Why older people are so much more vaccinated than younger people

First Florida Nursing Home Workers Receive Covid 19 Vaccinations
POMPANO BEACH, FLORIDA - DECEMBER 16: Vera Leip, 88, receives a Pfizer-BioNtech COVID-19 vaccine from Christine Philips, RN Florida Department of Health in Broward County, at the John Knox Village Continuing Care Retirement Community on December 16, 2020 in Pompano Beach, Florida. The facility, one of the first in the country to do so, vaccinated approximately 170 people including healthcare workers and elder care people. (Photo by Joe Raedle/Getty Images)
Joe Raedle/Getty Images

(CNN) — Vaccination rates in America vary widely between blue and red states, between urban and rural populations and between those with college degrees and those without.

But perhaps no demographic factor shows as stark of a difference as age.

Nearly 92% of adults over 65 have had at least one vaccine dose and over 81% are fully vaccinated, higher than any other age group, according to data from the US Centers for Disease Control and Prevention.

Younger age groups have much lower vaccination rates, dragging down the country’s overall coverage by 20 percentage points. Among people 12 and older, 71% have had at least one dose and 60% are fully vaccinated, the CDC says.

The vaccine rate could still be higher for the elderly. The New York Times reported Tuesday that seniors in other wealthy countries have higher vaccination rates than in the United States.

Still, the vaccination differences by age groups are clear even in less-vaccinated parts of the country. In Alabama, one of the country’s least vaccinated states, 71% of people over 65 are fully vaccinated — the same rate as for all adults in New York. No matter the location, older people understand the importance of vaccination.

So why exactly are older adults so much more vaccinated than younger folks?

Interviews with several doctors, CDC data and polling from the Kaiser Family Foundation show five main reasons for the age difference: their earlier eligibility, the virus’s exponentially more severe impact on older people, their wiser perspective on life, their increased access to the medical system due to Medicare, and their functional immunity to vaccine misinformation.

Understanding these factors could help the US home in on ways to better encourage vaccination among younger people, whose general resistance to vaccination threatens to extend the pain of the pandemic for everyone, as the Delta wave has shown.

Dr. Tim Farrell, the chair of the American Geriatrics Society’s Ethics Committee and professor of medicine at the University of Utah School of Medicine, said young people should get vaccinated as a form of “inter-generational justice” for older people.

“What do the young owe the old? What do the old owe the young?” he asked CNN. “The older adults were the ones who were sitting home, and a lot of them were isolated for a year or more. They stayed home, they got vaccinated, they did their fair share. I think it’s time for some reciprocation.”

Older people were eligible earlier

A key explanation is time. People over age 65 became eligible to be vaccinated at earlier dates, so they have had more time to get vaccinated.

In December, when the vaccine supply was limited, vaccine advisers to the CDC recommended that health care workers and residents of long-term care facilities get top priority. People age 75 and older and frontline essential workers were next in line, and people 65 to 75, high-risk people age 16 to 64 and other frontline workers came after that.

Not every state followed that exact order. But across the US older people were able to get vaccinated this past winter, while many younger adults had to wait until spring. Children age 12 to 15 only became eligible to be vaccinated in May. There are no vaccine shortages in the US, and everyone 12 and older is eligible to be vaccinated.

Not everything can be explained by this timeline, though, and the uptick among younger age groups has been slower, according to CDC data.

In one clear example, three months after the vaccines first started going into arms — on March 16 — 62% of people 65 to 74 and 66% of people 75 and up had at least one dose, CDC data shows. By comparison, three months after 12 to 15 year-olds became eligible — on August 12 — just 48% had at least one dose.

Still, the data shows that the longer an age group has been eligible, the more of them are vaccinated.

Older people are at much higher risk of severe Covid

A second major explanation is that older people are more willing to get vaccinated because they are at far higher risk.

Covid’s devastating impact on the elderly has been clear ever since the novel coronavirus tore through a Washington state nursing home in February and March 2020.

The 18 months since then have further confirmed its impact. People over 65 make up only 13% of all Covid-19 cases but account for about 80% of all deaths, according to CDC data. And the risk goes up even more the older people get. Those over 85 years old make up just 2.1% of all Covid cases but 30.6% of all deaths.

“The mortality is basically exponential when you get past age 65. It just increases so substantially,” Farrell said. “My patients are well aware of that.”

For younger people, the risk of severe Covid-19 illness and death is comparatively much lower, so vaccination is less of a clear life-or-death situation.

But lower risk does not mean no risk. More than 100,000 people under age 65 have died from Covid-19, far more than the annual flu or any other viral infection. And that doesn’t take into account those dealing with long-haul Covid symptoms and long-term respiratory issues.

“People didn’t understand that something like 0.5 to 1% death rate is still really high. That still means thousands of people dying,” said Dr. Peter Hotez, dean for the National School of Tropical Medicine at the Baylor College of Medicine.

Older people know from experience and perspective

Another reason older adults are more vaccinated stems from their personal experiences with vaccines. They remember the days when infectious diseases like polio and measles sickened and killed classmates, friends and family members.

Farrell saw this firsthand. Earlier in the pandemic, a patient pulled out a decades-old polio vaccine card that showed the patient had been a volunteer in a polio vaccine trial.

“I think that really speaks to how proud he was at that time to be participating in a trial, advancing science, helping contribute to the solution rather than be part of problem. I think that sort of spirit is still alive and well in a lot of patients,” Farrell said. “Anecdotally, it seems like most of my patients are very happy to take the vaccine, and I think part of it is what they’ve lived through and their experience having done this before.”

Younger Americans, meanwhile, have grown up in an era in which polio has been eliminated and serious infectious diseases are relatively rare due to widespread vaccinations. And with the confidence of youth, they are more likely to believe they will be just fine even if they do get infected.

Indeed, the perception of risk is a major explanation of why some people are less likely to be vaccinated, according to polling from the Kaiser Family Foundation.

“Unvaccinated adults, especially those who say they will ‘definitely not’ get a vaccine, are more likely to say they are not worried they personally will get seriously sick from the coronavirus and to believe that getting the vaccine is a bigger risk to their own health than getting the virus,” KFF found in July.

“(Older adults) are more mindful of their mortality and their risk, and perhaps there’s a sense among younger cohorts that ‘I’m young so I’ll be fine,'” Farrell said.

Access to the medical system

Even though the Covid-19 vaccines are all free, having health insurance is correlated with higher vaccination rates — and most Americans over 65 are eligible for insurance through Medicare.

The differences between the uninsured and the insured is stark. A KFF poll from July found that among uninsured people under age 65, only 44% have received at least one dose of a vaccine. For people under 65 with health insurance, about 65% have received at least one dose.

The underlying idea is that people with health insurance, no matter the age, have access to the medical system. They are more able to get preventative care and more likely to have a personal doctor or health care professional they trust.

“Even though you don’t have to have insurance to get vaccinated, it’s kind of a marker of your attentiveness to the health system and how well you’re plugged into it,” Hotez said.

Medicare beneficiaries also have the right to free annual wellness visits, as do most other people covered by federally qualified health insurance plans. Farrell said he uses these to discuss broader health issues rather than acute problems.

“What this enables patients to do is to take a step back and look a little more comprehensively at their health,” he said. “(They can) be less concerned about cost and more concerned about engaging and taking a deeper dive into preventative care.”

That access to physicians also enables closer trust in the opinions of medical experts.

“One of the most important factors in getting people vaccinated is just that they trust their physician, and that longitudinal relationship is incredibly important,” Farrell said.

Misinformation is targeted at young people

Finally, the anti-vaccine misinformation that has proliferated in this pandemic has generally not targeted the fears of older adults.

In particular, one of the most common fears of getting vaccinated is the false idea that the vaccines impact fertility. It’s a claim that has been around for years, according to vaccine expert and pediatrician Dr. Yvonne Maldonado.

“Oh my goodness, people have been saying this about every vaccine since I can remember,” Maldonado, the chief of Stanford University School of Medicine’s division of pediatric infectious diseases, told CNN in May. “There is no evidence that this vaccine will affect development or fertility.”

Indeed, the CDC recently strengthened its recommendation that people who are pregnant, breastfeeding or trying to get pregnant should all get vaccinated, saying the vaccine is safe and effective.

“There is currently no evidence that any vaccines, including Covid-19 vaccines, cause fertility problems in women or men,” the CDC says on its website.

Fertility is generally less common of a concern for people over 65, as it naturally declines with age.

For younger people, these false fertility claims have proven effective. Among unvaccinated people who want to “wait and see” before getting vaccinated, 44% say they are concerned the vaccine may negatively impact their fertility, according to a KFF study. Among unvaccinated people who will “definitely not” get vaccinated, 66% say they’re concerned about fertility.

Hotez, who has long been a target of anti-vaxxers, said the anti-vaccine talking points for Covid-19 are directly taken from other anti-vaccine language, which is generally targeted at parents who are in charge of their children’s vaccinations.

“Most of the anti-science, anti-vaccine aggression and disinformation was specifically targeting young adults and their kids,” he said. “That’s where the messaging was directed at and that’s why you see the vaccine uptake so low.”

Fear of side effects is not as big of a deal, and Farrell noted that some of his patients cited the famous, though perhaps outdated, quote from the late actress Bette Davis: “Old age ain’t no place for sissies.”

“They’re used to some aches and pains,” Farrell said. “They are seasoned patients who have seen this before, at least in a different way, and for many patients … They just can roll with it. They’re like, ‘In the grand scheme of things, this is a pretty minor annoyance at most for the large benefit we’re going to receive.'”