Who’s not getting the COVID-19 vaccine and why

Rachel Brown, MD

Family Medicine

Although the COVID-19 vaccine is available to everyone age 12 and older, many are choosing not to get one. Rachel Brown, MD, explained what the data is showing and why getting vaccinated is something we should still be talking about.

Why should we care that people are refusing the COVID-19 vaccine?

Dr. Brown said the majority of COVID-19 infections, and almost all deaths, are occurring among the unvaccinated population. There are breakthrough infections – people who get the COVID-19 infection even having been vaccinated – but those infections tend to be very mild.

“The increase in the rate of the delta variant infections is also concerning because we know that the delta variant is more easily transmissible,” said Dr. Brown. “The good news is that the vaccine does seem to be protective against the delta variant. So, vaccination is the answer to preventing infection and spread, and bringing an end to this pandemic.”

Why are people refusing the vaccine?

There have been studies looking at who is getting vaccinated, who is thinking about getting vaccinated, and who absolutely is not going to get vaccinated. Here’s some of the data that has come out of that research.

People who say they want to wait and see before getting vaccinated tend to be in one of three main groups: 18 to 29-year-olds, African American adult men, and the uninsured. “Unfortunately, the folks in the last two groups – African Americans and the uninsured – are at higher risk for getting the disease and having complications from it,” said Dr. Brown.

What are their reasons for not getting the vaccine? The most common responses are:

• I don’t need it because I’m healthy.
• I don’t trust that the vaccines are safe because they only have emergency use authorization.
• I’m concerned about myocarditis, or inflammation of the heart.

Dr. Brown said myocarditis occurs in a very small percentage of people who receive the vaccine – about 16 per 1 million people who’ve been vaccinated. Also, myocarditis tends to be mild, temporary and treatable. “There are folks who are at high risk for cardiac disease who may be reasonably concerned, but for the most part, this is a very rare, treatable consequence of the vaccine,” she said

People who say they’re healthy and COVID-19 won’t impact them are correct to an extent because most healthy people do well overall. But Dr. Brown offered two things to consider:

• We can’t predict who won’t do well. Young people still can get incredibly sick.
• Long haul COVID. One in every three people who gets COVID has prolonged symptoms up to nine months or a year, well past resolution of the infection. Symptoms include shortness of breath, brain fog, chronic fatigue, neurological and psychiatric consequences, and more. These can have a significant impact on quality of life.

What might convince the “wait and see” group to be vaccinated?

Dr. Brown said studies have found that no incentives, mandates or requirements are persuading people to get the vaccine. But there are two elements that seem to be most successful – engagement with a primary care provider and persistent messaging.

Why? When someone goes to their primary caregiver, they can have their personal questions answered. This tends to be the most effective way to move someone from a hesitant vaccine status to getting the vaccine.

The other element that seems to be useful is persistent messaging. Continue to talk about the vaccine. Continually remind people that the vaccine is effective, safe and available.

Is the perk of not having to wear a mask an incentive to become vaccinated?

Not necessarily, according to preliminary data. People are not asked to prove that they’re vaccinated; therefore, despite the recommendation that unvaccinated people wear masks, it has been found that some unvaccinated people are no longer following that recommendation.

Why should those who are hesitant get vaccinated?

In addition to protecting against COVID-19 infection, Dr. Brown offered these reasons for getting the vaccine:

1. Reduce the disease burden. We know that the more people who get the vaccine, the less likely we are to see an increase in disease and, therefore, the less likely we are to have to go back to social distancing, masking, etc.
2. Prevent the virus from mutating further. The concern is that if we still have a large population that is able to pass this virus around, there is the opportunity for that virus to develop a mutation against which the vaccine is no longer effective.
3. Prevent or resolve long haul COVID. Data has shown that when people with long haul COVID got the vaccine, their symptoms resolved.

“So, another wonderful reason to get the vaccine, other than it could prevent infection, is that it’s the right thing to do civically, and it could help put an end to this pandemic – and that’s what we’re all ultimately going for,” said Dr. Brown.