Less Than Half of Eligible Veterans Received COVID-19 Booster Shots

COVID-19 boosters were administered to less than half of eligible veterans in the United States, prompting researchers to recommend greater outreach to vulnerable populations by the Veterans Health Administration (VHA). Investigators reported their findings in a research letter on JAMA Network Open.

“Some subpopulations have lower rates of primary COVID-19 vaccination than others, suggesting that increasing numbers of individuals will lack protection against COVID-19 should booster-eligible individuals fail to receive boosters,” authors wrote. “We investigated the association of demographic, clinical, and social determinants of health with COVID-19 booster completion to identify vulnerable subpopulations.”

The retrospective cohort study was conducted using electronic health record data for 3,578,627 veterans who completed their initial vaccination series and were eligible for boosters. Veterans were excluded from the study if they had received a third dose with 6 weeks of primary vaccination due to being immunocompromised.

December 11, 2020, the date on which vaccines first received Emergency Use Authorization and were administered in the VHA, marked the beginning of the study period. Investigators analyzed patient data through February 8, 2022.

Veterans were predominantly male (91.2%) and an average age of 65.9 (15.1) years. Self-reported demographic data showed:

• 0.6% of participants were American Indian or Alaska Native;
• 0.7% were Native Hawaiian or other Pacific Islander;
• 0.8% were of multiple non-Hispanic races;
• 1.4% were Asian;
• 7.1% were Hispanic;
• 18.3% were non-Hispanic Black or African American;
• 65.5% were non-Hispanic White; and
• 5.5% were of unknown race or ethnicity.

Only 1,423,084 (39.8%) study participants received a booster dose. Veterans with the lowest booster rates were younger (aged 18 to 34 years), lacked an assigned primary care team, lived in rural areas, and reported housing and food insecurity.

Additionally, booster rates were highest among Black or African American veterans (44.3%) and lowest for American Indian or Alaska Native veterans (35.4%).

Authors noted their results could not be generalized to nonveteran populations.

“The VHA serves more than 6 million US residents each year. Outreach to younger, rural, American Indian or Alaska Native, and homeless populations and encouragement of primary care clinicians to engage unvaccinated and unboosted patients in conversations about COVID-19 vaccination may mitigate residual disparities,” researchers concluded.

Reference:
Seal KH, Bertenthal D, Manuel JK, Pyne JM. Association of demographic, clinical, and social determinants of health with COVID-19 vaccination booster dose completion among US veterans. JAMA Netw Open. 2022;5(7):e2222635. doi:10.1001/jamanetworkopen.2022.22635