Editor's note: Information on the COVID-19 crisis is constantly changing. For the latest numbers and updates, keep checking the CDC's website. For the most up-to-date information from Michigan Medicine, visit the hospital's Coronavirus (COVID-19) webpage.

Vaccines only work if people take them.

Health experts have said that ending the COVID-19 pandemic relies heavily on the vast majority of people getting vaccinated to safely reach herd immunity and limit the ability of the coronavirus to spread.

Yet, according to a recent University of Michigan sponsored National Poll on Healthy Aging, just 58% of adults aged 50 to 80 asked in fall 2020 said they'd get vaccinated against COVID-19 when it was their turn. Other more recent polls see that willingness is increasing as frontline healthcare workers, essential workers and older people are vaccinated. Yet, many remain hesitant for various reasons.

One vocal source of opposition appears to be made up of people with certain strongly held political and cultural beliefs on topics that range from opposing public health mandates or vaccines in general, to supporting fringe groups and white nationalism. Members of this widely varied group briefly shut down a mass vaccination site in Los Angeles in late January.

"The overwhelming whiteness of the anti-vaccine movement is worth noting," says Anna Kirkland, Ph.D., J.D., who is the Arthur F. Thurnau Professor of Women's Studies, director of the institute for research on women and gender, or IRWG, and a professor of health management and policy.

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This group is "fundamentally led and funded by the right wing, particularly unregulated quackery," she said in a recent webinar on vaccine hesitancy sponsored by the Center for Bioethics and Social Sciences in Medicine. The inner core of this group is likely unreachable when it comes to persuading them to get vaccinated against COVID-19, she says. The question is whether their beliefs will spread—like the virus itself—even more widely, and convince those who haven't yet firmly made up their minds about vaccination.

However, there is a difference between the small group of people who are strongly against vaccines in general and "the large swath of the population who is hesitant, questioning what is right for them, their families and their children," says Brian Zikmund-Fisher, Ph.D., professor of health behavior and health education at the University of Michigan School of Public Health.

He and Kirkland joined Susan Woolford, M.D., an associate professor of pediatrics, and Abram Wagner, Ph.D., a research assistant professor in epidemiology, to discuss techniques for reassuring this latter group, with advice for understanding and communicating with people who have doubts about the COVID-19 vaccines in particular.

Some of these doubts can be traced to the difficulty many people have with assessing personal risk. For example, many worry about the long term effects of the vaccine. While it's true that the first volunteers for COVID-19 vaccine clinical trials were vaccinated just months ago, past knowledge about vaccines still applies to these new vaccines.

Says Woolford, "If something were going to happen, it probably would have in the first month or two. And the fact that it hasn't is reassuring," especially given the large number of people who signed up for the vaccine tests last summer and fall, and the millions who have been vaccinated in the past two months.

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Furthermore, the benefit of the vaccine should be put in the context of the very real and known threat of COVID-19 itself, says Zikmund-Fisher. "We know from the psychology of decision-making that people's risk perceptions are intimately linked to their benefit perceptions," he says.

"If we have a conversation about vaccine hesitancy, we also need a conversation about vaccine need and the threat and seriousness of the disease," he emphasizes.

That means reminding vaccine-hesitant people that COVID-19 itself may have long-term effects, long after the immediate risk of serious illness and death that far exceeds that of another vaccine-preventable disease, influenza.

Convincing people of the benefits of vaccination can't rely on just facts, Zikmund-Fisher stresses. A person's risk assessment doesn't come from facts but from experience.

"The fact is COVID-19 is not something most people are experienced with until it's too late," says Zikmund-Fisher. "Until we know someone who is already sick, died or spread it in our family, we don't necessarily have that first-hand experience, and that's one of the things that makes it hard to be concerned about it."

He recommends that more people should share their experience with COVID-19 to make it more real for the unvaccinated.

Wagner says the same technique applies for the vaccine itself.

"For some people, seeing their coworkers and people around them get the vaccine and be healthy will lead to them wanting it too."

Building trust for vaccines

For many Black people in the U.S., vaccine hesitancy is based on a long history of mistrust of the medical establishment and persists despite the disproportionate effect of COVID-19 on the Black population in the U.S. A recent Kaiser Family Foundation poll found that Black adults were amongst the least likely to say they would get the COVID-19 vaccine.

"As a community engaged researcher and a Black person in America, when faced with the issue of COVID-19 and vaccination, not only are we dealing with concerns about [the vaccine being developed] very quickly and the political climate, all of these decisions are being made with the background of bias and health disparities for decades," says Woolford.

A history of—and in some instances, ongoing—mistreatment by medical providers has eroded trust within this community. So have ongoing inequalities in access to care. In an effort to change this and encourage vaccine uptake, Michigan Medicine has dedicated resources to engage underserved communities and provide information within a historical and social context. As Woolford says, "people will care about what we know about vaccines when they know that we actually care about them."

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A recent webinar, co-sponsored by the Program for Multicultural Health featured trusted messengers, including Bishop Harry S. Grayson, who described his harrowing experience after being hospitalized with COVID-19. Kiela Samuels, PharmD, and Jessie Kimbrough Marshall, M.D., an adjunct assistant professor in the Michigan Medicine Division of Hospital Medicine, also talked about instances of medical abuse and answered questions about the vaccines. "Thank goodness we have the vaccine," said Samuels during the webinar. "That piece is going to help us reach herd immunity faster."

Overcoming vaccine hesitancy

Trying to convince someone to be vaccinated? Here are seven more key pieces of advice from these U-M experts:

1. Provide emotional support. Say "I know there is uncertainty, but this disease is scary. I got the vaccine (or am planning to) and I want it for my family and want you to get it too."

2. Acknowledge uncertain risk. People react very strongly to any kind of new risk, or perceived risk from something they have no experience with. But it's not the case that we go through life never facing risk: we face it every time we drive our car, or allow our kid to ride their bike down the street. The threat of COVID-19 is real and increasing, and while it is reasonable to wonder about the vaccine or seek more information from reliable sources before deciding to get vaccinated, getting vaccinated will reduce risk to yourself, your loved ones and society as a whole.

3. Talk about known risks. Let people know what to expect when getting the vaccines, from common side effects like muscle soreness and fever to the rare risk of allergic reactions. Talk about what's being done to monitor and respond to those reactions.

4. Provide information for information-seekers. Share articles from reputable sources to combat misinformation about the vaccines and their safety and efficacy.

5. Partner with communities. Approach patients who are skeptical with transparency and respect. For example, with Black communities, acknowledge the problems that exist and partner with those with long-standing relationships in the communities to provide information.

6. Share your experience. Saying "go get the vaccine" is one thing; showing that you are willing to do it openly is another, and even more powerful.

7. Tap into people's desire to protect. Use those pre-existing motivations to protect friends and family, and frame getting vaccinated as something you and everyone can do concretely for the people you love.

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