ORIGINAL RESEARCH article
Front. Health Serv.
Sec. Implementation Science
Volume 5 - 2025 | doi: 10.3389/frhs.2025.1477530
COVID-19 Vaccine Uptake at Six Months Post Vaccine Availability in Central Texas: An Observational Study Disentangling the Moveable Middle
Provisionally accepted
- 1The Litaker Group, LLC, Austin, Texas, United States
- 2Sendero Health Plans, Inc, Austin, Minnesota, United States
- 3The University of Texas at Austin, Austin, Texas, United States
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Background: Vaccine hesitancy is a multifactorial construct that posits vaccine uptake is based on person, place, time, and vaccine type. This study sought to identify individuals at about the six-month mark of COVID-19 vaccine availability in Central Texas to determine if they were vaccine acceptors, vaccine refusers, or in the moveable middle using the COVID-19 Vaccination Uptake Behavioral Science Task Force framework developed for the US Centers for Medicare and Medicaid Services and to disentangle individuals in the moveable middle to either vaccine acceptors or vaccine refusers. Methods: An online survey was distributed to individuals with Affordable Care Act insurance to assess: (1) COVID-19 vaccine uptake; and (2) plans to obtain a COVID-19 vaccine for those who had not yet received at least one dose of a COVID-19 vaccine. The study period was June 27, 2021, through July 13, 2021. Quantitative and qualitative data were collected.Results: 900 individuals participated in this study. The point prevalence of COVID-19 vaccine acceptance and refusal was 94.9% (n = 854) and 5.1% (n = 46), respectively. For those who were initially identified in the moveable middle, 84.6% exited the moveable middle as vaccine refusers. Black or African American race (p<0.001), income level (p=0.004), and education level (p=0.015) were associated with obtaining at least one dose of the COVID-19 vaccine.Conclusions: Real-world evidence at the time of a public health emergency can be used to determine point prevalence of vaccine uptake to stratify individuals as vaccine acceptors, vaccine Deleted: and the distribution of individuals in one of three categories of vaccine acceptor, vaccine refuser, and the moveable middle… refusers, or the moveable middle. Such evidence can be used to support health policy and planning during a public health emergency.
Keywords: Vaccine uptake, Moveable Middle, Public health emergency, COVID-19, Affordable Care Act, Sendero Health Plans, Vaccine Acceptors, Vaccine Refusers
Received: 07 Aug 2024; Accepted: 28 Jul 2025.
Copyright: © 2025 Litaker, Lopez Bray, Tamez, Durkalski and Taylor. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: John R Litaker, The Litaker Group, LLC, Austin, Texas, United States
Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.