Risk Factors for COVID-19 and Influenza Nonvaccination during the 2025–2026 Respiratory Season among a Cross-Sectional Sample of Older US Adults

Adults aged ≥ 65 years are high-risk for severe coronavirus disease 2019 (COVID-19) and influenza outcomes, but reasons for nonvaccination remain understudied. We estimated age- and gender-adjusted prevalence ratios (aPRs) and 95% confidence intervals (CI) among adults aged ≥ 65 years in the Communities, Households, and SARS-CoV-2 Epidemiology (CHASING) COVID Cohort living in the USA for two comparisons: (1) receiving neither the COVID-19 nor the influenza vaccine versus both vaccines, and (2) receiving only influenza versus both vaccines between September 2025 and March 2026. Reasons for nonreceipt are summarized. Among 649 participants, 42.1% did not receive the COVID-19 vaccine and 21.4% did not receive the influenza vaccine in the 2025–2026 respiratory season. Those with the lowest trust in their doctor (aPR: 5.56, 95% CI: 4.25–7.27), most difficulty asking their provider vaccine questions (aPR: 2.59, 95% CI: 1.70–3.94), lowest perceived community benefit of influenza (aPR: 12.25, 95% CI: 8.58–17.49) and COVID-19 (aPR: 12.12, 95% CI: 8.52–17.26) vaccination, and receipt of no other (respiratory syncytial virus [RSV], shingles, or pneumococcal) vaccine during the 2025–2026 respiratory season (aPR: 3.48, 95% CI: 2.13–5.66) had a higher likelihood of receiving neither versus both vaccines. These associations were attenuated when comparing receiving only influenza versus both the influenza and COVID-19 vaccines. Side effects and safety concerns were the most common reasons for not receiving the COVID-19 vaccine, though lack of a health care provider recommendation was a commonly reported reason among those who received ≥ 1 other vaccine (influenza, RSV, shingles, or pneumococcal) during the time period. For nonreceipt of the influenza vaccine, concerns about side effects and low perceived need were common reasons cited. Focused efforts are particularly needed to increase COVID-19 vaccination among this high-risk group. Health care providers should leverage clinical encounters to build trust, address safety and efficacy concerns, and ensure that older adults receive the full range of recommended vaccines, but reducing access barriers and building and maintaining trust in vaccines among older adults will likely also require a multipronged approach.