COVID-19 Vaccine Hesitancy in the Military Is a Manageable Challenge

The U.S. Department of Defense (DOD) is in the final stages of a largely effective COVID-19 vaccination campaign, but a small percentage of service members are vaccine hesitant. As efforts enter a second year, military planners and policymakers should reflect on the nature of this hesitancy to enhance U.S. military preparedness for future global health emergencies and similar contingencies.

How has DOD policy on COVID-19 vaccination evolved?

In December 2020, when the first COVID-19 vaccine met the U.S. Food and Drug Administration’s (FDA) criteria for emergency use authorization, the DOD implemented a tier-based vaccination plan. Military health-care professionals, service members responsible for critical national capabilities or preparing for overseas deployments, and medically high-risk individuals were prioritized first. Though the department encouraged all members to get vaccinated, doing so was voluntary until the FDA issued a full approval.

For more than eight months of the campaign, including during the transition between presidential administrations, the DOD’s COVID-19 vaccination policy was the same. In August 2021, however, when the FDA fully approved the first COVID-19 vaccine, the DOD mandated vaccination of all active-duty and Ready Reserve members of the armed forces.

What are the vaccination deadlines?

The DOD authorized all military services—the U.S. Air Force, Army, Navy, Marine Corps, and Space Force—to execute this order as each deemed appropriate, but directed “ambitious timelines for implementation.” The services then established unique vaccination deadlines for their components, ranging from early November 2021 for active-duty airmen to mid-December for reserve sailors and marines. The only outlier is June 30, 2022, for members of the Army’s Ready Reserve, due to force structure and logistical challenges.

How is the vaccination effort going?

As of December 2021, more than 97 percent of the nearly 1.4-million-member active-duty force has been vaccinated. Close to half of unvaccinated active-duty service members submitted requests for exemption or accommodation, which are pending. Members can seek medical and administrative exemptions or religious accommodations, but so far only medical and administrative exemptions have been approved by any service.

What happens if a service member refuses vaccination without an exemption?

Recently, the U.S. Air Force became the first service to discharge members who refuse the vaccine. The U.S. Marine Corps discharged 103 members shortly thereafter. The U.S. Army and Navy also intend to discharge members who refuse the vaccine. However, overall numbers of service members refusing vaccination will not increase, as recruits are now required to acknowledge and comply with the vaccination mandate as a precondition for joining the military.

What groups have been the most hesitant?

Young, junior service members are most likely to reject the vaccine. For example, all twenty-seven of the airmen recently discharged by the Air Force had less than six years of military experience. This trend is consistent with an April 2021 analysis of vaccine hesitancy among military members conducted by the DOD’s Defense Health Agency. The study also found that among all active-duty forces, “Non-Hispanic Black service members were 28 percent less likely to initiate vaccination.” Additionally, in the first three months of the DOD’s vaccination campaign, female service members were 10 percent less likely than their male counterparts to initiate vaccination. Factors associated with greater vaccination rates include higher age, education level, and rank. 

What’s behind this reluctance?

The limited vaccine hesitancy within the military is driven by many of the same factors that influence the civilian population. The first and arguably most critical factor driving vaccine hesitancy in the military is misinformation, as some DOD leaders have acknowledged. This is consistent with hesitancy assessments among the broader population, but it does not fully address demographic disparities, which, as the DOD has found in studies, are influenced by other “interpersonal and societal factors.”

Second, vaccine-hesitant military members express a general sense of mistrust of public institutions, both military and nonmilitary, albeit at a considerably lower rate than the public. This mistrust is often deep-seated, shaped by various historical factors, and therefore more difficult to overcome than misinformation. Whereas institutions can directly combat misinformation through outreach and education, restoring trust requires a longer and more holistic approach. Sustained efforts to build trust over time would likely decrease the vaccination disparities among non-Hispanic Black service members and young service members.

Personalization of risk is a third significant factor among vaccine-hesitant military members, particularly the young. Ultimately, an individual’s decision to accept a vaccine hinges on how they perceive the risk of getting vaccinated compared to the risk of inaction. For instance, in the late 1990s and early 2000s, the military required service members to get the anthrax vaccine. Unlike the COVID-19 vaccine, the anthrax vaccine was not widely distributed outside of the military. Service members who refused—many of whom had accepted several other required vaccinations throughout their careers—stated that the reported side effects weighed heavily on them.

In the case of COVID-19, the perception of lower risk to the young and healthy appears to be similarly influential. These risk assessments, however, can change rapidly. For example, consider an anecdote from one Air Force unit: One of the highest increases in vaccinations within this wing occurred when deployed members were preparing to close U.S. medical facilities at Bagram Air Base in Afghanistan. There is nothing like the closure of the only hospital accessible within thousands of miles to alter one’s risk assessment.

Is political affiliation a factor?

One correlating factor for vaccine hesitancy outside the military is political affiliation, and some have assumed that partisanship is influencing the vaccination decisions of service members. However, there is no data to support that assumption. Throughout the earliest stages of the pandemic, commanders of all services recognized a broad undercurrent of vaccine hesitancy that suggests party politics are an insignificant influence. Most of those who are hesitant appear to be making a personal statement, not a political one, in refusing the vaccine, which comports with historical experience. From smallpox vaccine hesitancy in the eighteenth century to anthrax vaccine hesitancy in the late twentieth century, American service members have demonstrated a history of skepticism that predates today’s hyperpoliticized environment.

What are the lessons from the DOD’s campaign?

Although the DOD’s COVID-19 vaccination campaign has been widely effective, leaders should consider adjustments to enhance preparedness for future public health emergencies. Traditional, hierarchical communication can work, but it is not likely to motivate 100 percent of today’s force. Future communication efforts on vaccines should take demographic disparities into account, as well as hesitancy caused by misinformation and mistrust. Such efforts should emphasize transparency, acknowledge occasional missteps, and immediately correct course, when appropriate.

The lingering COVID-19 vaccine hesitancy in the military—particularly among non-Hispanic Black members and female members—should embolden the DOD to accelerate progress on diversity and inclusion. Command teams that represent and reflect the forces they are empowered to lead are an essential element of trust restoration among service members. More diverse command teams, as well as empowered frontline supervisors, are generally more adept at inspiring action among varied demographic groups. 

Finally, to influence the personal risk assessments of service members, especially among younger personnel, policymakers should consider incentives for vaccination. Accurate information about the benefits of vaccines should be an element of motivation but not the only one. Beyond mandating action, when policy and health guidance permit, the DOD should weigh enticements such as prioritizing vaccinated members for mission and training opportunities and offering accelerated leave and pass approval processes.

Providing these and other incentives early in vaccination campaigns could encourage more service members to get protected from a disease sooner, help overcome pockets of hesitancy, and even preclude the need for a mandate.

Disclaimer: Opinions, conclusions, and recommendations expressed or implied within are solely those of the author and do not necessarily represent the views of the Air University, the U.S. Air Force, the Department of Defense, or any other U.S. government agency.