America Is Now in the Hands of the Vaccine Hesitant

Vaccine-acceptance rates are typically stagnant, but that doesn’t mean they’re stuck in place. It’s often said that more people would get their flu shots if they only grasped the toll of the disease. The deaths caused by influenza—tens of thousands in the U.S. every year—are usually invisible, so much so that the risk is misperceived. For COVID-19, though, the cost is counted every day. When it nears a big, round number—10,000, or 100,000, or 200,000, or 400,000, or half a million—front-page headlines follow. This transparency alone might sway the vaccine-hesitant. So too could the thought of returning to a semblance of one’s former life. Get a COVID-19 vaccine, and you can hug your parents: No other vaccination has this perk.

As distribution centers open up to all adults, and more people get their shots, even just the idea of getting immunized could spread through social networks as its own happy contagion, bringing up acceptance rates. “The thing that works best for getting vaccinated is that it gets normalized,” says Maya Goldenberg, a philosopher of science at the University of Guelph, in Ontario, Canada, and the author of a new book, Vaccine Hesitancy: Public Trust, Expertise, and the War on Science. “When vaccination becomes the norm, most people will do it unless they have a really strong inclination not to.”

What might that mean in practice? At the moment, one-fourth of all adults have already gotten at least one dose of their vaccine. Another 35 to 40 percent say they plan to get vaccinated as soon as they can, and about 20 percent are now at maybe. Goldenberg told me that we shouldn’t think of this latter group as being truly undecided. “We know that a lot of people are saying ‘I want to get it, but I don’t want to be first in line.’ Does that count as vaccine-hesitant? I’m inclined to say no.” So even if the nevers never budge, it’s certainly possible that in the next few months, amid the vaccination saturnalia, nearly all the nation’s maybes will come around. In that case, we’ll end up with 80 percent of all adults having their vaccination cards filled out or making their appointments—right in Fauci’s sweet spot for herd immunity.

Of course, another problem should be considered here: It’s one thing to say you want to get vaccinated, and another thing to do it. (SARS-CoV-2 antibodies, as the saying goes, don’t care about your feelings.) Past research shows that the pipeline from vaccine intentions to behavior can be somewhat leaky. Consider our efforts to address the previous pandemic, of the H1N1 swine flu in 2009. Then, as now, Americans varied widely in their estimations of the disease’s severity, and in how much they trusted the vaccine: A Pew Research poll conducted that October found that 64 percent of Democrats were ready to be immunized, compared with 43 percent of Republicans, and overall, half of American adults said that they planned to get the shot. By June 2010, only 27 percent said they’d actually done so. A somewhat milder attrition rate has been identified in small-scale research. Two very modest flu-shot studies, conducted at Rutgers University and among health-care workers in the Netherlands, compared vaccine intentions to behavior and found that about one-quarter of people who say they plan to be immunized fail to follow through. For the sake of argument, if we apply that rate to all the people who now say they’re yes or maybe on the COVID-19 vaccine, and then add the rest to the group of people who have gotten it already, the total coverage would come out to roughly 65 percent.

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