Vaccines are a simple, safe, and effective way to protect people from harmful diseases by using your body’s immune system to build resistance. However, a large portion of people in the United States are hesitant to receive vaccines for various and complex reasons. Vaccine hesitancy is a term used to refer to the reluctance or refusal to vaccinate despite the availability of vaccines. Hesitancy exists on a wide spectrum, as the image below illustrates.
Today, the main reasons for vaccine hesitancy can be grouped into 3 C’s: confidence, complacency, and convenience.
- Confidence – refers to a lack of trust in the safety of vaccines and in the healthcare system, such as the reliability of healthcare professionals and policy makers.
- Complacency – refers to a low perceived risk of vaccine-preventable diseases, leading to the notion that vaccines aren’t necessary. This is becoming more common as better technologies and healthcare continuously improve health.
- Convenience – refers to the accessibility, affordability, language and health literacy that is needed to understand information about the vaccine and to receive the vaccine.
These 3 C’s and data about COVID-19 vaccine hesitancy can be used to explore the complex reasons behind vaccine hesitancy.
Black people are the most hesitant, with 41% of poll respondents reporting hesitancy about the COVID-19 vaccine. This is due to both confidence and convenience issues. There is a long history of medical abuse of Black bodies from slavery to the present day, ranging from the Tuskeegee Syphilis Trials to everyday racism as Black peoples’ symptoms are continuously not taken seriously. As a result, confidence in the healthcare industry is understandably lacking. Additionally, convenience is an issue as many Black people work frontline jobs and often can’t take time off to get vaccinated. This is why it’s important for employers to give paid time off to allow employees to receive vaccines. There is also still some confusion about who is eligible to receive the vaccine. According to the KFF COVID-19 Vaccine Monitor, lack of information about the vaccine, including eligibility, is still a determining factor of whether Hispanic adults get vaccinated or not.
Republicans are the most hesitant, with 44% indicating so when polled. This is seen as a result of vaccinations becoming politicized. Counties with the most vaccine-hesitant people generally also voted for Donald Trump. Concerns are mostly around confidence and a sense of complacency. There’s uncertainty about side effects and whether the vaccine is effective. Some also don’t think COVID-19 will impact them and thus don’t see a need for getting the vaccine. Confusion about mask mandates at the beginning of the pandemic helped spread misinformation about the virus and vaccine mandates are being pushed against with concerns over individual rights.
The 18-34 age group is the most hesitant. According to KFF COVID-19 Vaccine Monitor, around ¼ of 18-29 year olds want to wait and see how the vaccine is working. Furthermore, a lot of information has been circulated about how harmful COVID-19 is to older adults. Complacency is part of this, as less concern about younger generations leads to thinking that vaccines aren’t necessary for younger age groups. As a result, young adults are more receptive to the vaccine if friends have taken it, so peer networks play a large role. Lastly, a lack of public messaging about the vaccine on social media, where Gen Z and Millennials get most of their information, is a missed opportunity to spread important information about vaccines to younger age groups.
According to the poll, people who make less than $50,000 are the most hesitant. This is mainly due to convenience issues. People with lower income brackets often don’t have the time to go to a vaccination site. They often also have poorer access to transportation, which is needed to get to a vaccine center or doctors office. Some people also have health issues, disabilities, and experience language barriers which, combined with jobs and family duties, makes getting vaccinated a daunting ordeal. These lower-income jobs are also not as flexible and typically remained in person throughout the pandemic, limiting the time that could be used to receive the vaccine.
Rural residents are the most hesitant. About 60% of rural residents in the poll said they already got the vaccine or were going to as soon as possible, compared to 71% of urban residents. This hesitancy falls into the complacency and convenience categories. For rural residents, getting the vaccine is more of a personal choice. 39% say they aren’t worried about someone in their family getting COVID-19, compared to 23% of urban residents. Additionally, rural communities tend to have a high percentage of people who are older, who lack health insurance, and who have limited access to healthcare facilities, which can all be barriers to vaccination.
Non-college graduates are more hesitant, with 43% reporting hesitancy in the poll. Adults with a bachelor’s degree or higher see the vaccine as safer and more effective. The Understanding America Study, found that people with less than a college degree believe in a higher risk of a serious side effect from the vaccine. Adults with college degrees are also more likely to know someone who is vaccinated, which helps to encourage their own vaccination.
How should we continue the conversation about vaccine hesitancy? It’s important to listen to people’s concerns and not shame those who are vaccine hesitant or anti-vaxx. Correcting misinformation about vaccines and possible side-effects is also very important. Personal healthcare providers are who the majority of people turn to for advice about vaccines so they are at the forefront of communicating accurate information. Speaking in a nonbinary dialogue, rather than limiting it to people who get vaccines versus people who don’t is imperative in order to understand the broad continuum of vaccine acceptance. A person doesn’t have to and likely won’t go from skepticism to acceptance right away but any shift along the spectrum towards vaccine acceptance is still valuable. It’s also important to recognize the role that medical institutions have played in historic racism to gain a better understanding of how Black and Brown people have been mistreated and why it results in hesitancy and skepticism today. Lastly, perhaps ‘vaccine hesitancy’ is the wrong phrase to use as accessibility, convenience, and institutional problems in the healthcare field are huge contributors to why people don’t get vaccines.