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Trust in COVID-19 vaccines is vital to control the pandemic. Why are some hesitant?

For Neomi Oppenheimer, “there’s nothing on this Earth that could convince me to take” the coronavirus vaccine.

The 70-year-old Nuyorican lives in the Bronx, an early epicenter of the global COVID-19 pandemic during the first surge last spring. But she’s skeptical about the vaccine, even after her oncologist told her, a breast cancer survivor, to think about getting it. As a Mormon, she said she was also not persuaded even after Russell Nelson, the 96-year-old president of The Church of Jesus Christ and Latter-Day Saints, was vaccinated against the virus on Jan. 19.

She’s not alone. As the record-breaking pace of vaccine development meets logistical bottlenecks slowing down vaccine distribution, 58 percent of Americans said in mid-January that they would get vaccinated against COVID-19 if the vaccine were available to them, according to polling from the PBS NewsHour, NPR and Marist. But another 31 percent said they would not get vaccinated, and an additional 8 percent of Americans were unsure about rolling up their sleeves for the shot. Since August, polling trends suggest American attitudes about getting the COVID-19 vaccines have stagnated. Non-white Americans were signficantly more likely to say in mid-January that they did not plan on getting vaccinated, at 35 percent, than 28 percent of white Americans who felt the same — a trend that experts say can be traced in part to a history of mistrust in the medical community that stems from abuses against communities of color.

Chart by Megan McGrew/PBS NewsHour

Among the many coronavirus challenges the Biden administration faces, boosting public trust in the vaccine is a problem it must solve to move the U.S. past the pandemic. President Joe Biden, Vice President Kamala Harris and Dr. Anthony Fauci have invited cameras to watch them getting their shots in the hopes of building trust. And both of the currently available vaccines, developed in less than a year and authorized for emergency use in the U.S., have been shown to be more than 90-percent effective in preventing COVID-19 infections. But that hasn’t been enough yet to assure millions of Americans, more of whom ultimately must be vaccinated so that the country can achieve herd immunity.

Dr. Paul Offit, director of the Vaccine Education Center at Children’s Hospital of Philadelphia, told reporters last Thursday that if the U.S. sees between 65 percent and 70 percent vaccinated or immunized, “we can stop or slow the spread.” Fauci, head of the National Institute of Allergy and Infectious Diseases, said during a Biden White House briefing that if 70 to 80 percent of Americans get vaccinated by the end of summer 2021, “then by fall, we’ll be approaching a degree of normality.”

On his second day in office, his administration committed to launching “a large-scale campaign to promote trust and build vaccine confidence, in close collaboration with doctors and nurses, faith-based, civic, and advocacy groups working with or representing the hardest-hit communities.”

Those messages, delivered by those trusted sources, can go far to boost public confidence, experts have said. But will it be enough to convince those like Oppenheimer, who said the speed with which the vaccine was produced made her uneasy?

“I might take it next year,” she said.

Why are Americans reluctant?

In mid-January, weeks after the first vaccine doses had been given, New York City emergency physician Dr. Uche Blackstock had seen any significant public awareness campaigns about getting vaccinated against the virus. Even among fellow health care workers, Blackstock, a medical contributor for Yahoo News, said some had talked about being “adamant against receiving the vaccine.”

For months, Dr. Rahul Gupta, West Virginia’s former public health commissioner, heard from colleagues at state and local health departments that they felt that the federal government had “left us to our own devices,” he said, on just about everything but especially the vaccines. Since last spring, states and communities struggled to cobble together their own pandemic plans, producing dozens of mismatched strategies to contain the virus while the U.S. earned its tragic title as the world’s leader in COVID-19 infections and deaths. There was little to no time to build public trust in these vaccines, something that Gupta said should have been started long before any vaccines were available.

The Ad Council, a nonprofit that has historically partnered with the federal government to produce public service announcements, has launched an education campaign centered around the COVID-19 vaccines, rolling out its first ads in December. Lisa Sherman, Ad Council president and CEO, said the organization will air its first national television campaigns “in the weeks ahead.”

“While there are millions of Americans who have already received their COVID-19 vaccinations, the vaccines have not yet been made widely available to the full population, and it’s important to phase the rollout of our mass marketing campaign with the distribution and availability of the vaccines,” Sherman said in a written statement to the PBS NewsHour.

Elvis Presley receiving a polio vaccination at CBS studio 50 in New York City. Photo by Seymour Wally/NY Daily News Archive via Getty Images

But in the meantime, many people searching for information about the vaccines have stumbled into a messaging vacuum or succumbed to misinformation, said Gupta, who now serves as the chief medical officer for the March of Dimes. Gupta recalled how the March of Dimes had Elvis Presley go on national television in 1956 to get the polio vaccine as one part of bigger strategy to build public trust and ramp up immunization against a debilitating disease that the U.S. eliminated in 1979. At the time, celebrities like Presley worked to unite the country around a common cause — stomping out polio. But some reports suggest it is unclear if such star power could capture people’s attention in the same way against coronavirus.

Under the Trump administration, basic public health precautions, such as the need for face masks and social distancing, were politicized, Gupta said, and the absence of a national, coordinated strategy garbled the messaging around vaccines.

To Dr. Mary Bassett, who served as New York City’s health commissioner and now directs the FXB Center for Health and Human Rights at Harvard University, the encouraging news about the efficacy and safety of the vaccines was offset during the Trump administration by “an extraordinarily disorganized” national response to the pandemic.

“It’s almost the textbook of how not to do things,” she said.

To make people more comfortable with vaccines now, they need easy-to-find vaccine resources that are “conveyed in a digestible and culturally responsible manner,” said Blackstock, who was then awaiting her second dose of the Moderna vaccine. Simply being a responsible health consumer and hunting down information about the vaccines “can be very overwhelming.”

She suggested that physicians and nurses could proactively give patients a heads-up about incoming vaccine shipments and offer informational pamphlets during routine or general health appointments. And faith leaders could partner with public health departments to host virtual town halls where congregants can get their questions answered. These simple and inexpensive efforts can be effective. “It shouldn’t be one-size-fits-all messaging,” she said.

How history drives hesitancy

Context matters when thinking about why some Americans might remain hesitant about or outright reject a growing mountain of data that shows the coronavirus vaccines to be safe and effective. In the U.S., the virus has disproportionately killed Black people at higher rates — 147 deaths per 100,000 people — than any other race or ethnic group, according to federal data. Comparatively, white people are dying at a rate of 98 deaths per 100,000. Members of Black and Latino communities are most likely to say they are hesitant about getting vaccinated for COVID-19, Sherman said.

That hesitancy can be traced back to race-based disparities and patient abuse that haunt the nation’s public health history, Bassett said.

Starting in 1932, the U.S. Public Health Service recruited an estimated 600 Black men to participate in the Tuskegee Syphilis Study. Being told they would receive treatment for “bad blood,” hundreds of men went without treatment for the sexually transmitted disease, even when highly effective options, like penicillin, became available. Instead, researchers monitored what syphilis did to the men’s bodies. Originally designed to last six months, the study did not end until 1972, when the Associated Press exposed the government’s work, sparking public outrage.

FILE PHOTO: Herman Shaw, a survivor of the Tuskegee Syphilis Study, spoke at the White House in 1997, where President Bill Clinton apologized to the survivors and families of the victims of the Tuskegee Syphilis Study. Photo by Paul J. Richards/AFP via Getty Images

Decades later, distrust of physicians and medicine endures among Black Americans at higher rates than among white Americans. Amid the coronavirus pandemic, generations of disparities still inflict real and devastating consequences on the same communities of color. Black, Latino and Indigenous patients have been more likely to get infected and die of COVID-19 than white patients. In early December, Dr. Susan Moore, a Black physician in suburban Indianapolis, was hospitalized with coronavirus. During her stay, she posted a video to Facebook where she said a white doctor downplayed her condition, “made me feel like I was a drug addict” and left her feeling “crushed” while she lay in pain. Moore died from her illness on Dec. 20, the Indianapolis Star reported.

While Bassett said she couldn’t comment on Moore’s care, she said it is clear that Moore “felt disrespected” and “that’s not appropriate — that she felt she had no alternative.” And Moore is not the only patient of color who has received medical care that was “an affront to their dignity,” Bassett said.

Early vaccine distribution data is still coming into focus, but preliminary numbers from some states suggest racial disparities have already emerged. Virginia shared data this week that showed that 224,000 white people had been vaccinated so far, while Black people, who make up roughly a fifth of the state’s population, had received fewer than 33,000 vaccine doses.

To ease skepticism in these communities about care and vaccines, Bassett said public health officials and medical experts must be resourceful and creative.

“I don’t think there’s a magic bullet here,” Bassett said. “It’s persistence. It’s repetition. It’s showing up. It’s willingness to address in an open way, and acknowledge ways the health care delivery system has failed.”

Biden’s challenges beyond fighting hesitancy

During his first few days in the White House, Biden has taken several actions to improve the U.S. response to the pandemic, including announcing the purchase of 200 million additional doses of COVID-19 vaccines, but his team has also warned that they know tackling vaccine hesitancy won’t be easy.

“It’s going to be hard,” White House press secretary Jen Psaki said Tuesday. “And we are not trying to sugarcoat that.”

On Jan. 21, Fauci told reporters during a White House coronavirus briefing that “we really need to do a lot of good outreach” to overcome vaccine hesitancy and get enough people vaccinated.

Chart by Megan McGrew/PBS NewsHour

The U.S. is missing another fundamental component that complicates any plans to get people lined up for vaccines. Pediatric vaccinations such as chickenpox and measles are second-nature to U.S. health care, but in the haphazard COVID-19 vaccine rollout, adults may have no idea where and how to sign up.

“We don’t have a public health system that’s geared toward mass vaccination,” Offit said.

Some communities have big stadiums or shopping malls — standing empty thanks to the pandemic — that have been retrofitted into mass vaccination sites. However, that only takes care of a portion of the population savvy enough to actively advocate for themselves or have resources like technology to do their own research. In other cases, people were lucky enough to be offered the vaccine because they happened to be standing next to a grocery store pharmacy at closing time and the doses otherwise would have been thrown away.

“That’s the culmination of a rollout effort that has failed,” Gupta said.

Decades of deferred or cut funding have atrophied public health departments across the country. Fewer people stand ready to combat misinformation about vaccines — such as unfounded concerns that they will alter your DNA — and answer legitimate questions about what’s safe and effective.

The Biden administration’s COVID-19 plan prioritizes public health departments, “particularly in reaching the hardest-to-reach communities,” with support building vaccination clinics and overcoming the logistical hurdles of delivering vaccines that rely on cold-chain storage and transportation to work.

Without order and discipline in getting the word out to people and vaccines in their arms, Gupta said, “Some people are having to play the game of getting the vaccine.”