The prevalence of "vaccine hesitancy," blamed by politicians and public health officials for the recent COVID-19 vaccination slowdown in the United States, has been exaggerated.
The seven-day average of people receiving their first dose reached a high of almost 2 million on April 13. Two weeks later, that pace had fallen to just over 1.2 million, a decline of 39%.
Many have blamed the slowdown on a high degree of vaccine hesitancy, particularly among Republicans and men. Dr. Anthony Fauci, the chief medical adviser to President Joe Biden, recently said the vaccine hesitancy among many Republicans is "quite frustrating." Last week, the Biden administration began a massive public relations campaign involving celebrities and athletes to encourage more people to get vaccinated. This week, GOP members of Congress with medical backgrounds released a pro-vaccination public service announcement.
Yet public health experts downplay the idea that vaccine hesitancy is responsible for the vaccination slowdown.
“I don’t think [vaccine hesitancy] is a big problem,” said Otis Rolley, the senior vice president of the U.S. Equity and Economic Opportunity Initiative at the Rockefeller Foundation. “I think much of what we are seeing now is an issue of access — access to both information and the vaccine.”
While access is likely one problem, waning enthusiasm and a lack of urgency among other people may also be contributing to the slowdown in vaccination. Critically, though, such people are not hesitant — they are still willing to be vaccinated, but they are in no hurry to do so.
Dr. Marcus Plescia, chief medical officer at the Association of State and Territorial Health Officials, said that while vaccine hesitancy will slow down vaccination, in the long run, it won’t present much of a challenge.
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“We’ve moved on to folks who are more cautious, who won’t line up at a mass vaccination clinic,” Plescia said. “They want someone to talk to, like their doctor. Once they do that or they get nudged along by friends or family members who’ve gotten a vaccine, they will get around to it.”
But Dr. Georges Benjamin, executive director at the American Public Health Association, claims that vaccine hesitancy is a serious problem.
“I think it is still a significant concern,” Benjamin said. “From looking at polls and studies, we know people are hesitant because of safety concerns over the vaccine and efficacy concerns. And in some communities, the vaccine has been politicized.”
Most polls show that enough people are either unwilling or unsure about getting a vaccine that it could make it difficult to vaccinate the 70% to 80% of the population needed for herd immunity. A recent Morning Consult survey found that 20% of adults do not plan on getting vaccinated, while 14% were unsure.
Politically, the greatest unwillingness came from the GOP. According to the Morning Consult poll, 27% of Republicans said they would not get a vaccine, compared to 10% of Democrats and 21% of independents. A recent Monmouth University survey found an even wider divide, with 43% of Republicans saying that they would likely not get the vaccine, while only 5% of Democrats and 22% of independents said the same.
Plescia didn’t put much stock in those numbers.
“Some of that 20% who says they won’t, they will eventually come around,” he said. “And the demographic of white males who say they absolutely won’t get vaccinated, we’ve got some data now that suggests when a doctor talks to them and says that they need to do this, they are likely to change their minds.”
Benjamin said he thinks that problems with access have not received enough attention.
“There’s no question that the ability to get an appointment, with the initial scarcity of vaccines, caused huge disparities, as well as real problems getting people vaccinated,” he said.
Those disparities have, to some degree, fallen on minorities. The Morning Consult poll found that 77% of white people who wanted a vaccine got one, compared to just 60% of black people and 55% of Hispanics.
Rolley said that the vaccine campaign should have done more to target minorities from the beginning.
“To say that [the slowdown in vaccinations] is due to hesitancy is to not take ownership of what some of the systems may have done incorrectly during the initial rollout,” Rolley said. “The data shows that a lot of people didn’t know how to get a vaccine and wanted more information.”
A HIT Strategies poll commissioned by the Rockefeller Foundation revealed that in early February, 54% of those living in urban areas did not have enough information about where to obtain a vaccination.
Access is also an issue for those in rural areas, where people may have to travel long distances to get a vaccine.
“People [in rural areas] are doing a value equation,” said Dr. Jeffrey Chapman, chief medical officer at Cheyenne Regional Medical Center in Wyoming. “If people have to drive an hour to get vaccinated and they don’t see the urgency in it, then they won’t.”
Another reason that vaccination has slowed may be that most of the people who were most enthusiastic about the vaccine have already received a shot. The peak of vaccinations reached in mid-April may reflect the fact that by early April, most states had expanded vaccine access to all adults over age 16. The surge from that may now be waning.
“You had the people who were most interested jumping on the vaccine bandwagon early on,” Chapman said.
Chapman added that at its peak, the vaccine clinic at Cheyenne Regional was inoculating around 1,000 people a week. Now, traffic at the clinic is down to 25% of that.
Finally, there may be a lack of urgency among younger people, especially as hospitalizations and deaths from COVID-19 have declined in recent months. These are people who are willing to get vaccinated but are in no hurry to do so.
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“One of the age groups least vaccinated are younger people,” Chapman said. “They are also doing a value equation. They’re asking, ‘What is my outcome? I’m at low risk, and the number of cases are down.’"
