Who’s declining vaccine? How to gain their trust?
Even some health care workers said ‘no’ to immunization. Experts are examining messaging to persuade the hesitant.
Megan Leitzke thinks the COVID-19 vaccine is a great option for those who want it — but she’s not one of those people. As a massage therapist in Weston who still sees patients in person, Leitzke, 26, was eligible to receive the vaccine starting in late December. She has colleagues who have gotten the shots, and she acknowledges that the vaccine could help the country finally return to some version of normalcy. Still, she turned it down. “Personally, I just don’t feel comfortable with it,” she said.
“Some of the folks who may have had that wait-and-see approach are now stepping up.” Stephanie Schauer Wisconsin’s immunization program manager
Leitzke is among those who were eligible in Wisconsin’s first phase of vaccinations as a frontline health care worker, yet declined to be vaccinated.
The state doesn’t track health care acceptance rates, but recent headlines have caused concern for those closely watching the vaccine rollout. Ohio Gov. Mike DeWine said in December 60% of
his state’s nursing home staff were turning it down. A national survey of health care workers in late December by the Surgo Foundation, a nonprofit health care think tank, found that 15% of respondents declined the shot, with women, Republican and Black health care workers being the most hesitant.
In the wider population, an Associated Press/NORC poll from early February found one in three Americans were skeptical of the vaccine, and 15% were certain they wouldn’t get it. A January survey from the nonprofit Kaiser Family Foundation found that only about half of U.S. adults planned to get the vaccine “as soon as possible.”
Since the first vaccine was delivered in the U.K. on Dec. 7, more than 181 million doses have been administered worldwide, and more than 56 million in the U.S. The Centers for Disease Control and Prevention, which tracks people’s adverse reactions to the vaccine, had only seen 1,000 instances of serious side effects by the end of January — about one in every 22,000 people who’d had the shot.
Scientists have been cheered by initial safety data. The CDC reports no signs of increased risk of more than 20 common conditions among people who received the vaccine. The rate at which people have died or developed Bell’s palsy, a form of facial paralysis, has been lower in the vaccinated group than what would be expected in the general population, leading experts to conclude that the vaccine was not the cause.
And reactions to the shot involving anaphylactic shock — though they’re occurring at higher instances than with the flu vaccine — are still rare, at just a handful of those reactions per million people immunized. All have recovered.
Still, many Americans are cautious. They want to know how the shot works, whether it was developed too fast, whether it will protect against emerging variants, what effects it might have on pregnant people and whether it will prove safe in the long term.
Experts who study vaccine acceptance say those hesitancy statistics will improve as people learn more about the shot and see others receive it with no serious consequences.
The country will need a significant percentage of its population to receive the vaccine to reach herd immunity, the point at which virus outbreaks cease because there are so few new hosts for it to infect. Dr. Anthony Fauci, chief adviser on COVID-19 for President Joe Biden, told The New York Times in December that range is likely between 70% and 90%.
Understanding who’s saying no — and why — will be critical to the public health effort to decrease hesitancy, build confidence and eventually return to a more normal life through vaccines.
Some Wisconsin health care workers who refused the vaccine are warming to it
The second dose of the COVID-19 vaccine knocked Sondra Norder “right on (her) rear end,” and she doesn’t shy away from talking about it.
But soldiering through the shot’s side effects for a day was much easier than what the actual virus wrought, said Norder, who runs St. Paul Elder Services, a nursing home and assisted living facility in Kaukauna. COVID-19 left her ill for days, and she still deals with shortness of breath more than a month later.
She also knows as well as anyone how much worse it has gone for many in long-term care, who account for 30% of Wisconsin’s COVID-19 deaths, according to the Department of Health Services. When Norder’s employees ask why nursing home staff are first in line to be immunized, she reminds them of it.
“We know exactly how this virus gets to our residents,” Norder said. “No one wants us to be guinea pigs. We’re first because our residents need that shield.”
Three-fourths of the St. Paul nursing home staff have chosen to be vaccinated, a far higher rate than national averages, but lower rates among long-term care staff in general have prompted some employers to mandate the vaccine — a controversial move that can have ripple effects.
When Rock Haven, a Rock Countyowned nursing home in Janesville, required staff members to get the vaccine, some staff members were laid off because they declined it.
Mark Parkinson, president and CEO of the American Health Care Association, which represents long-term care facilities, said mandating the COVID-19 vaccine has been uncommon in part because of concerns about staffing shortages.
“Many would like to mandate the vaccine, but there’s a fear that if they do — they can’t afford to lose a single (certified nursing assistant) because of the shortage,” Parkinson said.
Wisconsin Republican legislators initially sought to bar employers from being able to require the vaccine, but have since turned their attention to a provision that prevents state and local health officers from requiring that anyone get the shot.
None of the state’s largest health systems are currently mandating the vaccine.
Some systems shared the number of eligible employees who have chosen to be vaccinated: Around 90% at SSM Health and UW Health, 75% at Prevea Health and 60% at ThedaCare.
Bellin Health, Aspirus Health System, Advocate Aurora Health and Ascension Wisconsin would not provide percentages of vaccinated employees. Marshfield Clinic did not respond to a reporter’s emails and phone calls.
According to the Surgo Foundation survey of 2,500 health care workers in late December, those who refused the vaccine were most likely to list as their primary reason that there was a lack of evidence about its effectiveness, that it might be unsafe or that its approval process was rushed. Workers in longterm care were more hesitant than those in hospitals.
Many Wisconsin employees were concerned about the vaccine’s effects on fertility and pregnancy, system leaders said. False reports that the vaccine can cause fertility problems, though they’ve been debunked, have spread widely and triggered panic among people of childbearing age.
Pfizer and Moderna clinical trials did not include pregnant people, but the American College of Obstetricians and Gynecologists has said that vaccines should not be withheld from people who are pregnant. Pregnant people are at an increased risk of severe illness from the virus, according to the CDC.
At Prevea, three obstetricians hosted a private town hall for employees to discuss what’s known about pregnancy and the vaccine, said president and CEO Dr. Ashok Rai. It went so well, he said, that they repeated it for a group of teachers, recorded that session, and sent it out to other school districts and businesses with questions.
Town hall-style information sessions have proved useful at ThedaCare and St. Paul Elder Services, as well, coupled with individual meetings with employees to talk through concerns.
And there’s another factor that could help — time.
Dr. Mark Cockley, chief clinical officer at ThedaCare, said that in the nearly two months since they received their first shipments of vaccine, hesitant employees have seen that their co-workers who’ve taken it are doing fine (and have lower absenteeism from illness, too). No staff members have had adverse reactions to the vaccine, Cockley said.
At Aspirus Wausau Hospital, approximately 100 employees who initially declined the vaccine have changed their mind, said hospital president Jeff Wicklander.
Officials at the Wisconsin Department of Health Services say they have seen evidence of that in nursing homes that have had multiple vaccine clinics, too.
“If folks had opted out that first time, … we are seeing uptake of first dose at those second-dose clinics,” said Stephanie Schauer, Wisconsin’s immunization program manager. “Some of the folks who may have had that wait-andsee approach are now stepping up.”
Experts focus on persuading the ‘movable middle’ to take the vaccine
Already, portions of the general public — including anyone over 65 — are eligible to receive the vaccine. But what can public health officials do now to increase confidence as more people become eligible?
People who study acceptance are looking at those who fall into what’s called the “movable middle,” said Alison Buttenheim, an associate professor of nursing and health policy at the University of Pennsylvania who researches vaccine acceptance.
Health officials don’t need to worry about persuading people who are excited to take the vaccine, and they don’t want to waste much time on people who don’t take any vaccines, but there are three groups in between that can benefit from varying levels of strategy.
The first group is people who may just need nudges, or a reminder of where to go and when. The second will need more intentional messaging, which could invoke feelings of community and patriotism, Buttenheim said.
One example of that messaging is Sleeves Up, NOLA, a public service announcement from the city of New Orleans asking people why they got their shot — many of them referencing Mardi Gras and other events that could return once the pandemic is over.
The third group will require repeated, one-on-one conversations with people they trust.
“You want to talk to your physician, your pastor, the lady on your block you’re friends with,” Buttenheim said. It’s not about getting more information, she said, but “a process, a journey, getting from how you feel about it now to making a decision one way or the other.”
This trust-building could boost acceptance among Black Americans, who are receiving the COVID-19 vaccine at lower rates than the general population, a mid-January analysis from Kaiser Health News found.
Among Black health care workers surveyed by the Surgo Foundation, 55% disagreed with the statement that “people of my race are treated fairly in a health care setting,” compared to 5% of white respondents. Black health care workers were also three times as likely (12%) to disagree that pharmaceutical companies test vaccines carefully.
Black Americans have faced medical abuse in the U.S. for centuries. Perhaps the most well-known example is the Tuskegee Syphilis Study, in which hundreds of African American men were denied treatment for the infection over the course of 40 years. As recently as the 1970s, it was common in the South for doctors to sterilize Black women without their knowledge.
Racism and mistreatment of Black people by the medical community are reasons Michael D. Adams isn’t so sure about the vaccine. Adams, 47, lives in Chicago and runs a business in Milwaukee, and said he wondered about how many of the participants in the vaccines’ clinical trials were Black. (Black participants made up just under 10% of the Pfizer and Moderna clinical trials.)
He said he doesn’t doubt that the vaccine works, but is worried that there hasn’t been enough study involving Black people. If he and others could be assured that they’d be monitored and taken care of after the shot, he said, he might feel more comfortable.
“It’s almost like a fear,” Adams said. “What if it doesn’t work, and then you just push me to the side?”
In Wisconsin, where there’s already a gap between the vaccination rates of white residents and residents of color, interim health officer Julie Willems Van Dijk said DHS will allocate nearly $6 million in grants to quell those fears, funneling money to community organizations so people can talk “neighbor to neighbor.”
ThedaCare president and CEO Dr. Imran Andrabi said those individual conversations will be one of the most effective ways to get enough people vaccinated.
“The more we can encourage people to encourage people, the better opportunity we will have for folks to understand,” Andrabi said.
According to the January KFF survey, 31% of respondents said they would “wait and see” how the vaccine worked for others, before they decided whether to get it, including 43% of Black respondents.
Mattieanna Betts, a local caregiver in Wausau, is already warming up to the idea of getting the vaccine after initially refusing it. She said one reason she refused is that no one advised her any better.
But hearing doctors, politicians and celebrities talk about the vaccine gives her “hope,” she said.
“Once I discuss it with my providers and can see that someone close to me has had the shot, then I’ll be more comfortable with it,” Betts said. “That’s what will change my mind.”
Rai at Prevea said it will be a challenge to keep up with anti-vaccine groups that seek to spread misinformation about the shot, but that presenting clear facts will be more important than ever because of that misinformation.
“They have an audience, so I think it’s really important for those of us that are speaking based on science and fact and in the best interest of public health to do the same: Organize and have a consistent message,” Rai said.
For Buttenheim, there’s a better way to measure how COVID-19 vaccine rollout is going. Instead of saying a given city aims to get 95% of its residents vaccinated, she’d rather see them aim for allowing everyone to have a conversation about the shot with someone they trust.
“It’s more important to me, for equity reasons, that we meet people where they are,” she said.
Contact reporter Madeline Heim at 920-996-7266 or mheim@gannett.com. Follow her on Twitter at @madeline_heim.
Contact Allison Garfield at 715-3519799 or agarfield@gannett.com. Follow her on Twitter @aligarfield_.
Sarah Volpenhein is a Report for America corps reporter who focuses on news of value to underserved communities for the Milwaukee Journal Sentinel. Email her at svolpenhei@gannett.com. Please consider supporting journalism that informs our democracy with a taxdeductible gift to this reporting effort at JSOnline.com/RFA.