How Do We Overcome Vaccine Hesitancy?

JOHN DANKOSKY: This is Science Friday. I’m John Dankosky. This Memorial Day weekend, many people will be traveling to the beach, hitting the road, or socializing with friends maskless for the first time in over a year. As of this week, 50% of Americans 18 and over are considered fully vaccinated. Another 15% to 20% of people are taking a wait-and-see approach.

Of those still on the fence, some are concerned about the vaccine’s side effects. Others have a longstanding mistrust of the institutions responsible for the vaccine rollout. In order to fully end the pandemic, public health officials will have to find a way to get the vaccine hesitant on board. But how exactly?

Joining me now is someone who has thought a lot about that question. Dr. Gary Bennett is a professor of psychology and global health at Duke University. Dr. Bennett, welcome to Science Friday.

GARY BENNETT: Thank you, John.

JOHN DANKOSKY: As I mentioned in the intro, we still have around 15% to 20% of the population taking this wait-and-see approach. What do we know about who those people are and what’s keeping them on the fence?

GARY BENNETT: Well, you know, it’s a larger cross-section of American society than we originally imagined. In the past, when we think about hesitancy– and this has been most common for things like childhood immunizations, for influenza vaccine, and things of that ilk– we have tended to focus primarily on racial and ethnic minority groups, those in socioeconomically disadvantaged circumstances. And indeed, those populations do tend to be more hesitant at this moment. But we’ve also seen a large– in fact, a larger– number of individuals in rural circumstances, those on the right end of the political spectrum, who remain hesitant at this moment. It’s a major public health challenge at this point.

JOHN DANKOSKY: You say that hesitancy to getting the COVID vaccine is a behavioral condition. What do you mean by that?

GARY BENNETT: Well, you know, at this point in the pandemic, so many of the remaining hurdles are effectively behavior change challenges. The challenge, formerly, of masking or social distancing– these are effectively behavior change challenges. And indeed, at this moment, the primary challenge we face is helping the remaining segments of the American public to recognize that vaccines are really our best option for preventing the progression of the COVID crisis. And so in populations that remain hesitant, the challenge that we’re facing is really moving them along in the continuum. I think about hesitancy as really existing on a continuum from refusal to acceptance, and hesitancy’s somewhere in the middle. And our job, from a behavior change perspective, is to push people towards that end of the continuum that’s about acceptance and getting vaccinated.

JOHN DANKOSKY: So what are the strategies you use to encourage people? Are they the same as the type you might use to, I don’t know, encourage someone to quit smoking or to eat better to improve their health?

GARY BENNETT: They are indeed. One of the most important drivers of our behavior is what we’re seeing among the folks who we tend to surround ourselves with. We think about social norms, the kinds of behaviors that other people like us are doing, as being really, really important predictors of our own behavior.

And so one of the most important things we can do is to share with others that we’re getting vaccinated. And it’s pretty simple. You know, it’s not rocket science, right?

One of the recommendations I make to populations of all types is that if you want to see other folks in your community vaccinated, share that you’ve been vaccinated and share that those outcomes are positive. One of the most important drivers of hesitancy in all populations is concern about side effects, concern about the efficacy of the vaccine, and concern about the speed with which the vaccine was developed and tested. And so if we can correct some of those misconceptions, share our own stories, help to disabuse folks of those uncertainties, we can go a long way in promoting the kind of behavior change that we need to get people vaccinated.

JOHN DANKOSKY: You mentioned earlier that traditionally, Black and Hispanic groups are slightly more hesitant to get vaccinated than whites. Has that held up during this COVID crisis? Are we seeing more hesitancy amongst the Black and Latino community?

GARY BENNETT: We did at the beginning of the crisis, and certainly when vaccines initially became available. We certainly saw a high level of hesitancy in populations that have been traditionally hesitant. In fact, many of us in the public health community were concerned on the basis of what we’ve seen previously about hesitancy in these communities.

But I’m really pleased to say that over the months, as the vaccine has become more available and as municipalities have gotten better about facilitating access to the vaccine, we certainly have seen that hesitancy drop. And it’s dropped rather precipitously. At this point, our traditionally hesitant populations, racial and ethnic minority groups, are not the most hesitant populations in the US. I remain concerned about hesitancy in these populations, however, because of their disproportionate risk of experiencing COVID at high levels of severity and, of course, for incurring COVID-related mortality. So even though they are not the most affected by hesitancy from a public health perspective, they remain really important groups for us to be focusing on.

JOHN DANKOSKY: What more can you tell us about the rural white population that is showing to be more hesitant?

GARY BENNETT: Well, you know, in rural populations we’re facing challenges that are not unlike those that we see in other populations. In fact, most of the data suggests that the drivers are very similar– concerns about side effects, concerns about efficacy, and concerns about the ways that the vaccine was developed and the speed of testing.

What might be a little bit different in some rural populations, it’s that some of those concerns are undergirded by political forces that make our ability to intervene much more challenging. And so I remain very, very concerned about the impact of our politically fractious environment and the ways in which it’s affected hesitancy. It does make that intervention activity much, much more challenging. Really doing whatever we can to correct the misconceptions about the vaccine.

One of the things that I think we have to do in this space is we have to have empathy for folks who are hesitant. That is absolutely our first principle here, because in the same way that it takes people multiple tries to stop smoking or multiple attempts to lose weight or start a physical activity routine, it’s going to take us multiple presentations, multiple attempts, to move people along that continuum towards acceptance of the vaccine.

JOHN DANKOSKY: How concerned are you, and how concerned are other public health officials, about what I mentioned before– this grand opening of so much of the country. As states open up around the holidays, does it work against the effort to get people vaccinated? Because a lot of people are just walking around saying, it’s normal, the pandemic’s over, why do I even need to bother?

GARY BENNETT: Strictly from a public health perspective, absolutely. It is concerning. We’re moving into a new posture, where many, many people believe that the pandemic is ending. And so many of us, I think, in the public health community are concerned about what we imagine to be a reasonably arbitrary movement towards opening now. That’s speaking strictly from a public health perspective.

Nevertheless, our foremost priority at this moment is to continue to promote vaccinations as the most expedient way for us to move forward and truly get to a new normal. It’s really our only option.

JOHN DANKOSKY: Well, what sort of incentives are available to people? Because we’ve heard everything from free Krispy Kreme donuts to a lottery that’s taking place in Ohio. You could win a million dollars. Maybe you could talk about those kind of strategies, or other types of incentive strategies that you think might be more effective.

GARY BENNETT: I have to tell you, I’m actually reasonably bullish on these types of incentive strategy. What we know about incentives is that they do a reasonably good job of helping to motivate people to change behaviors in a relatively time-limited kind of fashion. Incentives aren’t so great for helping people to lose weight over the 12 or 18 months that it may take to lose some weight. But in making a decision to accept the vaccine, they can work in that way.

And so I think the kind of experimentation that we’re beginning to see with states and different municipalities in this space is really a good thing. I think the lotteries that we’ve seen in some Midwestern states, they have some appeal. And in fact, I think we’ve seen some uptake of vaccinations in some of the states that have begun to offer some of those.

In certain rural populations, those that may have some political concerns about the ways in which government involvement in vaccination efforts have been unfurled, these kinds of lottery types of strategies might actually be an extraordinarily helpful kind of strategy. We know that the lottery is actually much more embraced in many rural populations than are other types of government-led strategies. And so anything we can do, I think, at this point, is useful. And so I encourage this kind of experimentation. What I think we have to be careful about, though, is not trivializing the value of the vaccine as our best mechanism for ending this kind of public health crisis that we’re experiencing.

JOHN DANKOSKY: Is there a goal number in your mind of how many Americans or what percentage of Americans we need to get vaccinated to really take this next step toward effectively ending the pandemic?

GARY BENNETT: My epidemiologist colleagues will debate this number for [INAUDIBLE]. Many years after this is all long gone, we’ll still be debating this. I think, in many respects, as many Americans as we can get is really the right number. I fear us imposing sort of arbitrary thresholds or even evidence-informed thresholds that may change over time. Really, our primary goal just needs to be getting as many folks as possible vaccinated. At this point, we should be shooting for 100%.

JOHN DANKOSKY: You talked about empathy as something that we absolutely need. We probably just need more empathy in society to begin with. But if that’s one of the tools, walk us through– as a last thing here, doctor– what do you tell people? Whether it’s a family member, a neighbor, someone you just meet on the street, how do you talk to them about this to try to get them to accept the idea that maybe this is something that’s really good for you to do?

GARY BENNETT: At an individual level, I think the most important we can do is to share our personal experiences and to share our stories. And so I like to recommend, for folks who have been vaccinated, if you encounter someone who’s not been vaccinated, and you have an opportunity to share your story, then you should do that. But you should do it in a very empathetic and person-centered way. That is to say, you should talk about why you made the decision to get vaccinated and how you think about side effects and how you’ve been able to balance the evidence and some of these issues related to the speed of the testing and those kinds of things. We don’t want to sort of impose our decision making on others. But sharing your own story can be an extraordinarily effective strategy.

JOHN DANKOSKY: Dr. Gary Bennett is a professor of psychology and global health at Duke University. Dr. Bennett, thanks so much for joining us. I really appreciate it.

GARY BENNETT: Thank you, John.

JOHN DANKOSKY: And now, of course, we have the opportunity to vaccinate even more people now that the CDC has approved the Pfizer vaccine for children 12 years and older. But many American parents don’t want their children vaccinated at all, including for measles or the flu. So how could that complicate this vaccination effort?

One recent survey from this past April showed that over 30% of parents would wait to get their child vaccinated, nearly double the percentage of adults who were hesitant. Here to break down more about the numbers concerning vaccine hesitancy among parents is Matthew Simonson. He’s a political scientist studying public opinion and the pandemic. He’s lead author of “Vaccinating America’s Youth” from the COVID States Project. Matthew, welcome to Science Friday. Thanks for being here.

MATTHEW SIMONSON: Thank you. It’s a pleasure to be on the show.

JOHN DANKOSKY: Your survey asked parents a hypothetical question– if a COVID vaccine were available, would you vaccinate your child? What do parents say?

MATTHEW SIMONSON: So we find that about a third of young mothers say, absolutely no way. We gave parents five choices from extremely likely to extremely unlikely. And 31% of younger mothers– that is, mothers 35 or younger– say they are extremely unlikely to vaccinate their children. Older mothers, 25%; younger fathers, around 14%; older fathers, around 10%. So just a huge contrast when it comes to gender and age. A young mother, about one in three chance of saying, no way will my kid get vaccinated. An older father, a one in 10 chance.

JOHN DANKOSKY: So Matthew, you say mothers are much more opposed. What do we know about who makes the decisions about whether or not a child gets vaccinated?

MATTHEW SIMONSON: So the best data we have on this from countries similar to the United States are two studies from New Zealand. There was a study in 2016 that surveyed parents during pregnancy and asked them, how likely are you to follow the schedule for routine childhood vaccinations? And they found that while the mothers plan to vaccinate their kids or not vaccinate them lined up pretty well what they did later on, the father’s opinions didn’t matter so much– had only a weak effect.

And then a study from 2020 found that the father’s opinions had no effect, and it was really all about what the mother had in mind. And so to the extent the United States is similar to New Zealand in its culture and its gender norms and its parenting, it seems like a reasonable expectation that a mother’s plans for vaccinating or not vaccinating the kids will really outweigh the father’s.

JOHN DANKOSKY: I’m John Dankosky, and this is Science Friday from WNYC Studios. So how do all these findings compare to vaccine hesitancy for the flu or measles, say, amongst parents?

MATTHEW SIMONSON: Traditionally, we worried when vaccine resistance towards, say, measles or routine childhood vaccinations creeps up into the low single digits. You know, 5% of parents refusing to vaccinate their kids is somewhat alarming to us. So the fact that now we have 30%, 31% of young mothers saying they won’t vaccinate their kids against COVID is extremely concerning.

JOHN DANKOSKY: Do you think that the numbers are changing at all when it comes to that childhood vaccination number? If it’s concerning that we have, you know, close to double digits of people saying, I don’t want my kids to get a measles vaccine, do you think that the COVID vaccine question is actually shifting those numbers in any way, people just not wanting to get vaccinated at all for anything?

MATTHEW SIMONSON: I don’t necessarily think there’ll be that sort of spillover. We added a free response text box for people to type in their reasons for wanting to get vaccinated or not get vaccinated. And the most common reasons had to do with the newness of the vaccine, the fact that they thought it hadn’t been tested. It certainly has been tested quite rigorously.

Some people picked up on the fact that the vaccine currently has a emergency use authorization instead of the routine stamp of approval that vaccines get. And so if that is the predominant concern, if it’s the newness and the approval process that parents are concerned about, it shouldn’t spill over into other vaccines. However, it’s possible, though, that vaccine resistance was somewhat stigmatized in society at large, and now that parents who had some doubts are seeing, oh, there’s other people like me, it’s not that rare, it’s not that unacceptable to question vaccines– this could really have a more pernicious effect where the idea of rejecting vaccines becomes more normalized in our society.

JOHN DANKOSKY: What do kids think? What do we know about the kids’ own opinions about this?

MATTHEW SIMONSON: So we looked at the attitudes of the youngest adults that we can survey without parental consent. That is, 18- and 19-year-olds. And we found among this youngest, barely out of the nest– or in some cases, still seniors in high school living in their parent’s house– among this group of young adults, that they were far less hesitant than their mothers to get vaccinated. Still a bit more hesitant than their dads.

So this is quite hopeful, I would say. The fact that vaccine resistance is about 20% among that 18- to 21-year-old age group– still higher than we would like, but I think if peer pressure is having a negative effect on parents, it’s probably having a positive effect on kids in this case. So whereas mothers may be talking to other mothers who have been targeted by pernicious vaccine denial and vaccine misinformation sources, and are being told, oh, you’re a bad parent if you let your kid get vaccinated, you’re being irresponsible, and really attacking a mother’s self-worth by saying that she’s a bad parent, with kids, the peer pressure probably goes the opposite way.

Kids want to socialize. They want to go to birthday parties. They want to go to summer camp. And so they’re probably going to be exerting pressure on each other to beg their parents to let them get vaccinated. And so in some sense, kids might be their own best hope. If kids can use their amazing talents of persuasion and lobbying that are normally used for unhealthy ends, like a candy bar, to beg their parents to let them get vaccinated, then it really could be kids showing us the way out of this vaccine hesitancy crisis.

JOHN DANKOSKY: Matthew Simonson is a political scientist studying public opinion and the pandemic. He’s lead author of “Vaccinating America’s Youth” from the COVID States Project. Matthew, thanks so much for joining us. I really appreciate it.

MATTHEW SIMONSON: Thank you very much, John.

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