Chest Infections and Disaster Response


Addressing disparities of socioeconomic status, race, and education in vaccine hesitancy and uptake

Vaccine hesitancy is described by the World Health Organization (WHO) as a “delay in acceptance or refusal of vaccination, despite availability of vaccine services.”1 Disparities in COVID-19 vaccine uptake, in addition to preexisting views of vaccine hesitancy, are consistently in the mainstream news.

The United States has a high rate of vaccine hesitancy, with a third of the country surveyed in 2021 stating they were unlikely to become vaccinated against COVID-19.2 This is in contrast to over 90% of people in Australia, China, and Norway saying they were highly likely to become vaccinated. Prepandemic, however, vaccination rates for preventable respiratory illness were already suboptimal. In fact, in 2019, the WHO declared vaccine hesitancy a top 10 priority due to the threat low vaccination causes on a global level.1

Dr. Jamie R. Felzer, Mayo Clinic, Rochester, Minn.

Dr. Jamie R. Felzer

U.S. health care systems’ cost to patients may serve as a disincentive for health care utilization, decreasing health care contacts. Further, changes in insurance can lead to provider discontinuity, which may erode the trusted patient-physician relationship. These realities may contribute to vaccine hesitancy that has been inversely correlated to both number of health care visits and trust in health care providers. Vaccine hesitancy exacerbates health disparities.1 Health literacy (understanding of health), education level, and general vaccine knowledge contribute to vaccine hesitancy also. Additionally, high social vulnerability (a score calculated from factors related to socioeconomic status, race, household makeup, housing type, and transportation) is strongly inversely correlated with vaccination rates. In places with both high social vulnerability and vaccine hesitancy, the vaccine-hesitant individuals have far fewer vaccinations.3

Dr. Cassie C. Kennedy, Mayo Clinic, Rochester, Minn.

Dr. Cassie C. Kennedy

Providers can impact vaccine uptake. Broadly, efforts to understand and address issues of trust in health care are needed. Educational materials should be disseminated to high-risk and medically underserved communities. At medical appointments, assessment of vaccination status, followed by providing individualized information regarding vaccine benefits and specific concerns may help increase uptake. In a survey of high-risk adults, only 14.8 and 18.5% of patients stated that the pneumococcal vaccine was offered to them in the last year and 5 years, respectively.1 Providers can have a strong impact on people obtaining vaccines; over half of patients receive vaccines when their provider recommends it.1,4 As a medical community focused on respiratory health, we need to prioritize offering vaccinations during inpatient and outpatient encounters.

By Jamie R. Felzer, MD, MPH

Network Member

Cassie C. Kennedy, MD, FCCP

Vice Chair, Council of Networks

Dr. Felzer is a Fellow and Dr. Kennedy is Associate Professor of Medicine, Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN.


1. Gatwood J et al. Am J Health Promot. 2021;35:908.

2. Wong LP et al. Infect Dis Poverty. 2021;10:122.

3. Crane MA et al. Health Aff (Millwood). 2021;40:1792.

4. Strully KW et al. Front Public Health. 2021;9:645268.

Next Article: