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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.

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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”?

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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?

Narratives that assume vaccine hesitance or resistance also assume that vaccines are easily and equally available to all Americans. That just isn’t true.

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.

  • good article, but I think you missed a group. What about those people that don’t get the Covid vaccine because they simply aren’t worried about it. They are young, fit, healthy. They are simply not in the demographic that has a bad outcome from Covid so they figure, I’ll skip the shot(s) at least for now so that people in demographics that are more high risk have greater vaccine availability, or they figure they are not at risk of a bad outcome so they will acquire immunity the old fashioned way, they way my grandmother vaccinated us against chicken pox, by making sure we caught it.

  • Well, and this.

    20% of Americans are under the age of 18. Those people, along with pregnant women, and people with serious health conditions, can’t get vaccinated. So when we say “gee, only 40% of the population got vaccinated” it’s actually 50% of the population that can get vaccinated is vaccinated. We will never get to 100%. We won’t get to 80% – that would require us to vaccinate every possible person who can be vaccinated. Getting to 65% is likely the best we can do. So we are in fact 61% of the way to our goal.

    Also, as we vaccinate more, the rate of vaccinations will decline steadily. That is just because we have a shrinking pool of eligible people to draw from. The rate should be declining – such a decline is totally normal. We should have to work harder and harder to get people the shot. We were never going to be vaccinating 4 million people one week, and oops, we ran out of people. It is going to decline, slowly, until it becomes a trickle.

    The solution is pop up clinics in low vaccination neighborhoods, and getting the word out to everyone. Make getting the shot the easiest thing in the world. And I wouldn’t sweat whether people getting the first pfizer or moderna shots show for their second dose…it seems to give solid immunity with even one dose.

    • You don’t seem to have followed the news. Demand has fallen *dramatically*, while availability is widespread and not being taken advantage of. “Stalled” is an apt descriptor for the vaccination effort.
      You’re also misinformed about 2nd doses. The 2nd dose of mRNA vaccines is essential for long-term protection, as well as a higher level of protection. The higher level will help stave off the variants we know about and helps inch closer to herd immunity.
      These vaccines are a precious gift and people are squandering it.

  • It saddens me that people can be so selfish, for example the comment just before mine. Getting the vaccine is for the greater good. It is to protect everyone.
    Also, the article does not mention any of the types of people I have come across who are not willing to get the vaccine; people who are educated, white, financially stable and have plenty of information. Just scared or distrusting, I suppose. There are too many TikToks and stories out there spreading false information.

    • Wrong. It is, in my opinion, selfish to expect that people in lower risk groups would accept a non FDA-approved inoculation that has been shown to present serious adverse effects, albeit in rare occasions. We are not all the same and we are all not in this together, despite what you constantly hear on mainstream media.

  • We’re in the midst of a pandemic costing lives, long-term health issues, and jobs, and people are making excuses for not getting vaccinated ASAP while risking the appearance of worse variants than we already know about? Yes, that’s hesitancy, skepticism, selfishness and stupidity. Look at Australia and New Zealand for examples of how this so-called great country of the U.S.A. didn’t have to suffer like we have.

  • “Are people who aren’t ready today to get the Covid-19 vaccine skeptics? Or do they just have important questions about the vaccine?”

    Computer, define skepticism.

  • There have always been anti-vaxers among us, willing to have others become vaccinated to protect them without being civic minded enough to join in.The information about the COVID vaccines is torrential and now availability is becoming less and less of an issue.Regardless of their beliefs and hesitancies these members of society owe it not only to themselves but to others in the community to participate in this effort to stem the spread before other more virulent mutants appear.The same is true for other vaccine preventable infectious diseases.It is time that these “non-vaxers” were prevented from infringing on our liberties and lives.

    • I am vaccinated but I fail to see how anyone else being unvaccinated impacts me. Looks like breakthrough cases of the vaccinated stands at about 0.005%, which means for all intents and purposes the vaccine is a silver bullet.

    • I agree with Kevin’s answering post… I’m posting here because I couldn’t reply to his reply to your original post… I still think it’s all hooey… a lot of people do… BUT, I got my 2 Moderna vaccinations because I know it’s all a numbers game and until a certain threshold number of certified vaccinations happen, we’re not going to be able to take these damned masks off any time soon… My doesn’t plan on getting vaccinated and neither does a sister, both are skeptical of the lack of FDA overt enthusiasm… I don’t care if I’m a guinea pig for this, and I’m not trying to save the world from Covid… I’m just feeding the numbers-hungry Federal bureaucracy and I did the only thing I could with that in mind
      … a lot of people are like that…

    • @Kevin, it ought to matter to you that the more the virus is allowed to propagate, the more likely you are to suffer a break-through infection and the more likely it is that variants arise against which the current vaccines are poorly effective. Basically, the pandemic doesn’t end until we have herd immunity and vaccination is BY FAR the fastest, safest approach. If you want to look forward to years of booster shots, extra safety precautions, more deaths, slow job growth, more deficit spending, etc. then by all means, disregard what others do. It’s a free country. But no man or woman is an island.

  • There have been outreach programs all over the country aimed at those that do not actively seek the vaccines for whatever reason. The old saw that you can lead a horse to water rings so very true. There is only so much the medical community can do to address this lack of enthusiasm for getting immunized. We need to stop making excuses for those who are not actively seeking vaccination. But then there are many of us who are not woke!

    • Let’s say the obvious – no one wants to get a shot. And no one wants to be potentially sick for a day or two after a shot. So, this whole hesitancy talk…it’s like broccoli consumption hesitancy. People railing on those not vaccinated for not showing compassion …could show a little compassion (and a lot less selfishness) themselves.

    • Feeling mild flu-like symptoms for a day or two from a vaccine is far less risky and more comfortable than an active covid infection. And vaccination can take us to herd immunity faster without overwhelming our healthcare heroes.

  • The pandemic has become politicized because the Democrats and their Media used it to win the election by pushing out scare stories continually. Since suburban swing voters mostly watch TV while doing other chores, it worked. The greatest reason to get the vaccine quickly is the virus is evolving in a direction of becoming worse. This is to be expected for natural selection of a virus that spreads mostly pre-symptomatically via high viral loads. While current versions of the virus may present little danger to young people, future versions certainly will. The best course of action is to get vaccinated, and to get exposed to the virus as often as possible to build more immunity to new versions. That means returning to normal, and it means voting against every Democrat running for every office – local, state, or federal.

    • Last time I checked covid didn’t give a damn about your political beliefs. Also weren’t we inundated with information about the pandemic when Trump was president (and a lot of misinformation)? This isn’t about being republican or democrat; this is about stopping the death of millions of souls (as the airline industry respectfully says), not just here in America, but around the world. Period.

  • Maybe those under 50 simply understand that they are not at risk from covid. Sure they might catch it but so what? 96% of the deaths were older people and most of those younger had pre-existing health issues. If they are healthy they have better odds of surviving covid than they do driving home today.

    I got the vaccine mostly to get back to normal life but now I realize that was just a dream. I’m being told the vaccine is over 90% effective at preventing covid yet nothing has changed and I’m still supposed to wear a mask everywhere. I should be able to wave my vaccine card and go wherever I want without a mask or what was the point?

    The government and media are determined to milk this cow as long as possible. If I had not yet gotten it I doubt I would.

    • This is total disinformation. My 23 year old girlfriend got COVID-19 in January, and the lingering effects are horrific, and getting worse, including severe headaches which are getting longer and stronger every day, major negative changes to taste, gums bleeding every day, and nosebleeds every time she sleeps. If you don’t get vaccinated, you may survive, but you will suffer every day of your life. All because you didn’t want to take 30 minutes to get vaccinated, or were too stupid to see through interned FUD. The side effects of vaccines are ridiculously rare, and vastly more mild and short lasting than the symptoms I just described, and clearly preferable to a slow, painful death or weeks of agony.

      Additionally, when you don’t get vaccinated, you screw over everyone else around you, many of whom, like me, cannot get vaccinated because of health issues. Every time you shake someone’s hand, you risk dooming them to all those horrible symptoms for the rest of their shortened lives, or you risk killing them.

      All because you’re paranoid or lazy.

      STOP. SPREADING. LIES!

    • Sorry Christoban, but your anecdotal evidence of your girlfriend is about as useful as that my 18 year old niece had Covid and barely noticed. She had the sniffles. If the young don’t get vaccinated, 99.9999% will survive if they catch it. You’re “may survive” is worse than lie, it’s an outright lie. And if they catch it, they’ll then have the antibodies and will then (the vast majority) be equally immune. Hopefully they don’t go around hugging unvaccinated grandma while communicable.

      More to the point, if everyone that’s in the risk group is vaccinated, who is at risk if the young aren’t vaccinated? And if older people in the higher risk group refused to go get vaccinated (I’ve already had both shots), then that’s on them. The young should’t have to take any risk of death because some high-risk candidate didn’t want to take it.

    • @Tom, Christoban’s girlfriend survived and he’s emphasizing that the death toll doesn’t measure the full impact even on the young. The death rate alone for children is also far higher than the statistic you pulled out of a hat. With the variants, it appears to be even higher. The more opportunity the virus has to propagate, the worse it can potentially get.

  • This historic effort has not captured the less hungry maybe because they did not pay attention to the media blitz, they were not made to be eager, they were well resourced and they were also tech savvy. Because they could see that there was THE THEORY being pushed on the public, but it turns out it is just A THEORY. Some people believe the stock market is going higher and some believe it is going lower. Who is right will take time to know. Some have studied all the science of the market charts and can not believe what the other group is doing. History will reveal itself in due time.

    • Like many people, you seem to have cognitive difficulties. Other people believe or worry about anything they read on the Internet, real or not. They’re Internet MD’s.

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