Preparing for the Next Pandemic: Exploring Predictors of Vaccine Uptake in American Cities

Purpose COVID-19 devastated communities globally, with the United States leading in fatalities despite extensive control efforts. In 2021, COVID-19 vaccines emerged as the most promising solution, with an efficacy rate exceeding 95% after full vaccination. However, herd immunity remains an elusive target with only 70% of the U.S. population fully vaccinated. This study investigates whether prior vaccination and medical history significantly predict COVID-19 vaccine acceptance and uptake. Design Using data collected from the 66 th largest U.S. city after the widespread deployment of COVID-19 vaccines and boosters, we employed logistic regression to test whether an individual’s history of vaccination and prior medical engagement positively influence COVID-19 vaccine-related decisions. Setting Cross-sectional U.S. survey from July-October 2022 (N = 397) and November 2023-February 2024 (N = 429). Subjects Adult Residents of the City of Newark, New Jersey (Aged 18+). Measures Newark Community Health Survey (2022, 2023). Results Individuals with a history of preventive care, such as attending at least one non-emergency medical visit in the past year, receiving either the pneumococcal or influenza vaccine within the past year, strongly predicted COVID-19 vaccine acceptance. These predictors also demonstrated a strong positive association with the completion of the primary vaccine series and a higher overall total vaccine uptake. Conclusion Future vaccine campaigns should prioritize “low engagement” populations who lack both recent routine medical visits and a history of previous vaccinations.