This study elicited reasons for initiating COVID-19 vaccination in April 2022 or later. We interviewed patients (n = 51) from 2 healthcare systems in central Massachusetts. Participants were 66.7 % female, 39.2 % White non-Hispanic, 15.7 % Black non-Hispanic, and 39.2 % Hispanic. The most common reason for vaccination was that it was required for something the participant wanted to do, cited by 40/51 participants as the main reason for vaccination. Social influences, reported by 27/51 participants, were mostly (n = 22/27) described as secondary reasons. Increased disease risk appraisal and/or increased confidence in the vaccine were noted by 24/51 participants, also predominantly as secondary reasons (n = 14/24). Requirements to be vaccinated for work, school, or to participate in activities are an important lever for promoting COVID-19 vaccine uptake. Commonly cited as secondary reasons, social influences and factors that increase disease risk appraisal and/or vaccine confidence may serve to create a foundation for vaccine requirements.