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COVID vaccine hesitancy: Why people don't want the shot

Here's what influences someone's decision on whether to get the COVID-19 vaccine.

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When the Food and Drug Administration authorized the first COVID-19 vaccine in December after an arduous year of disease, death and sheltering in place, many celebrated vaccination as a way out of a once-in-a-lifetime pandemic. 

Others weren't as enthusiastic. Some became fearful of a vaccine they thought was rushed or experimental, and they may have heard false statements about vaccines causing infertility or containing a microchip. Others drew comparisons to a thick history of medical gaslighting and abuse of people who look like them at the hands of the US government. Then there are those who value individual liberty above all else, and view vaccine promotion as an intrusion on personal choice. The push for COVID-19 booster shots throw more light on the discussion.

The US is no stranger to a vocal antivaccine movement, but the people who've chosen not to get a COVID-19 vaccine yet aren't necessarily "antivax." In fact, antivaxxers are likely a small number in the much quieter and much larger group who are vaccine hesitant. 

"Television and the internet is going to highlight the people who are the most vehemently antivax, but if you take a look at it, a lot of the reasons people aren't getting vaccinated is that they just don't know," says David Dunning, a professor of psychology at the University of Michigan who studies human misbelief.

"A lot of people are uncertain as opposed to hostile," Dunning says. "For a lot of people it's really about the nuts and bolts of getting the vaccine, rather than any sort of ideological stance."

Pfizer is now fully approved by the FDA, and some institutions and businesses have used the FDA approval as a green light to mandate vaccines for employees. There is also the hope that the FDA's total confidence in Pfizer's COVID-19 vaccine (now marketed as "Comirnaty"), with Moderna hard on its tail, will inspire people on the fence to go get the shot on their own accord. 

As of Sept. 2, 2021, 75.2% of adults in the US have had at least one shot in the COVID-19 vaccination series. (The two mrNA vaccines require two shots; Johnson & Johnson is a one-dose vaccine.) Cases of COVID-19 are on the rise again as the newest and most dangerous delta variant is causing some hospitals to run out of beds as more people are getting severely sick with COVID-19 -- the vast majority of them unvaccinated. A report published by the Centers of Disease Control and Prevention suggests unvaccinated people are more than 29 times more likely to get hospitalized with COVID-19 than vaccinated people who experience a breakthrough infection. While the numbers of COVID-19 cases and hospitalizations are clear, the reasons for people opting out of coronavirus vaccination isn't.

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What the polls say

White evangelical Christians and people who're under 65 who don't have health insurance are the most likely to say they "definitely" will not get a COVID-19 vaccine, according to a July poll by the Kaiser Family Foundation. How people identify politically also matters, according to the foundation, as Republicans make up 58% of the group who said they definitely won't get vaccinated. White Americans polled were much more likely to be adamantly against the vaccine than the people of color that were queried, who made up 40% of the group who say they want to "wait and see" before they get the COVID-19 vaccine. 

Younger adults age 18 to 29 are also more likely to give a hard "no" to the vaccine, as are adults living in rural areas.

The way the poll splits hairs between people saying they "definitely" won't get the vaccine and them saying they want to "wait and see" draws the line for the way we might define vaccine resistant versus vaccine hesitant. The way people identify and respond to a questionnaire about why they're holding out on a shot appears to have a lot to do with their personal or community history and what kind of information and media they're exposed to. It's hard to put everyone who doesn't want the vaccine in a single box, because it's a diverse community with many different reasons.

'Smoke and mirrors:' Misinformation and the media 

Trevor Tilseth lives in western Wisconsin and isn't getting the coronavirus vaccine because he sees the shot as a placebo. To him, vaccines aren't the "miracle drug" they're made out to be, and the delta variant may be a "cop-out" reason to explain why vaccinated people are experiencing breakthrough infections. 

Tilseth also doesn't believe the coronavirus is that dangerous of a virus, because he knows people who've had COVID-19. One case in particular "should have been a death sentence" because of the person's preexisting conditions, he says. Tilseth has also seen conflicting media coverage of COVID-19, including that regarding hydroxychloroquine.

"What it comes down to is actually finding stuff that you can believe in -- where you get your facts, what's real, what's not," he says.

Tilseth is a disabled veteran and declines the coronavirus vaccine when it's offered to him at the Veterans Affairs hospital. But if one of his two children decided to get vaccinated when they're eligible (one is currently eligible), he'd support them as long as they're informed. Tilseth's main hangup on the coronavirus vaccines is not knowing what information to believe.

"It's a lot of 'How do we trust what we see?' There's a lot of smoke and mirrors," Tilseth says. "When I talk to my neighbors, a lot of us think the same thing."

Dunning believes a key issue in vaccine hesitancy is one of trust. Different cultural speakers and political speakers disagreeing over the same information inhibit progress. "If your goal is to get everybody vaccinated, it's important that everybody with a microphone sing from that hymnal," he says.

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Many people who don't want the COVID-19 vaccine aren't antivaccine in general. Their hesitation may stem from history, lack of access, politics and other reasons. 

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Undoing Tuskegee: Racism and abuse in American medicine

Dr. Ijeoma Nnodim Opara is a pediatrician, an internal medicine doctor and a Black woman. At a Twitter event Thursday discussing vaccine hesitancy in the Black community with the nonprofit Black Coalition Against COVID-19, Opara said her knowledge of a history in which Black people have been mistreated in the medical system made her, a medical professional, vaccine hesitant. As one of the first people to be eligible to get the shot, Opara was nervous. 

"I get it when folks are skeptical about anything that begins to sort of seem like it's targeting us, because we have receipts longer than CVS to show for the ways that we've been negatively impacted," Opara said. What solidified her choice to get the shot was a conversation with her brother and father, also doctors, who discussed with her their own decision-making on why they got the vaccine as soon as it was available to them. 

One of the most notable events in which Black people were wronged by the medical community was the Tuskegee Study, an experiment by the Tuskegee Institute and the US Public Health Service Commissioned Corps that began in 1932 and studied syphilis in 600 Black men from Alabama. The participants were given false pretenses about the experiment, and when penicillin became available as treatment for the disease in 1947, none of the 399 men who had syphilis were treated. Many died. 

Modern health disparities also exist, including overall access to care and research that suggests Black people receive worse health care than their white counterparts, even with health conditions, insurance and income adjusted. In the coronavirus pandemic, the Black community also lost a disproportionate number of lives, in part because of how the community is disproportionately affected by health conditions that lead to severe COVID-19. According to CDC data from July 2021, Black Americans were 2.8 times more likely to be hospitalized with COVID-19 and two times more likely to die from COVID-19 than white Americans. There were similar disparities for other people of color, including Native Americans and Hispanic people. 

While Black and Hispanic people have lower vaccination rates in their communities compared to whites, according to data reported by the Kaiser Family Foundation, vaccination rates among Black and Hispanic people increased from Aug. 2 through Aug. 16, helping narrow the gap in vaccine disparity and suggesting that community-based motivation, like that from the Black Coalition Against COVID-19, helps gain people's trust.

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A man with a fear of needles covers his eyes while receiving the Johnson & Johnson COVID-19 vaccine. Dunning says a fear of needles is common -- about one in 10 people will have an anxiety reaction in a doctor's office. 

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The tyranny of 'and': Good health vs. the vaccine

There've been a few reports circulating online about people who didn't get vaccinated because they were generally healthy and didn't think they were susceptible to severe COVID-19, only to get hospitalized or die from the coronavirus. These serve as tragic reminders of our mortality, and also of the cruel lottery a virus like the coronavirus inflicts. And while most of us appear to be born with at least a little sense of immortality, those most likely to say they "definitely" won't get the COVID-19 vaccine are also the most likely to think they won't get a serious case of COVID-19, or that the vaccines pose a worse threat to their health than the virus itself, according to data from the Kaiser Family Foundation. 

At the Coalition discussion on Thursday, a nurse called in and posed a question: If certain health conditions predispose a person to severe COVID-19 (obesity, heart disease and diabetes, for example, all of which make a person eligible to receive monoclonal antibody treatment if they catch COVID-19), why are doctors championing the vaccine instead of lifestyle changes that will make a person healthier?

Dr. Reed Tuckson, a co-founding member of the Black Coalition Against COVID-19 and the former commissioner of public health for Washington DC, said that while taking care of your overall health is important, it doesn't mean you don't need to get vaccinated. 

"There is the tyranny of the 'and' which we have to deal with. We need to be vaccinated and take care of our overall health," Tuckson said. "But one does not substitute the other."

The information contained in this article is for educational and informational purposes only and is not intended as health or medical advice. Always consult a physician or other qualified health provider regarding any questions you may have about a medical condition or health objectives.