/condo, apartment, mobile/boat/recreational vehicle).
      The percentage of people who did not receive ≥1 dose of COVID-19 vaccine, were not fully vaccinated,⁎
      Full vaccination was defined as receiving ≥1 dose of the Johnson and Johnson (Janssen vaccine), ≥2 doses of Pfizer-Biontech or Moderna vaccine, or ≥2 doses of “one of the brands that requires two initial shots, but not sure which brand”
      ⁎ or were not boosted†
      Booster vaccination was defined as receiving ≥2 dose of the Johnson and Johnson (Janssen vaccine), ≥3 doses of Pfizer-Biontech or Moderna vaccine, or ≥3 doses of “one of the brands that requires two initial shots, but not sure which brand,” among adults who are fully vaccinated for COVID-19.
      The data that support the findings of this study are openly available at https://www.census.gov/programs-surveys/household-pulse-survey/datasets.html.
      † was assessed overall and by sociodemographic characteristics and select groups. Factors associated with not being vaccinated, fully vaccinated, or boosted were assessed using multivariable regression models. Analyses accounted for the survey design and weights to ensure a representative sample in Stata (version 16.1).

      RESULTS

      For all categories of vaccination, coverage was lowest for younger age groups (Table 1, Fig 1). For example, one in 5 adults ages 18-29 years had not received any COVID-19 vaccines and almost two thirds of fully vaccinated adults ages 18-29 years had not received a booster vaccination. NH Black adults were also more likely to not have received the booster vaccination than NH White adults (adjusted prevalence ratio = 1.22, 95% confidence interval = 1.16,1.29). Adults with lower educational status and income levels were also more likely to have lower vaccination coverage across all vaccination groups. Adults without health insurance and those with a previous COVID-19 infection were less likely to be vaccinated, fully vaccinated, or boosted. Adults in the South, Midwest, and West (HHS regions 4,6,7, and 10) were more likely than adults in the Northeast (HHS region 1) to have lower vaccination coverage across all vaccination groups.
      Table 1COVID-19 vaccination status by socioeconomic characteristics, United States, December 29, 2021 – January 10, 2022
      TotalNot vaccinated (n = 7,314)Not fully vaccinated
      Full vaccination was defined as receiving ≥1 dose of the Johnson and Johnson (Janssen vaccine), ≥2 doses of Pfizer-Biontech or Moderna vaccine, or ≥2 doses of “one of the brands that requires two initial shots, but not sure which brand”.
      (n = 8,076)
      Not boosted (n = 22,904)
      Booster vaccination was defined as receiving ≥2 dose of the Johnson and Johnson (Janssen vaccine), ≥3 doses of Pfizer-Biontech or Moderna vaccine, or ≥3 doses of “one of the brands that requires two initial shots, but not sure which brand,” among adults who are fully vaccinated for COVID-19.
      Unweighted (n)%95%CI%95% CIaPR
      Model adjusted for age, gender, race/ethnicity, educational attainment, annual household income, health insurance, previous COVID-19 infection, and HHS region.
      95% CI%95% CIaPR
      Model adjusted for age, gender, race/ethnicity, educational attainment, annual household income, health insurance, previous COVID-19 infection, and HHS region.
      95% CI%95% CIaPR
      Model adjusted for age, gender, race/ethnicity, educational attainment, annual household income, health insurance, previous COVID-19 infection, and HHS region.
      95% CI
      All74,99514.9(14.4, 15.4)16.6(16.0, 17.2)44.9(44.1, 45.6)
      Age group (years)
       65+19,59322.2(22.1, 22.4)6.4(5.7, 7.2)ref.7.3(6.3, 8.2)ref.24.9(23.5, 26.2)ref.
       50-6421,41325.5(25.3, 25.7)11.6(10.9, 12.2)1.94(1.69, 2.23)13(12.3, 13.8)1.9(1.65, 2.20)41.1(39.5, 42.8)1.65(1.54, 1.77)
       40-4914,10816.5(16.3, 16.8)18.7(17.5, 20.0)3.4(2.86, 4.03)20.5(19.2, 21.8)3.23(2.73, 3.82)51.4(49.4, 53.3)2.08(1.94, 2.23)
       30-3913,45518.7(18.3, 19.2)21.2(19.5, 22.8)3.93(3.31, 4.67)23.1(21.4, 24.8)3.7(3.12, 4.39)55(53.1, 56.9)2.31(2.16, 2.47)
       18-296,42617(16.6, 17.3)20.5(18.7, 22.4)3.29(2.79, 3.87)23(21.2, 24.8)3.21(2.75, 3.76)64.7(62.8, 66.5)2.51(2.35, 2.68)
      Gender
       Male30,67248.4(48.4, 48.4)15.5(14.7, 16.3)ref.17.1(16.2, 17.9)ref.43.2(42.0, 44.4)ref.
       Female44,32351.6(51.6, 51.6)14.4(13.8, 15.0)0.95(0.89, 1.03)16.1(15.5, 16.8)0.98(0.91, 1.05)46.4(45.4, 47.4)1.07(1.03, 1.11)
      Race/ethnicity
       NH White54,97762.2(62.1, 62.3)15(14.5, 15.6)ref.16.5(15.9, 17.1)ref.39.8(39.0, 40.6)ref.
       NH Black5,75211.4(11.3, 11.5)18.2(16.6, 19.9)0.85(0.77, 0.94)21.1(19.3, 23.0)0.86(0.78, 0.94)57.9(55.8, 60.0)1.22(1.16, 1.29)
       NH Asian4,0655.6(5.4, 5.7)3(1.9, 4.2)0.22(0.14, 0.36)3.4(2.2, 4.5)0.23(0.15, 0.35)34.4(32.2, 36.7)0.87(0.80, 0.95)
       NH multi/other2,7343.5(3.3, 3.7)21.9(18.3, 25.5)1.11(0.96, 1.28)23.8(20.3, 27.3)1.09(0.95, 1.25)48.6(44.7, 52.4)1.04(0.96, 1.12)
       Hispanic or Latino7,46717.3(17.1, 17.5)14.7(13.1, 16.4)0.55(0.47, 0.63)16.6(15.0, 18.2)0.56(0.49, 0.64)58.2(55.6, 60.8)1.03(0.97, 1.08)
      Educational attainment
       High school or less10,06239(38.9, 39.0)22.1(21.0, 23.3)3.78(3.26, 4.37)24.6(23.2, 25.9)3.52(3.08, 4.02)54(52.2, 55.8)1.94(1.84, 2.05)
       Some college and Associate degree22,70730.2(30.2, 30.2)15(14.2, 15.8)2.53(2.21, 2.89)16.7(15.8, 17.5)2.39(2.12, 2.69)49.9(48.9, 50.9)1.7(1.62, 1.78)
       College graduate (Bachelor degree)22,08617.2(16.9, 17.4)6.7(6.2, 7.2)1.27(1.09, 1.49)7.6(7.1, 8.1)1.25(1.09, 1.44)36.4(35.3, 37.5)1.32(1.26, 1.38)
       Above college graduate20,14013.7(13.5, 13.9)4.6(4.0, 5.1)ref.5.2(4.6, 5.7)ref.25(24.1, 25.9)ref.
      Annual household income
       Less than $35,00013,11622.1(21.5, 22.7)19.9(18.6, 21.1)1.48(1.34, 1.63)23(21.5, 24.5)1.6(1.45, 1.77)55.1(53.1, 57.0)1.29(1.23, 1.36)
       $35,000-$49,9996,8319.8(9.3, 10.2)14.1(12.3, 15.9)1.15(1.01, 1.31)15.8(13.9, 17.7)1.21(1.07, 1.37)50.6(48.6, 52.6)1.23(1.17, 1.30)
       $50,000-$74,99910,60513.7(13.1, 14.2)13.1(11.7, 14.6)1.19(1.04, 1.36)14.2(12.8, 15.6)1.2(1.06, 1.36)45.5(43.5, 47.4)1.2(1.14, 1.26)
       $75,000 and above32,79533.8(33.4, 34.2)8.7(8.1, 9.3)ref.9.3(8.7, 9.9)ref.33.4(32.3, 34.4)ref.
       Did not report11,64820.7(20.0, 21.3)21.6(19.8, 23.3)1.39(1.15, 1.67)24(22.2, 25.8)1.44(1.23, 1.69)53.4(51.2, 55.5)1.18(1.10, 1.26)
      Health insurance
       Yes63,92291.4(91.0, 91.8)11.9(11.4, 12.4)ref.13.1(12.6, 13.7)ref.41.3(40.5, 42.0)ref.
       No3,2818.6(8.2, 9.0)28(24.6, 31.4)1.46(1.27, 1.69)32.7(29.0, 36.4)1.54(1.36, 1.75)69.3(66.0, 72.6)1.17(1.11, 1.24)
      Previous COVID-19 infection
       Yes14,68223.6(23.1, 24.2)21.2(20.0, 22.5)1.6(1.46, 1.77)23.8(22.6, 25.1)1.63(1.50, 1.77)62.6(61.1, 64.2)1.39(1.34, 1.43)
       No5852976.4(75.8, 76.9)11.9(11.4, 12.5)ref.13.3(12.7, 13.9)ref.39.8(39.0, 40.6)ref.
      HHS region
      Health and human services regions (HHS) are defined as the following: Region 1 – Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, and Vermont; Region 2 – New Jersey, and New York; Region 3 – Delaware, District of Columbia, Maryland, Pennsylvania, Virginia, and West Virginia; Region 4 – Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina, and Tennessee; Region 5 – Illinois, Indiana, Michigan, Minnesota, Ohio, and Wisconsin; Region 6 – Arkansas, Louisiana, New Mexico, Oklahoma, and Texas; Region 7 – Iowa, Kansas, Missouri, and Nebraska; Region 8 – Colorado, Montana, North Dakota, South Dakota, Utah, and Wyoming; Region 9 – Arizona, California, Hawaii, and Nevada,; Region 10 – Alaska, Idaho, Oregon, and Washington.
       17,8534.6(4.6, 4.6)8.1(7.1, 9.2)ref.9.3(8.2, 10.5)ref.38.1(36.2, 40.0)ref.
       23,0938.6(8.6, 8.6)8.7(6.9, 10.5)1.09(0.82, 1.43)10.4(8.3, 12.4)1.08(0.84, 1.41)44.6(41.6, 47.5)1.1(1.01, 1.20)
       38,7759.4(9.4, 9.4)13.4(11.6, 15.2)1.69(1.40, 2.04)14.7(12.9, 16.6)1.61(1.33, 1.94)42(40.0, 44.0)1.07(1.00, 1.15)
       410,25920.8(20.8, 20.8)18.3(17.0, 19.7)2.15(1.87, 2.46)20.7(19.2, 22.2)2.09(1.82, 2.39)49.2(47.5, 51.0)1.21(1.13, 1.28)
       59,47115.9(15.9, 15.9)16.9(15.7, 18.1)1.88(1.60, 2.20)18.5(17.3, 19.7)1.81(1.53, 2.13)41.4(39.5, 43.3)1.06(0.98, 1.14)
       67,71412.8(12.8, 12.8)17.6(16.0, 19.3)1.85(1.54, 2.22)19.6(17.8, 21.4)1.78(1.50, 2.11)50.6(48.6, 52.5)1.15(1.07, 1.23)
       74,6274.2(4.2, 4.2)16.7(14.9, 18.4)1.92(1.59, 2.31)18.5(16.8, 20.2)1.81(1.52, 2.16)43.9(41.2, 46.6)1.11(1.01, 1.21)
       86,7523.7(3.7, 3.7)16.8(15.2, 18.3)2(1.69, 2.38)18.5(16.9, 20.0)1.92(1.63, 2.26)41.6(39.6, 43.6)1.04(0.96, 1.13)
       99,77015.6(15.6, 15.6)12.2(10.4, 14.1)1.58(1.25, 1.99)13.3(11.4, 15.2)1.49(1.19, 1.86)44.1(41.9, 46.3)1.07(1.00, 1.15)
       106,6814.5(4.5, 4.5)12.9(11.6, 14.2)1.57(1.30, 1.88)13.7(12.4, 15.1)1.44(1.20, 1.72)42.6(40.8, 44.4)1.1(1.03, 1.18)
      aPR, adjusted prevalence ratio; CI, confidence interval; HHS, Health and Human Services.
      low asterisk Full vaccination was defined as receiving ≥1 dose of the Johnson and Johnson (Janssen vaccine), ≥2 doses of Pfizer-Biontech or Moderna vaccine, or ≥2 doses of “one of the brands that requires two initial shots, but not sure which brand”.
      Booster vaccination was defined as receiving ≥2 dose of the Johnson and Johnson (Janssen vaccine), ≥3 doses of Pfizer-Biontech or Moderna vaccine, or ≥3 doses of “one of the brands that requires two initial shots, but not sure which brand,” among adults who are fully vaccinated for COVID-19.
      Model adjusted for age, gender, race/ethnicity, educational attainment, annual household income, health insurance, previous COVID-19 infection, and HHS region.
      § Health and human services regions (HHS) are defined as the following: Region 1 – Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, and Vermont; Region 2 – New Jersey, and New York; Region 3 – Delaware, District of Columbia, Maryland, Pennsylvania, Virginia, and West Virginia; Region 4 – Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina, and Tennessee; Region 5 – Illinois, Indiana, Michigan, Minnesota, Ohio, and Wisconsin; Region 6 – Arkansas, Louisiana, New Mexico, Oklahoma, and Texas; Region 7 – Iowa, Kansas, Missouri, and Nebraska; Region 8 – Colorado, Montana, North Dakota, South Dakota, Utah, and Wyoming; Region 9 – Arizona, California, Hawaii, and Nevada,; Region 10 – Alaska, Idaho, Oregon, and Washington.
      Fig 1
      Fig 1COVID-19 vaccination status by age group, United States, December 29, 2021 – January 10, 2022.
      People who are unemployed, frontline essential workers, and those working in family businesses were more likely to be unvaccinated (Table 2). Households with children, particularly children <5 years, were more likely to be unvaccinated than households without children. Adults who often do not have enough to eat, or live in transient homes such as mobile home, boat, van, or recreational vehicles, were more likely not to have received any doses, not to be fully vaccinated, or not to be boosted than those with enough to eat or those living in single family homes, respectively.
      Table 2COVID-19 vaccination status by select groups, United States, December 29, 2021 – January 10, 2022
      OverallNot vaccinatedNot fully vaccinated
      Full vaccination was defined as receiving ≥1 dose of the Johnson and Johnson (Janssen vaccine), ≥2 doses of Pfizer-Biontech or Moderna vaccine, or ≥2 doses of “one of the brands that requires two initial shots, but not sure which brand”.
      Not boosted
      Booster vaccination was defined as receiving ≥2 dose of the Johnson and Johnson (Janssen vaccine), ≥3 doses of Pfizer-Biontech or Moderna vaccine, or ≥3 doses of “one of the brands that requires two initial shots, but not sure which brand,” among adults who are fully vaccinated for COVID-19.
      % (95% CI)% (95% CI)aPR
      Separate multivariable logistic models were conducted for each group as the explanatory variable and adjusted for age, gender, race/ethnicity, educational attainment, annual household income, health insurance, previous COVID-19 infection, and Health and Human services region.
      (95% CI)
      % (95% CI)aPR
      Separate multivariable logistic models were conducted for each group as the explanatory variable and adjusted for age, gender, race/ethnicity, educational attainment, annual household income, health insurance, previous COVID-19 infection, and Health and Human services region.
      (95% CI)
      % (95% CI)aPR
      Separate multivariable logistic models were conducted for each group as the explanatory variable and adjusted for age, gender, race/ethnicity, educational attainment, annual household income, health insurance, previous COVID-19 infection, and Health and Human services region.
      (95% CI)
      Employed
       No44.4 (43.7, 45.0)15.4 (14.5, 16.4)ref.17.3 (16.2, 18.4)ref.42.5 (41.4, 43.7)ref.
       Yes55.6 (55.0, 56.3)13.1 (12.4, 13.8)0.83 (0.76, 0.89)14.5 (13.8, 15.2)0.82 (0.76, 0.89)46.2 (45.3, 47.2)1.00 (0.96, 1.04)
      Essential worker group
       Non-essential worker64.8 (63.9, 65.8)12.3 (11.5, 13.1)ref.13.5 (12.7, 14.3)ref.46.0 (44.7, 47.2)ref.
       Healthcare personnel8.9 (8.4, 9.4)5.9 (4.7, 7.0)0.54 (0.45, 0.67)7.9 (6.6, 9.1)0.65 (0.55, 0.77)40.6 (37.5, 43.8)0.86 (0.79, 0.83)
       School4.7 (4.4, 5.0)7.5 (5.9, 9.1)0.91 (0.74, 1.12)8.9 (7.1, 10.7)0.96 (0.79, 1.17)36.2 (32.8, 39.7)0.88 (0.79, 0.98)
       Frontline worker9.5 (9.0, 10.0)21.5 (19.2, 23.8)1.36 (1.19, 1.56)22.8 (20.4, 25.1)1.32 (1.16, 1.49)53.6 (50.4, 56.8)1.03 (0.96, 1.11)
       Other essential worker12.0 (11.3, 12.7)17.7 (15.3, 20.2)1.15 (0.96, 1.39)19.8 (17.3, 22.2)1.78 (1.00, 1.38)50.0 (46.6, 53.4)0.98 (0.91, 1.06)
      Employment type
       Non-profit9.3 (8.8, 9.8)6.1 (4.7, 7.6)ref.6.7 (5.3, 8.1)ref.35.2 (32.7, 37.8)ref.
       Private63.4 (62.6, 64.1)13.4 (12.5, 14.3)1.37 (1.06, 1.76)14.9 (13.9, 15.9)1.42 (1.13, 1.78)48.5 (47.2, 49.7)1.18 (1.09, 1.27)
       Government14.0 (13.5, 14.6)9.6 (8.1, 11.1)1.24 (0.91, 1.69)10.7 (9.1, 12.2)1.28 (0.95, 1.71)43.2 (40.8, 45.6)1.11 (1.01, 1.22)
       Family business (including self-employment)13.2 (12.6, 13.9)19.5 (17.1, 21.9)2.26 (1.69, 3.03)21.2 (18.7, 23.7)2.29 (1.76, 2.98)45.5 (42.9, 48.0)1.15 (1.06, 1.26)
      Disability status
       No86.0 (85.4, 86.5)12.9 (12.3, 13.5)ref.14.3 (13.6, 15.0)ref.42.4 (41.5, 43.3)ref.
       Yes14.0 (13.5, 14.6)16.1 (14.2, 17.9)0.97 (0.87, 1.09)18.4 (16.6, 20.1)0.99 (0.91, 1.09)48.4 (46.1, 50.7)1.03 (0.98, 1.08)
      Mental health symptoms
       None67.9 (67.2, 68.7)13.0 (12.4, 13.6)ref.14.3 (13.6, 14.9)ref.39.9 (39.0, 40.8)ref.
       Anxiety or depression32.1 (31.3, 32.8)14.6 (13.7, 15.5)0.79 (0.72, 0.87)16.7 (15.7, 17.8)0.83 (0.76, 0.90)50.9 (49.3, 52.5)1.02 (0.97, 1.06)
      Households with children
       None63.3 (62.6, 64.1)10.8 (10.3, 11.4)ref.12.1 (11.6, 12.7)ref.39.5 (38.6, 40.4)ref.
       <5 years old7.1 (6.7, 7.5)24.9 (21.5, 28.2)1.75 (1.48, 2.06)28.8 (25.0, 32.5)1.86 (1.63, 2.13)55.5 (52.6, 58.4)1.13 (1.05, 1.21)
       5-11 years old10.9 (10.5, 11.4)22.0 (20.4, 23.6)1.53 (1.37, 1.72)24.1 (22.5, 25.7)1.51 (1.37, 1.67)56.3 (54.3, 58.2)1.16 (1.11, 1.22)
       12-17 years old18.7 (18.1, 19.3)20.8 (19.3, 22.3)1.51 (1.37, 1.68)22.5 (21.0, 24.1)1.48 (1.34, 1.62)56.3 (53.7, 58.8)1.12 (1.06, 1.19)
      Food sufficiency
       Enough food to eat89.8 (89.4, 90.3)12.5 (11.9, 13.0)ref.13.7 (13.2, 14.3)ref.41.4 (40.6, 42.2)ref.
       Sometimes7.9 (7.5, 8.4)22.2 (19.3, 25.1)1.14 (0.98, 1.32)26.4 (23.3, 29.4)1.21 (1.06, 1.38)65.3 (62.4, 68.3)1.12 (1.07, 1.18)
       Often not enough to eat2.2 (2.0, 2.5)29.4 (24.6, 34.3)1.33 (1.08, 1.66)33.4 (28.3, 38.4)1.34 (1.11, 1.62)72.2 (66.9, 77.5)1.16 (1.07, 1.27)
      Housing type
       Single-family home66.4 (65.7, 67.1)12.5 (11.8, 13.2)ref.13.9 (13.1, 14.7)ref.39.8 (38.8, 40.7)ref.
       Townhouse/condo7.6 (7.2, 7.9)9.3 (7.8, 10.9)0.69 (0.57, 0.84)10.4 (8.8, 12.0)0.69 (0.58, 0.82)45.1 (41.9, 48.2)1.01 (0.94, 1.09)
       Multi-unit home20.5 (19.9, 21.2)13.3 (11.7, 14.9)0.84 (0.74, 0.95)14.9 (13.3, 16.4)0.84 (0.75, 0.94)49.9 (48.0, 51.8)1.00 (0.96, 1.05)
       Other- including mobile home, boat, van, RV5.5 (5.1, 5.9)26.9 (23.8, 30.1)1.26 (1.09, 1.45)30.8 (27.4, 34.3)1.27 (1.13, 1.43)56.5 (52.5, 60.4)1.11 (1.03, 1.19)
      aPR, adjusted prevalence ratio; CI, confidence interval; ref, reference.
      low asterisk Full vaccination was defined as receiving ≥1 dose of the Johnson and Johnson (Janssen vaccine), ≥2 doses of Pfizer-Biontech or Moderna vaccine, or ≥2 doses of “one of the brands that requires two initial shots, but not sure which brand”.
      Booster vaccination was defined as receiving ≥2 dose of the Johnson and Johnson (Janssen vaccine), ≥3 doses of Pfizer-Biontech or Moderna vaccine, or ≥3 doses of “one of the brands that requires two initial shots, but not sure which brand,” among adults who are fully vaccinated for COVID-19.
      Separate multivariable logistic models were conducted for each group as the explanatory variable and adjusted for age, gender, race/ethnicity, educational attainment, annual household income, health insurance, previous COVID-19 infection, and Health and Human services region.
      The main reasons for not being vaccinated were concerns about side effects (53.4%), lack of trust in vaccines (42.4%), lack of trust in the government (36.3%), and belief that a vaccine is not needed (29.8%; Fig 2)
      Fig 2
      Fig 2Main reasons for not intending to receive COVID-19 vaccination in United States.

      CONCLUSION AND DISCUSSION

      Despite increases in vaccination coverage since the beginning of the vaccination campaign,
      • Nguyen K.H.
      • Nguyen K.
      • Geddes M.
      • Allen J.D.
      • Corlin L.
      Trends in COVID-19 vaccination receipt and intention to vaccinate, United States, April to August, 2021.
      almost 1 in 6 adults have not been vaccinated or not been fully vaccinated, and almost one-half have not received a booster vaccine. Similar to sociodemographic characteristics for nonvaccination found in previous studies,
      • Nguyen K.H.
      • Srivastav A.
      • Razzaghi H.
      • et al.
      COVID-19 vaccination intent, perceptions, and reasons for not vaccinating among groups prioritized for early vaccination—United States, September and December 2020.
      ,
      • Nguyen K.H.
      • Nguyen K.
      • Geddes M.
      • Allen J.D.
      • Corlin L.
      Trends in COVID-19 vaccination receipt and intention to vaccinate, United States, April to August, 2021.
      lack of booster vaccination was highest among younger adults, Hispanic and NH Black adults, adults with lower educational attainment and income levels, adults with no insurance, adults with a previous COVID-19 diagnosis, and adults living in the Southern region of the United States. Furthermore, adults who were not employed, were frontline essential workers or worked in a family business were more likely not to be vaccinated or boosted.
      The findings in this study are subject to several limitations. First, although sampling methods and data weighting were designed to produce nationally representative results, respondents might not be fully representative of the general US adult population. Second, vaccination status for respondents was self-reported and is subject to social desirability bias. Third, the survey did not collect dates of vaccination, so lack of full vaccination coverage or booster vaccination may be due to ineligibility in a small percentage of individuals. Finally, the HPS has a low response rate (<10%); although non-response bias assessment conducted by the Census Bureau found that the survey weights mitigated most of this bias.

      Nonresponse bias report for the 2020 household pulse survey. Census Bureau. Accessed January 29, 2022. https://www2.census.gov/programs-surveys/demo/technical-documentation/hhp/2020_HPS_NR_Bias_Report-final.pdf

      With preventive measures, such as social distancing and mask mandates, lifting throughout the United States,

      Mask mandates ending in all but one state. WebMD. Accessed February 23, 2022. https://www.webmd.com/lung/news/20220223/mask-mandates-ending-all-but-one-state

      it is crucial that all eligible individuals receive the recommended number of vaccines as soon as possible to prevent further transmission of COVID-19 and to bring an end to the pandemic.

      References

      1. Centers for Disease Control and Prevention. COVID-19 ACIP vaccine recommendations. Accessed December 12, 2021. https://www.cdc.gov/vaccines/hcp/acip-recs/vacc-specific/covid-19.html

      2. Centers for Disease Control and Prevention. COVID data tracker. Assessed March 2, 2022. https://covid.cdc.gov/covid-data-tracker/#vaccinations_vacc-total-admin-rate-pop18

      3. Centers for Disease Control and Prevention. People with certain medical conditions. Assessed March 2, 2022. https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-with-medical-conditions.html

        • Nguyen K.H.
        • Srivastav A.
        • Razzaghi H.
        • et al.
        COVID-19 vaccination intent, perceptions, and reasons for not vaccinating among groups prioritized for early vaccination—United States, September and December 2020.
        MMWR Morb Mortal Wkly Rep. 2021; 70: 217-222
      4. Centers for Disease Control and Prevention. Trends in number of COVID-19 cases and deaths in the US reported to CDC, by state/territory. Assessed March 2, 2022. https://covid.cdc.gov/covid-data-tracker/#trends_dailycases

        • Nguyen K.H.
        • Nguyen K.
        • Geddes M.
        • Allen J.D.
        • Corlin L.
        Trends in COVID-19 vaccination receipt and intention to vaccinate, United States, April to August, 2021.
        Am J Infect Control. 2021; 50: 699-703
      5. Source of the data and accuracy of the estimates for the household pulse survey – phase 3.3. Assessed March 2, 2022. https://www2.census.gov/programs-surveys/demo/technical-documentation/hhp/Phase3-3_Source_and_Accuracy_Week41.pdf

      6. Fields JF, Hunter-Childs J, Tersine A, et al. Design and operation of the 2020 household pulse survey, 2020. U.S. Census Bureau. Assessed September 9, 2021. https://www2.census.gov/programs-surveys/demo/technical-documentation/hhp/2020_ HPS_Background.pdf

      7. Nonresponse bias report for the 2020 household pulse survey. Census Bureau. Accessed January 29, 2022. https://www2.census.gov/programs-surveys/demo/technical-documentation/hhp/2020_HPS_NR_Bias_Report-final.pdf

      8. Mask mandates ending in all but one state. WebMD. Accessed February 23, 2022. https://www.webmd.com/lung/news/20220223/mask-mandates-ending-all-but-one-state