In his March 2022 State of the Union address, President Joe Biden vowed, “We will never give up on vaccinating more Americans.” The reality, however, is that this is an uphill battle: vaccination rates have stalled, and with each new booster, fewer people are eager to get shots. While incentives, community clinics and mandates once made a difference, the number of people seeking vaccines, whether it is their first or fourth, has sharply declined. Health workers, community workers and volunteers tasked with vaccinating the remaining around 50 million Americans over 5 years old who haven’t received a single shot, and millions more who are not up to date on their Covid-19 vaccines, are overworked, underappreciated and underfunded. With the depletion of federal funding and congressional reluctance to renew funding, vaccination efforts may be even worse off during future waves.
At this critical junction, the nation is torn between those who want to focus on individual risks and choices, and those who want to dismantle systemic healthcare inequities. Vaccinations have become about ideologies, politics, inequalities and misinformation – and about who advances and who is left behind.
In our work at the Brown University School of Public Health, we focus on how complex, intersecting factors — behavioral and social drivers, information and structural factors — come together to shape people’s decision making about vaccinations. Alongside other researchers in this space, we find that unvaccinated and undervaccinated Americans are not a monolith, but instead diverse individuals with unique histories, identities and lived experiences — and more remain open to vaccination than public discourse may suggest, even among those who say they will not get vaccinated.
In early 2021, in a nation battered by a devastating pandemic, the prognosis was suddenly upbeat: Science had delivered a miracle.
Taking a closer look at those not yet vaccinated, we find concerns about Covid-19 vaccines among people of all races and ethnicities, faith groups, education and income levels, political leanings and affinity groups — but not the same concerns. We find people who never had or have lost trust in government and public health authorities, people who never had or no longer have any trusted messengers, and people for whom Covid-19 is just one of many threats to their health, safety and wellbeing, and by far not the worst. Some have more questions, some ask for more time for this important decision, some feel alienated, some are being misled, some don’t believe that Covid-19 is real.