The 6 reasons Americans aren’t getting vaccinated

This is the challenge the US has to overcome to get back to post-pandemic normal.

It’s the most important question in America today: Why aren’t people getting vaccinated?

America’s vaccine campaign has collapsed from its previous highs. While at one point in mid-April more than 3 million people received the shot each day, now only around 1.2 million are — a rate that’s less than half of what it was at the peak. So the US might not make President Joe Biden’s goal to vaccinate 70 percent of adults by July Fourth: At the current rates, roughly 175 million adults will get at least their first shots by Independence Day, falling short of the nearly 180 million needed.

If the vaccination campaign continues to stall out, it leaves the US vulnerable to a range of risks, from summer outbreaks in the South to continued resurgences of the coronavirus this fall to the possibility of new and dangerous variants. While the vaccinated are protected, the virus is still spreading among the unvaccinated as quickly as it was during the massive outbreaks of the recent fall and winter. That continued spread is particularly dangerous for those who can’t get vaccinated or don’t receive sufficient protection from the vaccines (if they’re immunocompromised).

So it’s crucial to understand why a segment of the population, even a minority, isn’t getting vaccinated — as a first step to figuring out what will make a difference.

According to experts, there are a variety of reasons: lack of access to vaccines, a refusal to see Covid-19 as a threat, concern about the vaccines’ side effects, little trust in the vaccines or the institutions behind them, and belief in at least one of several different conspiracy theories. Some of these reasons overlap and compound; for example, if someone doesn’t see Covid-19 as a big threat, they might decide the vaccine isn’t worth the side effects.

People in some of these categories might be persuadable while others may not. The most resistant are likely going to be really hard to move over at this point, staying at around 15 to 20 percent of the population from poll to poll. But between these hard noes and the already vaccinated are a lot of people who have shown signs of movement before — enough to put a real dent in the fight against Covid-19.

So understanding why people aren’t getting vaccinated and how to overcome those reasons is now crucial to beating back the coronavirus — to really put it in the past and guarantee it no longer threatens to warp all our lives once again.

Reason 1: Lack of access, real or perceived

According to the Kaiser Family Foundation’s surveys, about 4 percent of Americans intend to get the vaccine as soon as possible but haven’t yet and another 12 percent are in wait-and-see mode. Particularly among these segments of the population, access is still likely a major barrier.

It’s true that access to the vaccine has dramatically expanded in recent months, with the federal government now ordering and delivering far more doses than states actually use. A shot that once required an appointment potentially weeks in advance is now so abundant that it’s available to walk-ins at many pharmacies and other locales.

But there are still hurdles. People may not have the transportation to get to a pharmacy. A busy, inflexible family or work schedule may prevent them from taking time off work to get the shot and take a day or two off to recover from the side effects. Some people believe — incorrectly — that getting the vaccine isn’t free for everyone or just may not know that the vaccine is actually available to them.

“Access doesn’t just mean we’ve opened up eligibility to everyone,” Liz Hamel, director of public opinion and survey research at Kaiser, told me. “Access also means that I can find a way to get the vaccine without putting my livelihood at risk, or I can get it in a place I feel safe getting it.”

To combat this, vaccines could be deployed in more places, such as workplaces or entertainment venues. To reach a greater diversity of people, a study published by the National Bureau of Economic Research suggests offering vaccinations at Dollar General, finding that adding the stores to federal vaccine distribution programs “would substantially decrease the distance to vaccine sites for low-income and minority US households.”

Employers could also offer paid time off for workers to get the shot and recover from any side effects — something the Biden administration has already subsidized. And public officials and agencies could do more to make it clear the vaccine is free for all and widely available for Americans 12 and older.

Reason 2: Covid-19 isn’t seen as a threat

Even after the past year, some Americans still don’t see the coronavirus as a serious threat. Maybe they’re young, seeing that the virus isn’t as deadly for them as it is for older groups. They could be Republicans, who bought into particularly to former President Donald Trump’s claims that the coronavirus wasn’t a big deal and that Democrats, experts, and journalists have exaggerated its risk. Polls show both groups tend to be less likely to want to get vaccinated.

Not seeing Covid-19 as a threat remains one of the biggest predictors for those who are most resistant to getting vaccinated — the hard noes. These are many of the same people who spent much of the past year rejecting lockdowns and mask mandates as unnecessary and violations of their civil liberties.

“They are far more willing to believe that, basically, it’s OK. You’re fine. You’re not going to get the virus, and so you can behave normally,” Kathy Frankovic, a public opinion polling expert at YouGov, told me.

Unfortunately, these are also some of the same people for whom views about the vaccines seem most entrenched. Whether it’s a survey from Kaiser, YouGov, or Civiqs, around 1 in 5 Americans have consistently remained in this group over the past few months.

Still, there are possibly some ways to overcome this. Based on Kaiser’s polling, about one-third of the hard noes would get vaccinated if it were required (by, say, an employer). Some would be persuaded by incentives, whether hard cash or free tickets for sporting events.

To put it another way, they may not be motivated by the risk of Covid-19 to get the shot, but some could get vaccinated if there’s another reason for them to do so.

Reason 3: Vaccine side effects

For some, the concern is the vaccine itself — and particularly the side effects that can come with it. These concerns can be about something the vaccine really causes, like a day or two of aches, fever, and fatigue or, in extremely rare cases, potentially blood clots. But they can also be about things that aren’t real or proven, like other long-term health risks or unproven claims about, for example, infertility.

Some of this comes down to getting the right information to the vaccine hesitant. Officials, media, and experts can continue to communicate that side effects are almost all mild and don’t last very long — and are, in fact, a sign the vaccines are working and getting the immune system going. And while wilder ideas spread on social media, there’s no evidence that the vaccines have worse side effects in all but very rare circumstances. Blood clots, for example, were found in only 28 of 8.7 million people who got the Johnson & Johnson shot at the time of reporting, and they haven’t been found in anyone who got the Moderna or Pfizer shots.

But there are more practical considerations as well. Some people focused on side effects may worry, for example, that a day or two of fatigue and fever will keep them out of work — putting their job at risk or, at the very least, costing them pay that’s needed for bills. Fixing that will simply require getting more employers to offer paid time off or a bonus not just for getting the shot but the recovery period too.

Reason 4: Lack of trust in the vaccines

Beyond concerns about side effects, many of the hesitant just don’t have much trust in the vaccines. They may believe that the process for the vaccines was too fast — it was, after all, a record time from conception to mass production. They may note the vaccines aren’t even technically approved by the Food and Drug Administration since the agency has only authorized them for emergency use.

And some are traditional anti-vaxxers, distrusting vaccines in general.

There are messages that can break through this group, like explaining the clinical trials and the many safety and efficacy checks that went into them. Some of these people may simply change their minds as they see others around them getting vaccinated and doing well — that’s likely one reason, Frankovic said, that older demographics, who’ve been eligible for the vaccines for longer, are more likely to get the shot.

One thing that could help is the FDA’s full approval of the vaccines. Kaiser’s survey found that about one-third of unvaccinated Americans say they would be more likely to get vaccinated if the vaccines got full approval. (Moderna and Pfizer have applied, but it’s unclear what the timeline is just yet.)

Reason 5: Lack of trust in institutions

For some of the hesitant, the concerns may not be about Covid-19 and the vaccines but the institutions that surround both. They may not trust the government agencies or companies that helped develop the vaccines. Or they may not trust the health care system in general.

These feelings could be newly developed. Over the past year, especially, polling has found much of the public, but especially Trump voters, lost trust in major government institutions, like the Centers for Disease Control and Prevention. People in this category are less likely to listen to the agency and other government officials’ calls to get vaccinated.

Some views could be more entrenched. Black Americans, for example, report lower levels of trust in the health care system — a result of outright abuses, like the Tuskegee study (in which Black people were experimented on without their consent), but also day-to-day discrimination they experience when they go to doctors and hospitals. This distrust can then extend to vaccines.

Restoring trust in institutions is a long-term, difficult job. But in the meantime, approaches like incentives and education campaigns can at least get people to think that, regardless of what these organizations are doing, it’s in their interest to get vaccinated.

Reason 6: A variety of conspiracy theories

At least half the people who say they won’t get vaccinated believe at least one conspiracy theory about the Covid-19 vaccines or vaccines in general, according to a YouGov poll from May.

The best hope for refuting such disinformation, based on political science research, is for public officials and the media to stop spreading it and, when it does pop up, correct it. But the spread of disinformation is a much thornier problem that society at large is still coming to terms with as the internet and social media have made it so easy for people to proliferate lies and myths — and it will take a while to really get a handle on this.

Thankfully, the conspiracy theorists are still a minority of Americans overall.

A common theme

All of the reasons people provide for not getting vaccinated, from lack of access to conspiracy theories, share a common theme: A significant portion of Americans don’t believe the vaccines are worth the potential downsides.

Everything officials and experts are now doing to vaccinate more Americans is in effect meant to beat back this theme. Better access would mitigate a major downside. Incentives could push the vaccine over the top, making it worth the downsides. Mandates could too.

If all of this is successful, the country could truly defeat Covid-19. But if enough people believe the downsides are still too bad, the threat of the virus could lurk for years to come.