Investigators analyzed data from 3,390 adults enrolled in the CHASING COVID Cohort who completed assessments in August 2025 and again in March 2026. The analysis examined the gap between stated intention to vaccinate and actual receipt of vaccine during the 2025–26 respiratory virus season. The team operationalized vaccine willingness by combining prior-season vaccination behavior with stated intention to vaccinate in the upcoming season. In August 2025, 73% of the cohort qualified as influenza vaccine willing, while 68% were COVID-19 vaccine willing. By March 2026, the cohort showed measurable attrition: 17% of those who were influenza-willing remained unvaccinated, and 39% of those who were COVID-19-willing had not received vaccine. These figures indicate that a substantial proportion of adults who reported openness to vaccination did not complete vaccination within the season covered by the study.
The trajectory analyses the authors reported separated two distinct patterns. Some participants simply failed to follow through on their earlier-stated intentions. Others represented a group of prior-season vaccinators who discontinued vaccination during 2025–26. The data thus suggest gaps arise from both incomplete follow-through among the vaccine-willing and loss of continuity among previous vaccinators.
The study team identified several predictors associated with non-vaccination among people who had expressed willingness. The single strongest predictor was absence of prior-season vaccination; the authors reported adjusted risk ratios indicating substantially higher risk of remaining unvaccinated when individuals had not vaccinated in the prior season. Additional factors linked to non-vaccination included food insecurity and the presence of any healthcare barrier. Confidence in vaccine safety also mattered: participants reporting that they were not at all confident in vaccine safety were more likely to remain unvaccinated despite earlier willingness.
The associations were quantified in the source using adjusted risk ratios and 95% confidence intervals for influenza and COVID-19 non-vaccination; the abstract lists these effect estimates, which show consistent direction and magnitude across both vaccine types. The pattern of predictors implies both socioeconomic and health-system barriers contribute to the willingness-uptake gap, not just attitudinal hesitancy alone.
The study collected self-reported reasons from participants who were willing but remained unvaccinated. The most commonly cited logistical barrier was difficulty finding a convenient time, place, or appointment to get vaccinated. For COVID-19 vaccination specifically, lack of a healthcare provider recommendation was also a frequently reported reason among willing non-vaccinators. Those findings point to access and provider engagement gaps as concrete obstacles to converting intention into action.
The authors framed these reported barriers as operational failures that could be addressable by programs designed to reduce friction—examples implied by the data include appointment flexibility, expanded clinic hours, mobile or community-based vaccination sites, and more proactive provider outreach or recommendation practices. The source did not report specific intervention trials or implementation details; investigators limited their report to the observed reasons and associations.
Data indicated missed opportunities to increase coverage among adults already open to vaccination. Clinicians and health systems could respond to the observed patterns in two complementary ways: reinforce vaccine confidence during encounters, and reduce logistical and access barriers that prevent completion of vaccination. Provider recommendation emerged as an actionable factor for COVID-19 vaccination; therefore, routine, explicit recommendations during clinical visits may convert some of the willing-but-unvaccinated into vaccine recipients. Structural supports—reducing appointment friction, addressing transportation or scheduling constraints, and outreach to food-insecure populations—align with the predictors identified by the study team.
Trajectory analysis suggesting discontinuation among prior vaccinators points to another practical target: reminder and recall systems that engage people with a history of vaccination, reminding them that vaccination remains advised for the season and facilitating easy completion.
The abstract reports observational survey data from a defined cohort; as such, the authors describe associations between prior behavior, socioeconomic and healthcare access indicators, and non-vaccination but do not present causal proof. The source did not report detailed intervention testing or operational solutions within this study. The authors provided adjusted risk ratios and confidence intervals for associations but did not report randomized comparisons of specific access or confidence-building measures.
Several practical questions remain unresolved in the source: which targeted interventions most effectively close the willingness-uptake gap, how durable any improvements would be across seasons, and which delivery strategies best reach populations affected by food insecurity and healthcare barriers. The manuscript does report clear descriptive signals pointing to missed opportunities and suggests avenues to improve coverage, but testing of those avenues was outside the scope of the study as reported in the abstract.