LEXINGTON, Ky. – Nearly 40,000 doses of the COVID-19 vaccine developed by Pfizer have been delivered to 11 Kentucky hospitals and administered to front-line healthcare workers. Nearly 30,000 more doses of the Pfizer and 100,000 of the Moderna vaccine are expected to arrive over the next two weeks.

Transporting and administering the vaccine seems to be the easier part of the rollout, while experts feel as though one of the more difficult tasks is expected to be convincing members of hesitant groups to the vaccine.

Hesitant groups

A Kaiser Family Foundation (KFF) study shows about a quarter (27%) of the public remains vaccine-hesitant, saying they probably or definitely will not get a COVID-19 vaccine even if it were available for free and deemed safe by scientists. Vaccine hesitancy is highest among Republicans (42%), people ages 30-49 (36%), and rural residents (35%) – those three groups represent a substantial portion of Kentuckians. 

Thirty-five percent of Black adults, a group the KFF study shows has “borne a disproportionate burden of the pandemic,” say they definitely or probably will not get vaccinated, as do one-third of those that say they have been deemed essential workers and 3-in-10 (29%) of those who work in a healthcare delivery setting.

Different groups have different reasons for COVID-19 vaccine hesitancy, according to the study.

Among those hesitant to get a COVID-19 vaccine, the main reasons are worries about possible side effects (59% cite this as a major reason), lack of trust in the government to ensure the vaccines’ safety and effectiveness (55%), concerns that the vaccine is too new (53%), and concerns over the role of politics in the development process (51%). About 4-in-10 cite as reasons the risks of COVID-19 are being exaggerated (43%) or they do not trust vaccines in general (37%), while a third say they do not trust the healthcare system (35%), and smaller shares say they are worried they may get COVID-19 from the vaccine (27%) or they don’t think they are at risk of getting sick from the virus (20%).

Members of different racial groups have somewhat different reasons for being vaccine-hesitant. Black adults who are vaccine-hesitant are more likely than white adults to cite concerns about side effects (71% vs. 56%) and the newness of the vaccine (71% vs. 48%) as major reasons for not wanting to get vaccinated. About half of Black adults who say they probably or definitely will not get vaccinated cite they are worried they may get COVID-19 from the vaccine (50%) or that they don’t trust vaccines in general (47%) as major reasons.

Reasons for vaccine hesitancy also differ somewhat by partisan identification. Among Republicans that say they will not get vaccinated, a top reason is they think the risks of COVID-19 are being exaggerated, which was named as a major reason by 57% of Republicans who are vaccine-hesitant and 24% of all Republicans.

Experts say the mistrust can be seen in the lack of diversity among vaccine trial participants and efforts to diversify the national COVID-19 trial registry have fallen short of the goal for it to reflect the distribution of disease burden within the population, according to a previous article by Spectrum News 1 national health reporter Erin Billups. COVID-19 Prevention Network Executive Director Dr. Jim Klubin said fewer than 12% of participants in vaccine clinical trials were Black or Hispanic. The CDC reports 37% of COVID-19 infections are among Blacks and Hispanics in instances where race was recorded. 

Why are certain groups hesitant?

American Medical Association President Dr. Susan Bailey said she’s worried about the number of adults that do not intend to get vaccinated and say more information will not change their mind.

“Experts estimate that up to 80% of people will need to be vaccinated in order to slow the pandemic spread,” Bailey said. “It is so important that we educate the public about coronavirus vaccines in a responsible way without unintentionally fueling vaccine hesitancy because we are right at the beginning of the deployment of vaccines and there’s so much to be hopeful about in the future.”

National Medical Association (NMA) President Dr. Leon McDougle said questions of political influence on the scientific process because of Operation Warp Speed (OWS) have threatened the public trust in the Food and Drug Administration (FDA) and adversely affected participation in clinical trials, especially among the Black community.

“The protocols for the OWS clinical trials are overseen by the federal government, as opposed to traditional public-private partnerships, in which pharmaceutical companies decide on their own protocols,” McDougal said. “Rather than eliminating steps from traditional development timelines, the steps have been proceeding simultaneously, such as starting manufacturing of the vaccine at an industrial scale well before the demonstration of vaccine efficacy and safety as happens normally.”

The abuse of Black slaves used as subjects of medical experiments is well documented. The scars run deep, even as effigies of scientists like J. Marion Sims, once celebrated for his medical breakthroughs, are ripped down in recognition of the crimes committed in the name of research.

“It is not just the legacy of the way Blacks have been treated by researchers in the past. It is the current day experiences of discrimination in the health care system that reinforce that mistrust,” said Dr. Lynn Richardson, emergency medicine professor and co-director of The Institute for Health Equity Research at the Icahn School of Medicine at Mount Sinai told Spectrum News 1. “There’s a lot of work that's going to have to be done to really promote vaccine acceptance in Black and Latino communities.”

Appealing to vaccine-hesitant groups

The KFF study revealed the importance of messages combatting particular types of misinformation may be especially important for increasing vaccine confidence among hesitant groups. 

There has been an increase in vaccine willingness among Black, Hispanic, and white adults, with the most dramatic rise among Black adults, among whom willingness to get vaccinated increased from 50% in September to 62% in December. While Black adults were about evenly split in September on whether they would get a COVID-19 vaccine that was free and determined to be safe by scientists, they are now almost twice as likely to say they will get vaccinated as to say they would not (62% vs. 35%).

While a large partisan gap remains, willingness to get vaccinated for COVID-19 has increased for both Democrats (from 77% in September to 86% in December) and Republicans (from 47% to 56%), but has remained the same among independents (67%).

As public health and political leaders struggle to find ways to convince Black Americans and other affected groups that have been prioritized in distribution plans that the vaccine is safe, there is concern that others who should not gain early access to the vaccine will fill the void. 

“There are going to be so many people lining up who figured out every avenue to get it,” said Dr. Kristen Marks, lead investigator of Weill Cornell Medicine’s Moderna COVID-19 vaccine trial site. “One of the things I worry about most is that, you know, people who need the vaccine the most aren't going to be the people who get access to it.”

Experts and politicians are calling for an unprecedented level of transparency to build the necessary trust within vaccine-hesitant groups. Gov. Andy Beshear offered a glimpse of Kentucky’s vaccine education and engagement campaign Thursday, Dec. 17, during his COVID-19 briefing. Claire Tidmore, of Louisville-based public relations firm Doe-Anderson, said her agency is working on the campaign with the goal of ensuring “Kentuckians understand the vaccine roll-out plan, especially those most hesitant to take it.”

Beshear said the campaign will be unveiled in two phases – education and engagement – with education having three components.

“We want to assure awareness and public confidence about the safety and efficacy of COVID-19 vaccines,” Beshear said. “Second, we want to ensure understanding of the phased roll-out of the vaccine when that information is available, and third, we want to help Kentuckians know that by visiting kyCOVID19.ky.gov they can get trusted information about the vaccine,” adding the website will have updated information on Monday, Dec. 21.

The engagement phase includes appealing to Kentucky’s population groups to encourage commitment to taking the vaccine.

“Messaging will be shaped based on what we learned through community outreach efforts with Black, Hispanic, and rural populations,” Beshear said. “Specifically, what we learn in these discussions will help shape how we openly, honestly, and effectively communicate with those populations and ensure there is an equitable roll-out of this vaccine, that everybody gets protected, and we not only provide the information but also provide it in the best way to get as many people protected as possible.”

Beshear said the main goal of the campaign is reminding Kentuckians this “little shot” represents the end of “what might happen.”

“This little shot does more than keep you from getting sick. It gets folks back to work. It gets your kids back in school, it gets our economy up and running again,” Beshear said. “It's the road to getting back to so many things that we enjoy. It's a shot of relief. It's a shot of hope.”

The city of Lexington and the Lexington-Fayette County Health Department will work with state and federal messaging guidelines and use their current outreach teams to appeal to vaccine-hesitant groups, health department communication officer Kevin Hall said.

McDougal said the Black Coalition Against COVID – a consortium of four black medical schools, the National Medical Association, National Black Nurses Association, and the National Urban League – wrote “A Love Letter to the Black Community” with the goal of resonating with people of color with regard to getting the COVID-19 vaccine.

“The No. 1 concern you hear is that there's a legacy of mistrust in regard to medical research dating back to the Tuskegee syphilis experiment,” McDougal said. “There are a number of mishaps – unfortunate, painful historical events as it pertains to research – that speaks to the need to build these coalitions and involve Black people in the process.”