The survey of responses from about 68,000 adults conducted Jan. 6-18 provides the most comprehensive picture yet about which Americans are hesitant to get vaccinated—and why.
About 51% of unvaccinated adults said they will definitely get the vaccine, with 26% saying they probably will, 14% saying they probably will not and 10% saying they definitely will not.
Studies show that to stop the spread of Covid-19 and its mutations, between 70% and 80% of the population must develop immunity, raising the stakes for health officials to lure ambivalent Americans into taking the vaccines.
At present, about 8% of the U.S. population has had at least one dose of vaccine, according to CDC and Census data.
Previous surveys of Covid-19 vaccine skepticism have shown that people have become less hesitant as they see others vaccinated. The Census will continue to gauge hesitancy going forward, with data released every two weeks.
The Biden administration has said it plans to launch a targeted vaccination campaign that focuses on people who data show are the most hesitant, including rural populations and communities of color.
The plan is to build confidence in the vaccine in collaboration with doctors and nurses, faith-based groups and advocacy organizations working in those communities.
“Right now, we have limited vaccine supply and high demand, but at some point in the future we will have more supply than demand,” said Claire Hannan, executive director of the Association of Immunization Managers, which represents state immunization officials. “We have to work very hard to establish trust in the vaccine and access to the vaccine in all communities to ensure we reach vaccination levels to produce herd immunity.”
Opponents of vaccine requirements have found common ground during the pandemic with people suspicious of drug companies, business shutdowns and other government restrictions. Among unvaccinated adults in the Census survey who said they were unsure about getting vaccinated, 9% said they don’t like vaccines. Antivaccine protesters disrupted a vaccination site at Dodger Stadium last week.
In the absence of a broad, national appeal, many Americans are forming opinions of Covid-19 vaccines on their own and aren’t planning to be vaccinated. “You can’t just say, ‘It’s here and if you don’t want it, you don’t want it,’ ” said Parinda Khatri, chief clinical officer at Cherokee Health Systems, who has been working on the vaccine-hesitancy issue in a health system that spans 14 counties in Tennessee from Appalachia to Memphis. “From a prevention and infection-control standpoint, if you ignore 50% of the people because you say, ‘Well, I offered,’ we’re all still at risk.”
Across race, age groups and regions of the country, concern about side effects was the most frequently cited issue among vaccine-hesitant survey respondents.
Christopher Thomas, a cardiologist in Minnesota, said he tells his patients that he had a fever for two days after receiving his second dose of vaccine and it was easily managed with a couple of acetaminophen. He tells them to compare that possible discomfort with the more serious complications and blood clotting he has seen in Covid-19 patients.
A lack of trust in government and the vaccines themselves were also high among people planning to avoid the shots, echoing earlier surveys that pointed to a widespread distrust in institutions. The proportion of respondents who said they don’t trust the government was highest among 18 to 25 year-olds. The cohort was nearly twice as likely to cite those concerns as Americans over 65 years old. They were also more likely to say they thought others needed the vaccine more than they did.
About a fifth of Hispanic and white adults don’t plan to get vaccinated, while a third of Black adults say they plan to avoid the shots, according to the survey, which was developed in concert with the Centers for Disease Control and Prevention and the National Center for Health Statistics. The hesitancy among Black and Hispanic populations is a particular concern for public health officials because those groups have been among the hardest hit populations in the pandemic.
Public-policy experts need to seek out and give priority to the most at-risk populations, said Nancy Berlinger, a research scholar at the Hastings Center, a bioethics think tank that has issued guidance about effective prioritization of Covid-19 vaccine access.
“Low risk and high privilege is easy to vaccinate,” Dr. Berlinger said. “The infection will keep spreading. The virus is working against you. The virus is winning if people at high risk of infection keep being at risk.”
Dr. Chris Pernell, a physician in Newark, N.J., who focuses on broader community-health needs and the systems that serve them, has been hosting live Zoom and Facebook sessions to engage with Black and Brown communities about the science behind the vaccine and acknowledge the reasons some may be distrustful or hesitant. She said people are eager for information right now. Dr. Pernell, who is Black, said she shares with her audience that she decided to participate in one of the vaccines’ first clinical trials and that she too has been hurt by Covid-19, which killed her father.
“The one thing you should not do is to devalue or belittle the concerns that are in various communities,” Dr. Pernell said. “We can’t begin to shame or stigmatize groups where there have been historical injustices that have contributed to broken trust.”
During her discussions she sometimes acknowledges that some distrust among Black people stems from the history of unethical medical research, such as the Tuskegee syphilis study, which began in the 1930s and continued for 40 years. Black men who participated weren’t informed of the true nature of the research and some were deprived of penicillin when it was found to be an effective treatment.
Unvaccinated Black adults, more than any other group, cited among the reasons against taking the vaccine that a doctor hadn’t recommended the vaccine. In previous surveys, 79% of U.S. adults who hadn’t yet been vaccinated said their health-care provider’s opinion would be a key factor in their decision about whether to be vaccinated.