From incentives to easy access, experts discuss defeating vaccine hesitancy

May 9, 2021

PeopleImages/iStock

(WASHINGTON) — Robin Banks was hesitant about getting the COVID-19 vaccine. The 27-year-old California resident felt he was young and healthy enough that the virus wouldn’t affect him.

“I didn’t really know much about [the vaccine], so I thought, maybe wait a little bit and see how that goes,” Banks told San Diego ABC affiliate KGTV.

Banks isn’t alone.

A recent ABC News/Washington Post poll found that still nearly 1 in 4 Americans are disinclined to get vaccinated.

Those ages 18 to 29 are the highest among the “wait and see” crowd, according to the latest Kaiser Family Foundation vaccine monitor report. An Axios-Harris Poll released earlier this month also found that Generation Z (those younger than 25) are more likely to say “they will get the vaccine whenever they get to it.”

Banks now wishes he got the vaccine when he had the chance. On April 30, he told the station he had a slight headache that progressively got worse. He was bedridden for four days, he said, before he tested positive for COVID-19.

“Me believing that being young and strong and in great shape that … it wouldn’t affect me this way, it’s not true,” Banks told KGTV. “I do regret not getting the vaccine earlier because I would not want to go through what I’m going through right now.”

With vaccination numbers dropping from an average of over 3 million daily doses administered a month ago to now under 2 million, according to Centers for Disease Control and Prevention data, public health officials are trying to reach those Americans who have yet to get inoculated, especially young adults. As of May 8, 10.8% of 18- to 29-year-olds in the U.S. are fully vaccinated and 0.8% of those between 16 and 18 are, per the CDC.

“There’s been a lot of people talking about, well, we’ve gotten the easy 40%,” Dr. Aaron Tande, an infectious disease specialist with the Mayo Clinic in Rochester, Minnesota, told ABC News. “Now it’s going to be the more difficult.”

Vaccination barriers — and possible solutions

Experts say one of the greatest challenges with the vaccine rollout is access. Since demand has dropped, the focus needs to turn to making the vaccine as easy as possible to get in order to reach more hesitant populations, Brian Castrucci, an epidemiologist and president and CEO of the de Beaumont Foundation, which advocates for public health, told ABC News.

“Wouldn’t it be nice if a vaccine was as easy and accessible to get as a Quarter Pounder with Cheese?” Castrucci said. “If you’re gonna take it, it’s gonna be right there. We need to work much harder to get these vaccines available in the offices of primary care providers.”

To reach neighborhoods hard-hit by the pandemic, Chicago’s Rush University Medical Center set up a vaccine clinic in a gym and deployed “SWAT-like teams” to nursing homes, halfway houses, the homebound and the homeless, chief nursing officer Angelique Richard told ABC News.

“If we’re not thoughtful about getting the vaccine into those communities and helping them, they’ll be even more devastated,” she said.

Incentives — like free beer, baseball tickets and even college scholarships — have also been dangled to entice apprehensive people to get the shot. They can be part of what needs to be a multifaceted vaccination approach, Richard said.

These incentives could be the “carrot” people need, Dr. Gabor Kelen, head of the emergency medicine department and a COVID-19 response leader at Johns Hopkins Medicine, told ABC News.

“We’re still, on some days, upwards to 1,000 deaths and 40, 50,000 new infections, that’s devastating. And so I think it’s appropriate to really encourage rapidly getting to herd immunity,” Kelen said. “If we have to give people a few candies along the way, then that’s what we’re gonna do.”

In some cases, it works.

In Benicia, California, 17-year-old Harjot Saini decided to get the vaccine after the city offered young people free pizza for getting inoculated.

“I think half of my decision was based on the pizza, if I am being honest,” she told San Francisco ABC station KGO Wednesday after the shot.

For young people in particular, who don’t have any underlying health concerns, there’s also a “messaging challenge” in helping them understand why they need to get vaccinated, Castrucci said.

“It’s really the same reason you wear a seatbelt,” he said. “You don’t wear a seatbelt because you know you’re going to get into an accident. You wear a seatbelt to mitigate the damage should you get into an accident. And there are plenty of young folks, healthy folks who have died from COVID or had their quality of life irreparably changed because of COVID.”

Public health officials should be focusing less on the goal of herd immunity, and instead tying vaccination to things people want to do, such as gathering safely with friends and family or being able to do certain activities without needing a COVID-19 test, experts said.

“Herd immunity, the societal good, is very important, but it may not be the primary motivating factor,” Tande said.

‘The four Ps’

Celebrities, athletes and even former President Barack Obama have endorsed the vaccine on social media to encourage their admirers to follow suit. Former President Donald Trump also used encouraged the public to take the vaccine before his exit from office.

Leaning on trusted messengers will be key to reaching the vaccine-hesitant, experts said.

From focus groups with vaccine skeptics, Castrucci has found that the most trusted messengers are what he calls the four Ps: physicians, pastors, parents and peers.

Rush University Medical Center invited 120 faith leaders from across the Chicago’s pandemic-stricken neighborhoods to the hospital for the shot to encourage congregants to follow suit.

“We first started with people who are trusted, leaders within their community, and we charged them with going back to their communities to tell their story, because we knew that their congregations trusted them,” Richard said. “That was really, very effective.”

Peer networks may be particularly effective in vaccinating young adults, according to the Kaiser Family Foundation. In its April vaccine monitor report, it found that “those who say at least half of their close friends are vaccinated are much more enthusiastic about getting vaccinated themselves compared to those who say just a few or none of their friends have gotten a shot.”

“We all have people that we trust their opinion of. So if somebody hasn’t felt comfortable getting a vaccine based on guidance from Dr. [Anthony] Fauci and the CDC and their local public health authorities, more of the same may not change their minds,” Tande said. “But that same message with accurate information from their local pastor or peer group may do the trick.”

He pointed to recent comments from the Biden administration about identifying trusted, influential messengers as being a good strategy.

Opening a shame-free dialogue

Experts stress that the best way to reach the vaccine-hesitant — whether it’s healthy young adults who aren’t in a rush to get the shot, people on the fence or those mistrustful of the science — is to “meet them where they are.”

Kelen said the worst thing you can do is shame someone.

“Something that we’re not very good at when encountering people with sort of a more political/philosophical hesitancy or resistance is trying to empathize with where they’re coming from, and truly listening to them, [so] that you feel that you can establish a relationship and a dialogue,” he said.

One of the common concerns Tande hears from his patients about the COVID-19 vaccine is over safety, from immediate to long-term side effects. He said he’s been able to have effective conversations when patients feel comfortable asking questions in the first place.

“I think the things that are probably going to be helpful for people are to be listened to and have their questions validated and addressed,” he said. “There’s nothing worse for people than feeling belittled for their concerns.”