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Attitudes and Intentions of US Veterans Regarding COVID-19 Vaccination

Educational Objective
To identify the key insights or developments described in this article
1 Credit CME
Key Points

Question  What are veterans’ attitudes and intentions associated with COVID-19 vaccination?

Findings  In this survey study of 1178 US veterans in March 2021, 71% of veterans reported being vaccinated against COVID-19. Fears about side effects and worry about the newness of vaccines were the primary reasons given for not getting vaccinated, reflecting vaccine skepticism and deliberation.

Meaning  These findings suggest that targeting veterans’ concerns around the adverse effects and safety of COVID-19 vaccines through conversations with trusted Veterans Health Administration health care practitioners is key to increasing vaccine acceptance.


Importance  Compared with the general population, veterans are at high risk for COVID-19 and have a complex relationship with the government. This potentially affects their attitudes toward receiving COVID-19 vaccines.

Objective  To assess veterans’ attitudes toward and intentions to receive COVID-19 vaccines.

Design, Setting, and Participants  This cross-sectional web-based survey study used data from the Department of Veterans Affairs (VA) Survey of Healthcare Experiences of Patients’ Veterans Insight Panel, fielded between March 12 and 28, 2021. Of 3420 veterans who were sent a link to complete a 58-item web-based survey, 1178 veterans (34%) completed the survey. Data were analyzed from April 1 to August 25, 2021.

Exposures  Veterans eligible for COVID-19 vaccines.

Main Outcomes and Measures  The outcomes of interest were veterans’ experiences with COVID-19, vaccination status and intention groups, reasons for receiving or not receiving a vaccine, self-reported health status, and trusted and preferred sources of information about COVID-19 vaccines. Reasons for not getting vaccinated were classified into categories of vaccine deliberation, dissent, distrust, indifference, skepticism, and policy and processes.

Results  Among 1178 respondents, 974 (83%) were men, 130 (11%) were women, and 11 (<1%) were transgender or nonbinary; 58 respondents (5%) were Black, 54 veterans (5%) were Hispanic or Latino, and 987 veterans (84%) were non-Hispanic White. The mean (SD) age of respondents was 66.7 (10.1) years. A total of 817 respondents (71%) self-reported being vaccinated against COVID-19. Of 339 respondents (29%) who were not vaccinated, those unsure of getting vaccinated were more likely to report fair or poor overall health (32 respondents [43%]) and mental health (33 respondents [44%]) than other nonvaccinated groups (overall health: range, 20%-32%; mental health: range, 18%-40%). Top reasons for not being vaccinated were skepticism (120 respondents [36%] were concerned about side effects; 65 respondents [20%] preferred using few medications; 63 respondents [19%] preferred gaining natural immunity), deliberation (74 respondents [22%] preferred to wait because vaccine is new), and distrust (61 respondents [18%] did not trust the health care system). Among respondents who were vaccinated, preventing oneself from getting sick (462 respondents [57%]) and contributing to the end of the COVID-19 pandemic (453 respondents [56%]) were top reasons for getting vaccinated. All veterans reported the VA as 1 of their top trusted sources of information. The proportion of respondents trusting their VA health care practitioner as a source of vaccine information was higher among those unsure about vaccination compared with those who indicated they would definitely not or probably not get vaccinated (18 respondents [26%] vs 15 respondents [15%]). There were no significant associations between vaccine intention groups and age (χ24 = 5.90; P = .21) or gender (χ22 = 3.99; P = .14).

Conclusions and Relevance  These findings provide information needed to develop trusted messages used in conversations between VA health care practitioners and veterans addressing specific vaccine hesitancy reasons, as well as those in worse health. Conversations need to emphasize societal reasons for getting vaccinated and benefits to one’s own health.

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Article Information

Accepted for Publication: September 2, 2021.

Published: November 3, 2021. doi:10.1001/jamanetworkopen.2021.32548

Correction: This article was corrected on December 6, 2021, to fix an error in the number and percentage of transgender or nonbinary individuals in the Abstract.

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2021 Jasuja GK et al. JAMA Network Open.

Corresponding Author: A. Rani Elwy, PhD, Bridge Quality Enhancement Research Initiative Program, Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, 200 Springs Rd (Mailstop 152), Bedford, MA 01730 (

Author Contributions: Drs Elwy and Meterko had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Jasuja, Meterko, Carbonaro, Clayman, LoBrutto, Midboe, Asch, Gifford, McInnes, Elwy.

Acquisition, analysis, or interpretation of data: Jasuja, Meterko, Bradshaw, Carbonaro, Clayman, Miano, Maguire, Midboe, Asch, Gifford.

Drafting of the manuscript: Jasuja, Meterko, Bradshaw, Carbonaro, LoBrutto, Elwy.

Critical revision of the manuscript for important intellectual content: Jasuja, Meterko, Bradshaw, Carbonaro, Clayman, Miano, Maguire, Midboe, Asch, Gifford, McInnes.

Statistical analysis: Meterko, Bradshaw, Carbonaro.

Obtained funding: Midboe, Gifford, McInnes, Elwy.

Administrative, technical, or material support: Carbonaro, Clayman, LoBrutto, Miano, Maguire, Midboe, Gifford, Elwy.

Supervision: Clayman, Asch, Gifford, McInnes, Elwy.

Conflict of Interest Disclosures: None reported.

Funding/Support: This project was funded by grant No. QUE 20-017 from the Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development, Quality Enhancement Research Initiative.

Role of the Funder/Sponsor: The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

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