The signs are clear: The U.S. vaccine rollout is plateauing.
A remarkable 230 million shots have been given in a few short months, fully vaccinating about 95 million Americans as I write this. The next 100 million shots will be harder.
News reports are chronicling a slowdown in appointments across the nation. The number of daily doses administered is down from the peak of 4.6 million on April 10 to about 3 million today. By now, this historic effort has captured the vaccine-hungry individuals who are eager, well-resourced, technologically savvy, and excited to get vaccinated. But as fewer people sign up to get their shots, a dominant narrative is emerging: It’s because of hesitancy — too many people don’t want to get the vaccine. Some even call this vaccine resistance.
Those are convenient narratives. But they are false, and can have harmful consequences.
Let’s start here: If you didn’t get your flu shot last year, are you “vaccine hesitant”? If you haven’t been vaccinated yet and aren’t actively seeking an appointment to do that, are you “resisting”? If you skipped your vaccination appointment because the Food and Drug Administration’s pause of the Johnson & Johnson vaccine raised questions you wanted answered first, are you a “vaccine skeptic”?
Few people would answer any of these questions with “yes,” yet experts and commentators are quick to use hesitancy to explain the recent dip in vaccinations.
We have seen this before: When the Johnson & Johnson vaccine was found in January to be 72% effective in U.S. studies — lower than the Pfizer and Moderna vaccines — many predicted this difference would make people less likely to get the J&J vaccine. It did not. Instead, this vaccine became the go-to for hard-to-reach groups that prefer a one-shot deal.
After the pause was announced for the J&J vaccine, many worried about its possible impact on the intent to vaccinate for all vaccines. This, too, was unfounded. In one new poll, 71% of people said the pause didn’t matter to them, or that it was a good example of rigorous safety monitoring. In another poll, 88% said the pause was the right call.
As daily vaccination rates settle and the country’s progress toward herd immunity slows down, let’s not rush to the same misguided conclusion that this is mostly about lack of vaccine confidence.
Individuals who aren’t seeking a Covid-19 vaccine right now are not necessarily the same people as those who are truly anti-vaccine. Instead of talking up hesitancy, it’s time to talk about what motivates people to get vaccinated and identify the ongoing barriers to vaccination. Here are three ways to do this.
First, retire the term “vaccine hesitancy.” As any crisis communications expert will point out, it’s not a good idea to say things you don’t want people to be thinking. Repeating the term over and over again unwittingly communicates that there may be something to be hesitant about. The more people talk about it, the more it becomes a self-fulfilling prophecy. It’s the same psychology that puts guardrails around using the word suicide, which news media are urged not to put in headlines and to apply with utmost caution.
Second, keep in mind that vaccine confidence is not a fixed mindset. Instead, it describes where someone is in his or her vaccination decision-making at a specific time. Are people who aren’t ready today to get the Covid-19 vaccine skeptics? Or do they just have important questions about the vaccine? Did they check the “no” box in the poll because they knew enough and truly didn’t want the vaccine, or because they didn’t know how and where to get a vaccine, were concerned about health insurance bills, didn’t have time to make an appointment, were worried about missing work, or have had negative encounters with the health care system?
Third, looking past the behavior of individuals can shed light on the more systemic drivers of what prevents people from getting vaccinated against Covid-19, which include a host of systematic health and information inequalities.
I lead a team at Brown University School of Public Health that is undertaking new research in partnership with the Rockefeller Foundation and community organizations across the U.S. to understand people’s experiences regarding vaccination, public health, and the health care system more generally, rather than just their intentions about this specific vaccine. What we have learned so far from this survey, fielded by HIT Strategies in communities of color in five U.S. cities, is telling: Even though a majority of Black and Latino Americans want to get vaccinated — 72% in this survey — a surprising 63% said they didn’t have enough information about where to get the shot. In addition, more than 20% said they had regularly been treated with disrespect when getting health care in the past, and 20% said they have had trouble finding health care when needed.
Despite these systemic barriers, only 3% of the total sample said that nothing at all would move them to get the Covid-19 vaccine.
Everyone else, even those who said “no” to getting a vaccine now, listed reasons that would motivate them to get a shot, such as “seeing a person I trust get the vaccine” or having “a vaccination site close to my home.”
In fact, “having more information” is the single most important concern expressed by those unsure about the Covid-19 vaccine, according to almost every poll that asks this question. This is true across the political spectrum. Blaming conservative Americans for taking their time or for believing lies, and labeling them as hesitant or resisters only hardens their viewpoints. Instead, the public health community needs to come to grips with what motivates people, and also with the harmful impact of misinformation on Americans who do not have access to quality information.
It’s still a long road to getting most Americans vaccinated against Covid-19. It can be shortened by worrying less about today’s confidence polls and more about persistent barriers to vaccination. The health and public health communities need to continue the hard work of making vaccines ubiquitous and available without complex sign-up procedures — at churches, grocery stores, barber shops, food pantries, and yes, even in bars and restaurants.
People’s questions must be answered and false narratives preempted by flooding online and offline spaces with high-quality information in the languages people speak on the platforms they frequent. Concerted effort is needed to expose misinformation tactics and how they are unleashed to generate confusion, as well as to regulate the platforms that empower them.
For most Americans — and that includes conservatives — who are given the chance to discuss vaccination on their own terms and timelines and for whom vaccination is easy, nearby, and supported by employers, the question shifts from if they will get vaccinated to when and how.
Stefanie Friedhoff is a professor of the practice in health services, policy, and practice as well as strategy director at Brown University School of Public Health.