Historic Vaccination Patterns Provide Insights for COVID-19 Vaccine Rollout

A nurse places a band aid on a patient's arm, after being given a flu shot.

An examination of historical vaccination trends highlights potential access barriers and opportunities to improve racial and economic equity in COVID-19 vaccination outreach and planning.

The Issue

Longstanding barriers to vaccine uptake—including fears that vaccines will cause illness or side effects, insurance obstacles, and lack of access to health care providers—will likely affect the success of COVID-19 vaccination efforts. Vaccine hesitancy is particularly pronounced among people of color and others who have faced discrimination inside and outside the health care system. These issues may be exacerbated during the COVID-19 pandemic due to the vaccine’s novelty, as well as racial and economic tensions across the United States.

Key Findings

Researchers examine historic flu vaccination patterns among adults from the 2016-18 National Health Interview Survey for potential opportunities to make COVID-19 vaccination efforts more equitable for all, including people of color and uninsured populations.

  • Researchers found that high-risk nonelderly Black adults and high-risk nonelderly individuals covered by Medicaid/CHIP were more likely to receive a flu vaccine than their low-risk counterparts.

  • The findings suggest that patients with health conditions have more established relationships with their health care providers, who can positively influence vaccination uptake.

  • Building on existing research, the data also show that Black and Hispanic adults were less likely to receive a flu vaccine than their White counterparts. Additionally, uninsured individuals and those who lack a regular source of care were least likely to get immunized.


To make COVID-19 vaccine distribution more equitable and build trust among hesitant populations, current vaccination efforts should focus on reaching people who are uninsured, publicly insured or don't have established relationships with health care providers.

About the Urban Institute

The nonprofit Urban Institute is dedicated to elevating the debate on social and economic policy. For nearly five decades, Urban scholars have conducted research and offered evidence-based solutions that improve lives and strengthen communities across a rapidly urbanizing world. Their objective research helps expand opportunities for all, reduce hardship among the most vulnerable, and strengthen the effectiveness of the public sector. Visit the Urban Institute’s Health Policy Center for more information specific to its staff and its recent research.