Vaccine Hesitancy

A third of Americans are unsure they want the life-saving COVID shots.

The Atlantic‘s Derek Thompson points to surveys showing roughly a third of Americans are hesitant to get the COVID-19 vaccine despite half a million dead from the disease and strong evidence that the vaccines are safe and effective. This is obviously problematic:

[This hesitancy] remains disconcertingly high among Republicans, young people, and certain minority populations. In pockets of vaccine hesitancy, the coronavirus could continue to spread, kill, mutate, and escape. That puts all of us at risk.

Alas, the causes of that are complicated.

Last week, I called several doctors and researchers to ask how we could reverse vaccine hesitancy among the groups in which it was highest. They all told me that my initial question was too simplistic. “Vaccine hesitancy” isn’t one thing, they said. It is a constellation of motivations, insecurities, reasonable fears, and less reasonable conspiracy theories.

“I call it vaccine dissent,” Kolina Koltai, who studies online conspiracy theories at the University of Washington, told me. “And it’s way more complicated than being anti-vaccine. It goes from highly educated parents who are interested in holistic, naturalistic child-rearing to conspiracy theorists who want to abolish vaccines entirely.”

“I call it vaccine deliberation,” said Giselle Corbie-Smith, a professor at the University of North Carolina and the director of the UNC Center for Health Equity Research. “For Black and Brown people, this is a time of watchful waiting. It’s a skepticism of a system that has consistently demonstrated that their health is not a priority.”

“It’s not vaccine hesitancy among American Indians, but rather hesitancy and distrust regarding the entire government,” said Margaret Moss, an associate professor at the University of British Columbia School of Nursing and an enrolled member of the Three Affiliated Tribes of North Dakota. “After decades of distrust, on top of centuries of genocide, now they appear and say, ‘Here, you have to take this!'”

Let’s not forget vaccine indifference. Two-thirds of Republicans under 30 without a college degree say that they are “not concerned at all” about COVID-19 in their area, according to polling from Civiqs. The same percentage of this group says that they won’t take the vaccine, making them the most vaccine-resistant cohort among all of those surveyed.

Dissent. Deliberation. Distrust. Indifference. Vaccine hesitancy is not one thing. It’s a portfolio. And we’re going to need a portfolio of strategies to solve it.

The rest of the piece is about misinformation, conspiracy theories, and the complications presented by the modern information environment. But here’s a key takeaway:

“You shouldn’t say that people are idiots for believing false or misleading information, because they’re not idiots,” [Koltai] said. “That’s part of what makes this such a hard problem to solve.”

Rather obviously, the politicization of the issue by former President Trump and Republican governors—and aided and abetted by Fox News, Rush Limbaugh, and the right-wing infotainment complex are a major part of the problem. But so is anti-government conspiracy theories in traditionally Democratic constituencies.

Because in-residence military education is considered essential, I’m actually scheduled to get my shots through the Defense Department next week—well ahead of when it would otherwise by my turn locally. So far as I know, none of my colleagues, military or civilian, are balking. But some one-third of American military personnel—roughly the same percentage as the nationwide polling cited by Thompson—is refusing to get the shot. (Because it’s considered “experimental,” it’s optional right now even though a plethora of other vaccinations are not.)

Even among my Trump-supporting friends on Facebook, I’m not seeing a resistance to getting the shot. And these are people who think mask mandates and government shutdowns of restaurants and the like are outrageous restrictions on our freedoms. Indeed, they’re mostly skeptical of the “the restrictions will still apply even after you’re vaccinated” message.

One presumes that, as the number of Americans getting their shots and suffering only mild reactions increases, much of this reluctance will fade. But significant pockets will surely remain.

One wonders, then, at what point vaccination becomes mandatory? Or, at least, mandatory for those who wish to send their children to school, work in public-facing jobs, and the like.

FILED UNDER: COVID-19, Health
James Joyner
About James Joyner
James Joyner is Professor and Department Head of Security Studies at Marine Corps University's Command and Staff College and a nonresident senior fellow at the Scowcroft Center for Strategy and Security at the Atlantic Council. He's a former Army officer and Desert Storm vet. Views expressed here are his own. Follow James on Twitter @DrJJoyner.

Comments

  1. OzarkHillbilly says:

    Meanwhile, high risk people like me can’t get vaccinated or are traveling hundreds of miles for one. Not sure how much of that is due to my living in Misery.

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  2. Sleeping Dog says:

    Got my second shot Friday (Pfizer) and no adverse reactions, except a sore arm.

    The US isn’t the only country facing hesitancy, France and Germany are also seeing high levels of refusal, about 50% in France and slightly less in Germany, but the Germans who are willing to get the shot are holding out for the Pfizer vaccine, because it was co-developed with a German company. People are strange.

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  3. Jon says:

    Seems apropos: No, the Tuskegee Study Is Not the Top Reason Some Black Americans Question the COVID-19 Vaccine.

    That article points out that hesitancy is not the same things as refusal, which supports (or is supported by) some of the quotes in the OP above.

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  4. James Joyner says:

    @OzarkHillbilly: It definitely seems to vary widely from state to state but Missouri is damn near the median state (24th) in distribution judged by vaccinations per dose received—but near the very bottom in vaccinations per 100,000 population.

    Missouri Gov. Mike Parson, a Republican, has faced criticism that he has short-changed the St. Louis region on vaccine supply, favoring the state’s rural areas. Parson’s office did not respond to a request for an interview but told local media this month that there was no bias.

    “We look at geography and population, but we also look at where our elderly populations are and they are more commonly in rural areas,” he said.

    @Sleeping Dog: Yep. And I imagine some here are going to hold out now for the single-shot J&J variant approved yesterday.

    @Jon: Yes but they’re part and parcel. Most people I know are trying to get to the front of the line.

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  5. CSK says:

    @Sleeping Dog:
    It was also co-developed in the town where I live.

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  6. Jon says:

    @James Joyner:

    Most people I know are trying to get to the front of the line.

    Which, interestingly enough, is one of the things the article I linked to posits is a factor in the hesitancy. But yes, I was not trying to imply there is no correlation at all between hesitancy and refusal, just that it isn’t as simple as we might think. From the article:

    While Black people were twice as “wary” of participating in research, as compared to white people, they were equally willing to actually participate.

  7. CSK says:

    An added complication is that it seems impossible to get a straight answer as to whether co-morbidities such as high blood pressure or diabetes that are controlled by proper diet and medication are in fact counted as co-morbidities. I asked my dentist this last week, and he sighed and replied: “We don’t know.”

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  8. OzarkHillbilly says:

    @James Joyner: I have a number of STL friends who traveled to rural Misery to get their shots, one as far as St. James. I am now on 2 lists and would get myself on a 3rd if I could find one. I can isolate fairly easily so I’ll be patient with what’s around here.

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  9. James Joyner says:

    @CSK: Yeah, a year in there’s still a ton we don’t know. We’ve added obesity as a comorbidity in the most recent CDC update, which complicates things further—especially since so many of us have put on a few pounds while cooped up during the pandemic.

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  10. CSK says:

    @James Joyner:
    I hope further research is being done in these areas, because the difference between controlled high blood pressure and uncontrolled high blood pressure–just to name one of the pre-existing conditions–could move the individual from one priority group to another.

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  11. James Joyner says:

    @CSK: I suspect, and indeed hope, that we’ll have everyone vaccinated before we figure that out.

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  12. mattbernius says:

    In addition to the topics that are well covered above, an additional issue with vaccinating Black and other PoC communities in many places is the overall design of the vaccination experience. computer-based scheduling systems can be an issue if they are not mobile-friendly. Another issue is that scheduling people for specific times (versus time blocks) creates challenges for those who don’t have flexible working (or child care) schedules or access to personal transportation.

    That’s before we get to “vaccine tourism” and people traveling to other communities to get the shot.

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  13. Kathy says:

    It’s times like these when I believe the answer to Fermi’s Paradox, is that we’ve been quarantined by the other sentient species because stupidity turns out to be contagious.

    Meantime, the vaccine trickle in Mexico sputters along.

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  14. Erik says:

    @James re: military vaccinations: there is a significant disparity locally between refusals amongst officers and enlisted. One creative OIC doubled vaccination rates for his enlisted population by authorizing vaccinated personnel 48 hours of special liberty (with restrictions) post vaccination to “ensure that if anyone had side effects they would not need to be on duty.” The problem became staggering the doses so the enough people would be in duty for the unit to remain mission capable.

    ——
    This seems a good place for my periodic plug to please sign up at https://vsafe.cdc.gov/ so we can get better data on vaccine side effects

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  15. Bill says:

    “Certain minority groups “? Just fn say it, even espn has come out and said it…but we’re still glossing over it.

    Oh, lots of people under 40 got the vaccine as demand is kinda low- and it’s just because of “certain minority groups”.

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  16. Mister Bluster says:

    @OzarkHillbilly:..I have a number of STL friends who traveled to rural Misery to get their shots, one as far as St. James.

    St. James Infirmary

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  17. @Bill: What are you trying to say?

    And, ESPN?

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  18. Roger says:

    @OzarkHillbilly: On Thursday, I drove two hours from KC to a rural vaccination event. The folks in line in front of me had driven over four hours from the St. Louis metro. In what seems to me to be a very strange political calculation, our governor has sent a large number of vaccine doses to rural areas that don’t seem to particularly want them while limiting the number of doses sent to the larger metro areas. The result is caravans from the cities to the country to get vaccinated. I suppose the best thing you can say is this plan brings a little boost to the economy of the guv’s political base when we big city liberals buy gas and a burger in outstate Misery.

    I signed up to ease my wife’s mind even though I suppose I’m in the “vaccine hesitant” class. I hesitated, not because I’m any kind of anti-vaxxer or Covid non-believer, but because the last four years have poked some holes in my faith in the apolitical nature of the scientific process at the FDA, and I have some concerns about what may have been overlooked or minimized in a potentially politically-influenced fast-track process.

  19. Gustopher says:

    @CSK:

    An added complication is that it seems impossible to get a straight answer as to whether co-morbidities such as high blood pressure or diabetes that are controlled by proper diet and medication are in fact counted as co-morbidities. I asked my dentist this last week, and he sighed and replied: “We don’t know.”

    We certainly know whether we count them as co-morbidities.

    As to whether or not they affect outcomes… “we don’t know” is the straight answer.

    (I’m surprised there is no answer as to whether people on blood thinners because of clotting issues are at more or less risk of bad outcomes. Covid causes clotting, so I could see it going either way, but… no data. So odd we haven’t been collecting that data, since there are so many olds on blood thinners)

  20. Gustopher says:

    @Roger: I would say that I am very slightly hesitant, for the same reasons, but all the data looks good so far. And being 50, working from home, with only one counted co-morbidity… I’m pretty far down the list to get vaccinated, so I have time to see if people grow extra heads.

  21. Michael Reynolds says:

    [This hesitancy] remains disconcertingly high among Republicans, young people, and certain minority populations.

    I’m not sure ‘idiots’ is a minority population. I can point to 74 million idiots just as a start.

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  22. Sleeping Dog says:

    @Roger:

    …but because the last four years have poked some holes in my faith in the apolitical nature of the scientific process at the FDA…

    Not at all unreasonable and I shared some of those same concerns and actually put more faith in what the drug companies were saying about safety. My reasoning being that very early the pharma CEO’s were forthright in saying that the vaccine development was “too big to fail” and rejected pressure from the Trump admin to submit for approvals early in the fall. Insisting that the process for the trials needed to be completed, so that the public would be assured of the safety of the vaccine.

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  23. Bill says:

    @Steven L. Taylor: That blacks need to be encouraged by celebrities/athletes to do anything that requires a brain!? It was kind of embarrassing to see that scroll on the chyron, especially when you’re in a bar with a few black guys/girls and no you have to pretend you were watching the Chive channel.
    Personally I don’t have much interest in getting the shot- I’ve been working since the whole panicdemic started and go out to bars/ restaurants all the time since they reopened in May.
    Trying to hide from an airborne virus doesn’t seem to work- and the bulk of the people who encourage these shut downs haven’t lost a dime let alone their entire livelihood.
    But hey, I’m not here to judge the easily misled crowd.

    Oh, I forgot the ? mark at the end of the first retort , big fingers/small phone!

  24. CSK says:

    @Gustopher:
    You’ll be the first I’ll notify if I grow an extra head.

  25. Kurtz says:

    @Bill:

    If you’re going to criticize, the best thing to do is make sure you correctly quote the passage. “Certain minority populations” has a different connotation from “certain minority group.”

    Population has a specific meaning in research.

    Your objection says more about your priors than it does about the rest of us.

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  26. Kurtz says:

    @Bill:

    That blacks need to be encouraged by celebrities/athletes to do anything that requires a brain!? It was kind of embarrassing to see that scroll on the chyron, especially when you’re in a bar with a few black guys/girls and no you have to pretend you were watching the Chive channel.
    Personally I don’t have much interest in getting the shot- I’ve been working since the whole panicdemic started and go out to bars/ restaurants all the time since they reopened in May.
    Trying to hide from an airborne virus doesn’t seem to work- and the bulk of the people who encourage these shut downs haven’t lost a dime let alone their entire livelihood.
    But hey, I’m not here to judge the easily misled crowd.

    Oh, I forgot the ? mark at the end of the first retort , big fingers/small phone!

    Wherein one sets a standard for having a brain then admits he will not meet that standard for having a brain.

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  27. Gustopher says:

    @Bill:

    That blacks need to be encouraged by celebrities/athletes to do anything that requires a brain!?
    […]
    Personally I don’t have much interest in getting the shot- I’ve been working since the whole panicdemic started and go out to bars/ restaurants all the time since they reopened in May.

    Do you now identify as Black? Or are you not willing to do anything that requires a brain even if athletes and celebrities tell you to do it?

    From here it looks like even your racist caricature of a Black person is smarter than you.

    (As an aside, I half suspect that the reason restaurant dining is such a bad risk is that the people who insist upon doing it are the people who take no precautions elsewhere — it’s a risky activity being done by population with higher infection rates to start with, so even more spread. I wonder whether a vegan restaurant would be less dangerous)

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  28. Gustopher says:

    @James Joyner:

    We’ve added obesity as a comorbidity in the most recent CDC update, which complicates things further—especially since so many of us have put on a few pounds while cooped up during the pandemic.

    The donuts are going to get you your vaccine sooner. They’re a health food!

    (I am 6’5” and 255 lbs — that 5 lbs is the co-morbidity that moves me up compared to the general population, rather than the history of massive pulmonary embolism which seems far more serious. But, it means I get to have a donut now and then, so it’s all good…)

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  29. Kurtz says:

    @Gustopher:

    I find it disconcerting that the anti-precaution crowd seems to center their view on whether they got really sick or not. This JAMA study estimates that half of infections are from asymptomatic transmission.

    If that estimate is in the ballpark, it’s likely that the individuals in that crowd have caused the death of another person by behaving recklessly. Whether it rises to the level of wanton disregard…well…IANAL

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  30. @Kurtz:

    Wherein one sets a standard for having a brain then admits he will not meet that standard for having a brain.

    It is a pretty remarkable position, isn’t it?

    4
  31. steve says:

    Most recent lists of co-morbidities that increase risk or might increase risk for Covid serious illness. Type 2 diabetes is a definite risk and Type 1 a maybe. Suspect that is just because there are fewer type 1 and they are younger.

    https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-with-medical-conditions.html

    Steve

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  32. Michael Reynolds says:

    @Gustopher:
    Great. I was thinking I’d make a nice, healthy chicken salad, and now I’m remembering that Door Dash does donuts.

  33. Gustopher says:

    @Michael Reynolds: Gavent you already gotten your vaccine? You’ve got no health reason for donuts.

  34. DrDaveT says:

    @Bill:

    Personally I don’t have much interest in getting the shot

    Works for me.

    Let me guess — you have no idea why slave-descended Americans might be skeptical of what the medical authorities are telling them? But you’re sure it’s their fault, and reflects poorly on their intelligence? Yeah, that’s what I thought.

    3
  35. Jen says:

    @steve:

    Suspect that is just because there are fewer type 1 and they are younger.

    This is a very common misconception. Children who develop Type 1 diabetes grow into adults with type 1 diabetes, they do not age out of the disease. Also, increasing numbers of adults are being diagnosed with Type 1.

    There are, however, far fewer people with Type 1, which is an autoimmune disease. It accounts for about only 7-10% of the total population of those with diabetes in the US.

    On high blood pressure and controlled vs. uncontrolled: part of the issue there is that which type of medication you are on to control high blood pressure seems to matter in outcomes, at least somewhat.