As the Covid vaccine supply increases throughout the U.S., the next hurdle to reaching herd immunity will be convincing those who are hesitant about vaccines to receive their shots. Surveys show Black and Hispanic adults are more likely to be “waiting to see” before they get a vaccine (but are also less likely to say they definitely won’t take one than white adults).
Experts say the best way to tackle vaccine hesitancy is for people to have conversations with those they trust, whether a doctor, pastor, family member, or friend. So STAT spoke with a number of experts on the frontlines — global vaccine scholars, physicians tackling low vaccination rates in Black communities, and multilingual doctors who are taking matters in their own hands to get out the word — to create this guide on how best to handle these sometimes difficult conversations. Their suggestions may surprise you.
One word of caution: be ready if the conversation gets emotional. Issues about vaccines often center more on anxieties than facts, said Heidi Larson, an anthropologist at the London School of Hygiene and Tropical Medicine and global vaccine expert. “This can be a messy, emotional, difficult space.”
Shoot for the middle
Pick your battles. Some people are dead-set against receiving any vaccines and unlikely to change their minds. But there are also plenty of people in the middle, the so-called “vaccine hesitant,” who may just want more information or be waiting until more people they know are vaccinated before they step up. Kaiser Family Foundation surveys show 22% of people they polled recently are in this “wait and see” category (55% have already received the vaccine or will get it as soon as they can, 15% say they definitely won’t take it, and 7% say they’ll only take it if required). It’s this “wait and see” group that’s most worth focusing your efforts on.
“There are some people that aren’t going to change their minds no matter what, so focus more on the so-called movable middle,” said Larson, who previously headed global vaccine communications for UNICEF and now directs the Vaccine Confidence Project. “You might think of it as your swing vote — any political strategist will tell you that getting as much of the swing vote as you can is what’s important. It can also make people more resilient to the predatory behavior of anti-vax groups.”
Have a conversation
Don’t lecture your family and friends, and don’t assume you know what their concerns are. Make sure to listen.
“Try to address their concerns, not what you assume are their concerns,” said Jorge Moreno, an internist and assistant professor at the Yale University School of Medicine. While you may be thinking people are ensnared in the darkest of conspiracy theories, many may have concerns that are much simpler to address. For Moreno, who even had to convince his mother the vaccine was safe, many questions he’s received have centered around side effects, and whether they might make people too sick to work. A Carnegie Mellon University survey released this week showed 70% of vaccine-hesitant people were concerned about side effects.
“Let people know it’s OK to have questions and that having concerns is legitimate,” added Reed Tuckson, the former public health commissioner for Washington, D.C., and a founding member of the Black Coalition Against Covid, which co-developed a campaign called “The Conversation: Between Us, About Us,” with the Kaiser Family Foundation and public health advocate Rhea Boyd, to provide Black families credible vaccine information. “Letting people have a safe space to have this conversation is essential,” he said. “Wagging your finger against someone is not very useful.”
Speak people’s language. Literally
Moreno has spent much of the year treating coronavirus patients, either in his primary care practice, or in the Covid-19 units of Yale New Haven Hospital. In early January, once it became clear that vaccines were on the way, Moreno couldn’t find information to share with Spanish-speaking patients. “I saw a lot of information online, some of it good, some of it bad, but everything was in English,” he said. “I felt that was a disservice, especially for our older citizens — the ones we were supposed to be vaccinating.”
Moreno created a YouTube video, describing the vaccine and his own experience with being vaccinated, in Spanish. “I thought this was just going to be viewed a few times, but then it got picked up,” he said. His hospital has since asked him to make more videos, and reliable vaccine information in different languages is increasingly becoming available from government agencies such as the Centers for Disease Control and Prevention, which created this PDF about “las vacunas”; the Food and Drug Administration, which has vaccine information in more than 20 languages, including Arabic, Cherokee, and Gujarati; and the World Health Organization, whose website translates Covid-19 information into six languages.
Understand the doubts
Vaccine hesitancy in the Latino community has been of particular concern because inoculation rates are low and misinformation in Spanish — that the vaccines contain microchips, for example, or will alter DNA, or are part of satanic rituals — is spreading through Facebook posts and WhatsApp private messages. Especially worrisome to many Hispanic people are false rumors that the vaccine may impair fertility, which is a painful issue for Latino communities that have experienced a history of sterilizations performed without consent.
“The fertility question keeps coming up, and a lot of people believe the myth that undocumented people can’t get the vaccine,” said Moreno, who has spoken at two forums at churches about the vaccines. Others ask if they can get the vaccine if they don’t have insurance. (They can.) “Everyone has a different question. You just have to listen to those questions and get to the root cause of their doubts.”
Don’t get bogged down
“A key is to keep it simple,” said Boyd, who is a pediatrician with the Palo Alto Medical Foundation. “If people think they might get Covid from the vaccines, it’s because they don’t understand it’s not a live vaccine.” (None of the vaccines authorized for use in the United States contains any live virus.) “If people are asking about the costs, it’s clear they don’t understand the vaccines are free.”
Don’t focus on science
This is a corollary to keeping it simple. You could talk about mRNA, spike proteins, and viral vectors until the cows come home, but that knowledge might not be the best thing to draw on when you’re talking to people who are vaccine hesitant.
“Facts by themselves rarely do anything, and sometimes they aggravate the situation because people feel like you are not listening to their concerns,” Larson said. As she wrote in “Stuck,” her recent book about vaccine rumors, “Science alone is not going to change the mind of those with strong beliefs.”
What might work instead, at least for some, is appealing to altruism — that getting vaccinated will help protect your family and community by getting us closer to herd immunity. Said Larson: “Some people are more willing to take the vaccine if you say, ‘It’s not for you, it’s for your grandmother,’ or ‘It’s for those you work with.’”
Talk about safety
Remind people that the vaccines have been tested on tens of thousands of people — and on a diverse range of people. When the vaccine was approved, Moreno wondered whether it had been tested on Hispanic people like himself. “In Pfizer and Moderna [clinical trials] combined, there were 10,000 Hispanic people tested, and the vaccines were shown to be safe in all ethnicities,” he said he discovered. “Many of my patients didn’t know this.”
More than 6,000 Black volunteers were enrolled in the two trials. And of the nearly 45,000 people enrolled in Phase 3 trials for the Johnson & Johnson vaccine, 15% were Hispanic and 13% were Black.
Polls show people’s hesitation is diminishing as they see more and more people they know get vaccinated. Boyd said her relatives were very much in the camp that was “wait and see” and turned to her as the doctor in the family. “They didn’t want to be first in line. They wanted other people to go first, but once I could share data that millions of people had taken it safely, it became easier,” she said. “With every additional poll, the number of people in the ‘I’m waiting to see’ category gets smaller.”
Don’t use blame
“Looking down your nose at someone is just not going to work,” Tuckson said. “Making people feel guilty and making people feel stupid about asking questions are two definite nos.”
Instead, show empathy. “No matter what, this is a brand-new virus and these are brand-new vaccines. It’s reasonable for people to have concerns,” said Larson. “Take a deep breath and just hear people out. Everyone’s had a rough year one way or another. People are worn down, and we need to help each other.”
Dry lectures are definitely not going to work. Use humor to lighten the situation and make it easier for people to open up. Boyd looked to comedian W. Kamau Bell, whose easygoing, funny questions — like discussing if turning into a vampire or a zombie might be a side effect, or if only “NASCAR white folks” were part of the clinical trial process — created an inviting environment for the serious information from physicians that follows. A number of doctors are taking to YouTube to spread vaccine information with silly remixes of the “Hamilton” song “I’m Not Throwing Away My Shot.”
Many Black Americans have a distrust of the medical system because of the racism they have encountered from health professionals; public health officials fear this is leading to suspicion about Covid vaccines. Lingering mistrust, Tuckson said, is something Black physicians are uniquely suited to battle. “We can say, ‘I understand you. I am from the same place as you are. I have the same anger and frustration as you do. But these are safe and effective vaccines that are critical for our survival,’” he said.
Talk about religion
Some people are hesitant because the use of fetal cells in the production of some vaccines — though not in the vaccines themselves — creates moral concerns for those opposed to abortion. This is an issue for the J&J vaccine, which used cell lines that originated from fetal cells during research and production. While the Vatican has called the vaccines “morally acceptable,” the United States Conference of Catholic Bishops recommended people avoid the J&J vaccine if possible. (Moderna and Pfizer vaccines both used fetal cell lines in their early testing but not their development.)
The pope received a Pfizer vaccine on Jan. 13. “He’s told Catholics it’s their moral obligation to be vaccinated,” Moreno said. As supplies increase, many people may be able to avoid this issue by choosing which vaccine they receive.
Nothing works as well as sharing personal experiences. In her book, Larson recounts the story of Ethan Lindenberger, a teen from Ohio whose story went viral when he joined a Reddit group asking where he could be vaccinated since he had turned 18 and no longer had to follow his parents’ anti-vax views. “People can just ask, ’How did it go for you?’ and they’ll get more comfortable,” said Boyd. Many physicians are avidly sharing their vaccine experiences on social media and even on live broadcasts, hoping that it will help persuade others to get vaccinated.
It may take several conversations before someone is ready to be vaccinated. You may have to keep answering questions and have several conversations. “I haven’t been 100% successful,” Moreno said. “I’m very passionate about this and I want people to get vaccinated, but I don’t want to force them.”
Offer to help
For many people, it may not be vaccine hesitancy holding them back, but an inability to navigate the complex vaccination landscape. Boyd argues that low rates of vaccination among Black populations may be more a matter of access than hesitancy, and it’s true that well-heeled and well-connected white people have been taking vaccine spots at distribution sites set up in lower-income communities of color. So offer to help. “If you’re young and know computers, sign them up,” said Moreno. “Give them a ride to the vaccination center.”
Focus on the future
If all else fails, the best strategy may be to focus on what herd immunity could offer: a path back to normalcy. Larson suggests asking: “Do you really want to stay in this mess forever?” Adds Tuckson: “I ask people, ‘Would you like to have Christmas and Thanksgiving in person? Do you want your daughter to graduate in person, or your son to be able to have a wedding? Would you like your life back?’”
“If only ‘NASCAR white folks’ were part of the clinical trial process . . .”
Very funny! LOLOL!!!
Now, help me out here–if someone used, instead, “fried chicken and watermelon Black folks,” would you say that would be a) much funnier, b) as funny or c) not nearly as funny?
Thank you kindly,
It’s all apples and oranges per se. The reality is that some will get vaccinated and some won’t. My own concern is to make sure I keep doing my part in this whole pandemic. It’s personal no matter what is said. I’ve had my vaccine and it was a personal choice based on my own personal risk/reward scale.
“Predatory anti-vaxxers?” Get real. Very condescending. Whatever happened to my body my choice? Why the double standard? Medical tyranny is upon us. God help us! Moderna openly states this is an operating system and changes DNA. What does this make you!! People against this believe in their views as strongly as you do. There is more than one point of view on this planet. Are you always in the right?
I find this article like many regarding “vaccine hesitancy” condescending. There is a significant highly educated population who have experienced vaccine injury in their family and have genuine concerns about long term autoimmune issues. My immunoligist is not recommending the mRNA vaccines. There is no way we can tell people they’re safe and effective yet. They are officially in clinical trial until 2023. That aside, the bigger concern is that people think these vaccines can create herd immunity. The vaccines are designed to lower symptoms in those who take it. They are not designed to prevent transmission. If they don’t prevent transmission we’ll never get herd immunity. Someone please share any science that shows they could create herd immunity. None of the scientists, virulogists and immunoligists I’ve listened to can find any evidence.
Walt, there are early study results coming out now showing a reduction in viral transmission from vaccinated people. It’s too early to say exactly what the total effect will be, but it’s very promising. Ultimately if you reduce symptomatic cases, you inevitably reduce transmission.
But the most important point is that in a world where almost everyone is vaccinated, making severe disease and death extremely rare, herd immunity doesn’t really matter so much. The vaccines do a remarkable job of that.
Sydney I understand your point but I have not seen any evidence that the vaccines prevent or reduce transmission. If asymptomatic cases (in vaccinated people) don’t spread Covid 19 (which many scientists believe) than why have people had to quarantine when they are positive with no symptoms? If vaccinated people are allowed to take part in society than asymptomatic people should also.
And to your second point, yes! If people are protected by the vaccine (but not “herd immunity”) than it should not matter how many take the vaccine. Let it be a personal choice given all the concerns others have mentioned (severe adverse reactions to the vaccines like clots, strokes, heart failure, neurological disease) among healthy people. Also those with autoimmune conditions who cannot take the vaccine are being discriminated against due to this societal pressure and one size fits all approach, especially the vaccine passport idea.
Very comprehensive demonstration; may help many to handle some critical situations about vaccination. Congrats from a former pediatric allergist !
This article is very helpful.
Sharon O: your last sentence was cruel and unnecessary
I’m a doctor. I’ve always been a passionate supporter of vaccines and vaccinations.
But now I’m waiting and seeing. Why? Because I’m concerned about the long term safety of mRNA and viral-vector vaccines. Because nobody – and I mean nobody – knows anything about the long term safety of these brand-new technologies. In such a matter, I’m unwilling to guess. As soon as I can get an inactivate-virus vaccine, or a protein-based vaccine, I’ll take my shot. Then I suggest that you give people the opportunity to choose which vaccine they receive, if you want to improve vaccination rates.
Thank you Caterina for speaking up. So many doctors I know are afraid to. There have been many scientists speaking up about the risk of ADE (antibody dependant enhancement) reaction that is particularly risky for anyone who’s had covid or has been recently exposed, yet there are no cautions not to take the vaccine if you’ve had covid or to screen out people by testing as some experts are recommending but not being listened to https://pubmed.ncbi.nlm.nih.gov/33113270/
The VAERS database which tracks vaccine injury already has thousands of severe adverse reactions recorded so people need to be informed (remember informed consent) of the true risks.
This review in the British Medical Journal brings up many concerns of the mRNA studies https://blogs.bmj.com/bmj/2020/11/26/peter-doshi-pfizer-and-modernas-95-effective-vaccines-lets-be-cautious-and-first-see-the-full-data/
Sharon O might want to reread the article.
I am sorry, but this is a personal decision. Yes, I would welcome input from a friend, but only to a point. I am NOT an anti vaxxer. I am smart enough to understand that ALL medications of any type pose a risk of a negative consequence. I also understand what EUA means. I also see drugs being taken off of the market and attorneys seeking billions of dollars in damages for drugs that went through the entire normal process and were fully vetted. We know NOTHING about potential long term consequences of these new vaccines beyond perhaps the one year they have been in testing and then dispersal. So when I see talking points like this…..It really does not sit well with me. When I am comfortable with the risks associated with a Covid vaccine I may take it. Until then…I’ll roll the dice of risk versus reward despite being 62 years of age.
Paul, it’s hard for me to understand the concern that something might go wrong with the vaccine, long-term effects, etc. versus the KNOWN disaster of getting Covid. I dare say you probably drive and get on a plane, but what about the possibility of a bad accident or a plane crash? Seems to me that you are weighing risk vs reward incorrectly, to your and my disadvantage. After all, I need you to help us achieve herd immunity, so your “personal” choice affects me (and everyone else) as well. No, sorry. I’m afraid you are being a bit of a drama queen and I’m-more-important-than-everyone-else here. For these reasons, it seems like it would be best if you got Covid and left us.
Nice, Sharon O. Great example on what not to do when talking to vaccine hesitant people. Was that your intent? Surely you didn’t mean to be quite so callous …
Sharon O. – get a grip, with the two main vaccines being 95% effective, the holdouts are not really putting other people at very high risk. This whole “but you are putting me at risk” thing is way overblown in this case. If the vaccines were much less effective, such that you really need everyone vaccinated for protection, you would have more of a point.
And if you must wish people die, please get to work on all the people who are more dangerous than an unvaccinated person will be to a vaccinated person, after all willing recipients of vaccines receive them. Serious illness after the Pfizer vaccine was supposed to be extremely rare- trhe unvaccinated person first off may never get Covid, and if infected may not spread it at all, and if spreading it, only 5% of those he spreads it to would get severely ill if unvaccinated, and if those he would have spread it to are vaccinated, 95% will not get sick at all, and maybe less than 5% get seriously sick.
When you get Covid and are gasping for air, call an attorney to discuss suing somebody.
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