Adults without a high school degree were more than three times as likely to be unvaccinated against COVID-19 as adults with a graduate degree, and uninsured adults were more than twice as likely to be unvaccinated as insured ones, according to an analysis of 13,802 survey responses published in the journal Vaccine.
The finding that complicates the familiar story is what the same data show about trust. Among participants who said they distrusted various institutions as sources of COVID information, vaccination rates still ranged from 72.4 to 83.8 percent. Even among people who said they did not trust the Food and Drug Administration to ensure vaccine safety, 52 percent had received at least one dose.
One thing must be established before any of these numbers can be considered current. The surveys were collected between November 2020 and November 2022. These are pandemic-era figures being analyzed now, not a measure of how Americans are behaving this fall.
Access and Schooling Separated the Vaccinated from the Unvaccinated
Researchers at Rush University College of Nursing analyzed responses from the Community Engagement Alliance Common Survey 2, as summarized by the Center for Infectious Disease Research and Policy. Across the full sample, 87.2 percent had received at least one COVID vaccine dose.
The gradients within that figure are where the useful information sits. About 21 percent of people without a high school degree were unvaccinated, compared to 6.2 percent of those holding a graduate degree. Adults 65 and older were the least likely to be unvaccinated at 5.5 percent, while 17.5 percent of those aged 18 to 24 had not received a dose.
Insurance status is tracked closely with both. A quarter of uninsured participants were unvaccinated, compared with 11 percent of insured participants, even during a period when COVID vaccines were free at the point of care. That gap points to something other than price. Being uninsured usually means no regular clinician recommending the shot, less flexibility to take time off, and fewer routine appointments where vaccination comes up.
Vaccination rates also differed by race and ethnicity. Non-Hispanic White participants had the highest rate at 91.8 percent, followed by Hispanic participants at 87.9 percent and non-Hispanic Black participants at 81.8 percent.
Distrust of Institutions Did Not Reliably Predict Refusal
Roughly 40 percent of respondents expressed deep distrust in the federal government's ability to provide a safe vaccine for children. Yet only 8.5 percent said they did not trust the FDA to make safe COVID vaccines for adults, and fewer than 5 percent said they did not trust their own doctors as a source of COVID information.
The gap between stated distrust and actual behavior is the most transferable finding here. A person can hold a low opinion of a federal agency and still get vaccinated because a clinician they know recommended it. Survey questions about institutional trust, which drive much of the public commentary, are poor predictors of what an individual does. Separate work on vaccine conspiracy beliefs has pointed in a similar direction, tying such beliefs to broad distrust of government and media rather than to any single message.
Among the 1,772 unvaccinated participants, stated reasons varied by race and ethnicity, age, education, and employment, and included concerns about side effects, doubts about vaccine safety, and the belief that the vaccines did not work. That last belief was most common among adults aged 25 to 34, at 10.4 percent, and declined with age, reaching just 2.7 percent among adults over 65.
Data Collected in 2020 to 2022, Not This Year
The limitations deserve to be stated early rather than at the end. This is an observational survey analysis, not a study of what changes behavior, so nothing in it demonstrates that any particular intervention would raise uptake. Participants self-reported their vaccination status, which was not verified against records.
The timing limitation is the one most likely to be lost in secondary coverage. The data predate the current vaccine policy environment entirely, including subsequent changes to federal advisory processes and recommendations. Anyone citing the 87.2 percent figure as a description of present-day coverage would be misusing it.
The survey population also came through a community engagement research network rather than a probability sample of the whole country, which limits how directly the percentages can be generalized.
Doctors Retained Trust That Agencies Lost
The authors' practical conclusion follows from the trust findings rather than from the demographic ones. They write that "there is unrealized potential for doctors educating patients about vaccination" and argue that future campaigns should build on the role clinicians play in individual vaccine decisions. They also call for trusted community leaders to help address hesitancy locally and conclude that a one-size-fits-all approach is likely to miss meaningful differences between populations.
For households, that translates into a narrow and unglamorous action. If a family member is uncertain about a vaccine, the conversation that matters most is with their own clinician, not with a broadcast message from an agency. People without a regular clinician can access one through federally qualified health centers, which use sliding-scale fees, and through county health department clinics.
The findings also identify who tends to fall through the gaps: younger adults, people without a high school degree, and people without insurance. Those are the household members worth checking on when any vaccine campaign is underway, whether for COVID, flu, or routine childhood immunizations.
Nothing in this analysis changes a recommendation. Anyone deciding whether to get a fall COVID or flu vaccine should base that decision on current guidance and a clinician's advice rather than on pandemic-era survey percentages. Infectious disease specialists have said that updated flu and COVID vaccines will be available and covered this fall. Separate work has estimated that COVID vaccination prevented more than 4,000 deaths in a single Washington county, a reminder of the stakes behind the coverage gaps this survey documents.
Key Questions Answered
What did the analysis find? Among 13,802 US adults, 87.2 percent had received at least one COVID vaccine dose, with uptake varying sharply by education, age, and insurance status.
When were the data collected? Between November 2020 and November 2022. These are pandemic-era figures and do not describe current vaccination behavior.
Which groups had the lowest uptake? About 21 percent of adults without a high school degree were unvaccinated, along with 17.5 percent of adults aged 18 to 24 and 25 percent of uninsured participants.
Did distrust of government predict refusal? Not reliably. Vaccination rates among people who distrusted various institutions still ranged from 72.4 to 83.8 percent, and 52 percent of those who distrusted the FDA on vaccine safety had received a dose.
Do people trust their own doctors? Largely yes. Fewer than 5 percent of participants said they did not trust their doctors as a source of COVID information.
Does this study change any vaccine recommendations? No. It is an observational survey analysis describing past behavior. Current decisions should follow present guidance and a clinician's advice.
What can someone do with this information? People uncertain about vaccination are most likely to benefit from a conversation with their own clinician. Those without one can use federally qualified health centers or county health department clinics.
