Why Adults 50+ Are Skipping Flu and COVID-19 Vaccines: Poll Data and Clinical Communication Strategies

A national poll of U.S. adults age 50+ from the University of Michigan’s National Poll on Healthy Aging suggests that gaps in flu and COVID-19 vaccination track more with perceived need and confidence than with access: 42% reported receiving neither a flu shot in the past six months nor a COVID-19 vaccine in the past year, 29% reported receiving both, and 27% reported receiving only the updated flu shot within the poll’s time windows.

Responses collected from late December 2025 through mid-January 2026 sort uptake into clinically useful “buckets” for routine encounters. Beyond the 42% neither / 29% both / 27% flu-only split, COVID-19 history extended outside the last-season frame: 49% said it had been more than a year since their last COVID-19 dose and 15% said they had never received a COVID-19 vaccine. The practical implication is that many patients appear “partially vaccinated” rather than categorically opposed, creating repeat-visit openings for incremental gains aligned to individual risk and expectations.

Belief-based reasons dominated the “main reason” selections for skipping each vaccine, although the rank order differed modestly by product. For influenza vaccination, 28% cited low perceived need, 19% cited worries about side effects, and 18% cited belief that the vaccine is not effective; for COVID-19 vaccination, 29% cited low perceived need, 27% cited side-effect worries, and 19% cited perceived lack of effectiveness. “I don’t need it” led for both, while COVID-19 nonreceipt leaned more toward side-effect concern than influenza in this self-reported snapshot.

Practical barriers were rarely named as the main reason, with time, cost, insurance, availability, or eligibility each cited by only 1%–4%. Smaller shares reported they “didn’t think of it” (flu 10%; COVID-19 6%) or “wanted to wait” (flu 4%; COVID-19 3%), a pattern consistent with missed cues and ambivalence rather than structural inaccessibility. In settings where panels similarly seldom cite logistics, visit time may yield more by clarifying perceived benefit, setting expectations for common post-vaccine symptoms, and using simple prompts to revisit the decision at a defined follow-up point.

Subgroup gradients add context for where the “belief and confidence” pattern concentrates. Recent COVID-19 vaccination (within the last six months) was reported most often among adults age ≥75 (46%), compared with 37% for ages 65–74 and 20% for ages 50–64, while flu vaccination exceeded COVID-19 vaccination in each age band (76%, 64%, and 42%, respectively). By chronic disease status, adults reporting at least one chronic condition were more likely to report recent vaccination than those without; even so, 39% of respondents with chronic conditions still reported receiving neither vaccine in the last six months (vs 59% among those without chronic conditions). The “never COVID-19 vaccine” segment was 15% overall and higher among ages 50–64 (20%) and households with income under $60,000 (19%) than among those with income over $60,000 (12%) in the same poll of 2,964 U.S. adults age 50+. For outreach planning, these self-reported differences highlight segments—particularly ages 50–64, lower income, no chronic conditions, and never-COVID-vaccinated—where tailored engagement can be concentrated without presuming access is the dominant barrier.

Recommended framing in the report emphasizes linking “effectiveness” to patient-relevant outcomes, normalizing expected side effects, and re-establishing perceived need as a seasonal, personal-benefit decision for adults in their 50s and up. One communication move is shifting from percentage-style effectiveness language to outcomes patients tend to value—reduced risk of serious illness, hospitalization, and death, and the possibility of shorter or less severe illness even when strain match is imperfect—while keeping statements clearly in the realm of expected benefit rather than guarantees. Another is anticipatory guidance that positions post-vaccine symptoms as typically mild and short-lived (e.g., sore arm, fatigue, low-grade fever) paired with practical “what to expect” counseling; clinics often translate these concepts into brief EHR outreach phrases, rooming prompts that elicit the patient’s main reason (need vs side effects vs effectiveness), checklist hooks to keep vaccine discussion from being missed, and a simple follow-up plan for patients who prefer to wait. Federal recommendation changes were rarely selected as the main reason for skipping COVID-19 vaccination (with <1% citing ineligibility), leaving message alignment and small workflow cues as the most actionable levers suggested by the poll’s belief patterns.