As the COVID-19 pandemic continues to run rampant globally, adolescents and young adults in the United States are still hesitant to take the coronavirus vaccines, which affect efforts to achieve herd immunity, according to a study conducted by the University of California, San Francisco (UCSF) published in the Journal of Adolescent Health.1

Many young adults do not see their peers getting sick and, therefore, do not see themselves as at risk, commented Mary Koslap-Petraco DNP, PPCNP-BC, CPNP, FAANP, clinical assistant professor at Stony Brook University School of Nursing, Stony Brook, New York. “We health care providers also need to do a better job of advising young adults that the danger from COVID is not just to themselves” but rather to family and friends who may have health issues such as diabetes or heart disease, which puts them at higher risk for death or long-term complications from COVID, said Dr Koslap-Petraco, who is not affiliated with the study.

Achieving Herd Immunity

To reach herd immunity, approximately 70% to 90% of the population must be fully vaccinated against COVID-19. “Understanding COVID-19 vaccination intention is necessary to achieve population-level immunity and to end the pandemic. In this nationally representative sample of young adults (aged 18 to 25 years; n=5082), 76% were ‘definitely’ or ‘probably’ planning on becoming vaccinated; however, 24% were unlikely to do so,” the researchers stated.  

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Dr Koslap-Petraco stated that herd immunity is a moving target and a misnomer. “Our goal needs to be to immunize every individual for whom the vaccine is indicated unless that individual has a true medical contraindication. The more people who get the virus the greater chance there is for the virus to mutate. We have seen that already with the Delta variant now becoming the dominant strain. The current vaccine still offers a high degree of protection against this particular variant but if the virus mutates again we might not be so lucky,” she said.

Among the unvaccinated respondents who did not “definitely” plan to get vaccinated, the most frequently cited reasons were:

  • “I plan to wait and see if it is safe and may get it later” (56%)
  • “I am concerned about possible side effects of a COVID-19 vaccine” (53%)
  • “I think other people need it more than I do right now” (44%)

The rate of COVID-19 vaccine distrust was significantly higher among respondents who “probably/definitely will not” vs “probably will” get vaccinated (36.8% vs 8.1%; P <.05)  

Although young people aged 18 to 29 years are less likely to die from COVID-19, they make up more than 20% of all COVID-19 cases to date and 1 in 3 young adults are at risk of developing “severe COVID,” according to data from the Centers for Disease Control and Prevention (CDC).2

Weighing the Risks and Benefits of Vaccination

Side effects are another common reason why young adults are skeptical of the vaccine. Just like viruses, vaccines can be accompanied by side effects, such as heart inflammation, which was recorded in young adults following the Moderna and Pfizer trials, according to the researchers.

COVID-19 infection poses more danger to adolescents than being inoculated and as more adolescents contract the virus, there will be an increase in the most severe form of COVID-19 in children, according to Dr Koslap-Petraco.

Though many young people are hesitant, there are some adolescents who are eager to get the vaccine for the simple reason that they see the vaccine as a way back to life as we know it, said Dr Koslap-Petraco. Some adolescents have shown up at vaccination sites inquiring about how they can receive the vaccine without their parents’ consent.

“An example is the state of Tennessee where the age for medical consent is 14 years. Unfortunately, the state government has now forbidden the health department from offering any form of outreach for COVID vaccine to adolescents,” said Dr. Koslap-Petraco. “Parents of adolescents admittedly have reservations about the vaccine often because of all of the misinformation circulating on the internet.”

The study authors highlighted the need for research on vaccination motivation and access, as it is unclear whether young adults who intend to get the vaccine are motivated to take action, they noted.

“Public health initiatives need to adapt rapidly as vaccine intentions and availability change, and research needs to close the knowledge gap regarding young adult vaccination motivation, barriers to vaccine access, and factors that might mitigate hesitancy, including vaccination recommendations by a clinician or other trusted source,” the researchers said. “Continued monitoring of vaccine intention, motivations, and barriers to access, with updated surveys reflecting real-time changes, can contribute to improved messaging and targeted outreach to increase young adult COVID-19 vaccination.”


1. Adams S, Schaub J, Nagata J, Park M, Brindis C, Irwin C. Young adult perspectives on COVID-19 vaccinations. J Adolescent Health. 2021;S1054-139X. doi:10.1016/j.jadohealth.2021.06.003

2. Center for Disease Control and Prevention. Risk for COVID-19 infection, hospitalization, and death by age group. Accessed July 15, 2021.

3. University of California, San Francisco. Vaccine hesitancy in young adults may hamper herd immunity. Press release. Accessed July 15, 2021.