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The latest data from the Centers for Disease Control and Prevention (CDC) indicates that nearly 38% of U.S. adults are fully vaccinated against COVID-19, but officials have warned about a portion of the 55% of those who have received their first dose skipping out on the second. According to a new study, those 8% who are skipping the second dose could be prolonging the pandemic.

The research, published Wednesday in the New England Journal of Medicine, focused on responses from 1,000 American adults who were asked about the vaccines in February. One-fifth of respondents indicated to the Cornell-led research team that they believed the Modern and Pfizer COVID-19 vaccines, each two-dose shots, provided strong protection after only one jab, while 36% said they were unsure. Less than half said they believed the shots provided strong protection a week or two after the second dose, according to a news release posted to EurekAlert.org.

Multiple studies have proven that the vaccines are most effective at preventing COVID-19 two weeks post-second dose. 

The issue surrounding dosing and efficacy may be in the messaging and missed opportunities to inform, as the researchers found that about half of respondents said they were told about the timing of vaccine protection. One of the study’s lead authors, Jillian Goldfarb, assistant professor in the Department of Biological and Environmental Engineering in the College of Agriculture and Life Sciences, said she became concerned about the lack of information being given to vaccine recipients when she got her first dose at a county-run site.

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Goldfarb said the missed opportunity for relaying vital information such as post-vaccination prevention measures and the importance of a second dose could "end up prolonging the pandemic because people don’t follow through."

"Many Americans, including many of those who have already received a first vaccine dose, remain confused about the timing of protection and the necessity of a second dose," the researchers wrote. "Moreover, a large proportion of vaccinees report being uninformed about CDC guidance regarding the need to continue to take prophylactic measures."  

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In recent weeks, the Biden administration has deployed community messengers in an effort to combat misinformation regarding the vaccines and help reach populations otherwise left out of inoculation efforts. Some critics of the Johnson & Johnson COVID-19 pause earlier this month had voiced concern about replacing a one-dose shot with the two-dose vaccines in hard-to-reach communities due to scheduling issues and follow through.

In the new study analysis, researchers warned that the issues surrounding second doses could be heightened among minority racial and ethnic groups that have historically had higher attrition rates for multidose vaccines. The Biden administration has placed equity at the forefront of its vaccine distribution plan, but the researchers warn that a failure to communicate the importance of a second dose "risks magnifying existing racial disparities in the virus’s human toll."

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They called for more communication and information at the time of the first dose as well as "fuller guidance and greater contextual explanations."