While most people are eager to get their Covid-19 vaccine when their turn comes, some have questions and concerns. We may even face the possibility of vaccine delayers and resisters leading to a longer pandemic, with more Covid variants and further surges in the disease. 

As of March 4, Marin County had vaccinated almost a quarter of its adult population with at least one dose. There continue to be obstacles for people who want to get their vaccine; supply-side issues, continual changes in the eligibility criteria, difficulty accessing locations, language barriers, technology limitations, long phone waits and transportation all remain impediments. But with emergency approval of three types of vaccines, the promise of enough for every adult in the United States by the end of May marks huge progress. 

Some people did not want to be the first in line, but now that the vaccine rollout has shown good results, they are feeling much more comfortable. Others are feeling better about the Johnson & Johnson single-dose vaccine because they don’t like needles, or because of the inconvenience of two shots. Others may have misinformation about Covid vaccines or a distrust of science or government. 

At the far end of the spectrum are anti-vaxxers, people who subscribe to conspiracy theories or denialist views about vaccines and other aspects of medicine. People with these views are likely to be resistant to all vaccines, and sometimes present a combination of pseudo-scientific thinking with distrust of government, technology or science. There is an ugly history of antivaxxers spreading disinformation; the downside of the internet is the rapid spread of false information and the echo chamber of listening only to those with similar thinking.  

So how should you talk with your friends and family about their vaccine concerns?

If friends express concern or hesitancy about the vaccines, start by asking them questions and listening carefully to their concerns. As you listen, think about what issues they bring up—information/misinformation, trust/mistrust, values and faith. Listen respectfully and find what common ground you share. Find out where they get their information. Avoid arguing or shaming. Fact-based arguments won’t convince someone whose resistance is based on non-fact related reasons, so understanding their concerns may help you have a meaningful conversation about why they are hesitant. Allow people to save face and not dig themselves more deeply into antivaxx views. 

Gathering information and having questions and concerns is part of normal decision making, but there is a difference between conspiracy theory and a healthy democratic skepticism of government, politicians and pharmaceutical companies. Asking friends who are vaccine hesitant about their beliefs may help you understand if they have an issue with misinformation, mistrust or values. 

Science-based health information is presented with full transparency, which means that as new information becomes available, advice can change. For example, at this time, all three Covid vaccines with emergency approval are safe and effective, but over time we may discover that one lasts longer, or it may be that we need booster shots. Science-based advice changes with new information, while dogma and polemics resist change no matter the evidence. People tend to get defensive about new information that is inconsistent with their beliefs.

Misinformation can come from clickbait online, rumors heard from friends, or news outlets looking for controversy. 

Lower rates of vaccination of people of color are often blamed on resistance stemming from horrific treatment in the past—such as the Tuskegee syphilis study—but actually reflect the many obstacles to access faced by non-white populations.

Misunderstandings can come from attributing any event that occurs after a vaccine to the vaccination. Some websites profit from pandering to an antivaxx agenda. 

Reliable sources of information about Covid vaccines include Marin County’s public health website and the Centers for Disease Control. Local voices are important in making people comfortable with vaccine information and seeing photos on social media of trusted friends and even celebrities provides some cultural context to our choices.

Messaging around Covid and the pandemic has been confusing for many, with changes in business, school and mask advice, and the painful isolation of quarantine. This has led to understandable problems: frustrated kids and parents, financial heartbreak and anger directed at politicians, public health officials, unions and school districts. 

Some have concerns about the emergency approval status of the vaccines, and distrust how rapidly they were created. Yet the rapid development reflects the huge resources that were poured in. Testing has shown that each of the vaccines is safe and effective. They do what they are designed to do: prevent serious disease and death from Covid. 

While you may intuitively believe that people would want to get vaccinated to prevent harm to themselves and others, vaccine resisters and delayers may be working off of different intuitions. Some social science research suggests vaccine delayers and resisters may value personal autonomy or ideas of personal liberty, purity or naturalness over harm reduction and community, and they exhibit a greater rejection of authority. People who believe Covid-19 conspiracy theories tend to struggle with scientific reasoning, making them more prone to pseudo-scientific disinformation. One study noted that higher levels of vaccine hesitancy were associated with lower accuracy in frequency estimation of negative events and overestimation of rare events, especially negative ones.

Arguments about not wanting to put something “unnatural” into their body is one way of expressing this moral value of purity. Discussions about what is natural versus unnatural are generally not fact-based, but more connected to faith-based belief systems, in that what one may characterize as natural, pure or godly is not really open for challenge in the same way that specific information is. 

Those with anti-vaccine views may be particularly susceptible to the Dunning-Kruger effect, in which people with limited knowledge or competency overestimate their knowledge and abilities. Rebecca Solnit’s characterization of “mansplaining” has some overlap with this phenomenon.

So talk with your vaccine hesitant friends about what they are thinking and why, and offer information or discussion, but don’t get drawn into the weeds by trying to dispute every bit of misinformation. As we see more people vaccinated with good results, and with cases and deaths dropping, most people will likely be comfortable getting their vaccines. The focus should be the good news, greater vaccine availability, and a timely return to more normal activities and socializing. We are not done with the pandemic, there are still concerns about variants, and we may be wearing masks for a long time. 


Dr. Martha Singer is an orthopaedic surgeon with interests in disability and medical ethics. She practices in the East Bay and lives part time in Inverness Park.