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Who isn’t getting vaccinated, and why

A new report highlights why different groups are hesitant to get the coronavirus vaccine and what can be done about it.

A person wears an “I Do Not Comply” pin on a “Don’t tread on me” t-shirt at a protest against masks, vaccines, and vaccine passports.
A new report looks into why people don’t want to get vaccines, and what can be done to change their minds.
Elijah Nouvelage/Getty Images
Rani Molla is a senior correspondent at Vox and has been focusing her reporting on the future of work. She has covered business and technology for more than a decade — often in charts — including at Bloomberg and the Wall Street Journal.

After a historically speedy development, the coronavirus vaccine is expected to be widely available to American adults by May, but getting every adult to take it might be an even bigger challenge. A report released on Monday sheds light on why some people are hesitant to get the vaccine, and what can be done to change that.

Since April 2020, the Delphi Group at Carnegie Mellon University, in partnership with Facebook, has collected 18 million responses — the biggest survey of its kind — regarding people’s attitudes and behaviors surrounding the coronavirus, ranging from questions about vaccinations and symptoms to mask-wearing and mental health. Focusing on the data from January 10 through the end of February, the report highlights the specific challenges health officials will face in getting the country vaccinated, and how those vary by demographics, including where people live, their age, and their race.

The share of adults surveyed who are vaccinated or are willing to be vaccinated has grown from 72 percent to 77 percent from January through the end of February, a rise that reflects the increased availability of vaccines. However, the share of unvaccinated adults who are hesitant to get a vaccine has remained constant, at around 23 percent. It is this group that poses the greatest challenge to health care officials hoping to vaccinate the population to the point of herd immunity to stop the spread of coronavirus.

Some respondents hesitant about vaccination indicated general health concerns. Forty-five percent of those who said they definitely would not get the vaccine feared side effects, and 40 percent said they wanted to wait to see if vaccines were safe. (The vaccines have been shown to be safe and have generally mild side effects under clinical trials.) Others cited more conspiratorial reasons, with 29 percent of people not wanting the vaccine saying they didn’t trust vaccines and 27 percent saying they didn’t trust the government. Meanwhile, 20 percent said they didn’t think the vaccines work. People could select multiple reasons for not wanting a vaccine.

The vaccine rollout has been marred by misinformation, especially on social media. Some of the top narratives around the vaccine on social media include mentions of coronavirus conspiracy theories involving microchips and Bill Gates, according to new data from media insights company Zignal Labs. There’s also a conspiracy theory known as “the Great Reset,” the debunked idea that the coronavirus was created by the government to take control of the global economy.

Facebook, which has long been a bastion for the anti-vaccine movement, helped Carnegie Mellon survey its users for the report and is hoping to lead a large inoculation information campaign. After trying for years to crack down on vaccine misinformation, Facebook finally banned users from sharing anti-vaccine content in February. But vaccine misinformation can still be found on the site. A recent Washington Post report by Elizabeth Dwoskin examined internal documents at Facebook that suggest QAnon-supporting groups and a relatively small number of influential people are responsible for a significant share of vaccine skepticism on the site.

The Carnegie Mellon survey showed that acceptance of the vaccine varied by demographic, including race. Respondents who considered themselves to be of more than one race were most likely not to have been vaccinated and to not want to be vaccinated, followed by American Indians and Black Americans. Part of the disparity has to do with where vaccines are being made available. American Indians reported the highest rate of vaccination of any racial group, in part because of distribution efforts by Indian Health Services.

Misinformation on social media geared to Black and Latinx communities also plays a role in vaccine hesitancy, although the roots of distrust are complicated. Zignal Labs has been tracking spikes in mentions on social media of Tuskegee, a reference to the decades-long medical experiment on Black Alabamians who were not given treatment for syphilis, and to Henrietta Lacks, a Black woman whose cancer cells were collected without her consent. The firm also documented a rise in Spanish-language posts about the debunked relationship between Covid-19 vaccines and infertility. The data uses keyword matching, so it includes posts with factual news stories on these topics in addition to misinformation.

The Carnegie Mellon data also showed that young people, who are less likely to be vaccinated since priority has gone to people 65 and older, are also less likely than older people to say they want the vaccine.

Vaccine acceptance also varies by state. The states where unvaccinated people were least likely to say they’d accept a Covid-19 vaccine were Wyoming, Mississippi, Oklahoma, Alaska, and North Dakota — all sparsely populated or Southern states. Washington, DC, and states in the Northeast have some of the highest levels of vaccine acceptance. Generally, willingness to get vaccines is higher in cities.

Vaccine hesitancy has also been perpetuated by Fox News, which is considered a key news source by many Republicans, according to data from Pew Research Center. The Carnegie Mellon study did not include data broken down by political party, but a NPR/PBS NewsHour/Marist poll conducted earlier this month showed Republican men and Trump supporters were more likely than any other group to say they wouldn’t get a vaccine if it were offered.

What to do with this data

The new Carnegie Mellon report offers a number of prescriptions about how to use this data in order to more fully vaccinate the population.

The report’s authors suggest vaccination campaigns should address fear of side effects, a main reason some unvaccinated people said they weren’t willing to get a vaccine. Mild side effects like fatigue and soreness are actually a good thing and can show that the vaccine is working.

Transmitting vaccine-related messaging through local health care workers also is likely to convince people who are hesitant. People across demographics said vaccination recommendations from a local health care professional meant more than from any other group (they were least likely to cite politicians). Health organizations have been courting influencers to help spread the message about getting vaccines, but perhaps encouraging doctors and nurses to spread the word could be more effective.

Finally, the report encouraged state-specific approaches to vaccine messaging for vaccine-hesitant people. While vaccine hesitancy is higher in Florida than the national average, for example, Floridians were also more likely to say that side effects from the vaccine were a concern, so vaccine campaigns in that state should address the issue specifically.

As time goes on, and as more people get Covid-19 vaccines, their experiences could affect how those who’ve been hesitant view vaccination. This new data suggests there are numerous ways to go about marketing the vaccines, and some people whom the vaccine-hesitant are more likely to listen to than others.

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