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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.”

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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.”

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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.

Crowdsource

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.”

Use humor

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.”

Understand mistrust

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.

Get personal

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.

Be patient

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?’”

  • We are NEVER returning to normal. People still take their shoes off at the airport like sheep because 1 guy almost 20 years ago now, tried to light off some gun powder in the sole of his shoe… Good grief.

  • When you all get liver cancer in 5 years, Im going to laugh when you cant sue the drug companies. What a bunch of terrified sheep you are.

    • Ummm … just add the corona vaccine to the toxic brew already there. Like the beer at the party was made from whatever hop plus water from some unknown source like carcinogens polluted river. The peanut butter had peanuts coated with fungus and aflatoxin, a liver cancer trigger. The mist of hairspray has carcinogens. The haircolor has urinary bladder carcinogens. The make up, sunbloc and drycleaning fumes contain carcinogens. And the vaccine is not as bad as the chemo drugs either

  • Good article here nicely summarizing the keys to helping people reach the decision to get vaccinated. The biggest problem here is really one of scale, because the time needed to have these one-on-one conversations can be quite long. Many health care providers don’t have the time to add another 10 to 20 minutes onto an existing appointment slot to fully discuss the vaccines with their patients. The most ideal solutions are the ones that enable you to reach the largest audience possible using a variety of these approaches.

  • This article reeks of the contempt you feel for those you believe to be your inferiors. That attitude will not convince anyone to change his mind about getting the vaccine. As others have pointed out here, these vaccines have been rushed out and have only emergency use. Better than 90% of Americans have not been infected and of the less than 10% who have, better than 95% have recovered. So what is the emergency, exactly?

    • The vaccine was not rushed in the sense that the remarkable groundwork in molecular biology was painstakingly laid over the past 30 years. Excepting a pandemic with substantial lethality, pharmaceutical companies were never going to invest billions of dollars in doing the necessary clinical trials and scaling up production and distribution of this type of product without having enormous government financial support and a very large number of paying customers who want and need the product. In a very real way, the science and technology required for this vaccine has been just waiting on the shelf. The US government stepped up to what any war requires: financial and production resources, bridging administrative obstacles and offering logistical support and security. Emergency use authorization is an administrative term and the process is strikingly similar to the usual and fussy FDA approval process. At some point, it would likely be a good idea to proceed with the full approval classification so the public is not misled, as you appear to be, by the nomenclature.
      Your estimate of 10% infected is very low and not supported by facts.
      Your contempt for medicine and for those of us who try every day to help our fellow human beings and to prevent needless suffering and death is sad. If you have a withered heart or are just angry, perhaps it’s worth discussing your own loneliness and fears with a professional. Explanations are not haughty, they are just explanations and asking questions is a more constructive response that helps all of us learn. In the meantime, please be gracious and stand aside to allow the rest of us to continue to do our jobs in all ways, both great and small.

  • I favor vaccination and do not feel afraid of the ones we are using. But as far as talking people into getting them goes:
    1. If the variants do not deal us a brand new (bad) hand, we will soon have so many vaccinated people, with very effective vaccines, that the holdouts will be at very low risk of getting sick. As we do with other diseases, those of us who get vaccinated protect the holdouts- it is unfair, since they are an ongoing risk for us, but without truly mandatory vaccination, that is how it is. The same thing will happen with Covid, they will argue their risk of getting sick is very low, and they will be correct.
    2. The variants are a wildcard. So far, we keep being given, IMO, wishful thinking about the vaccines we use here stopping the variants. But no one seems to have hard data, or be able to give a truly concrete reason this is so. Right after reading the Moderna vaccine would stop the South African and Brazilian variants, I read Moderna is working on an updated vaccine to stop them. So which is it?
    Right now, getting vaccinated with current vaccines, to protect against our original strain, and B1117, seems a very good move – they are the most common by far – but in a few months, with those two knocked down by other people getting vaccinated, some will feel they do not “need’ the vaccine for those two – and if the vaccines do not protect against South African and Brazilian, which may be greatly on the rise, why bother?
    We need to know if our vaccines stop these variants or not.

    • If the ‘holdouts’ (in the U.K. we refer to them as ‘freeloaders’) are hoping that they’ll be protected because so many others are willing to be vaccinated, they better hope the vaccination programme reaches 80% of the population.

    • Ted – So, I am not advocating any such position, but from what you are saying, after we get to 80% vaccinated, they can pretty safely “freeload” ? I bet a lot of people who are not really against vaccines but not sure what to think will do exactly that. Of course, some people will not be able to get into the first 80% vaccinated no matter what they do (too young and no qualifying condition) and may decide not to bother if the epidemic dies down enough. But unfortunately, from what i read, those will be mostly be those most likely to be spreaders.

  • “You can’t reason a person out of a position they haven’t been reasoned into.”

    How do you complete with a German blogger who said the vaccine kills people? How to you even have a conversation with someone who believes this source above all others, and automatically dismisses anything from “Main Stream Media” as part of the plot?

  • These vaccines are all experimental. FDA approved only for emergency use. The pharma companies are rushing them to market chasing the $$. Moderna, which has never had an FDA approved vaccine , and Pfizer are projected by Wall Street analyst to have revenues of $32 billion this year. All demanded and received immunity from liability.
    So, if you are okay with being part of an experiment with unknown long term affects, knowing there is no recourse if something goes wrong, by all means go for it.
    If it were a life and death choice, maybe, but this is not. If you believe Dr Fauci, 99% of those infected will eventually recover and 1% will die. Mostly elderly and those with underlying conditions and weakened immune systems.

    • The variants are expanding their hunting grounds to steadily increasing numbers of healthy younger people – who are getting very ill – and the death toll in this group is increasing too. The vaccines have been thoroughly investigated by the FDA, and “Emergency Use Authorization” will likely turn into full authorization as millions of people have now been vaccinated with no serious side effects. And with the high efficacy rates : getting the vaccine certainly beats getting Covid – with potentially long-lasting set-backs – or death. Get vaxxed !

  • “NASCAR white folks” is clearly racist.

    Someone needs to go back to her race sensitivity training.

  • I do appreciate this article, but as an individual who has a close family member – perfectly healthy – no medications at all – who took the vaccine and developed bilateral blood clots in their lungs and also a HUGE one in the leg, yes, am waiting and seeing. It is grievous that clotting and other blood issues are being dismissed – they should not be – for a few – yes, very few cases when looking at percentages – this is a grave cause for concern as people are dying post vaccine from stroke and heart attacks due to clotting issues and from pulmonary embolisms as well as one case I am very familiar with, frank bleeding post vaccine in a perfectly healthy, no med individual . . . to know that over 1000 deaths related to clotting, bleeding, etc. have been taken off the VAERS system, is most grievous and is not providing the public, and those who are following reactions in the medical and pharma industries, honest, full, and forthright information. Young and middle adults are dying from unexplained strokes – perfectly healthy – as have been many others that at first were reported, but cast off as not applicable to vaccine when it is clear, they were. This is world wide – seeing from my own research that these severe reactions are mainly Pfizer and now Astra (though not exclusive) – yet, now testing is being done on children and why would the United States even consider Astra for approval until this is resolved? This is happening and needs to be followed up on and noted as a severe and infrequent, side effect so those who take the vaccine can make an informed decision. It should not be dismissed – there is certainly correlation and yes, causation, present. That is most evident. And no ma’am, I am not an anti-vaccer – at all, but I am also an educated, able to think and process ACCURATE information, for myself and I do have a choice – NO ONE should be condemned for taking, or not taking, the vaccine and no one should be forced to take it or coerced . . . thank you for your article and thank you for the opportunity via comments to express concern as this issue will not go away – no matter how much pharma (or whomever), etc. desires it to – others will die or have blood issues unless it is addressed and research is done to find out the “why” and formulations are changed to prevent this from happening to others.

    • What is the authoitative source for your quote regarding the 1000 cases taken off of the VAERS system?

    • Thank you for your clear communication of some of the “vaccine hesitant’s” concerns, Diginee.

      An additional comment related to the rare clotting issues, I find it unsettling when a blanket statement is made that “the benefits outweigh the risks” for the vaccine when the risk of covid is DRAMATICALLY based on age, comorbidities, Vitamin D levels, etc. How can anyone say the benefits outweigh the risks for everyone when the benefit is life-saving in some and almost no benefit in others?

    • You have some points that are worth talking about and others that don’t appear to be supported by data. If you are so knowledgeable and well educated, why are you fearful of putting your real name on your post?

    • Jennifer – I think you make one of the most salient points – old folks and those with certain health problems are at vastly greater risk than young folks in perfect health.
      I think they are making a point of NOT saying that out loud because young folks are also the big spreaders. In fact, there were some arguments in favor of vaccinating young folks with very low risk of severe illness, because it would slow the epidemic down much more than vaccinating old folks.
      Although the young people are at very low risk from the virus, the vaccine appears so safe that I think young people should get it to protect others – but is it 100% ethical to not tell them “Your chance of dying if you get infected is 1 in 3,000? (in my county, among those 30 and under that is the statistic, but it is probably actually lower because many are asymptomatic and never get tested, or have mild symptoms, suspect Covid but do not bother with a test, since they are only going to get palliatives anyway)

  • I will not vaccinate at this time. I am 69 years old which puts me in a higher risk group however, these vaccines have not been through extensive clinical trials, they are not FDA approved at this time, the manufacturers are making uncountable profits off this vaccine and our Government is more concerned about the political optics than the safety of this vaccine. They pushed the pharmaceutical to rush to create these vaccines and because of that, and rightly so, the pharmaceutical industry insisted on blanket immunity from law suits involving the vaccine and received it. That means that if two years from now people start having some really bad reactions and sever medical issues, they are screwed. The manufacturers are going to claim immunity from being sued, your health insurance company will most likely not pay because the vaccines were not FDA approved, were experimental in nature so those giant medical bills are all yours! I don’t recall Congress passing any laws that mandate health insurance companies cover issues arising out of these vaccines.

    • “These” vaccines have been through extensive clinical trials. The FDA did approve the mostly widely used vaccines. Would it encourage you to be inoculated, if you could sue the manufacturers? Do you feel protected by such litigation? They are taking a high risk in producing a product that will be used by a world population, so they get a high reward. A single jury award, out of a potential pool of millions, could force them into bankruptcy. You can’t base your decision on the completely hypothetical belief that two years from now there might be latent downsides that might emerge. If you believed that, you’d never have a bone set. Your position wouldn’t be unethical if the consequences only applied to you. But they don’t and the more people inoculated, the sooner we can get back to “normal.” The cemeteries are full of Christen Scientists and others who don’t believe in medical treatment. At least they have the courage to embrace their beliefs and not rely on spurious reasoning to justify what is basically a selfish position that harms others.

    • Craig D’Ooge: I think your position is too extreme. I believe in the vaccines, but if someone was giving out the vaccines before the EUA, he would be prosecuted, right? I mean, before the EUA, but AFTER the clinical trials -so, while I disagree with it, really, holding off on the vaccine is not that different than taking the conservative FDA position, or what it would have been in normal times.
      As I said in my other Comment – if the vaccines are 95% effective, and going to remain about that good, after the variants come in – then the unvaccinated will not really put the vaccinated at all that much risk. At some level of risk, we have to accept it and not shame over it. If my risk of getting sick, at all, is 5% no matter what you do- maybe that is still too high and you can object – but what if it is 1 in 1,000? The clinical trials for Pfizer, I read anyway, came up with 95% protection against ANY observed disease – but the protection against severe disease was higher.

    • Who you gonna sue when you get Covid and your medical bills pile up? Why should you be treated if you get Covid after you had access to a vaccine and refused it? You shouldn’t get to have it both ways…… You should not get paid Covid treatment if you refuse the vaccine.

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