- When pressed with an overwhelming challenge.

How many times have you heard someone say if only there were a silver bullet, some would argue in the midst of a pandemic COVID-19 vaccines are the solution.

The silver bullet to ending the pandemic, yet many Americans are reluctant to embrace it.

There is a myriad of reasons for this an anthropology team from Grand Valley State University is tackling vaccine hesitancy through an ethnographic study, designed to build trust, creating public health messaging.

We talk with it's lead investigator on Newsmakers.

(upbeat music) Thank you for joining us on Newsmakers.

Our guest has long researched the history of American vaccine hesitancy.

Dr. Kristen Hedges is Assistant Professor of Anthropology at Grand Valley State University.

You recently said "Vaccination campaigns have always been a project of public cooperation.

A vaccine can only be as effective as the public willingness to participate and community access to the resource."

Dr. Hedges.

Thank you so much for joining us.

You have to love, starting out with a quote and it's yours.

(laughter) - Thank you for having me.

- The COVID-19 vaccines are effective.

They're readily available, but there's this disconnect that we're seeing take place, the big picture.

What, what is that?

What are the influencing factors out there?

- Well, really, I mean, as I said in the quote that you started off with it, vaccines have always been a project of public cooperation.

When we look at the history of vaccines, there's always been this tension in between citizens and authorities.

And even if we start with the smallpox vaccine back in the 18th, 19th century in the United Kingdom.

When they made it compulsory, when they made the smallpox vaccine mandated, we had the first United kingdom's anti-vaccination league come out against that.

We can trace that through to even vaccinations with DPT vaccinations with MMR measles, and this cooperation of having an argument over the vaccine, is it causing more harm than good is where a lot of the tension comes from.

So because of this long history and vaccine hesitancy, really being nothing new, many social scientists were arguing from the beginning.

They knew this wasn't going to be a silver bullet, as much as it was kind of portrayed as this, you know, once we get the vaccination the pandemic is going to be over, but we knew, history told us, that a lot of people for a myriad of reasons are hesitant.

They they're really it's this long continuum, you know, from you hear the term anti-vax or anti-vaccination and then vaccine acceptance or pro-vax.

And the reality is there's not just two sides.

It's this large continuum of people on one side possibly refusing vaccines, all the way to people maybe a little bit hesitant even to people who are impeded from getting the vaccine and access to the vaccine.

So then we have some who are just indifferent, not seeing a need for the vaccine because they haven't maybe been hit personally yet with COVID.

So this large continuum leads to all these different reasons of why people may be hesitant.

And even the term like vaccine hesitancies become this catch phrase for anyone who's not getting the vaccine.

When there's a lot of different reasons, it could be for transportation.

It could be because you know, the skills of actually getting an appointment.

It could even be because when we look at medical atrocities in some communities, the trust just isn't there.

And so what we've tried to do in our campaign is really work on because there's so much diversity in the reasons why someone maybe hasn't gotten vaccinated yet.

We need tailored messaging, because one message isn't gonna work.

It doesn't address all the concerns out there.

- There is that big picture, right?

The 30,000 feet, which is how do you end that pandemic?

- Yes - And as we're seeing the Delta variant, right, more contagious variant taking off, you know, you just feel like, are we taking a step back, but there is this reality of, okay, then how do we end it?

- Yes.

And that, that really the way we end it, is we need community immunity.

And I try to use that phrase particularly, you maybe have heard herd immunity in the news.

And a lot of people bristle at that.

Like we're not, we're not livestock animals.

And what we're really going for is we need that population immunity.

We need the community level, because COVID 19, just like other things, we have vaccines for, it's an infectious disease, it moves around in the community.

And if we can get enough people to get vaccinated that cuts off pathways for the virus.

So the more, the more people vaccinated kind of the bigger our community umbrella is, and the more pathways are cut off, which then reduces variance.

variants actually come from there still being enough room for the virus to move around and infect other people.

And so what we really need to strive for, to end this pandemic, which is really what everybody wants.

We want to be past it, but to end it, we have to look at it of how do we get the pathways blocked off.

And then the reality is that's not even just in the United States, this is a global pandemic.

We need community immunity at the global level, because even our variants that we're looking at, they're coming from different areas around the world and we're all interconnected.

So until the whole world is vaccinated, that's where we're going to be able to cut off all the variants.

- And here in the states.

I mean, we're big on labels and identity, right?

And, and part of what's at play here is this, and it's a very American ideology, which is my freedom, - Yes - my freedom, right?

- Yes - I mean, that seems, or, or government, you don't tell me what to do.

- Yes - However you want to look at this, right.

- Umm hmm - Is that one of those overarching walls that you're seeing that's really at play here when we have this discussion.

- It is, you know, and I would even, I would break down like from this large continuum, there's, you know, historical context, reasons of why people are hesitant.

There's some people who are concerned about maybe the vaccine and safety, but there's this whole continuum of individual influences.

And that's where perceptions and your social groups, your social networks play a big part because we're social creatures.

When we want to work together and we feed off each other in social environment.

And so if your whole social group is either, oh yeah, we're, we're getting the vaccine.

You can see a trickle-down effect of more people getting vaccinated.

But if everyone you're socializing with, it's not, then that's where it also gets tied into identity.

That's also why I really caution people to not think of it in this dichotomy of anti-vax or pro-vax because the more we come up with, the more we're thinking in labels and two sides that really reinforces it's about identity, more than anything.

And identity and ideology is a lot harder to change.

It's a lot harder to, to talk about when it becomes more about your identity for why you're doing something or not doing something.

So the more realizing it's really this large continuum of, of meeting people where they are...

It's going to be a way forward.

- Before we get into the study and how you do make that approach, and perhaps, you know, influence people, change minds for the common good.

You and I talked, I want to say it was back in July or August.

I've lost track.

It's like it's pandemic Groundhog day.

So, just give me a moment here.

I can't remember exactly when that was, but we were talking then, and how big the FDA full approval would be.

- Um hmm - All right.

Now that we've had a couple weeks to kind of look back, are we seeing that as a motivator?

Yes or no.

And then, how the Delta variant has been impacting unvaccinated people.

So we'll kind of break that down in two ways.

- Two fold - One the FDA approval.

Yeah.

- You know, there was a lot of hope that the FDA approval was going to pivot a lot of people in their thinking and I think it did on some level.

I think having that, that full FDA approval made a difference and feeling more confident in the safety and the efficacy of the vaccine that this really is safe.

And it went through this rigorous process and we're beyond just emergency use.

So I think for some, it did help feel more secure and more safe about getting the vaccine.

I think it wasn't, if we even look at the FDA approval, being the silver bullet, we are hoping that that would change everything.

I don't think it changed everything as much as maybe we hoped and change minds as much, but at the same time as the full FDA approval, as you mentioned, the Delta variant has been rampaging through the country.

And really where I think maybe we've seen a bigger pivot is those who might've been, what you can call vaccine indifferent.

Like, well, it doesn't impact me.

I'm not at risk, I'm young.

I don't have any pre-existing health conditions.

So it's not, really anything I have to consider.

And really that indifference really comes from if they have been untouched by the pandemic, this pandemic has not unfolded in an equitable way whatsoever.

We've seen, especially the African-American community and communities of color have been disproportionately affected by COVID-19 because of preexisting health conditions that are tied to structural racism in our healthcare system, for all these reasons that we could have predicted seeing it because of health inequities that already existed, but some communities were touched more than others.

And so for other communities that might have been in different, I think the Delta variant has challenged some of that, especially when we see even more people infected with the Delta variant.

When we look at who's in the hospital right now, and look at those who are severely sick, even on respirators, the majority of all of those across the country are those who are unvaccinated.

So that indifference, I think, is shifting because of actually seeing the reality of the risk of being now touched by it.

And maybe it's not that person in the hospital, because at that point it's not, they can't get vaccinated at that point, but their family members around them that trickle down effect that's had an impact.

- So yeah, you're looking at the inequalities just in groups, but then even individuals and the way that individual bodies react to this virus.

I mean, for some people, it's the sniffles - Yes - for others, you know, unfortunately it's a ventilator.

- Yes - And so how much of it is having that, that personal connection that, because if you haven't been touched by it personally, you know, it's been called just the flu, right.

- Yes, Yes - So how does that change perception, and then maybe being pushed towards acting positively to do something about it?

- Yeah.

I think, I think the reality of when we think of emotions and perceptions and how we view things and having experience with it, that's what does make a shift.

I actually was a Peace Corps volunteer back in the early 2000's in Kenya and worked on HIV education for over a decade.

And in Kenya, even at that time in the early 2000's HIV rate was really high and I would talk to community members and they would say, oh, this, isn't a problem for us.

This is the other town.

This is in the city.

This is here.

And in the beginning, people, didn't see it as a risk for themselves.

And it wasn't until the case has really started to increase that I saw a switch, and how people viewed it, they were touched by it.

And then they were more willing to talk about, oh, this really is a risk for me.

I need to think about prevention steps.

And so it's almost a similar pattern in that way of the more people, unfortunately, because we don't want to have more deaths and that's, what's happening.

We're losing almost 1800 Americans a day in the last few weeks.

And so thinking of how many deaths there are, it's a tragic loss, but what is happening from that as more people are touched by it, and then more people are realizing when they're weighing the risk of what could be a prevention tool for them.

If they were to accept the vaccine, I think what happens, what's difficult in the past with vaccines and say the measles vaccine, sometimes parents are weighing getting the vaccine versus not getting the vaccine.

And then they have these questions about the safety of the vaccine, and then deciding, no, there's not really a risk.

So I, so we don't need, now there's more of a risk to get the vaccine.

And really what needs to be reoriented, and what the science and the scientific community is.

assuming people are making decisions based on getting the vaccine versus getting the virus.

And so the more that we can have people reorient the scale, you're not weighing the vaccine versus no vaccine.

You're weighing the vaccine versus getting the virus.

You know, even long-term impacts, I get that in interviews, a lot of people saying, well you don't know the long-term impacts because it's only been out for this amount of time.

Now one, now we've had over a year and a half, if you put in the clinical controlled trials of people, who've had the vaccine and we would see some long-term impact with the numbers we've had.

But at the same time, we do see long-term impacts of the virus.

And even if there's questions left of five years down the road for the vaccine, we are seeing long-term COVID and impact on the brain, on the heart, on the lungs.

And so we know, we for sure, have longterm impacts of the infection.

- So I want to dig into the study itself.

You'll have to take me back to when this all began, but vaccinatewestmichigan.com is the place to go for a lot of the infographics that you've put together.

And other information, if you have questions about the vaccine.

You were working with Kent county, along with west Michigan health departments, healthcare providers, and universities, all partnering, and this was launched.

I want to say, in late 2020.

What was it that came together?

Was it misinformation, disinformation?

What was going on at the time?

Where everyone felt, Hey, there's a need for us to address this.

- So Vaccinate West Michigan, the coalition was put together in really early 2020.

And even before we had a lot of vaccines to roll out, there was a recognition that in the region healthcare systems, healthcare departments, universities, that there was a benefit and banding together to be able to talk with each other, to hear what was going on in the different areas and then to coordinate messaging.

And one of the hard things about this pandemic is it hit in this kind of perfect storm.

We were already a country that was politically divided.

It's also considered a time of an infodemic where there's information everywhere, we're living in this kind of post alternative facts that people are not sure how to judge or how to understand, what's a valid source versus an invalid source.

And so a recognition of that, Vaccinate West Michigan the coalition came together, trying to unite messaging, trying to learn from each other and work as a team throughout this whole region.

And so that helped, especially during the push for mass vaccination clinics when they opened the DevOps center, but then to hear, how our different health care, how our county health departments handling it, how are they rolling things out?

What groups are they prioritizing?

How do we kind of consistently message the priority groups?

And then from there, you know, where a lot of the demand was high and we didn't have enough vaccines early in February, March.

And then by May, the demand dropped.

(laughs) And so the mass vaccination clinic, DevOps center, there wasn't enough demand.

So that was closed down and moving more into primary care doctors, CVS, Walgreens, and other facilities to continue having the vaccine available and as many spots as we can.

But the coalition has continued of like how, you know, especially with this new Delta wave, like learning from each other, how are you handling it?

What are you facing?

How can we learn from each other?

How can we support each other?

- So let's, let's dive into the ethnographic study right.

There's, a part where you have to figure out, okay, what are all the people, what are the concerns out there?

- [Dr. Hedges] Umm hmm - How do we address them?

- [Dr. Hedges] Yes - How do you answer all of those?

- [Dr. Hedges] Yes - So you begin this process, it's called an ethnographic study.

- Umm hmm - So for anyone who does not understand what that means, what's the baseline for people to know when it comes to a study like this.

- So ethnography is a key methodology in anthropology, especially for cultural anthropologists.

And it's the idea of immersing in the environment and the community and the day-to-day life and seeing what's happening and using, this kind of participant observation of sitting on these calls with Vaccinate West Michigan and hearing stories from how health departments, our hospitals, but then also doing in-depth interviews and ethnographic interviews with community members and in an open-ended fashion.

So asking questions in an open-ended way, tell me your thoughts about vaccines.

Can you tell me where you get your information?

How did you choose those sources?

How do your thoughts compare to friends?

How do they compare to family?

How about you and your partner?

How are your thoughts any different than your partners?

How do you come to these decisions and really just listening with respect and openness, as much as it's possible, really just hearing what people have to say and what helps us with that is getting an insight into what are some of the challenges?

What are some of the reasons why somebody is, you're either refusing a vaccine they're hesitant, maybe they're impeded from getting the vaccine because they're worried about side effects and they don't have the ability to take two days off of work, if they've got some severe side effects with, having fevers and aches for two days afterwards.

And so there can be lots of different reasons.

And so what the interviews have done for us is to give us an insight into what are some of the questions, what are some of the concerns people have?

And then what we've done with those insights is created these tailored graphics.

The goal of the graphics were to try to keep it image based.

So if someone's scrolling through their social feed and they see one, maybe it makes them stop and think and have a further conversation.

We're at the space.

I think we're people are overwhelmed with even articles with peer reviewed articles and digging into sources becomes exhausting.

So the goal was to try to create graphics in a way that people could respond to, and that could actually address some of those concerns.

So I had an incredible two research assistants that were funded from the office of undergraduate research at Grand Valley State University.

And one of them, an anthropology student, which helped with the transcribing and coding of the interviews Maggie Wilson and Donovan Lopez was my graphic design student.

We would sit as a team weekly, and talk about the insights from the interviews and then work together, what kind of image would help, and then bounce ideas around.

And Donovan did a great job of drafting them up.

Each one of those graphics that are released probably went through five different versions of tweaking, and then we would take the graphics and put them on the community meetings with Kent County Health Department to get community members feedback on What's working?

What's clear, what do we need to adapt?

We're lucky enough to work with employees from Spectrum Health to get them translated into Spanish.

So then we could release them in English and Spanish.

We also had epidemiologists from Kent County Health and Ottawa County Health review, all the graphics.

We didn't want it to make sure we weren't putting any information.

That's misinformation, unintentionally.

So we had an epidemiologist then look them over before final approval.

- They looked like they could be billboards.

I mean, they're pretty simple, right?

- Ya, Umm hmm - Well, no, because you want to get people's attention and what that three to five seconds.

- Yes - And are there certain ones that you particularly liked that really address certain issues?

I know sometimes there's this, there's really, it's a lack of trust out there right now.

So how do you, how do you get into that?

- You know, the one that I think that speaks close to my heart is that I got vaccinated to be their umbrella.

And this one speaks to looking at the risk and the risk of exposure to COVID and how parents, especially because the vaccine is not approved for those under 12, that the more people in society and your family, particularly that are vaccinated can help protect those who haven't been able to be vaccinated yet, because it cuts off, how many windows of exposure.

So I think the messages around like get vaccinated for your community were incredibly strong messages.

And those resonated really well early on.

But I think what we try to do with that one was pivot the perspective a little bit.

Think about those young people in your life, whether it's your children or your siblings, or your niece or your nephew.

Like if, if you don't feel the risk for you, try to protect them who don't even have the ability to get vaccinated yet.

- And there are those who don't don't know what's in it.

That comes up quite a bit.

Well, what's in it.

- [Dr. Hedges] Yes - And then there's the development of something so quickly, - [Dr. Hedges] Yes - or they don't trust the MRN, a technology.

Like how do you, how do you have that conversation?

Because I believe that came up quite a bit in, in your study.

- It did the speed of the vaccine is something that's brought up over and over again of have, do trust and feel like it's safe.

And, and people looking and saying, no, it was developed too fast.

And feeling like, because it came out so fast, it was rushed.

So we have, one graphic we're still trying to finalize.

It's targeting that message.

That's that one's becoming more difficult because it's got more words in it.

And so we can try to like, how can we do this in a simpler way, but really what it comes down to ... Why was it able to come out so fast?

Research and people.

You know, this mRNA vaccine, this may be the first mRNA vaccine we have, but it's been researched and using mRNA technology for the last 30 years.

Actually being able to sequence the virus.

That's been a technique that has been researched for the last 15 years.

So because we had these years of research already in place, they were able to quickly develop a vaccine and get it ready.

The other thing that was really key to fast, is having people.

And sometimes when a vaccine going to clinical controlled trials, you need volunteers.

And it takes a while to gather enough volunteers to test it.

And this health emergency people were volunteering, you know, across the globe, I will sign up for clinical controlled trials.

It was able to start the clinical controlled trials quickly because of that reason.

In addition to being in a pandemic, they could actually see, if you are surrounded and exposed to the virus everywhere, it's a lot faster to be able to see if the vaccines working or not.

Versus there's not as much virus circulating.

It takes longer to be able to see the impact, but because it was endemic they could see the results quicker.

And so there weren't any steps skipped, at all, all of these things came together to allow it to be in a fast, rapid way that we are thankful for, as one of the tools that we can use for ending the pandemic.

- So there you are.

You're answering a question.

So that's part of the dialogue that needs to take place, what you just did.

- [Dr. Hedges] Yes - Right.

- [Dr. Hedges] Umm hmm = So how, how does, I mean, we're so divided right now.

- [Dr. Hedges] Yeah - What do you recommend?

How do you approach someone?

I mean, the vaccinated half of the population, to be honest, not really happy right now.

- Yeah - Right But how do you remove that for lack of a better term anger, - Yes, yes - that's out there to have a conversation with somebody who is not vaccinated, and maybe has their heels dug in, maybe not, but how do you have a real conversation with somebody about this topic of vaccine hesitancy?

- That's such a great question and such an important question for how are we going to move forward as a society?

And I understand the anger because we want to move past this.

We don't want our healthcare system continuing to be under stress.

So, I do understand where anger comes from, but I firmly believe, that we're not going to change anything with anger or blaming or even shaming people about, about choices.

I think the way forward is through open conversations, honest conversations and respectful conversations.

Understanding that for so many, the parents especially, they're trying to make choices of the best choices they can.

And if they're choosing not to get that vaccine, I've talked to some parents who are afraid, if there's a side effect, how am I going to take care of my kids?

A lot of it comes from fear.

And so recognizing that we all are fearful, we're all frustrated.

And we have that commonality is just over different issues.

So if you can start with an open conversation, I would say, even starting with openly, just saying, what are your thoughts about the vaccine?

Have you thought about getting the vaccine?

Do you have any specific concerns?

Trying to get to what are the concerns to, how to address or answer them.

And willing to share resources and talk about resources, but one of the biggest things is sharing your own experience.

I think what we've seen, especially in this world of an infodemic of not trusting what's fact and what's false and what's a good source and what's a bad source.

And do you trust the government do not trust the government?

Like all of these issues, having people within your social circle that you do trust having those conversations with them and asking them and sharing your own experience of if you got vaccinated, Why did you get vaccinated?

What was important for you and share the experiences of what happened afterwards?

Did you feel anything after the first shot?

Did you feel the thing, anything after the second shot?

How long did it last for and what did you have to do?

Did you have to take a day off work like sharing?

What, what you went through really makes a big impact?

The more I think that people can hear that those that they know and their trusted circle got the vaccine and they were okay and it's helped them.

And even if they got COVID later, that it ended up being the sniffles on the couch versus in the hospital, the more understanding of kind of merging and finding our way across this divide that we're in.

- Saved the best for last Dr. Kristin Hedges, Professor of Anthropology at Grand Valley State University.

Thank you so much.

- Thank you for having me.

- And thank you all for joining us.

We'll see you again soon.

(upbeat music)