As The Atlantic's Derek Thompson notes, the roughly one-quarter to one-third of Americans that are actively refusing a COVID-19 vaccine have multiple different reasons for not trusting or wanting it for them or their families, and finding the alchemical formula for convincing them otherwise is the major public health issue of our time.
Why wouldn’t someone want a COVID-19 vaccine?
Staring at the raw numbers, it doesn’t seem like a hard choice. Thousands of people are dying of COVID-19 every day. Meanwhile, out of the 75,000 people who received a shot in the vaccine trials from Pfizer-BioNTech, Moderna, AstraZeneca, Johnson & Johnson, and Novavax, zero died and none were hospitalized after four weeks. As the United States screams past 500,000 fatalities, the choice between a deadly disease and a shot in the arm might seem like the easiest decision in the world.
Or not. One-third of American adults said this month that they don’t want the vaccine or are undecided about whether they’ll get one. That figure has declined in some polls. But it 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.
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.
Kolina Koltai has been studying online disinformation since 2015, with a special focus on anti-vaccine groups on Facebook. “People come into the space for a variety of reasons,” she said. “At first, it was mostly parents, more women than men, and overwhelmingly white, ranging from stay-at-home moms to people with high levels of education who wanted a naturalistic upbringing for their child.” The group didn’t initially have a political lean. But in the past few years, Republican politicians have played more directly to anti-vaccine fears, pulling these groups to the right.
Today, resistance among the GOP seems to be the most significant problem for vaccinating the country. Just half of Republicans say that they plan to get the shot, while the share of pro-vaccine Democrats has increased to more than 80 percent.
Online denialism and conspiracy theorizing about the COVID-19 vaccine is more complex than previous anti-vaccine skepticism, Koltai said. “Crisis often breeds conspiracies, and the extended nature of this public-health crisis has given conspiratorial people lots of time to build elaborate theories,” she told me. Beyond the more outlandish theories—for example, that Bill Gates is using the shots to inject Americans with his microchips—she said that most online skepticism is more prosaic. People claim that the vaccine trials were rushed and shoddy. They worry about the long-term side effects of a newfangled chemical that monkeys around with our cells. They read news reports of people getting sick after having taken the shots, and become afraid.
“You shouldn’t say that people are idiots for believing false or misleading information, because they’re not idiots,” she said. “That’s part of what makes this such a hard problem to solve.”
This is the country that gave us Jonas Salk's polio vaccine. This is also the country that gave us the Tuskeegee Experiment and gave smallpox-laden blankets to Native Americans, and to this day uneven health outcomes for people of color continue to exist.
There are reasons for distrust. But there's also a lot of disinformation out there, and there are also more than 500,000 Americans dead.
That last part is the most important and why we need to solve this problem, and it's going to take a multi-directional, multi-disciplinary solution.