The many different types of vaccine hesitancy

Most of the people who are vaccine hesitant aren't actually conspiracy theorists.

Maija Kappler 9 minute read July 28, 2021
vaccine hesitancy

Understanding why a person is hesitant may provide insight into how you can provide them with accurate information. Getty

Not enough people are getting vaccinated.

It’s true in Canada, where vaccination rates have started to stall. It’s also a problem in the U.S., particularly in southern states like Alabama, Mississippi and Arkansas, where only about 35 per cent of people have gotten the jab. And as variants continue to emerge around the world, once again overloading intensive care units, convincing people of the benefits of getting vaccinated is becoming more critical than ever. 

So, what’s the trick to swaying the vaccine hesitant?

According to one expert, it’s all about sharing accurate information and then talking about it.

“There are some people who just will not get vaccinated, whether it be for COVID-19 or other things,” says Dr. Susy Hota, infectious diseases specialist at Toronto’s University Health Network (UHN). “But the hesitancy is a very different group: a lot of times it’s people who haven’t had access to the right kind of information to help them make a decision that they feel comfortable and informed making, and what they hear in the media may not be addressing their actual questions and their concerns.”

According to an Abacus poll released Tuesday, 30 per cent of Canadians said they were hesitant about getting the COVID vaccine in early March. Today, that number is way down at eight per cent. That’s a significant decrease, but it still leaves about 2.4 million people who — although they haven’t ruled out getting vaccinated — don’t yet feel comfortable enough to do it. (Another eight per cent refuse to get the vaccine — a statistic that hasn’t changed between early March and late July.)

Hota told Healthing that she’s found that one-on-one conversations really help to increase the comfort level around vaccination among hesitant people. Often, she and her colleagues end up repeating the same concepts, including things that have been published widely — but even when it’s repetitive for them, it’s new to a lot people they talk to.

“There’s a value in hearing from someone and having the opportunity to have a back-and-forth discussion,” she says. “It can be really valuable for people who are hesitant.”

Here are some of the common concerns she often hears about vaccines, and some of the ways that are most effective at addressing them.

Confusion over public messaging
Public health recommendations on COVID has changed as our understanding of the virus has changed. That’s normal in the medical community, but to the average person, it can seem like experts are flip-flopping because of lack of knowledge.

The confusion around the AstraZeneca vaccine is an example of this, Hota says. The vaccine was said to be safe, then there were reports it was unsafe in older people, and then, unsafe in young people. Canadians were encouraged to get it if it was offered, but were also told an mRNA vaccine might be preferable. Then people who had received AstraZeneca worried they might not be eligible for international travel.

“There was so much back and forth, and so many changes, not just within Canada, but everywhere,” Hota says. “And not just the message was confusing, but also the changing data that we’re getting over time. I think that shook a lot of people’s confidence in all of the vaccines.”

The media plays a role in this too: sometimes a news story will get a lot of attention, but an update or retraction that comes later is given less airtime. That was the case with a study published by JAMA in late June that initially reported it was dangerous for kids to wear masks, a claim that created a stir, especially in the anti-lockdown crowd. The study was retracted two weeks later because the research was faulty, but the damage was done — the error made scientists look as if they were uncertain and did not help to increase confidence in the experts.

How to combat it: Acknowledging someone’s confusion can go a long way — it’s true that public health recommendations have changed a lot, and that that can make it hard to know what to do. But despite the evolving rules, one thing that the world’s foremost experts agree on is that vaccines are safe and effective.

Misunderstanding side effects vs. adverse effects
Some people report no side effects after being vaccinated; some feel awful for days. But there doesn’t seem to be a clear delineation between feeling sick as your body builds up antibodies to the virus, and feeling sick because the vaccine is bad for you.

“People do sometimes mix up the side effects — which we expect to happen when you get a vaccine because it’s a sign that your body’s reacting to it — with something serious or bad happening, or there being an ill effect on the body,” says Hota. “There’s confusion between side effects and adverse effects — things we weren’t expecting to happen, the unintended consequences that are separate from your body’s response to any vaccine.”

How to combat it: Assure people that feeling slightly ill after the vaccine is normal: our bodies are responding to the vaccine and building up immunity. (If you’re interested in a specific breakdown of what that process looks like, here are some explainers from the U.S. Centers for Disease Control and Prevention, and from McGill University’s Office for Science and Society.) Also note that the temporary unpleasantness is nowhere near as bad as a severe case of COVID. 

Lack of trust
Some people don’t trust that the government is truly acting in our best interests. Some of these concerns are totally illogical, like the racists who believe Bill Gates wants to microchip people.

But other people have completely valid reasons to be suspicious. For example, it’s understandable that racialized communities might not trust public health authorities. Only a few decades ago, the CDC conducted an experiment on over 600 Black men who told they were getting treated for “bad blood,” when in fact many had syphilis that doctors knew about but deliberately left untreated. The Associated Press reporter who broke the story in 1972 called the Tuskeegee syphilis study “one of the grossest violations of human rights I can imagine.”

But the reality is that people of colour are at a higher risk of developing COVID complications. Some of these reasons are systemic: there are often barriers preventing people of colour from accessing adequate medical care, and accurate and culturally-relevant information from sources they trust. Science communicator Dr. Krishana Sankar previously told Healthing that groups like Regina, Sask.-based Indigenous health lab Morning Star Lodge and Toronto’s Black COVID Task Force are doing great work in this area, but that there isn’t enough funding for these kinds of groups.

How to combat it: Again, acknowledging the validity of someone’s concerns can go a long way. But remind them that the risk of staying unvaccinated is far greater than the risk of vaccination. Look for community-specific information or a trusted leader if you can. Religious authorities, community leaders, local experts and family doctors can all make a big difference, says Hota.

“I don’t need it, I’m young and healthy”
A common refrain among vaccine-hesitant people is that COVID isn’t that bad, and that getting the virus would barely impact people who are young and otherwise healthy. 

“A lot of people remember the messages from the early stages of the pandemic, where the vast majority of individuals getting really sick and dying from COVID-19 were older Canadians, people in long-term care,” Hota says. “At the beginning, the whole thing was a lot scarier to people, and everyone was paying more attention. So that thought, that ‘this is a disease that only affects older people,’ is burned into many people’s brains.”

By the pandemic’s third wave, a notably different age group started making up the bulk of new cases and hospitalizations: people in their 20s, 30s and 40s. But by that point, it was hard to get people to understand that even the young and healthy could get seriously ill or die from COVID.

How to combat it: Showing a young, healthy person the recent statistics might make an impact on them: over the last three months, 96 per cent of people in Ontario between the ages of 19 and 29 who were infected with COVID-19 were unvaccinated. And while it’s true that young, healthy people are less likely to die, it’s not impossible. Canadian-born Broadway actor Nick Cordero was only 41 when he died last summer. Before contracting COVID, he was in great health. But he suffered severe complications from the virus, including heart attacks, sepsis, a tracheotomy and leg amputation, and died three months after contracting COVID.

An unvaccinated person, even if young and healthy, also poses a risk to others — protecting those they love may be a vaccine motivator.  

“The vaccine doesn’t work since vaccinated people are still getting COVID”
Breakthrough infection — when the virus breaks through the barrier of the vaccine — happens sometimes, but they are rare and usually cause mild symptoms, or none at all.   

“The goal was never to eradicate COVID from being annoying—it was to eradicate it from being a killer,” emergency medicine physician Dr. Dara Kass told Slate. And all evidence so far points to the vaccines as being very effective at that goal. In fact, the director of the CDC, Dr. Rochelle P. Walensky, has started calling COVID-19 the “pandemic of the unvaccinated“: while vaccinated people might get COVID and recover, many unvaccinated people who get it will not.

“Our biggest concern is that we are going to continue to see preventable cases, hospitalizations and, sadly, deaths among the unvaccinated,” she said earlier this month. “Do it for yourself, your family and for your community. And please do it to protect your young children who right now can’t get vaccinated themselves.”

How to combat it: The statistics tell a very clear story: 99.2 per cent of COVID deaths are in the unvaccinated population. So while it’s possible vaccinated people could get the virus, the odds of dying from it are low — which is not the case for the unvaccinated.

Convincing people to get the shot is difficult, but Hota hasn’t lost hope. She’s on a mission to change minds.

“Every time you do [an info] session, you have maybe 20 people in the room who are sitting on the fence, and you get through to a small number of them each time — maybe five, maybe just three,” she says. “It’s a lot of effort for three people or five people, but that’s how you have to do it. You just have to pick away at it.”

COVID Resources Canada hosts a twice-weekly Zoom call where volunteer scientists and experts answer questions about the COVID-19 vaccines for people who have concerns.