Many officials have given up on those hesitant about COVID-19 vaccinations, but new data on vaccine accessibility, community structure, and human behavior and beliefs show that such people may be less hesitant than originally thought.
A major data challenge, particularly in public health, are limitations when forced to use a few binary and numerical data types to describe diverse communities of people with differing needs, health, beliefs, and backgrounds. Data has proven to be one of the most valuable elements of our COVID-19 response; however, now that only a little over half of the U.S. is fully vaccinated (a number that may decrease if people forego booster doses), data on cases, deaths, and vaccination rates is not sufficient to understand and combat the specter of “vaccine hesitancy.”
“Vaccine hesitancy” is a nebulous phrase that refers to the black box of assorted reasons people cite for not getting COVID-19 vaccines. This carries quite a stigma that risks alienating populations for remaining unvaccinated even if it may not be due to malicious or selfish intent. Public health officials have labeled entire swaths of the country as “vaccine hesitant,” when the underlying reasoning may have nothing to do with COVID-19. We need to better understand hesitancy and why people make the choice to vaccinate, or not, to push for more complete vaccination, requiring new data streams on vaccine accessibility, human behavior, and community structure.
Dr. Jennifer Nuzzo and I recently discussed issues with testing and the need for data on testing accessibility to address inequalities. Many of the same points remain true with regards to vaccine data, as shown by this modified closing line:
While the U.S. vaccine supply is sufficient, it is unclear whether everyone can access a vaccine. The CDC’s vaccine accessibility site1 demonstrates that COVID-19 vaccines are available in all corners of the country. Take the example of Wolf Point, MT (shown below), whose zip code contains a population of just 5,838, most of whom are Native American.2 Even in an area with low population density, there are three vaccination sites within an hour’s driving distance. This data suggests that geographic availability is not wholly indicative of vaccine accessibility.
Even if vaccines are present in a person’s area, they may be unvaccinated due to unrelated problems: they can’t leave work, they don’t have transportation, they don’t have childcare, or vaccine appointment times are inconvenient. While the CDC’s vaccine accessibility data is a powerful data set, it indicates that we need more data to understand why people are not getting vaccinated even if vaccines are available nearby.
Every element of society is influenced by human behavior, from advertising to politics, making data on individual behavior invaluable to corporations like Facebook.3 One of the more successful ventures with collecting and aggregating behavior data during the pandemic has been the COVID Behaviors Dashboard, led by the Johns Hopkins Center for Communication Programs. For more information on the COVID Behaviors Dashboard, please read our recent Q&A with Marla Shaivitz and Dr. Dominick Shattuck.
The figure above, from the COVID Behaviors Dashboard,4 highlights the barriers to vaccination faced by those who would definitely or probably get vaccinated, but have yet to do so. As of Sept. 30, 16% of respondents couldn’t get an appointment time that worked for them, 16% couldn’t take time off from work or school, and 10% couldn’t get to a testing site, proving that just because there are vaccines available does not mean people can access them.
Behavior data also helps us to understand the beliefs that drive vaccine hesitancy, even for people self-identified as unlikely to get vaccinated. As discussed by Dr. Filipe Campante and Drs. Janice Bowie and Darrell Gaskin, determining the right messengers is just as important as devising the right message. Data on why people are unvaccinated can help identify those ideal messengers. The image below4 shows that, compared to other countries, religious beliefs and fears about side effects dominate in the United States. This indicates that religious organizations may be even more valuable vaccine-outreach partners5 and that health organizations could prioritize assembling and presenting data on vaccine side effects. Data on human behavior deepens our understanding of the motivations of unvaccinated populations and can inform the development of more effective outreach strategies as opposed to labeling these populations as “hesitant” and giving up.
Social determinants of health and human behavior are influenced by the environments in which people live, and we can collect data on them. In their recently published study, Ensheng Dong and Dr. Lauren Gardner investigated the role of certain community variables on vaccination rates.6 The two Johns Hopkins researchers found that social determinants of health play a major role in a community’s vaccine uptake. The more conservative, rural, poor, uneducated, and vulnerable an area is, the less likely its inhabitants are to be vaccinated. None of those characteristics are damning of individuals, but they reveal that the failure of our country to equitably support everyone’s health is playing a major role in vaccine uptake.
As I testified to before Congress, we need more and better data on the social determinants of health. The study by Dr. Gardner, director of the Johns Hopkins Center for Systems Science and Engineering, clearly shows that such community elements are major influences in convincing people to get vaccinated. When the problem is systemic, it may be outside the scope of public health professionals to solve vaccine hesitancy without major government investment of time and resources. The data should encourage policymakers to address issues of health access, health literacy, and wealth inequality as sources of vaccine hesitancy.
Taken together, these new data streams show that “vaccine hesitancy” isn’t necessarily hesitancy at all. The fact that an individual is still unvaccinated could be due to lack of access, missing support systems, or a lack of community investment. In the more than 40% of the U.S. population that remains unvaccinated, there are, of course, still many people who insist on selfish, dangerous opinions concerning the COVID-19 vaccines; however, these data show that the majority of vaccine hesitant people may simply not have received the support and outreach they deserve.
Title image provided by Marco Verch under Creative Commons License CC BY 2.0.