Have COVID-19 vaccinations peaked? Not necessarily, according to Deloitte’s research

By Asif Dhar, M.D., US Life Sciences & Health Care leader, Deloitte Consulting LLP

COVID-19 vaccines have been widely available in the US for about a year. Other valuable countermeasures, such as therapeutics and at-home tests, have become far more accessible. At this point, there is an assumption that people who aren’t yet vaccinated are probably never going to get vaccinated. Deloitte’s latest research on vaccination trends challenges that assumption.

Shortly after infections from the omicron variant began to increase, the Deloitte Center for Health Solutions (CHS) conducted a nationally representative survey of 4,545 vaccinated and unvaccinated people. [See the video below for complete survey results.] This follows a similar survey we conducted in 2021 after the Delta variant had peaked. In both surveys, we wanted to understand how people make their vaccination decisions and if they feel they have access to the vaccine if they want it. We know that geography, income, race, and education can influence vaccination rates. But we wanted to identify other barriers that might keep people from being vaccinated in hopes that those obstacles might be removed.

While some unvaccinated people remain opposed to vaccinations, our survey results indicate that others want the vaccine, or are amenable to the idea, but have been impeded by confusion about costs, canceled appointments, transportation challenges, inconvenient hours, and misinformation. We also confirmed that friends, family, and personal physicians continue to be highly valued sources of trusted information. Addressing barriers and activating trusted channels of informatio, might not only help increase COVID-19 vaccination rates, but also vaccination rates for influenza and other illnesses.

My colleague Dr. Jay Bhatt, D.O., MPH, MPA, executive director of CHS and the Deloitte Health Equity Institute (who is also a practicing physician) has been closely tracking vaccination trends. Here are some of his thoughts on CHS’s latest survey findings, and how removing certain obstacles could help increase vaccination rates:

Asif: As of May 19, 66.5% of the US population was fully vaccinated.¹ Is it possible to increase that percentage further?

Jay: Absolutely. CHS’s survey data show that there are pockets of people throughout the country who want to get the vaccine but have run into barriers. There are also people who are still unsure about the safety or effectiveness of the vaccine. And while a majority of Americans have opted to get vaccinated, boosters have not had the same uptake. We are dealing with the law of small numbers at this point. Small changes within small populations can have a surprisingly big effect.

Asif: Since they became available, COVID-19 vaccines have been free, regardless of insurance status.² However, 10% of all unvaccinated survey respondents who want the vaccine—and 15% of those who are uninsured—said the perceived cost kept them from getting it. Why are some people concerned about costs if the vaccinations are free?

Jay: Although the vaccines are free to the public, pharmacies, clinics, and other health care settings might ask people for insurance information when scheduling an appointment. In addition, clinics might ask for identification because state health departments need to track vaccination rates. They also use data to prevent people from getting multiple vaccinations, which can pose a health risk. However, asking patients for information at the point of service has led to some confusion that there is a cost for vaccinations. In addition, some individuals might be influenced by misinformation in the community and incorrectly believe vaccines require payment.

Asif: Nearly 20% of survey respondents said they aren’t vaccinated because a scheduled appointment was canceled. That’s up from 13% just six months earlier. This issue has become surprisingly prevalent in higher-income populations.

Jay: This is a growing issue that is impacting people in all socio-economic classes. Almost one quarter of people who earn more than $50,000 a year said they tried to get a vaccine, but their appointment was canceled, up from 16% in 2021, according to our data. But some people can’t get an appointment in the first place. They might have challenges with the technology used for scheduling or not know where vaccines are offered. Many of the mass-vaccination centers that operated a year ago are no longer around. Among respondents who want the vaccine but remain unvaccinated, 22% blamed inconvenient appointment hours—up from 15% six months earlier. Difficulties scheduling appointments has nearly doubled among low-income respondents since our last survey. Canceled or rescheduled appointments can impact trust. Some people might decide not to reschedule if they don’t have time or have other priorities. As a practicing physician, I have seen individuals who live alone, work two jobs and/or cannot get time off from work. These factors can create enormous obstacles to getting vaccinated.

Asif: Why is it important to focus on improving vaccination rates in low-income and underserved communities?

Jay: People who live in those communities tend to have lower primary-series vaccination rates compared to the overall population. Misinformation and disinformation are prevalent across the country. A trusted credible voice, and multiple conversations, is sometimes needed to counter misinformation. Being curious, listening with empathy, and connecting with what matters to people can help pave the way. Getting this population vaccinated and boosted can provide an additional layer of protection for the immunocompromised and children who are still too young to be vaccinated. I have had numerous patients who have come around after four or five conversations with me or other clinical team members. Sometimes they are interested in getting vaccinated because of upcoming travel. Sometimes they are motivated by increased infection-spread in their community. Other patients decide to get vaccinated to help protect unvaccinated grandchildren or other loved ones. Helping these patients decide to get vaccinated is about building trust and aligning information with what matters most to them.

Asif: Our research shows that people tend to see their doctor as a trusted source of information. More than 70% of all survey respondents, and 60% of unvaccinated respondents, said they would prefer to receive their vaccination during an in-person visit to a doctor’s office. However, medical practices generally are not set up to store and distribute vaccines. How can trust be improved outside of the physician’s office?

Jay: There is a realization that it might take meeting people where they live, work, learn, and play to address pockets of people who remain unvaccinated or who have not been boosted. A person might have a conversation with their doctor, the local pharmacist, or a public health worker. Some employers might make vaccinations available at work—for example, in the factory—or through community centers where people have trust and feel safe. Connecting all of these groups could help establish trust networks within the broader ecosystem. However, trust can be lost in a moment. Misinformation, poor communication, not following through, or fragmentation in the system [including lack of interoperability resulting in a lack of information for care coordination] can all have an effect. These factors can impact not only vaccination rates but also layered strategies of mitigation and treatment.

We have entered the third year of an ever-evolving pandemic, and it feels like the worst is behind us. We have reached a stage where there are multiple tools in the toolbox (e.g., vaccines, rapid testing, effective therapies) that can minimize the impact of this virus.

We are no longer hiding from COVID-19 because these tools make it possible to live with it. Vaccines are part of a multi-pronged strategy. While they won’t prevent everyone from getting infected and spreading the virus, they can help reduce the impact of the virus. We should not assume that vaccination rates have peaked. Instead, we should work to remove barriers that can make it difficult to get vaccinated.

This publication contains general information only and Deloitte is not, by means of this publication, rendering accounting, business, financial, investment, legal, tax, or other professional advice or services. This publication is not a substitute for such professional advice or services, nor should it be used as a basis for any decision or action that may affect your business. Before making any decision or taking any action that may affect your business, you should consult a qualified professional advisor.

Deloitte shall not be responsible for any loss sustained by any person who relies on this publication.

Endnotes

¹ Tracking COVID-19 cases, deaths, and vaccines worldwide, Washington Post, May 19, 2022

² Fact Sheet: Consequences of lack of funding for efforts to combat COVID-19 if Congress does not act, The White House, March 15, 2021

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