My brother, Dr Dave Ghilarducci, deputy head of public health in Santa Cruz County, is both concerned and understanding of people who do not receive vaccines. (On January 30, 2020, Dr Dave was asked if America was ready for the novel coronavirus, he said “our hospitals are not ready for Saturday night.”)
Data hits you like a ton of bricks. Having a COVID-19 vaccine significantly reduces the risk of hospitalization and death from COVID-19. Unvaccinated people commit suicide and vaccinate people by cluttering up hospitals and causing excessive deaths; “The pandemic has killed more than 700,000 Americans, but it has indirectly killed many more – all people with treatable health emergencies who have not been able to obtain care in hospitals overwhelmed with COVID patients. ”
Thus, scientists are urgently studying why 21% of eligible adults in the United States – and more in parts of Europe – refuse to be vaccinated.
In the United States, four characteristics of a person independently explain who is reluctant to vaccinate:
· People whose income depends on working outside the home;
· Have conservative political views;
· Have lower than average household incomes;
And have not previously tested positive for COVID-19.
Note that education, race, age and gender are not relevant factors in predicting vaccination. Yes, blacks are less likely to be vaccinated than whites, but this fact is not significantly related to being black; Blacks are more likely to have lower than average incomes and it is the low income that explains the reluctance, not the race itself. (If blacks had the same higher income as non-blacks, their vaccination rates would likely be similar.)
Cost vs. Benefit of COVID-19 Vaccine and Disease
First, people may not vaccinate or move away socially because they compare the costs with the benefits and find the costs of avoiding infection to be higher. For example, the cost of vaccine hesitation is in two parts: 1) the probability of being infected with COVID multiplied by the “total cost” of being infected with COVID-19 plus 2) the probability of infecting others and the cost of being sick with COVID-19. If you think these risks and harms are low and the vaccines are making you sick, the needles hurt, and emerging infections are occurring despite the vaccine, then the math is telling you to wait before vaccinating.
Dr. Spock (the Star Trek guy) would make that decision if he minimized the risk of illness and didn’t care about others.
Assessment of specific risks
Second, people make particular decisions just to belong to a group (perhaps this is why individuals identified as having conservative political views do not vaccinate and others get tattoos.)
In addition, avoidance of the vaccine is caused by different perceptions of risk. Italian sociologists and neurobiologists have studied vaccine reluctance which persists despite very high initial death rates in Italy.
Their results were counterintuitive. Oddly enough, people who go through super stressful events like loved ones and neighbors who die from COVID-19 can go both ways: become more fearful or take more risks. Those with relatively high degrees of “proactivity” – that is, being empathetic and more inclined to find social support and have creative coping strategies – were more likely to respond to community mask mandates and to get vaccinated. Their assessment of not vaccinating was risky and they also believed in people helping people.
A 2021 Brazilian study found that people with more to lose by avoiding work and people due to vaccine-induced illness are more likely to disregard recommendations for social distancing and other behaviors that prevent infection. Many people cannot afford a sick day and fear losing their income!
“On average, people tolerate a 38% risk of infection to leave their homes and earn a full salary. But when fear levels rise, they tolerate lower risks. If people’s perceptions of getting sick with Severe Acute Respiratory Syndrome coronavirus-2 were relatively high, they would only tolerate a 13% risk of infection to venture out of the house. Another light bulb went out. It’s not the poor who ignore social distancing. Middle to upper income people take more risks because they perceive prosocial behavior – staying home, getting vaccinated, moving away from society – will likely cost them money.
But fear is only partially linked to risk. Scientists explain the famous paradox that people who are phobic about dying in a plane crash do not fear the higher death threat of driving to the airport in a car in control. You drive the car; but not the plane. Unvaccinated people think that they cannot control the disease caused by the virus, but have 100% control over the disease caused by the vaccine.
How to communicate effectively
Canadian professors and public health experts have found that easy access to a free vaccine increases immunization rates, but different people have different levels of trust in a health authority, fear of needles, and being sick from a vaccine. Surprisingly, people fearful of risk have waited longer to get vaccinated only those at risk – neutral or at risk. It is the prudent who hesitate. This means that communicating a vaccine is 70% effective in signaling a risk for some.
A new and improved public service announcement could work. Maybe a graph showing they are going to the hospital is much higher for people who haven’t been vaccinated than for people who have.
What would Dr Dave do?
Dr Dave and colleagues advise staying away from areas of the country – Montana, Idaho, Arkansas – with hesitation about vaccination, if you are in a car accident or have a heart attack you may not be able to. not be getting medical attention.