The REAL Reason Why So Many People Won’t Get Vaccinated
There are lots of people who aren’t going to get the COVID-19 vaccine. According to a Carnegie Mellon report released in March 2021, about 23% of respondents are still hesitant to be vaccinated against coronavirus. The rate is highest among African Americans, people of color in general, and young people. Concern about side effects was the top reason cited in the report. Another Kaiser study identified evangelicals, Republicans, and those without college degrees to be less likely to be vaccinated.
The affirmative scientific case in favor of getting vaccinated is clear. And for what it’s worth — I am in the “get vaccinated” camp. I was working as a dialysis nurse in Chicago hospitals when the vaccine became available, so I was fully vaccinated by the end of January. On behalf of all healthcare workers who are sick of wearing N95’s and plastic gowns that double as sweat suits, please get vaccinated.
The problem of misinformation about the vaccine and vaccine-related deaths is real and bears some responsibility for people choosing to skip the vaccine. It’s also true that the larger anti-vax movement has been heavily influenced by social media.
However, blaming misinformation misses a very important question that needs to be considered:
Why are so many people trusting a random social media post or piece(s) of misinformation over the public health officials, local and state government, the federal government, the mainstream news, and the World Health Organization?
To answer that question, we first need to acknowledge the status quo bias. Getting vaccinated is a break from the status quo (being unvaccinated) and requires action that cannot be reversed. Skipping the vaccine is easy; especially when the decision can be punted for another day, week, month, or year.
So in order to get someone to take the vaccine, you have to not only convince them that the benefit outweighs the risk, but convince them strongly enough that they decide to take action. Winning that argument would be easy in a vacuum just by using data and common sense. The vaccines are effective (so far), rarely elicit severe adverse reactions, and haven’t been shown to have any long-term effects.
The biggest problem facing the U.S. vaccination effort isn’t the misinformation nor the strength of the arguments in favor of vaccination. It’s the lack of trust in the institutions that are presenting the case.
Below, I’ve listed the groups and institutions from which a person is most likely to receive COVID vaccine-related information and discussed some of the reasons why people find them untrustworthy — both in general, and in relation to the pandemic.
The suggestion here that large portions of the population don’t trust any of these entities. Nor is it that most people are well-informed enough to even make a coherent case to discredit them. The argument is that the aggregate distrust toward these institutions in general has created an environment in which it’s much harder for any of them to overcome the status quo bias.
A (very) brief history
It’s important to “set the stage” by reminding everyone about just a few of the awful things that American healthcare institutions have done to various groups — many of whom are the same groups that exhibit the most hesitancy to be vaccinated against COVID:
- Forced sterilization (early/mid1900's)- After a 1927 Supreme Court ruling upheld states’ right to sterilize people deemed “unfit to procreate,” about 70,000 people throughout the 20th century were sterilized in order to “breed out” certain traits. People of color, those with disabilities, the homeless, and “sexually promiscuous” women were especially targeted.
- Tuskegee Experiment (1932)- U.S. Public Health Service experiment in which a group of mostly African American sharecroppers, promised free medical care in an attempt to study and treat syphilis, were given a placebo instead of penicillin and watched as they (and their spouses, in many cases) suffered horrible consequences for years.
- Birth control trials in Puerto Rico (1955)- one of the earliest oral contraceptives was tested on impoverished and uneducated women, sometimes without informing them that they were part of a clinical trial. The side effects were severe, and three women died during that time (Puerto Rico was also a site for mass sterilization, often under false pretenses as well).
- Cornelius Rhoads’ entire medical career (1930’s-50's)- If you haven’t read or heard much about him, I’d suggest taking the time to do so. He did a bunch of awful experiments on Puerto Ricans and was exposed after writing a letter discussing his hatred and ill-will toward them. He came back to the states and was eventually promoted to Vice President of the New York Academy of medicine. Rhoads later directed chemical weapons trials that used thousands of U.S. soldiers as guinea pigs, and ultimately became a pioneer in chemotherapy treatments — and even had awards named after him until recently.
- Systemic racism in healthcare continues to be an issue for various groups whose access to care is diminished, and whose healthcare quality is inferior due to prevailing biases in institutions and providers.
Public health organizations
From the first confirmed coronavirus cases back in late January 2020, the United States’ CDC was slow to respond compared to many other countries. One of the starkest contrasts was with South Korea, whose initial response in testing, contact tracing, and subsequent infection data were significantly favorable to that of the U.S. It’s also important to remember that we already knew from the early experiences of China and Italy the potential for a massive health event, and still failed to respond quickly.
The lackluster response extended through the end of 2020, with the U.S. performing very poorly in most categories. It botched the testing process process, leading to an early spike in cases and deaths that overwhelmed many hospitals — and very well might have been otherwise avoidable. Its messaging on virus spread and recommendations was often inconsistent, and sometimes flat-out wrong.
And remember when the CDC told us not to wear masks?
When the CDC wasn’t busy getting things wrong, they were dealing with with meddling from the Trump administration, which actively tried to downplay the severity of the pandemic.
The result was deep damage to the credibility of the institution. A Harris poll from August 2020 found that only 73% of Americans saw the CDC as “very” or “somewhat” trustworthy. That number is way too low for an institution that is perhaps most representative of “the science” that we’re all supposed to follow.
The World Health Organization (WHO) did better than the CDC, but has had a few issues of its own. To its credit, the organization issued its “public health emergency of international concern (PHEIC)” declaration on January 30, 2020 and started making recommendations at that time — which were ignored by most countries.
The damage to WHO’s reputation seems to be much less severe than most other groups discussed here, and for reasons largely out of its control. For one, it simply didn’t have enough power to do much of anything to slow the spread of COVID besides making recommendations. There may be a good argument in support of giving the organization some teeth going forward, but that’s another conversation.
The more serious transgression was the rhetoric around restrictive policies (lockdowns, curfews, stay-at-home orders, etc.). As more data around these types of policies become available, it’s getting clearer that they were often over-utilized, causing additional distress that may have otherwise been avoided — particularly in the areas of mental health and substance abuse, as well as economically.
Again to WHO’s credit, lockdowns are actually useful in certain situations. And WHO was never explicitly in favor of lockdowns as a primary means of preventing the spread of the coronavirus, but instead as a short-term measure while a better plan could be developed. But the fact that it did recommend lockdowns so frequently in the early stages, combined with our country’s struggle with nuance in the national discourse, have led many to conclude that “lockdowns are useless and the WHO was wrong.”
Also, the organization has been scrutinized over its lack of criticism toward China for its obfuscation of knowledge and data and lack of cooperation with the global community— particularly in the beginning of the pandemic. It can be sometimes be hard to differentiate between jingoistic, bad faith anti-China sentiment and legitimate criticism, but in this case it seems to be warranted.
The inconsistencies in guidance from the CDC and WHO had the unfortunate effect of hindering the coordination between federal and state governments as well. For example, there was a brief time in August when a poorly-worded softening of guidelines caused some states to stop testing asymptomatic people, even if they had contact with someone with COVID (Classic CDC, am I right?). Even when the CDC clarified its new guidelines to say that anyone in close contact with an infected person should get tested, its website was still unclear in the following weeks and many states lagged in adjusting their policies.
All the inconsistency and, in some cases, incompetence from the most influential public health organizations not only damaged their own credibility, but made decision-making and discourse that much more difficult for other institutions and people.
Politicians
Our elected officials at the federal level are probably the lowest-hanging fruit when discussing trustworthiness or lack thereof. Pre-pandemic, the public trust in Washington was already at an all-time low and has been steadily declining since 2001, when there was a sharp increase in the aftermath of 9/11. As of early 2019, the percentage of people who always or usually trust the government in Washington was at 17% per Pew Research. The split between Democrats and Republicans tends to fluctuate depending which party holds the White House.
It’s not necessary to wade much deeper into the cesspool of our current national politics; the evidence of its untrustworthiness is clear enough on its own. I’m also going to go out on a limb and assume that most of my readers already have a basic understanding of negative impact that the Trump administration has had, both in terms of COVID response and on the discourse. If not, here you go.
State and local governments, however, have been shown to have more public trust. A 2018 Gallup poll reported that 63% of respondents had at least “a fair amount of trust” in their state government, along with 72% for local government. That’s certainly better, but keep in mind that these numbers represent opinions from before COVID. It’s also questionable whether that’s enough trust to carry water for other less-trustworthy federal institutions in the fight to reach herd immunity.
Of course, state and local governments’ responses have varied greatly, but most jurisdictions have either been following the CDC’s indecisive lead or have been picking and choosing which guidelines to follow — often incorrectly. Since pretty much all states have had their share of spikes in COVID cases and deaths and about 80% states falling between 8,000 and 12,000 cases per 100,000 people, not many states can boast a particularly impressive response in a country that still has nearly the most cases per capita in the world.
Lastly, I want to at least touch on one of the biggest detriments to real debate and change in our country. The binary nature of our politics — the tendency to frame all debates as “yes or no” or “pro- or anti-” — has been polarizing the country and hurting the national conversation for a while now. This problem is deeply rooted and multifaceted, but many state and federal elected officials have accelerated it in the last fifty years or so.
This framing problem inserted itself into both the country’s COVID response and the discourse surrounding it, making common sense mitigation measures like masks into a culture war issue. And I think that many, if not most people do have some instinctive understanding that our elected officials are largely to blame for that phenomenon.
The mainstream news media
News media, like politicians, have suffered greatly in terms of public trust in recent years. A big part of that erosion has been the result of coordinated attacks from Republican officials and conservative voices from Nixon and Goldwater to Rush Limbaugh, Hannity, Carlson, and Trump. And to be fair to the mainstream outlets, much of that criticism was either political strategy (that has proven to be quite successful over the years) or a way to fight back against changing cultural dynamics, especially in the years following the civil rights movement.
That being said — mainstream news media has also been truly terrible for a long time, and in many ways.
Traditional news outlets have historically and continue to provide cover for foreign policy atrocities from Vietnam and Southeast Asia in general to Central America in the 70’s and 80’s to Iraq more recently. I really want to emphasize this point because not only because of the countless lives lost due to aggressive and unnecessary U.S. foreign policy interventions, but also because it’s quite possible that we wouldn’t still be losing American lives in multi-decade wars in Iraq and Afghanistan if these outlets were more adversarial. Noam Chomsky and Edward Hermann’s Manufacturing Consent is a great place to start if you want to learn about the media’s role in U.S. foreign policy.
Aside from being propagandistic at times, the mainstream media — arguably beginning with Fox in the 90’s — has increasingly become entertainment more than news, relying on tapping into the emotion centers of the brain to increase viewer engagement. Matt Taibbi’s Hate Inc. discusses this point in much more depth.
Trump was able to take advantage of the media’s sensationalism, using spectacle to attract nearly $2 billion in free media throughout the campaign and propel him to the presidency. That pattern continued throughout his presidency, with coverage on both sides revolving around him since he was great for ratings. Fox was almost always pro-Trump, and pretty much every other major player was predictably anti-Trump. Many people, especially younger people, saw that trend for what it was and abandoned mainstream news outlets altogether.
Newspaper and cable has also become much more consolidated and financialized in recent years. I’m sure that many have seen this spooky video of the right-leaning Sinclair Broadcast Group’s media acquisitions by now:
This consolidation, as well as the other factors listed above, has resulted in a severely narrowed the range of substantive discourse in favor of stories that can keep eyeballs and increase ad revenue.
That’s why, for a lot of people, when Trump started identifying these outlets as ‘fake news,’ it stuck — because it’s kind of true.
Traditional news media outlets, with record-low levels of trustworthiness, were always going to have an uphill battle to be taken seriously by large enough numbers of people on COVID-related issues that they could make a real difference in the push for vaccination when the time came.
In the early stages of the pandemic, Fox News was absolutely terrible — often downplaying the virus and working hard to make COVID fit into the money-making culture war framework. The other mainstream outlets fell victim to their existing sensationalist flaws, focusing too heavily on Trump and fearmongering with up-to-the-minute case and death trackers and anecdotal personal tragedies to pull at the heartstrings. One study even found a correlation of the viewing of mainstream news’ coronavirus coverage and depressive symptoms.
Local healthcare workers
If we can’t rely on public health officials, government on any level, or the mainstream press to get us to herd immunity, then on whom can we rely?
According to the same Carnegie Mellon University report mentioned earlier, local healthcare workers — followed by friends and family — have the best shot.
The data from the report found that among those who hesitant to be vaccinated against COVID, almost 20% state that they would be more likely to be vaccinated if recommended by local healthcare workers. That number has been increasing since January when the vaccine became more widely available, and is more than double the percentage for government health officials, WHO, and politicians.
It makes intuitive sense — healthcare teams are generally viewed as authoritative sources for health information and will likely have the opportunity to build trust through repeat interactions. They are also much more accountable to their patients than any of the other sources previously discussed are to their audiences. In many smaller communities, there may be a connection outside the medical facility (friend of a friend, went to high school together, coworker’s niece, etc.). And a specific healthcare worker talking to a specific patient about their specific vaccine concern will be much more likely to change that person’s mind than a generic news report.
Plus, it helps that nurses — who do the bulk of patient education in many settings — have been the “most trusted profession” for almost twenty years running.
Unfortunately, large swaths of the populations that need convincing don’t have access to the types of healthcare that would likely yield a productive conversation about the COVID vaccine. Virtually everyone has access to an emergency department and hospital when necessary, but there’s a significant body of evidence to suggest that hospitalizations and ER visits are not very effective times for education. There’s just too much going on — added stress, financial worries, tests and procedures, changes in health condition, and need for more important types of education make it much harder for any extra information to stick.
Discussions with the healthcare team need to happen in an outpatient setting such as with a primary care doctor’s office, ideally when the person isn’t dealing with an acute illness or concern. But of course, this is the exact type of care to which many people don’t have access. As of 2019, about 1 in 4 adults didn’t have a primary care provider and that number was significantly higher in young people, people of color, and those living in southern states — a.k.a. the demographics that are most likely to express vaccine hesitancy.
So while local healthcare workers show the most promise as trusted individuals to make the case for COVID vaccination, they’re also the group that is hardest for an individual to access.
Again, the idea is not that most individuals can spout off all the facts that I discussed here. But if one group is skeptical of the CDC and WHO, one group is skeptical of the news media, etc. — and they’re all making the same arguments — the result is a “united front” of institutions that very few people can trust enough to take the (perceived) risk of getting vaccinated.
I wish that there were more that we could do to help in convincing people to get vaccinated. If you want to make an impact, here are a few simple suggestions:
- Figure out who are the best resources for information in your community, and point people to them. Changing minds will happen best at the local level.
- If you already got vaccinated, talk about it. You don’t have to be a salesperson; just be honest about your experience.
- Don’t be condescending. It doesn’t matter how good an argument is if you rub people the wrong way while making it.
- Meet people where they’re at. You probably can’t change a “hard-no” to a “hard-yes” in one conversation, but you might be able to change them to a “soft-no” and open the door for someone else to finish the job.
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