As the second April opens under the pall of the pandemic, there are about 129 million cases of COVID-19 and nearly three million deaths. The good news is that vaccines are becoming more available, and nearly three million doses are being distributed each day. So far about 97 million Americans have been vaccinated (including me). Nevertheless, vaccine hesitancy remains. Reasons for this have been explored on this site and elsewhere, but it seemed a good time to take a closer look at what’s driving it.

Some people have been deterred by the varied levels of efficacy across the COVID-19 vaccines. Pfizer, for example, is 95 percent effective; Moderna is 94 percent; Oxford/AstraZeneca is 70 percent; J&J is 66 percent, and so on (keep in mind that the data are still being collected, so the rates may change over time). This has led to some thinking that one shot is “better” than another. While it’s obviously true that higher efficacy is better than lower efficacy, that doesn’t tell the full picture. Some vaccines require a second shot, while others need just one dose. If there’s some concern about the availability for the booster shot (the person needs to return three to four weeks later), then the one-shot vaccine may be better. Some vaccines need to be kept in very cold storage and for practical reasons may not be able to be administered in tropical regions, for example. 

Some people seem reluctant to get the vaccine because they somehow think that anything less than 100 percent effectiveness is problematic. The SciBabe recently corrected this idea in a Facebook post:

Fully vaccinated people are going to get infected. That’s what anything less than 100% effective means. The ‘best’ of these are about 95% effective. Which means that, give or take, 1 in 20 may get a mild case if exposed. Note, 95% effective is on par with our most effective vaccines. The measles vaccine is 97% effective. The no-longer available Lyme disease vaccine was 80% effective (and don’t you wish that was still available?). Two doses of the chickenpox vaccine is 90% effective. A full course of the polio vaccine is about 99% effective. The pertussis vaccine is 98% effective after a full course of five doses, but only 73% effective after the first dose, and immunity can wane without boosters. So why don’t we see news stories all the time about fully vaccinated people getting those diseases? Is it because there’s something “better” or more trustworthy about those older vaccines? Is there something “they’re not telling us” about the covid vaccine? No.

Plus, of course, vaccine effectiveness rates are averages, and the real-world protection varies by individual. A person with an otherwise healthy immune system may only need a 75 percent effective vaccine, while someone who is immunocompromised may need a 95 percent effective vaccine. Complicating matters, you don’t know which variants you will be exposed to, and each vaccine conveys different protection against different strains. While there are some differences between the vaccines, the fine distinctions are moot. In the end, the consensus among experts is that anyone should get the first available vaccine. Trying to second-guess your exposure (or holding out for a more effective vaccine) just increases the risk of getting COVID-19—and potentially infecting others. 

Changing Minds

It’s tempting to respond to vaccine hesitancy with snide and snark, but for those hoping to change hearts and minds a more diplomatic approach is best. Sure, there are some people who are actively and knowingly sharing misinformation about vaccines (including, notably, Russian intelligence–led troll farms and the book-promoting viral video Plandemic, whose claims I and others have debunked). However, many people have genuine concerns, for whatever reason, and the issue is complicated by a plethora of COVID-19 pseudoauthorities. 

The problem is not helped by a news and social media context that exaggerates dangers of vaccination. Memes and social media posts constantly highlight the rare, minor, and expected side effects of getting vaccinated, and false (and true-but-misleading) news stories about people who suffered because of the vaccines are shared. Any medical treatment or drug—from a tooth extraction to aspirin—can have potential side effects; that’s not a reason to fear or avoid it. As a National Public Radio report noted:

The odds of dying after getting a COVID-19 vaccine are virtually nonexistent. According to recent data from the Centers for Disease Control and Prevention, you’re three times more likely to get struck by lightning. But you might not know that from looking at your social media feed. A new NPR analysis finds that articles connecting vaccines and death have been among the most highly engaged with content online this year, going viral in a way that could hinder people’s ability to judge the true risk in getting a shot. … To date, the CDC’s reporting system has not received evidence linking any deaths directly to vaccines. And yet, on almost half of all the days so far in 2021, a story about someone dying after receiving a vaccine shot has been among the most popular vaccine-related articles on social media.

With over half a billion vaccine doses given worldwide, by random chance alone some people will have had reactions, and some of those reactions will be severe (though expected in some small percentage of patients). Highlighting the real-but-rare problems with an otherwise overwhelmingly safe and effective treatment runs a real risk of doing more harm than good. The line between raising awareness and alarmism becomes blurred, especially when activists are involved.

People who are sincerely misinformed need to be provided accurate information to battle the rampant misinformation. Shaming people into getting vaccinated is less effective than promoting the personal, social, and economic benefits of widespread vaccinations. The carrot-and-stick approach has its uses but may backfire when people feel they are being forced into it (whether they in fact are or not). Nobody likes to be told what to do, and that’s especially true for people with an underlying distrust of authority, the government, and Big Pharma. 

Another effective approach is to recognize the various demographics of vaccine hesitancy and identify the specific ones. For example, polls show that Republicans and Trump supporters are less likely to be vaccinated than others. By pointing out to them that 1) the vaccines were developed during the Trump administration; 2) Trump personally vouched for their safety and efficacy; and 3) Trump himself received a COVID-19 vaccine, that will lay bare some obvious contradictions and perhaps induce some cognitive dissonance. They may still refuse the vaccine, of course, but they will likely be forced (in their own minds and on social media as well) to recognize the disparity between their professed support for Trump and rejection of “his” vaccines. 

The Center for Countering Digital Hate (CCDH), a nonprofit NGO, recently released a report titled The Disinformation Dozen: Why Platforms Must Act on Twelve Leading Online Anti-Vaxxers. As the report notes:

The Disinformation Dozen are twelve anti-vaxxers who play leading roles in spreading digital misinformation about Covid vaccines. They were selected because they have large numbers of followers, produce high volumes of anti-vaccine content or have seen rapid growth of their social media accounts in the last two months.

In previous articles for the CFI Coronavirus Resource Center, I have written in some depth about at least two of the “Disinformation Dozen,” Robert F. Kennedy, Jr. and Kelly Brogan. The others are Joseph Mercola, Ty and Charlene Bollinger, Sherri Tenpenny, Rizza Islam, Rashid Buttar, Erin Elizabeth, Sayer Ji, Christiane Northrup, Ben Tapper, and Kevin Jenkins. 

The CCDH analysis found that about three-quarters (up to 73 percent) of the anti-vaccine content posted to Facebook originates with members of the Disinformation Dozen, and they were responsible for 65 percent of the anti-vaccination material on Facebook and Twitter between February 1 and March 16, 2021. The report urges that social media companies take action:

Social media companies must now follow their repeated promises with concrete action. Updated policies and statements hold little value unless they are strongly and consistently enforced. With the vast majority of harmful content being spread by a select number of accounts, removing those few most dangerous individuals and groups can significantly reduce the amount of disinformation being spread across platforms. The public cannot make informed decisions about their health when they are constantly inundated by disinformation and false content. By removing the source of disinformation, social media platforms including Facebook, Instagram and Twitter can enable individuals to make a truly informed choice about vaccines.

Polls reveal that there’s little difference in levels of vaccine hesitancy between Blacks and Whites. A recent PBS Newshour/Marist Poll found that “73% of Black people and 70% of White people said that they either planned to get a coronavirus vaccine or had done so already; 25% of Black respondents and 28% of white respondents said they did not plan to get a shot.” 

Addressing concerns about vaccine hesitancy among African Americans in a New York Times opinion piece, pediatrician and public health advocate Dr. Rhea Boyd noted that despite the large impact on Black populations and low vaccination rates, 

Many are quick to blame “vaccine hesitancy” as the reason, putting the onus on Black Americans to develop better attitudes around vaccination. But this hyper-focus on hesitancy implicitly blames Black communities for their undervaccination, and it obscures opportunities to address the primary barrier to Covid-19 vaccination: access. A closer look at the data reveals that when Black people are given the opportunity, they do get vaccinated.

I explored the intersection of racism and COVID-19 vaccination (or, more accurately, anti-vaccination) agendas in a previous article, “Where Racism, Anti-Vaccination, and COVID-19 Conspiracy Meet.” While it’s true that demonstrable historical mistreatment of minorities plays a role in distrust of medical authorities, Dr. Boyd notes:

Many Black Americans need not resurrect the ghosts of the Tuskegee experiment to recall a moment in which they’ve endured medical mistreatment. As KQED recently reported, researchers say Tuskegee rarely comes up when Black people share concerns about Covid-19 vaccines. Rather, issues like racism in health care and safety concerns are cited much more often.

Thus—at least in the case of COVID-19 vaccines—while latent distrust of doctors is a factor in the African American community, it should not be seen as the main driver of vaccine hesitancy. Public health interventions are best crafted by listening to the affected populations instead of making assumptions about them or speaking on their behalf—and that’s especially true for underrepresented minorities. 

There are other media approaches that might help make a difference. From a public relations and messaging standpoint, one suggestion is that news and social media move away from illustrating COVID-19 vaccinations with images or video of people getting injections—not because it’s misleading or irrelevant but instead because it’s unnecessary and may unintentionally deter people. Most people don’t enjoy getting injections of any kind, and health or strong immunity would be a better image to pair with encouragement about getting vaccinated. 

We are not out of the covid pandemic yet, and each person who refuses to get vaccinated, for whatever reason, puts us one step further away from ending this outbreak. Until we have reached herd immunity, the best advice is to get vaccinated and continue wearing masks and social distancing. Yeah, it sucks—but you know what sucks even more? Infecting others and dying from COVID-19—or surviving it with long-term health effects.