The vaccine debate is more complicated than just those who are for or against immunizations. The vast majority of people support vaccination efforts, while a loud minority of those against vaccines (anti-vaxxers) dominate the other side with outlandish narratives and scare tactics ― and it’s typically those people whose minds we try to change.
But there’s a third group that’s often overshadowed: “hesitant vaxxers.” And when it comes to convincing people to trust science and get shots like the COVID-19 vaccine, we should focus more on this camp.
According to William Schaffner, a professor of preventive medicine and infectious disease at Vanderbilt University, hesitant vaxxers want to learn more about the benefits of vaccination, while anti-vaxxers have already made up their minds.
“I’ve learned that you’ll never change the opinion of someone who’s truly against vaccination,” Schaffner said. “The more logic and reason you use, the more they dig in their heels.” Those who are hesitant, on the other hand, “just want to understand vaccines better,” he said.
A hesitant vaxxer may be the mother who’s worried about injecting her small child with something she doesn’t know about, or a person who has heard horror stories that cause them worry about receiving their own vaccination.
“Even if the risk of a serious reaction is less than one out of a million, some can’t help but wonder, ‘What if I’m that one?’” said Martin Myers, a retired pediatric infectious diseases professor and the former director of the National Vaccine Program Office of the U.S. Department of Health and Human Services.
Myers said he believes anti-vaxxers are a relatively small group of people, while hesitant vaxxers are more common. “Most are just trying to sort out the risks and benefits of both the infections and the vaccines,” he said, something he called “sensible.”
And if we want to make progress in inoculations ― particularly with the COVID-19 vaccine ― there needs to be a more understanding approach to those who are hesitant.
What makes people pause in the first place
One reason people are hesitant is because they may see vaccinations as risky. “As humans, we’re generally not good at things like thinking about risk,” said William Hanage, a professor of epidemiology at Harvard University’s School of Public Health. The trick, Hanage said, is to keep risks in proper perspective. “Vaccines are far, far, far less risky than the diseases they prevent,” he said.
He offered COVID-19 as an example and explained that while the fatality rate can vary by age and from variant to variant, overall “about 1 in 200 people with the disease are expected to die.” By contrast, he said, “the risks of a severe allergic reaction to the mRNA vaccines based on early rollout data are less than 1 in every 200,000.”
“It’s hard to marvel at the miracle of vaccination when you’ve never witnessed the devastation of the diseases they prevent.”
Kristen Nordlund, a health communication specialist at the Centers for Disease Control and Prevention, had a similar take: “Like all medicine, vaccines can have side effects, but the benefits to protecting you from infection, hospitalization and death far outweigh common minor side effects you may experience.”
It’s also worth noting that people may be hesitant for reasons that don’t have anything to do with vaccination. Andrew Rowland, a professor of epidemiology at the University of New Mexico, cited a PBS NewsHour video and said he’s come to recognize that minorities and underserved communities may have been let down by health care professionals in the past. For those groups ignored by public health experts, “we should not automatically assume that vaccine reluctance is irrational,” Rowland said.
What’s more, some people may take pause simply because they do not fully appreciate the danger of the diseases vaccines are known to prevent. “Most hesitant vaxxers didn’t grow up during a time when 400 to 500 children were dying every year from measles,” Schaffner said. “They’ve never witnessed the crippling effects of polio or seen a loved one with diphtheria fighting to breathe. It’s hard to marvel at the miracle of vaccination when you’ve never witnessed the devastation of the diseases they prevent.”
And when you can’t see it for yourself, the only thing you have to go on is education. Schaffner also cited a lack of understanding from trustworthy sources as a reason for vaccine hesitation. “The purpose and benefits of vaccinations are often not taught properly or extensively in our public education systems,” he said. “Family doctors have had to bear the burden of educating parents on the importance of vaccines.”
And when the subject isn’t taught extensively in school and doctors aren’t seen regularly, people may be educated by “the rabbit holes of the internet,” as Hanage put it. Social media and the web, he said, are brimming with “self-reinforcing information and echo chambers within echo chambers.”
Nordlund said even well-meaning websites can feature inaccuracies: “Many people get misinformation from websites that seem credible on the surface, but in reality, are not.”
Indeed, many people turn to Google and other search engines to procure information, but such systems only generate lists of websites that mention a specific topic without separating out the credible ones.
How we can overcome vaccine hesitancy
We know that vaccines are safe and effective at stopping disease. In the case of the COVID-19 vaccines, those currently being administered to the population have been shown to reduce severe cases and to be extremely effective at preventing hospitalization and death. These outcomes are encouraging. We also need at least 75% of the country to take the vaccine in order to control the pandemic.
However, some people may not understand this, or knowing this information may not be enough for some people on its own. If you’re talking to someone who’s hesitant, “try to listen and ask open-ended questions about what’s going on,” Nordlund recommended. “There may be an underlying concern or reason that is driving the behavior.”
Misinformation, limited education or negative medical experiences in an individual’s past are all reasons someone might be weary of vaccinations.
“If we dismiss hesitant vaxxers as anti-vaxxers, we may lose the opportunity to help them understand why vaccines are vital in the first place.”
Once apprehensions are understood, Nordlund said, it may be helpful to direct hesitant vaxxers to credible sources of information to learn more, but be mindful that vaccination concerns are not likely to be abated overnight.
“It’s important to remember that it may take more than one conversation to address misinformation or a concern a family member or friend has,” Nordlund said. “Empathy will go a long way to have them feel heard, even if you don’t change their mind in one conversation.”
Hanage similarly stressed respect and understanding. (“I don’t think it helps to ignore or dismiss concerns,” he said.) But he also said that, in the middle of these conversations, everyone should bear in mind that vaccinations aren’t only about protecting oneself. They’re also meant to help protect the most vulnerable among us.
“One of the scary things about transmissible diseases is not only that you might get sick, but that you might transmit them to someone else,” he said. “By being vaccinated you may become a firebreak against a virus.”
Spreading trustworthy vaccine information is also crucial. Sources the experts recommended include the CDC’s Vaccine and Immunization online center, The National Library of Medicine, The Journal of the American Medical Association, the Vaccine Education Center at the Children’s Hospital of Philadelphia, and the official website of each state’s public health department.
Nordlund also said those who are hesitant about the vaccines should be encouraged to speak with their health care provider about any questions or concerns. “They are the most trusted relationship we have for getting health information,” she said.
Above all, Schaffner stressed that perpetuating an “us vs. them” mentality toward hesitant vaxxers won’t accomplish anything.
“It behooves us all to embrace and educate one another with accurate information, not push each other away,” he said. “If we dismiss hesitant vaxxers as anti-vaxxers, we may lose the opportunity to help them understand why vaccines are vital in the first place.”