Millions of Americans rely on emergency departments (EDs) as their only point of health care access. A new multi-city survey published in Morbidity and Mortality Weekly Report (MMWR) by the U.S. Centers for Disease Control and Prevention (CDC) suggests that this reliance may present both a challenge and an opportunity: underserved populations visiting EDs report large gaps in vaccination coverage, but many also express willingness to receive vaccines if offered during their visit.
Large Gaps in Vaccine Awareness and Coverage
The survey, conducted across 10 EDs in eight U.S. cities between April and December 2024, included 3,285 non–critically ill adult patients. Nearly half (49.4%) of participants had not heard of at least one CDC-recommended vaccine for their age group. More striking, 85.9% reported missing one or more vaccines, such as influenza, shingles, pneumococcal, or the newly recommended RSV vaccine.
Gaps were especially pronounced among Black and Hispanic participants, those without a primary care provider, and the uninsured. For example, uninsured individuals had three times the odds of being behind on vaccinations compared with insured peers. Geographic disparities also emerged: patients in Chicago, Detroit, and Fresno reported lower coverage than those in other study sites.
Missed Opportunities and Willingness to Accept Vaccines
Despite these gaps, the study revealed a strong willingness to catch up on vaccinations if the opportunity were presented in the ED. Nearly half (46.4%) of those behind on vaccines said they would accept one or more missing doses if offered during their visit. Among these, an overwhelming 86.7% indicated they would take all recommended vaccines at once.
The primary reasons for missing vaccines were simple: many participants were unaware of the vaccines or had never been offered them. Conversely, the most common reasons for declining vaccination in the ED included feeling too ill during the visit or wanting more information before making a decision.
Implications for Public Health Practice
These findings highlight an underused opportunity in the nation’s vaccination strategy. Traditional surveillance tools, like the National Health Interview Survey, often miss adults who lack regular primary care access. Given that U.S. emergency departments handle more than 150 million visits annually, even modest uptake of vaccination in these settings could significantly boost national coverage rates.
While providing all CDC-recommended adult vaccines in EDs may be impractical, embedding screening, counseling, and referrals into ED workflows could be a feasible next step. Previous trials have shown that targeted vaccination messaging in EDs can double or triple vaccine acceptance rates among underserved groups.
Looking Ahead
The study underscores both the urgency and the opportunity in addressing adult vaccination gaps. For health systems, public health agencies, and policymakers, the evidence suggests that emergency departments—long seen primarily as safety nets—could also serve as crucial gateways for preventive care. As vaccination schedules grow more complex, integrating ED-based approaches into broader public health strategies may be essential for reaching populations that the traditional system has left behind.
Rodriguez RM, Torres JR, Chinnock B, et al. Emergency Department Survey of Vaccination Knowledge, Vaccination Coverage, and Willingness to Receive Vaccines in an Emergency Department Among Underserved Populations — Eight U.S. Cities, April–December, 2024. MMWR Morbidity and Mortality Weekly Report, 7 August 2025.