The risks unvaccinated Americans are weighing

May 1, 2021

(NEW YORK) — Joshua Smith, an 18-year-old former high school baseball player who beat the coronavirus back in May, doesn’t particularly fear it, but he does fear side effects from the vaccine — and he doesn’t trust most sources that tell him otherwise.

What he does trust is what he sees around him, which is why Smith’s decision not to get a vaccine isn’t set in stone.

“I won’t say that I won’t,” he told ABC News. But he wants to see firsthand that the vaccine “is really helping and people had good reviews on it.”

“It won’t be quick, it would have to be a steady progression, getting better and better. And then I would say, ‘OK, I would be comfortable doing it now’,” Smith said.

For public health experts intent on quickly vaccinating as many people as possible to stomp out COVID-19 infections, that kind of wait-and-see approach poses a challenge to the progress the country could make — with 100 million vaccinated adults, deaths have already fallen 90% among those over 40, and that success could reach other age groups if vaccination is widespread. Health experts predict at least 70% of the country will have to be vaccinated to reach “herd immunity.”

Still, many Americans who are still wary of the vaccines say the ultimate persuader will be time.

Smith is one of the roughly 24% of Americans who said they’re disinclined to get a coronavirus vaccine, about one in four people, according to the latest ABC News/Washington Post polling.

“The point that we’re hitting is that for some people it will just take a little bit longer to make up their minds,” said Stefanie Friedhoff, a professor and senior director at the Brown University School of Public Health.

As difficult as that is from a public health point of view, it’s also not unusual in vaccination campaigns. And Friedhoff argues that it’s also not the same as “vaccine hesitancy,” a term she thinks is wrongly used.

“This is a moment. It doesn’t mean that people don’t change their minds in the future, and it’s why we don’t want to put this over emphasis on whatever it is that a poll is saying at a certain point in time,” Friedhoff said.

And as Friedhoff’s research confirms, that number — 24% — is shrinking, and will continue to do so over time. Three months ago, an ABC News/Washington Post poll found 32% said they would probably not get a vaccine.

Star Pyritz, a 60-year-old retiree in Eugene, Oregon, is also part of the quarter of Americans who said they’re disinclined to get a shot against the virus. But like Smith, she also acknowledged she might change her mind.

Pyritz said she’s nervous that her medical history of chronic obstructive pulmonary disease, high blood pressure and substance abuse could also make her more vulnerable to side effects from the vaccine. Health care providers point out that the net benefit of getting vaccinated is far greater since the vaccines, which work by creating antibodies in the body that can fight against the virus, present an extremely small chance of an allergic reaction and haven’t shown signs of longterm effects, while they can conversely protect someone with high risk factors from severe hospitalization or death.

“I don’t think I need either one. I don’t think I want either one,” Pyritz said about the virus and the vaccine.

While Pyritz doesn’t have the youthful confidence of Smith, she said she’s willing to forgo the vaccine but stay isolated from people indefinitely.

“I just don’t think I need it long as I stay away from people,” she said. “Who’s to say we’re not gonna have cancer or something later on from this vaccine?”

But seeing a neighbor in her apartment complex recently come down with the virus worried her, since it was so close to home and could’ve put her at risk.

“I don’t know, maybe I’ll change my mind later. But at this point right now, I just don’t think I want to,” she said.

Dr. Laura Miller, a physician in rural Jefferson Davis County, Mississippi, said she hears concerns like these from roughly 50% of her patients.

Hesitancy is highest among rural residents, Republicans and those with a high school education or less, according to ABC News/Washington Post’s latest poll.

Her strategy in trying to convince people to get the life-saving vaccine is to “meet them where they are.”

“The biggest thing is we ask their concerns and we meet them there,” she said.

Miller said she then explains that short-term side effects only last about three days and in comparison to getting the virus — which could be deadly — the benefits outweigh the risks.

As for long-term effects, both Friedhoff and Miller said they tell people that the technology used to create the vaccines has been in the making for decades, and that the trials were able to move faster than usual because so many people participated. Tens of thousands of people were in the trials for Moderna, Pfizer and Johnson & Johnson vaccines, while nearly 100 million people have since been fully vaccinated in the U.S, according to the Centers for Disease Control and Prevention’s vaccine database.

High levels of the virus in communities also made it easier too to determine whether the virus worked. Researchers didn’t have to wait long for trial participants to report infections; when those infections were reported by the group that received the placebo, scientists knew they had a working vaccine.

As for whether there are long-term side effects, experts point to what they know about vaccines in general — that when adverse reactions occur in vaccines, it happens within the first couple of months.

“It’s important to not try to convince people, but rather provide the space in which these concerns can be discussed,” Friedhoff said.

But there’s also a group of people, mostly young and healthy, who aren’t “hesitant” — they’re simply ambivalent. And for that group, particularly as cases rise among young people who have let their guard down but not yet gotten the vaccine, changing the message from fear to opportunity is vital.

For Miller, instead of telling young patients the vaccine will give them protection against a virus that they’re not afraid of, she tells them “hey, this is your ticket out,” she said.

“And then, I can win a few of them over,” Miller said.

She’s already seen a few young patients come in for a vaccine because it’s required for their summer plans.

Dr. Christopher Morse, a professor of crisis communication at Bryant University in Rhode Island, said this is a winning strategy for college-aged adults.

“The typical kind of guilt, you know, ‘it’s your duty to do this or if you don’t do this, bad things will happen’ that we’ve kind of been using so far, it doesn’t work on that group,” Morse said. “They completely just ignore it and turn off.”

“They’re more motivated by, ‘Remember this? We can get back to that if more people get vaccinated,'” Morse said.

Friedhoff, the professor at Brown University, puts the blame squarely on the country’s lack of attention toward young people up until this point, which now feels critical.

“We have not at all prepared our young population for their time to get the vaccine,” Friedhoff said. “If anything, we’ve been talking for months about wait your turn.”

That some young people aren’t eager to get their vaccine yet “doesn’t mean that they have made a conscious decision not to get the vaccine,” she said.

From where Miller sits, in rural Mississippi, it will be a “marathon, not a sprint.” There won’t be another giant wave where everyone decides at once that they’re comfortable and eager to get the vaccine, she said.

“But as we talk to people, I do think we’ll be able to reach them,” Miller said.

She said she’s comfortable with the idea that time might have a stronger influence than any study she can show a patient in a doctor’s office.

“As long as they agree to just continue to consider it, I’m on board with that,” Miller said.