Vaccine hesitancy: What it is and what it is not?

Close up photo of a health care professional administering a vaccine

The term vaccine hesitancy is frequently in the news these days, but what does it mean and why is it important to understand it as we continue the COVID-19 vaccine roll out? Janet McGrath, professor and chair of the Department of Anthropology at the College of Arts and Sciences, shared her expertise in a Q&A.

What is vaccine hesitancy?

This term is used in the media to refer generally to reluctance or refusal to get a vaccine, including the COVID-19 vaccine. Experts who study vaccine hesitancy define it as a delay in deciding whether or not to accept a vaccine.

Vaccine hesitant individuals often say they want to “wait and see” as vaccines are distributed in their community. The lack of experience derives from both the novelty of the vaccine and also from unequal access to the vaccine in communities across the world. Most people who report vaccine hesitancy are not opposed to vaccines in principle and often accept most vaccines they are offered. People who are “anti-vaxxers” generally oppose vaccines entirely or completely oppose a particular vaccine. Although they may express some of the same concerns as vaccine hesitant people, anti-vaxxers are more likely to reject scientific information about vaccines, disregard experiences of vaccine acceptors, or embrace unsupported stories about vaccines.

Why are people hesitant to get vaccinated?

Reasons for vaccine hesitancy vary across populations, vaccines and historical contexts. In the case of COVID-19, commonly reported reasons for hesitancy resemble those reported for vaccines in the past. These include overarching concerns about possible side effects, as well as specific fears that the vaccine contains live virus that will cause the disease or that the vaccine causes infertility.

Other reasons commonly reported for COVID-19 vaccine hesitancy include:

  • Concerns about the process of developing and testing the COVID vaccine, including questioning whether it was adequately tested in different racial/ethnic groups and the speed with which the COVID vaccines were developed.
  • Distrust of the medical establishment, rooted in historical legacies of institutional racism, as well as negative personal experiences.
  • Belief that patients have to pay out of pocket for the vaccine.
  • Fears that there will not be sufficient supply for two doses.

Who is vaccine hesitant?

Vaccine hesitancy is a global phenomenon that has been around since the beginning of vaccinations. Vaccine hesitancy is found in diverse contexts and across ages, ethnic and racial groups, education level, and political groups.

According to the Kaiser Family Foundation Vaccine Monitor, as of February 2021, only 15% of Americans report that they “definitely” do NOT want to be vaccinated, with the highest refusal rates in people living in rural communities and/or those who identify as Republicans. Twenty two percent of Americans say they want to “wait and see” before being vaccinated, with African Americans and young people being most likely to want to “wait and see.” Fifty five percent of Americans report that they want to be vaccinated ASAP, with people over 65 and those identifying as Democrats are most likely to want a vaccine now.

What are the recommendations for overcoming vax hesitancy?

Two factors strongly contribute to increased vaccine confidence across all groups. First, people report that they look to their health care professionals for the information they need when deciding whether to get a vaccine. Secondly, research shows that knowing someone who has been vaccinated decreases vaccine hesitancy.

This last point is critical: Currently minority communities in the US have lower access to vaccines, so community residents are less likely to know someone who has been vaccinated. Commenting on low vaccination rates in minority communities, Dr. Rhea Boyd noted, “Many are quick to blame ‘vaccine hesitancy’ as the reason, putting the onus on Black Americans to develop better attitudes around vaccination. But this hyper-focus on hesitancy implicitly blames Black communities for their under-vaccination, and it obscures opportunities to address the primary barrier to COVID-19 vaccination: access” (The New York Times, March 5, 2021).

Therefore, an important way to decrease vaccine hesitancy is to provide equitable access to vaccines.

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