Who is left to be vaccinated against COVID-19, and why is it the toughest task yet? – MLive.com

More than 4.44 million Michigan residents got vaccinated against COVID-19 during the first five months shots were available.

In the five months since, another 1.03 million have slowly followed suit, bringing the state’s vaccination rate up to 63.7% among its eligible population (12 and older).

That leaves Michigan, as of late October, with almost 3.12 million eligible residents unvaccinated, despite significant safety and efficacy data, countless medical experts affirming the shots’ benefits, and even the FDA granting full approval to Pfizer’s two-dose shot.

Those who have access to, but haven’t yet gotten a vaccine, represent the toughest group to convince it’s a good idea, explained Sarah Zimmerman, a University of Michigan lecturer who specializes in communication strategies including persuasion.

They aren’t typically the type to be moved by a mass messaging campaign or swaths of data. Instead, they require individual efforts from people in their lives who they already trust, to help breakdown the anecdotes that have influenced their hesitance.

“It really has to happen at the dinner tables of America,” Zimmerman said. “While the health department should continue to do research and share stats, the movement really isn’t going to come from government mandates or more research being done.

“It’s going to happen on a person-to-person level with people they already know and trust in their community — their friends, religious leaders, leaders within the family unit. They are far more likely to make a difference to those still holding out than any public health warning.”

It’s also important to note that not every individual who is yet to be vaccinated is opposed to getting the shot. Some of the remaining holdouts face hurdles to getting vaccinated, like a lack of paid time off in case they get sick as a result of the vaccine running its course.

“Vaccine hesitancy is complex and it’s multiple in most cases, and sometimes it’s not even hesitancy at all,” said Shobita Parthasarathy, a professor of public policy at the University of Michigan. “Yet, we’ve sort of been putting everyone into the same bucket and kind of being very insulting often toward those communities and when they already feel alienated, it doesn’t help.”

Meeting people where they are

Zimmerman, who teaches a class at U-M on persuasive communication strategies, explained that people generally fall into four categories based on which communicator style works best to drive them to make a decision. Individuals don’t necessarily fall into the same grouping for each decision either.

“With such a massive audience, understanding that people think differently and make decisions in different ways is really important,” Zimmerman said.

As it relates to vaccines, the first and easiest group just needs a clear and concise message about what to do and why. The second group might need an inspiring or big-picture appeal about how the decision would benefit the society at large.

For those groups, mass vaccine awareness campaigns like the ones advertised by the Protect Michigan Campaign through TV and radio commercials, social media posts and billboards can be successful.

Kerry Ebersole Singh, director of the commission, said the campaign has used public opinion research, making slight tweaks to its messaging along the way based on those surveys and discussions with residents about their concerns.

However, the message has stayed pretty consistent — getting vaccinated is the best way to protect yourself, your family and your community, and the best way out of the pandemic.

The third group is more data driven and needs to see the studies and research to make up their mind. Those individuals were more likely to get vaccinated heading into the late spring and early summer months as more concrete data became available on real-world vaccine effectiveness.

For the last group however, those large-scale awareness strategies are less effective. Zimmerman referred to them as the “amiables,” noting that they likely make up a large chunk of the remaining holdouts.

“With much of the remaining group, it’s about trying to reach out to people exactly where they are, on a human level,” she said. “You have to do it in a kind and personal way and work to overcome that individual’s anecdotes that they’ve heard.

Those individuals have developed anchors around certain information that can be difficult to remove, and doing so typically requires strong one-on-one relationships.

Zimmerman said it can be beneficial to gently ask them why they feel a certain way to “loosen up some resistance” but hammering them with information can make them only dig their heels in deeper.

“At this stage, you need to be a trusted confidant for them to listen to you and that takes patience and humility, kindness and empathy, and it can be really hard,” Zimmerman said. “As you engage with those people, it creates a bridge and higher credibility and helps them in their own mind to maybe find the pitfalls in their thinking, especially if their decision is based on an anecdote that’s not based on the greater reality.”

The upcoming holidays will likely bring together family members with differing beliefs when it comes to the coronavirus pandemic and vaccines. Zimmerman offers a few tips for respectful dialogue including:

  • Know that it’s unlikely that you will change their view. That mindset removes the win-lose dynamic and puts you in a better position to make a difference.
  • Talk one-on-one instead of in a large group where a person might feel singled out and thus attacked.
  • Ask questions to understand how/why they have come to their particular viewpoint and be silent long enough to really hear their perspective.
  • Briefly share an anecdote that may sway them, like noting a healthy person you know who died of COVID-19 or explaining what led you to get vaccinated.
  • Find another person who that individual trusts and encourage them to discuss their concerns with them.

Getting the remaining holdouts vaccinated is a slower process. That’s why over the last five weeks, Michigan has averaged about 52,728 vaccinations per week, excluding booster doses. At its peak in April, the state put more than 680,000 shots in arms in one week.

Not letting institutions ‘off the hook’

When it comes to discussions about getting the remaining holdouts vaccinated, Parthasarathy said the focus is too often on the hesitant individual and not enough on the institutions that are to blame for their deep-rooted mistrust.

“We’re letting social institutions, government institutions off the hook the more that we focus on the individual as the source of the hesitancy,” she said. “There’s a lot more that can be done than simply lumping everyone together and focusing on convincing people or demonizing them. Clearly it’s not working very well.”

The U-M professor noted a number of well-documented cases in which communities of color were marginalized or mistreated by institutions that were meant to help them. She referenced “unethical human experimentation” such as the Tuskegee Experiment, during which the CDC studied the untreated progression of syphilis in impoverished Black men for decades after a cure was discovered, as well as the decades of forced sterilizations conducted in the U.S.

Those and other such events have likely contributed to the lower vaccination rates among minority communities. State vaccination data indicates that 40.8% of the Black or African American population has gotten at least a first-dose vaccine. That’s a lower rate than reported for Asian, Native Hawaiian or Pacific Islanders (57.2%), and for non-Hispanic white residents (50.5%).

The city of Detroit, Michigan’s most-populated city, has vaccinated about 47% of its eligible population, and only 39% have completed their recommended dosage. That’s considerably less than Leelanau County, which leads all other counties at 82% vaccinated, and ranks closer to the 10 least-vaccinated counties, all sitting below 50%.

Experts say concern around the vaccine itself, as well as physical, economic and social barriers have been a driving factor in Detroit’s low vaccine rates.

Parthasarathy also pointed to the “trust the science” narrative used by state and federal leaders throughout the pandemic as a failure to be frank about the uncertainties surrounding the novel coronavirus.

“There is a history of people feeling like these institutions are not operating in their best interest and more specifically that these institutions can’t be trusted to take care of us and we need to take care of ourselves,” she said.

“It’s not surprising that people say they don’t trust the scientists or physicians or policy makers; none of these are new phenomenon. They’re unfortunately part of American life and it’s only now that institutions are paying attention to those questions.”

In the short-term, Parthasarathy said communities need to put more emphasis on vaccine accessibility. That includes things like more pop-up clinics and door-to-door outreach, which the Protect Michigan Commission has engaged in for months.

She’d also like to see companies be required to provide paid sick time for people who get vaccinated, much like provisions put in place early in the pandemic. That would remove another barrier that some low-income residents still face.

As for longer-term ways to address historic mistrust, Parthasarathy said we need to do a better job of helping people feel better represented by their government, scientific and medical institutions.

“The institutions themselves can become more trustworthy if they pay attention to the concerns that people have because often times people have really legitimate concerns,” she said. “They’re not being heard and then they feel alienated and this cycle continues.”

To find a vaccine near you, residents can visit Michigan’s COVID-19 vaccine website or go to VaccineFinder.org.

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