Why people won’t get vaccinated

Updated 23-Aug-2021

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This is by no means exhaustive, and is currently incomplete, but is meant to help me better understand those who are vaccine-hesitant and vaccine-rejectors in the face of the Covid-19 pandemic. In some cases a different category might be needed, such as vaccine-lazy who agree that they should get the vaccine, but don't feel an urgency to get it just yet, though this is likely a form of vaccine-hesitancy.

New, Untested, Not Yet Approved Vaccines

Some people say they are vaccine-hesitant because the vaccines are so new, not enough is known about them, and there are no studies regarding possible long-term side effects. It is true that vaccines are currently under emergency approval. However, that means that two months of follow-up of phase III trial data is available, and that thousands of cases are included in the submission.

It is clear and obvious that effective, safe vaccines are needed as quickly as possible, and the US FDA and the WHO have been fairly responsible in approving vaccines for use.

An enormous number of vaccinations have been given. As of 10 August 2021, 4.59 billion doses have been given with a fully vaccinated population of 1.25 billion (16%). We have significant and ongoing data and analysis which points to broad safety, especially when compared with the risk of contracting Covid-19 and its possible outcomes.

Vaccine Hesitancy

The American Academy of Pediatrics has an excellent primer on dealing with vaccine hesitancy, and how to speak with vaccine hesitant parents regarding their children's vaccinations. Interestingly, parents are more responsive to having their children vaccinated if given a presumptive rather than a participatory recommendation. That is, the doctors should declare the need and fact of vaccination to be provided for their children, rather than beginning with asking what the parent thinks about vaccines.

Fairness of Vaccine Distribution

There are many complaints that vaccines are being unfairly distributed. While true when looking across the average income data (rich countries gain access to vaccines more quickly), that is a small part of the overall picture. Here are some interesting facts (data as of 10 August 2021):

  • China has vaccinated 1.82bn doses of 4.59bn given worldwide, and it is a middle income country
  • India, a poor country, has vaccinated with 524m doses.
  • Indonesia, another poor country, has vaccinated with 78.2m doses (currently a greater percentage of its people are vaccinated than India)
  • Cambodia, yet another poor country has received 14.9m doses and 40% of its population is fully vaccinated

A lot of what determines vaccination is both money (the rich countries have it, and also paid for the development of vaccines), and either have their own vaccine development (such as China) or manufacturing (such as India), or were simply ahead of the curve when it came to

Social Media

Russian and Chinese state-actors and bots, massive disinformation mills,

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Right-wing Media

The propaganda and lies spread by it, and for what purpose. Influences from state actors.

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Anti-Vaxxers

History of these, who they are, how this has spread with Covid-19.

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Vaccines as a Conspiracy

Either the vaccines or the pandemic, or both are considered to be part of a conspiracy. The idea is that either the pandemic is fake, or that the reaction to it (shutdowns, masking, vaccines) are fake, and are meant to control the population in some way.

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Religious Exemptions to Vaccines

Very few religions -- in the United States, only Christian Scientists and the Dutch Reformed Church -- require a rejection of vaccines, and even those rejections are not wholehearted. Some religious adherents -- as opposed to leadership -- may interpret certain statements in their liturgy in order to reject vaccines.

There are some religious objections to vaccines dealing with how they were initially invented (using fetal tissue) or that they contain something forbidden by the religion. However, most religions do not specifically outlaw or forbid vaccination, as

The bigger problem with religious exemptions, is that anti-vaxxers call for people to claim a religious exemption when there is not religious basis to the claim, and many anti-vaxxers clearly state that they are not claiming the exception due to religious beliefs. This is because in order to receive a religious exemption, where available, one need only claim it. One need not prove or even indicate the religious basis for their exemption, only claim that there is one. It is fairly clear that the religious exemption for vaccinations, where they exist in the United States, isn't really about religion, per se, but the personal opinions or beliefs regarding vaccination of an individual (or that individual's parents). This is a form of conscientious objection.

While it is hard to examine closely, there is no reason to think most, or even a large share, of religious exemption requests to COVID-19 vaccines are from people whose opposition is religious. In fact, given the amount of misinformation about vaccine safety and the virus, chances are that most of the exemption requests are from people who do not want to get COVID-19 vaccines because of safety concerns or misinformation about the pandemic.

Granting exemptions on the basis of religion incentivizes these people to lie, and exemptions are more likely to be given to people who have lied well — for example, by getting input from anti-vaccine activists teaching others to game the system.

It seems to be the case that Religion is not in contradiction with vaccination and public health. It is only individual parents or religious leaders and their questionable interpretation of religious practices that are opposed to vaccination, no religion as such.

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Vaccines (and Masks) as anti-Freedom / anti-Liberty

Vaccines mandates are beginning to grow and resistance to them is as well. One can see the fault lines in the very simple requirement that one wear face-coverings (masks). How this is a violation of any sort of freedom (beyond that of the freedom to not contract the Covid-19 virus) is unclear. It is a simple ask.

However, there is obviously another side to this story, as there are people who distinctly feel otherwise, in particular about the mandatory masking of schoolchildren.

Mandatory vaccinations are seen as an effective improvement to vaccination rates, though there is concern it could increase resistance to vaccination. In Europe this is not usually the case, though any increase in vaccination requirements itself needs a large information campaign to accompany such changes.

These stances against vaccination or other measures to protect against Covid-19 are not equally shared in the population. In the United States, white evangelicals are more likely to be anti-vaccine and anti-mask. Even before Covid-19, in a 2017 research report, 20% of white evangelicals, more than any other group, believed that parents should be able to decide not to vaccinate their children, even if that may create health risks for other children and adults.

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Thoughtlessness

Because of the danger that a rejection of vaccines (and masks) yields with respect to the health of oneself and others, to what degree is a level of thoughtlessness (as opposed to outright delusion) a part of the ongoing problem?

The basic problem is one of inconvenience vs. risk to one's health, and more importantly the health of others.

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Diffusion of Innovation

The masterful book Diffusion of Innovation has many operationalized approaches to measuring the degree of diffusion of an innovation. It seems clear that applying these to the adoption of masks (both individual and by governmental bodies) and vaccines (again, by individuals and groups), would yield significant insight.