COVID Vaccine Hesitancy: Anti-Vax Craziness or Reasonable Caution?

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As more states open up COVID-19 vaccination to anyone 16-years and older, the federal government has now pulled out all the stops. Taking on a full-force media blitz that includes a multi-million dollar ad buy in both English and Spanish, they have enlisted groups from NASCAR and the NFL, to the Catholic Health Association, American Farm Bureau and American Medical Association.

The goal is to combat hesitancy, which has dropped considerably but remains substantial among those most susceptible to contracting and possibly dying from the virus. This includes people who work in medical fields and long-term care facilities. As the Pew organization reported recently, only half of long-term caretakers are vaccinated against COVID.

Taking a look at why certain groups remain hesitant and what messages may work to overcome their reluctance, we talk to Steven Thomas, MD, a professor at the University of Maryland’s School of Public Health in College Park and director for the Maryland Center for Health Equity, and Sarah Berry, MD, associate professor of medicine at Harvard Medical School and geriatrician at Hebrew SeniorLife.

The following is a transcript of their interviews with “Track the Vax” host Serena Marshall:

Marshall: Dr. Thomas, thanks for joining us here at Track the Vax. I want to talk to you today about such an important issue, vaccine hesitancy.

This is a topic that we’ve heard more and more about lately, especially as the administration has announced a huge ad buy to combat this very issue. Let me just start by asking you, is this a real issue right now especially since everybody still doesn’t have access to the vaccine? How do we actually measure and know that there are still those big pockets of hesitant Americans?

Thomas: Well, listen, there are a lot of things that we don’t know. But here’s what I do know from what I’m hearing in the community, right down at the local barbershop. And that’s being hesitant doesn’t mean never. And being hesitant is like protection from what has happened to my community, black people, over the years in the name of: “Hey, I’m here to help you. Here’s a vaccine. I’m here to help you. And not treat you.” So let’s hold up and make sure you understand why I’m hesitant now…

Marshall: Hesitancy isn’t anti-vaccine, it’s just caution.

Thomas: Thank you. So once we get that straight, now let’s deal with the broken system out there. It was like this. I could see it, three weeks ago, we had people that said “hell no, I’m not taking a vaccine.” Those folks are now saying “maybe.” In the people who were saying “maybe,” they are now saying, “where do I sign up?”

Marshall: That’s a big jump to make though in three weeks.

Thomas: And the people who have signed up are saying, “why isn’t anyone calling me back?” A broken system and those jumps happen because we’ve been doing Zoom town halls, conversations with communities, giving them the information they need to make informed decisions, not shaming them, not blaming them. That’s what we need to do.

Let’s recognize who would put a life saving vaccine at the end of the internet. And not ensure that everyone has access to the internet. It’s all before us, all over the newspapers, the broken system must be addressed. And that can’t happen fast enough. So I’m so glad we’re talking.

Marshall: Me too. And I just want to jump into what you just said there about not getting the call back about those town halls that you’re hosting. So talking directly to the communities has a big impact. So is that the same as an ad blitz or, in order to reach those hesitant individuals does it need to be more about outreach than ads?

Thomas: Well, I’m going to say yes, and, what we’ve been able to do as part of the rapid response team right here in Prince George’s County, Maryland, is minuscule compared to the federal government launching major ads.

Tone matters. What will be the tone? Our tone has been: let’s respect where people are. There’s a reason they’re hesitant, let’s address that and let’s make sure all these things that we’re doing in the name of addressing the pandemic don’t go away after the big threat.

Don’t forget those underlying conditions. These communities will still be suffering. That’s what we need to pay attention too, as well. But people are ready. I think that ice is melting. But we’ve got to get this system fixed and we need a message that is communication with the community, not messaging the community. Nobody wants to be sold. There are headwinds out there. Let’s recognize that there are organized groups that want to make vaccinations a political issue, just like they did masks. We have to stop fighting one another. We’re all in this storm of COVID, but we’re not in the same boats.

Marshall: One of the things you said a moment ago, Dr. Thomas, was that some of those individuals that have signed up haven’t gotten calls back, but that’s not only communities of color that that’s happening to. That’s really across the board when it comes to vaccination signups. And that’s a cause of the fact that there’s more demand for the vaccine than there are vaccines available or perhaps resources to distribute the vaccine. But at the same time, we are seeing those gaps when it comes to communities of color having access. So can we differentiate between those two elements there?

Thomas: Perfectly. It’s the difference between, “Hey, if you have access to the internet, you can register — an equity.” Well, I’ll give you an example just from today. One of my students who has now been signed up young, healthy, no underlying conditions. How did that happen? She described how her mother was up at like 3:00 AM in the morning, refreshing the screen, refreshing the screen until she got in and got the entire family registered. And she’s getting her first shot. So that — my 84-year-old neighbor across the street only has an iPad. And some of the people in the barbershops only have phones that make phone calls. That is inequality that must be addressed. And if we do that it will address the other issues that COVID has exposed him.

Marshall: When it comes to vaccine hesitancy, we do know though there also exists hesitancy among multiple racial groups — among white evangelicals, Republicans. How is the hesitancy that each of these individual groups face or are feeling differ or is it really the same hesitancy issues?

Thomas: You know, that’s very interesting you would say that, because you’d find unlikely people in the same bucket. I think hesitancy needs to be contextualized. So just to keep it simple, for many African-Americans they need look no further than the Tuskegee syphilis step. And if you look at the news coverage, that’s typically what is brought up. Then you have the anti-vaxxers protesting at Dodger Stadium, trying to shut down a COVID vaccine site. That’s a whole different ball game. Therefore understanding what it means with those two populations requires different strategies.

Marshall: What do you see those strategies being for each of those populations?

Thomas: I’m just going to speak to the one I know best…

Marshall: Okay.

Thomas: And that’s in the African-American community. That the real lesson from the Tuskegee syphilis study, which took place from 1932 to 1972, 40 years, those men were not treated. So the real lesson from Tuskegee is to ensure that today in the name of COVID and this disproportionate impact on African Americans and other communities of color, they should be prioritized to get the vaccine. And that doesn’t mean dangling it out at the end of the internet. Now let’s hope. Listen, you don’t erase the past four years in however many months since we’ve had an election. All right.

So our communities have been marinating in misinformation and disinformation. And at one point in the not too distant past, the number one source of that disinformation was the White House. You don’t overcome that overnight. So we got work to do. And if we do this right, we can come back together as one community. That’s my hope.

Marshall: We know the Tuskegee experiment was just one of multiple medical studies that occurred in past decades that was, on multiple facets, completely unethical and inappropriate. And so when you’re facing combating that institutional concern, how do you convince, and speaking to the population you know, African-Americans, the black population, to get the vaccine when they’re hesitant and overcome that institutional concern and especially given, there are still instances of it today.

Thomas: Absolutely. In fact, at our most recent town hall, we had a physician describe the fact that for her, it was not what happened during the Tuskegee study. It was what happened and what she sees last year or last month. So the racism in our healthcare system is real.

Marshall: And even just, what last week, or I guess maybe it was last month, with one of the most prestigious journals in America, questioning if racism still exists in medicine.

Thomas: I’ve been reading the blowback on that already. Therefore, I’m so glad we’re talking about this. It runs deep, doesn’t it? And that’s the conversation that we need to have. It runs all the way deep to why don’t we have more African-Americans and other scientists of color receiving grants doing the research, not only on COVID, but a whole range of the underlying conditions that existed before COVID.

So to your question, I will tell you what we’re doing. We’re building bridges to the community and we found a very interesting one. That we can scale. And it’s called HAIRR, Health Advocate in Reach and Research. So for the past decade, we’ve been bringing healthcare services into black barbershops and beauty salons. On top of that — boom — COVID hits.

So here’s the answer to your question. You have to serve the people at the point of their need. Then maybe they’ll listen to you when you have something they need that they don’t know they need. You have to build trust. It’s a calculated risk. So we’re now bringing the message of COVID mitigation to black barbershops and beauty salons through zoom. Made possible by, guess what, the pandemic. It’s thrown all of us in the deep end. And so in these conversations, we’ve been able to melt the ice, give people the information they need to make an informed decision.

Marshall: You just mentioned that at the root of it, it’s trust. And trust in the community. Trust in those who are doing the outreach. Trust is local. There’s no question about it. Do you think part of the hesitancy that comes from communities of color is that the distribution of this product has so far been mostly held at mass vaccination sites?

Thomas: Yeah. You know, I’m laughing here because you know, you have to make your friends before you need them. And so part of the scramble here is calling out the troops at a time when the relationships aren’t there for people to trust. I’m only now seeing mass vaccination clinics being held in the gymnasiums of African-American churches. Been two major stories about that. That’s only recently. The Six Flags — that’s another big mass event. Again, what was happening was you would have these events in communities as a way of reaching minorities.

But that’s not who you saw in line, because the way to get in line required getting online. And so you saw large white populations in majority black communities in line. The optics, obviously, don’t work good. But it’s a function of a disruptive system. You really, really need trust at moments like that. And I think that’s beginning to happen.

Marshall: At a moment like this though, we do also need to move fast. And if going online isn’t an option, is it going door to door? Having somebody go door to door with their mask on, in the pandemic, to sign people up?

Thomas: Here’s what’s happening in my neighborhood. Just announced that primary care practices are now receiving doses of the vaccine. Great. Now, would you just go to your doc. And I’m sitting here thinking that is great. If you have a doc. All right. If you have a medical home, so it’s still not so simple. Call centers are starting to be set up.

I think it’s getting better — door to door — I don’t know. What I’m hearing more of is people stalking grocery store lines, or where they have a CVS at the end of the day, “Do you have any left? Do you have any left?” It’s kind of sad. Isn’t it?

Marshall: Yeah.

Thomas: It really is sad.

Marshall: So what would be the best way to reach vaccine hesitant communities of color? Do you think that hesitancy will go away once that access is there? That it ultimately doesn’t come down to being hesitant and questioning, it just comes down to access?

Thomas: I think there’ll be a tipping point where we move from that hesitancy to where do I sign up? And the sign up is not a big log jam, and that will be a good thing. But different communities will be in different kind of parts of that awakening in time. Things can go backwards too. Don’t underestimate, we’ve had some little setbacks here lately. Such as a bad batch of vaccines coming out of a Baltimore pharmaceutical plant.

Marshall: And to be clear, it wasn’t distributed.

Thomas: That’s right. It did not get out of that plant. Okay, hey, checks and balances worked. That’s great. But those are little hiccups along the way. We just gotta be careful that we don’t lose momentum. I see a melting of the ice, but people need an easy way to get access.

— —

Marshall: Access. Often, what it does come down to for so many. But healthcare workers such as those working in long term care facilities had first priority in many states. Yet, Pew reported recently, just half of long term caretakers are vaccinated against COVID, many reporting hesitancy in getting the shot. Studying this issue is Sarah Berry, a geriatrician and associate professor of medicine at Harvard Medical School and Hebrew SeniorLife.

Dr. Berry, I’m glad you’re here to explore this issue with us because one group, in particular, that’s been a bit surprising in their reluctance to get the vaccine — medical professionals. You’ve examined this area at length, based on your work in this sphere, why is that?

Berry: It’s complicated. I think it’s probably multifactorial. I’ve been doing most of my work in the nursing home. And they’re in the nursing home, I think, given what all happened last spring with the severity of these COVID-19 outbreaks. You know, staff not feeling like they had adequate PPE or testing fast enough. There is an element of distrust. Distrust of management. Distrust that this, you know, that people weren’t helpful fast enough.

Marshall: That has carried over to now with the vaccines?

Berry: Yeah, I certainly think so. You know, I think that the decision to get vaccinated very much, comes down to whether or not you trust or feel comfortable in the people that are recommending it. A lot of our healthcare workers have mistrust for the government. Nursing homes are a very diverse population. You know, we’re about 50% non-white, minorities. And obviously, there’s many in these groups that have reasons to be distrustful.

Marshall: So when you look at these medical professionals, I mean, most folks see them and think, you know, they’re front and center of this epidemic. They’ve seen the impact that COVID has had, the death toll, that illness, up front, up close and personally. And so if they’re distrustful of these vaccines, why should I get them?

Berry: I think you’re right. As healthcare professionals, people are looking to us to tell us that it’s okay. There’s a lot of bad information out there about these vaccines. When we started doing the town hall meetings we had heard snippets of that, you know, that there were rumors that the vaccines had a microchip in them or that they caused infertility. But these issues came up in all 30 of the town hall meetings that we did. They’re clearly much more widespread than people realize.

Marshall: The same issues of fertility and microchipping came up in all 30 of them?

Berry: Infertility, in particular, did. I would say the microchip maybe came up in about two-thirds of the meetings. But infertility came up in every one.

Marshall: Dr. Berry, just to be clear here, these are town halls with medical professionals?

Berry: Yeah. So these are the frontline nursing home workers. So these are nurses, nursing aides, as well as other healthcare workers in the nursing home, where it’s critical that they get vaccinated. Like those in dietary, you know, who are preparing the food. Maintenance, housekeeping, recreational therapy.

Marshall: And what about the doctors in those facilities? The nurses, et cetera.

Berry: So there weren’t any differences in the concerns raised between the nurses, the nursing aides, you know, the housekeeping. It was really the same issues on every call. These rumors, this misinformation, again, appeared with every group. We didn’t interview the doctors, but doctors make up really a minority of the workforce of nursing homes. You know, 50% of the workers in nursing homes are the nursing aides. And so we thought it was really most critical to spend the time with them.

I think the number one concern raised by every discipline was: these vaccines were just developed too fast. They were too fast. They must have skipped some steps. You know, how can I be assured they’re safe when they came out too fast?

The other concern that we heard loud and clear was what about the long-term side effects? Again, because they were developed quickly, we just don’t know about long-term side effects. And we tried to really address these concerns by, you know, sharing our own personal hesitancy or family members who had hesitancy and how we helped them over that hurdle and got them good information.

Marshall: Is vaccine hesitancy that we see in the nursing home facilities translatable to the general medical population?

Berry: Absolutely. I mean this, COVID-19 didn’t get into nursing homes because we’re some isolated population. We are an extension of communities. So, absolutely. And these low income healthcare workers on the front lines in nursing homes, they’re going back to the communities that were hardest hit by COVID-19. They have the opportunity to get the vaccine first and to model for the rest of the community. So I think it’s very important.

Marshall: I’m just so surprised when you think about the nursing home setting, that they saw and experienced so much of the pain associated with COVID, that instead of being more fearful of the disease, they are more fearful of the vaccine.

Berry: Yeah. I mean we had all sorts of responses to that. Some said: I already got it and I survived, so I think I’ll be okay again. Others said: you know what, I know what it might look like if I get COVID. I’ve seen that this vaccine is so new, I just don’t feel like I have confidence or trust that I know what it’ll look like.

Trust was central in these discussions and, you know, our goal was not to try to get everybody to get a shot in their arm, but to give people good information and let them make a decision for themselves about whether vaccination was right for them.

Marshall: That’s so interesting. Dr. Berry, because we actually heard from a listener and they’d sent us a note saying that they’re concerned about the COVID vaccine because if they get it, there’s no turning back. There’s no reversal. There’s no knowing that long-term data.

Berry: Yeah, we heard that a lot. As I mentioned that this was developed too fast and that we don’t have long-term data. And we tried to reassure people by reminding them that all of the usual safety steps were taken when doing this vaccine. It’s just that the normal, safety steps and the studies overlapped with production. That, and of course, pharmaceutical companies and the government, everybody really partnered together given the enormity of this problem to move things along.

We also reminded people that if you think about the way that vaccines work and the history of vaccines, it’s really, really rare for a vaccine to have long-term side effects. The way they work is they prompt an acute immune response so that if your body sees this virus again, it’s ready.

And then the vaccine is gone. This particular vaccine, in particular with the Pfizer and the Moderna, they’re so unstable. You have to keep them in these cold freezers. They’re gone within hours. So, although it’s true that we don’t have long-term data, it seems very unlikely given what we know about vaccines, other vaccines and the way that this vaccine works, that it would cause long-term side effects.

Marshall: Would mandating them help increase hesitancy or decrease it?

Berry: I don’t think in the nursing home setting that mandates are likely to be helpful in the long-term because of the trust issue. We have some data, again, suggesting that even financial incentives, paying people, even giving people gift cards, that that may decrease a vaccine in this setting. And then it’s, you know, really promoting and giving people good information. Finding frontline healthcare workers that are like them, to talk to them about the vaccine. Setting targets that your facility wants to achieve this many percentage of their staff getting vaccinated by a certain date. Also giving out small thank yous, like t-shirts. All of those things may be more effective than payments or mandates.

Marshall: That’s really good for us to know Dr. Berry, thank you. Just really quickly, what do you think is going to take to get over the hump for those who are hesitant?

Berry: Yeah, I think open-mindedness. I think our model in these town hall meetings was all of these concerns are valid. I mean, if I heard from a trusted source that the vaccine was going to cause me to be infertile, sterilization was the word we often heard used, you know, I wouldn’t want it either. I think really listening to people and understanding their concerns. And trying to give them good information to make their own decision, rather than, you know, trying to force people or get a needle in every arm, is probably the best strategy.

Last Updated April 07, 2021

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