Too Many Americans Still Mistrust the COVID-19 Vaccines. Here’s Why

If you’re feeling impatient waiting your turn for a COVID-19 vaccine, here’s a little good news: Angela Padgett will gladly give you her place in line—at least for now. Padgett, president of a day spa in Raleigh, N.C., is under no illusions about the mortal danger the pandemic poses to herself, her family and the world writ large—indeed, she had COVID-19 back in July. But as for the vaccine that is supposed to put an end to all of the suffering at last? Not today.

“I am a little bit hesitant,” she says. “I can appreciate President Trump trying to get this moving fast and I’ve taken pretty much every vaccine [for other diseases]. But I think it was rushed through very early, very quickly. So I would like a little more data.”

Padgett is not alone. According to a December survey undertaken by the Pew Research Center, nearly 40% of Americans say they will definitely not or probably not get the COVID-19 vaccine when it becomes available to them. Gallup polls put the number at 37%. That’s bad news not just for the vaccine refusers themselves but for the public as a whole. Experts including Dr. Anthony Fauci, head of the National Institute for Allergy and Infectious Diseases, had previously concluded that achieving herd immunity—the point at which a population is sufficiently vaccinated that a spreading virus can’t find enough new hosts—would require anywhere from 60% to 70% of Americans to take the vaccines. But lately, he and others have been inching that number upward, now estimating that herd immunity could require as much as 85% vaccine coverage.

The holdouts have multiple reasons for their reluctance. There are, of course, the dead-enders in the anti-vax community, for whom no vaccine is safe or acceptable. There is, too, a faction peddling conspiracy theories about the COVID-19 vaccines in particular. As one falsely goes, the disease is caused by 5G cell towers, so a vaccine would be useless against it. (The rumor has been repeatedly debunked on Snopes.com and other sites.) Another spuriously claims the vaccines are a plot by the Bill and Melinda Gates Foundation—or, alternately, Elon Musk—to inject microchips into Americans. That last one—debunked here, here and elsewhere—has gained enough traction in the fever-swamp corners of the Internet that it prompted a rare acknowledgment from Bill Gates himself. “It doesn’t help that there are false conspiracy theories about vaccines, including some that involve Melinda and me,” he wrote in a foundation letter he released on Dec. 22.

Read more: What Bill Gates Thinks About the State of the Fight Against COVID-19

But most people in the COVID-19 vaccine hesitancy camp are more rational, more measured—informed enough not to believe the crazy talk, but worried enough not to want to be at the head of the line for a new vaccine. “For first responders and for older people with underlying conditions it’s a godsend,” says Padgett. “But I do believe this was rushed. I’m reasonably healthy. Six months to a year just to get more data on it is what I’d need to be vaccinated.”

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For all the urgency to get as many vaccines into as many arms as possible, the reluctance of such a large swath of the population to be among the early adopters is not completely without merit.

“I think it’s reasonable to be skeptical about anything you put into your body, including vaccines,” says Dr. Paul Offit, professor of pediatrics at the Children’s Hospital of Philadelphia and director of its Vaccine Education Center. Coming from Offit, a vocal proponent of universal vaccination and a particular boogeyman of the anti-vax camp, that carries particular weight. He goes further still, acknowledging that the speed with which the COVID-19 vaccines were developed can cause people special concern. “The average length of time it takes to make a vaccine is 15 to 20 years,” he says. “This vaccine was made in a year.”

Then too there is a question of effectiveness. Both of the vaccines that have been authorized for emergency use in the U.S., one from Pfizer-BioNTech and one from Moderna, have what Offit calls “ridiculously high efficacy rates—in the 95% range for all [COVID-19] disease and for Moderna’s product 100% for severe disease.” But in the haste to get the vaccine to market, test subjects have been followed up for only two to three months, so it’s impossible to say with any authority how effective the vaccines will remain at six or nine or 12 months.

Read more: Yes, We Have COVID-19 Vaccines That Are 95% Effective. But That Doesn’t Mean the End of the Pandemic is Near

Finally there are the side effects. Anaphylaxis—or a severe allergic reaction—is possible with any vaccine, though medical protocols call for people who have received the shot to wait 15 minutes before they leave so that they can be treated if they do have a reaction. More troubling are spotty reports of Bell’s palsy—partial facial paralysis—following COVID-19 vaccinations. But those numbers are exceedingly small. One false Facebook posting purported to be from a nurse in Nashville who got the vaccine and suffered Bell’s palsy, but that too has been debunked, as repeated searches have turned up no nurse in the Tennessee health system under that name. All the same, it sparked outsized fear of a real but minimal risk.

“There were four cases of Bell’s palsy within a month or month and a half in the Pfizer trial out of 22,000 recipients,” Offit says. “So that works out to roughly eight per 10,000 per year.” Such a case count may be low, but it does exceed the average background rate of Bell’s palsy in the general population, which is 1.2 per 10,000 per year, Offit says. Other sources put the incidence as a somewhat higher 2.3 per 10,000.

Armed with numbers like that, however, humans are not always terribly good at calculating risk. On the one hand even an eight in 10,000 chance of contracting facial paralysis does sound scary; on the other hand, about one out every 1,000 American was killed by COVID-19 this past year. The mortal arithmetic here is easy to do—and argues strongly in favor of getting the shots.

So too does the way the vaccines were developed—which is actually not as rushed as the calendar would make it seem. The Pfizer-BioNTech and Moderna vaccines both use mRNA—or messenger RNA—to prompt the body to produce a coronavirus spike protein, which then triggers an immune response. That is a novel method for making a vaccine, but the basic research was by no means conducted within the last year.

“The technology for the vaccine has actually been in development for more than a decade,” says Dr. Richard Pan, a pediatrician and a state senator in California. Pan has pushed hard over the years for laws mandating vaccines for children to attend school and, like Offit, has earned the animus of the anti-vax community for his efforts. He is just as big a booster of the COVID-19 vaccine—though he would not propose mandates until there are enough doses for everyone to get a shot—and tries to reassure doubters that no matter how soon they get the vaccine, there are a lot of people who went before them.

“I point out to people that when you get the vaccine you’re definitely not the first,” he says, “because there are tens of thousands of people who have been involved with clinical trials.” Health care workers who are already being vaccinated increase that number dramatically—some 2 million have gotten the shot in the U.S. as of this writing.

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Offit’s and Pan’s reassurances will surely not assuage everyone, and here demographics play a role. As with so much else in the U.S., vaccines have become a political issue. The Gallup organization has been tracking vaccine attitudes by party since July and has found Democrats consistently more likely to get vaccinated than Independents or Republicans. In a poll taken at the end of November, 75% of Democrats said they would be willing to take the COVID-19 vaccine, compared to 61% for Independents and 50% for Republicans. Age plays a role too, with willingness to be vaccinated generally tracking susceptibility to the disease. In the December Pew Research Center poll, for example, 75% of adults over 65 reported that they intended to be vaccinated, compared to just 55% under 30.

But nowhere is the difference starker than among racial and ethnic groups, with 83% of Asian-Americans surveyed expressing an intent to be vaccinated, compared to 63% in the Latinx community and 61% among Whites. In Black American respondents, the numbers fall off the table, with just 42% intending to be vaccinated.

This is of a piece with a long history of medical disenfranchisement and much worse. Some of the mistrust goes back as far as the infamous gynecological experiments J. Marion Sims conducted on enslaved women—without anesthetic—in the 19th century; as well the Tuskegee experiment that began in the 1930s and involved decades of studying the progress of syphilis in Black men without informing them that they had the disease or offering them the antibiotics needed to treat it. But the structural inequality and bias continues today.

According to the U.S. Centers for Disease Control and Prevention (CDC) the death rate from COVID-19 is 2.8 times higher for blacks than it is for whites and the hospitalization rate is 3.7 times higher. Dr. Ala Stanford, a Philadelphia-based pediatric surgeon and founder of the Black Doctors COVID Consortium sees a lot of reasons for that disparity, not least being that in the neighborhoods in which she works, Blacks and other minorities were being tested for COVID-19 at only one-sixth the rate of white communities, which tended to be higher-income, according to data from Drexel University. “[The tests] had to be scheduled from nine-to-five, when most people were at work,” Stanford says. “There were no evening or weekend hours [and] they weren’t accepting children.”

What’s more, Black Americans are disproportionately likely to be front-line or essential workers like home-health aides and are less likely to have the kinds of other jobs that would let them work from home. Less social distancing plus less testing means more sickness and death, which plays into the lived reality for many people that Black lives are valued less than white lives in the U.S. That, in turn, breeds more suspicions of the system as a whole—including of vaccines.

“The main fear I hear [about vaccines] is that someone is injecting coronavirus into my body,” says Stanford. “And I answer in as detailed a way as I can about the mRNA and the protein and how it looks like coronavirus but it’s not.” That kind of clarity, she says, can help a lot.

Offit hears even starker—and more poignant—fears from Blacks. “One particular man did not want to get the vaccine and I asked him why,” Offit says. “He said, ‘because for my race they make a different vaccine.’”

Read more: Fueled by a History of Mistreatment, Black Americans Distrust the New COVID-19 Vaccines

One way Stanford sought to push back against such suspicions was to offer up herself as a living example, getting vaccinated on camera through the Philadelphia Department of Public Health. The local media sent a pool camera and the footage was shown on the evening news. Dr. Brittani James, a professor at the University of Illinois Hospital and executive director of the Institute of Anti-Racism in Medicine, did something similar, streaming her vaccination online.

“I talk until I’m blue in the face,” she says, “but there’s something I think for people to see me or see other Black people getting it that can really do a lot to soothe their fear. Like hey, guess what? If I’m wrong, I’m going down with you.”

Whether that kind of role-modeling and example-setting will work to reduce resistance is impossible to know at the moment, simply because vaccines are still unavailable to the overwhelming share of the population. If you can’t get the shot in the first place, it doesn’t matter how hesitant or receptive you are to it. Offit, who is white, does believe that efforts like James’s, to appeal to members of her own community, can be truly valuable.

“I think if someone like me says something, people are just going to see it as ‘Of course he’d say that,’” Offit says. He cites by way of example the effectiveness of TV ads by the National Medical Association, a professional organization of Black American physicians, showing one Black nurse inoculating another with the COVID-19 vaccine. “It’s subtle,” Offit says, “but they’re trying to create those images.”

Stanford believes Black churches can play a role too. During one of the testing drives she helped organize, church parking lots were used as sites to administer the tests—which helped increase turnout. “We know that in the African-American community, [the church] is a trusted institution,” she says. “Even if you don’t go to church, you know that’s a safe space.”

In all communities, it helps too if doctors and other authorities listen respectfully to public misgivings about vaccines, explaining and re-explaining the science as frequently and patiently as possible. But there is a burden on the vaccine doubters themselves to be open to the medical truth. “Questions are fine as long as you listen to the answers,” Pan says. “So talk to your doctor, go to sources like the CDC and our incredible mainstream medical organizations. Those are the ones you should be getting information from.”

Adds Stanford: “My belief is that you don’t coerce or convince, you listen to concerns and you understand the fears and are empathetic with people. Then you educate and allow one to make their own choice.”

Pan also sees a role for social media companies, which must better control misinformation on their platforms. Journalists too must step up, avoiding false equivalency or both-sides-ism; there is no need to give equal time to rumor mongers or conspiracy theorists simply to appear balanced.

Ultimately, no vaccine is perfect, and the COVID-19 vaccines do have more questions associated with them than others, because there hasn’t been that much follow-up time since the study volunteers got their shots. But those questions are less about safety than about just how long the shots will prove protective. The truth is that they work.

Another truth, of course, is that for now, in the early stages of the vaccine rollout, masking and social distancing remain the best methods for protecting ourselves and others—and they will be part of our lives for at least many months to come. But slowly, over time, the vaccines will eliminate that need. What’s required now is trust in the power of the shots or, as Stanford puts it, in “faith and facts over fear.” Pandemics eventually stop raging. It’s vaccines that hasten that end game—and save millions of lives in the process.

Write to Jeffrey Kluger at jeffrey.kluger@time.com.

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