Key differences separate ‘anti-vaxxers’ from Michiganders hesitant to get COVID-19 vaccine

Lenny Lightner has no plans to rush to get a COVID-19 vaccine appointment once he’s eligible next month.

The 31-year-old Romulus resident isn’t typically anti-vaccine. Growing up he got all of his vaccines. He gets the flu shot annually.

But the newness of the coronavirus vaccine, paired with stories he’s heard about people feeling sick for a few days after getting a shot, has left him choosing to seek more reviews from his friends and family before he gets in line.

“I wouldn’t say not interested,” Lightner said. “I would say extremely hesitant.”

At first glance, it appears Michigan — along with other parts of the world — has seen a rise in the anti-vaccine crowd since the start of the coronavirus pandemic in spring 2020.

However, a closer look indicates the anti-vax crowd remains small in number, but can appear larger when clumped together with people who are hesitant to get the newly developed COVID-19 vaccine and those who generally oppose any further restrictions imposed by the government.

“The number of people who have very strong, very negative ‘I am definitely not going to vaccinate period is quite small,” said Brian Zikmund-Fisher, associate director of the University of Michigan Center for Bioethics and Social Sciences in Medicine.

“There are not that many people who hold that strong and confident of a belief. There are a lot of people who are questioning, hesitant, want to wait and see how it goes … or are not sure whether the hassle is worth it.”

The difference between those who are anti-vaccine and those who are hesitant of the COVID-19 vaccines is how likely they are to change their mind, said Anna Kirkland, a University of Michigan professor of health management and policy, and member of Michigan’s Institute for Healthcare Policy and Innovation.

Kirkland said the vast majority of people who remain undecided on the vaccine don’t have a strong ideological commitment against vaccines. They’re persuadable, and they’re who health care and public health workers are targeting to help them make informed decisions.

Anti-vaccine individuals on the other hand are publicly committed to their ideology. “That person is never going to change their mind and they’re not persuadable,” she said.

Social media sites are filled with comments indicating people’s lack of interest in the vaccine. But pressed further, many residents said they aren’t totally against vaccines, but want to wait longer to allow for more data to be collected on long-term effects and to hear more personal anecdotes from their family and friends.

Amanda Hanson, 33, of Rockford described her two-week bout with COVID-19 in November as “the flu times 1000.” Fear of feeling that way again due to potential side-effects of the vaccine has her choosing to wait a little longer before signing up.

Possible side effects for the vaccine include fatigue, headache, fever, chills, muscle pain, nausea, and pain or swelling at the injection site. Side effects might be more intense after the second of recommended doses, and typically last a few days, according to the CDC.

“As the weeks go on, I’m getting less and less afraid,” Hanson said. “I do plan on it. I just want to see what happens to others and to people my age. I know a lot of studies were done but I want to see more of the effects first.”

Theresa VanSumeran, 45, of Bay City said she isn’t getting the vaccine. But asked why, she said her doctor recommended she wait because there isn’t enough information available regarding the effects of combining the vaccine with the injections she receives for her multiple sclerosis.

“I figure me and my doctor are talking and doing what is best right now for my health,” she said. “I am not totally against vaccines but I want the choice to make sure it is not going to harm me.”

Vaccine hesitancy across the country has been on the decline in recent months. Gallup polling from September had the willingness to be vaccinated against COVID-19 at 50%. It climbed to 65% in December, and to 71% in February.

In Michigan, 66% of residents are “likely or very likely” to get a vaccine, according to survey results cited by the Michigan Department of Health and Human Services.

Available vaccines

There are currently three COVID-19 vaccines available in the U.S., with others working their way through clinical trials.

The available doses, developed by Pfizer, Moderna and Johnson & Johnson, received emergency use authorization from the U.S. Food and Drug Administration after an independent body of experts determined the benefits outweigh the risks in use by adults.

Pfizer and Moderna’s shots require two doses administered three and four weeks apart, respectively, while the Johnson & Johnson shot needs just one dose.

Some who are hesitant to get a vaccine question the speed to which these shots were brought from development to availability in a process that typically takes years.

But experts in the vaccine approval process say the urgency of this process removed the usual bureaucracy and allowed some approval and fundraising steps to run concurrently.

“To put it this way, we have voluminous and horrific evidence of the burden and the risk of COVID-19,” Zikmund-Fisher said. “There are real questions about that that we can talk about and I cannot guarantee everything’s perfect in the context of vaccines for COVID-19, but the tradeoff is pretty darn clear.

“In that context, I have no hesitation in saying to anybody that I think the right choice is to protect themselves by getting the vaccine.”

Based on data from the developers, all three vaccines are 100% effective in preventing death from COVID-19 and highly effective against severe illness or hospitalization from infection.

Coming out of clinical trials involving thousands of volunteers, Pfizer’s and Moderna’s vaccines were 95% effective against all infections, compared to 66% efficacy for the Johnson & Johnson vaccine. It’s important to note that the first two vaccines’ trials were conducted before more infectious strains of the coronavirus were spreading, while the Johnson & Johnson shot had the newer variants to impact its efficacy.

As of Wednesday, March 23, Michigan had reportedly administered more than 3.7 million doses of vaccine, including 2.4 million first doses. About 29.6% of the state’s 16 years and older population had gotten their first shot, and 16.8% were completely immunized.

One of those fully immunized Michiganders is Dr. Anthony Ognjan, who received two doses of the Pfizer vaccine within the first month of availability. About three months later, he went to his doctor and got a test to gauge his level of immunity — or if the vaccine worked.

Someone who isn’t immune would have an antibody response of 10 titers or less, he said.

His was around 230.

“That’s absolutely one heck of a response,” he said. “It looks like I’m very solidly immune. That’s a good degree of comfort that at least I can walk through the hospital seeing COVID patients today and knowing I have an extra layer of protection against COVID-19.”

Anti-vaxxer effect on the pandemic

The anti-vaccine footprint is relatively small in Michigan.

As of last fall, the state’s waiver rate — children whose parents opt them out of getting required vaccines before entering school — was 3.6%. Some opt-outs aren’t truly anti-vaccine, but are those who chose an alternate vaccine schedule, according to Linda Vail, health officer for Ingham County.

“As vocal as they can be, they really aren’t large in number,” Vail said. “Waive rates are low which goes to show the movement is much smaller than we tend to think because we hear about it a lot.”

The modern anti-vaccine movement is largely rooted in false claims made by former British physician Andrew Wakefield, who published a study in the medical journal The Lancet that found the vaccine for measles, mumps and rubella predisposed children to neurological conditions including autism.

Wakefield’s study came under fire following reports that his findings were fraudulently manufactured and that he intended to develop his own replacement vaccine and diagnostic kits after discrediting the MMR vaccine. His study was later retracted and he lost his license to practice medicine.

But many in the anti-vaccine community still hold up Wakefield’s retracted study as the proof that prevents them from getting their children vaccinated.

“He falsified data and did things wrong in so many ways,” said Dr. Ognjan, an infectious disease specialist at McLaren Macomb. “A lot of people took his research to heart and it’s still difficult to dissuade people from that. You tell them he’s unlicensed, he sold his soul for a few bucks, and they look at you incredulously.”

The coronavirus pandemic gave people across the globe a front-row seat to the scientific process as doctors and researchers worked to better understand a novel virus. As new information became available, guidance evolved.

But to some, those changes sowed distrust in medical and public health leaders and fed into conspiracy theories. Anti-vaccine groups used that confusion to sow further doubt in things like the effectiveness of mask wearing or the development of vaccines.

Vail said the biggest concern isn’t the anti-vaccine crowd, so much as it’s the groups that pool the various conspiracy theories together.

Many of the same groups attempting to discredit COVID-19 vaccines on social media today were active in protesting government orders aimed at reducing the spread of coronavirus in the early months of the pandemic. Attempts by MLive to reach most of those groups for comment were unsuccessful.

One group that has been vocally skeptical of the latest vaccines and recently spoke to MLive is Michigan for Vaccine Choice, which says it has about 10,000 members.

According to its Facebook page, the group has paid for billboard ads that read “You are the experiment,” and has taken issue with the state’s use of the word “approved” when describing the FDA’s emergency use authorization.

“Because anybody that’s saying that it’s safe and effective at this point when it’s in its experimental phase is being less than transparent,” said Connie Johnson, board member and media director for the group.

While anti-vaccine numbers in general remain low, a recent poll from Marketing Resource Group does support the group’s stance that COVID-19 vaccines shouldn’t be mandated by the government. The survey of 610 residents earlier this month found 71% were against requiring every adult to be vaccinated.

“Mandates are always going to be a concern,” Johnson said. “Mandates are forced or coerced medical intervention and no one wants to be forced to accept something that they have a religious, philosophical or medical issue with.”

Reducing hesitancy

Health care and community leaders are in agreement — reducing the hesitancy to get a COVID-19 vaccine is going to take a multi-pronged approach.

Ognjan said one problem contributing to the spread of misinformation around vaccines is the level of knowledge of some health care workers. The average physician isn’t up to date on the science of vaccines, he said, and can only tell patients the recommended dose schedule for their children.

“There lies the Achilles heel of physicians,” Ognjan said. “If parents can’t get answers from their physician, they go to the internet where you can fine a lot of misinformation supported by anti-vaxxers.

“I’d like to see all providers, nurse practitioners, PAs (physician assistants), nurses; they should all be well-versed and coached on how to advise on vaccinations so they can provide the information to mothers and prevent them from needing to go to the internet to see the weird stuff out there. Or so they can explain away the weird stuff when it comes up.”

To date, the state’s COVID-19 vaccines have largely been administered by local health departments, hospitals and pharmacies. But Mark Hamed, president of the Michigan Academy of Family Physicians, said he believes now is the best time to incorporate primary care physicians into vaccine distribution efforts.

Citing a survey by the Kaiser Family Foundation, he said 38% of adults prefer to get vaccinated at their doctor’s office. The survey also reported 75% of respondents said they’d be very likely to get the coronavirus vaccine if it were available there.

Hamed’s group sent a letter to Gov. Gretchen Whitmer commending her for efforts to get Michiganders vaccinated and informing her that physicians are ready and willing to help vaccinate patients.

“Especially for such a vaccine where there’s a lot of questions about efficacy and safety, I think the primary care physicians might be the best way to answer those questions for patients with the best degree of trust,” Hamed said.

Meanwhile, Zikmund-Fisher noted that groups that have historically been manipulated by the medical establishment, including people with disabilities and communities of color, have valid questions to be answered. He said it could help to have leaders of those same identities be open about their decision to get vaccinated.

“There are clearly people for whom their faith leader is more trusted than their doctor is,” he said. “There are clearly people for whom the where they get it is less the issue than who it is they’re listening to as to whether or not they should get it.”

Most of the state’s paid advertising has focused on increasing awareness of the safety and efficacy of the authorized vaccines, the vaccine review process and the credibility of the experts making the decision to authorize the vaccines.

That state also is hosting a series of virtual community town halls to answer questions about the vaccines, including one in January aimed at faith-based communities, and one earlier this month aimed at communities of color.

More virtual town halls are expected to be announced in the coming weeks.

Read more on MLive:

Whitmer vetoes bill aimed at limiting health department’s emergency powers

Michigan sees ‘alarming increase’ in COVID-19 hospitalizations among unvaccinated adults

Michigan’s Dr. Khaldun helps administer COVID-19 vaccines at Ford Field

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