Jennifer Reich, PhD, professor of sociology in CU Denver’s College of Liberal Arts and Sciences, is a national expert on the issue of vaccine hesitancy. As more and more people are eligible—and eager—to get vaccinated against COVID-19, her perspective can create understanding for the reasons why a small percentage of people are not yet signing up for an appointment.

Read her answers to the questions below to learn more about the reasons behind this reluctance and what you can do to help.

What’s the context for some people’s rejection of vaccines?

“There’s a small number of people who insist they never want a vaccine, that vaccines don’t work, or are never necessary, or are not safe enough to justify their use. Numerically, it’s a pretty small but persistent number. People have objected to vaccines since the very first vaccine in the 1800s.”

“In my work, I focus on the larger group of people who are labeled ‘vaccine hesitant.’ Those are the people who don’t say they’re against vaccines and don’t say they never want a vaccine, but who have questions or concerns about both the safety and necessity of recommended vaccines. They want more information, or want to wait until a vaccine feels relevant to them, their children, and their personal goals.”

“Thinking about the COVID vaccine, we have similar groups. We have a small number of people—somewhere around 12–15%, based on opinion polls—who say they never want a vaccine against COVID. But the more interesting group is the group of people who say they want to wait and see before deciding to get a vaccine, because that number has been coming down. As more vaccines are given out, fewer people are expressing a desire to wait, or are starting to feel persuaded that the vaccine is safe and effective.”

What are some of the reasons people feel hesitant to get vaccinated against COVID-19?

“We see younger people may be less interested in getting vaccinated because they perceive themselves to be at lower risk of severe outcomes of infections, and that people who are over 65 have much greater levels of enthusiasm for the vaccine because they are at greater risk of the worst outcomes. We see differences among people’s perceptions of risk and benefit. And that’s not surprising—all of us make decisions about how to weigh risk and benefit in our lives in a variety of ways.”

“Waiting to see or saying ‘no’ often feels like the safer path when it comes to vaccines, and we see that with childhood vaccines. In my research, I’ve talked to families who reject childhood vaccines, and they point out that polio hasn’t been seen in the United States since 1979, so delaying a polio vaccine feels like a low-risk decision. The math is really different on something like COVID, though, when we still have high levels of community spread. Waiting may not be the safer choice.”

How does misinformation affect people’s perception of vaccines?

“We definitely know there is some disinformation­—there is information that is knowingly untrue, that is put forward with the goal of dissuading people from using vaccines. It appears to be intended to sow discord among people on social media, to give people incorrect information on which to base their decisions. But what’s equally common is information that might have some kernel of truth, or be based on an isolated incident. For example, one of the largest, rapidly circulating stories in the first month of COVID vaccine distribution was about a nurse who fainted at the time of her vaccination, and there were reports that she died. It was reposted and shared as a kind of cautionary tale.”

“Wherever there’s a lack of formal information, as with COVID, we know the gap will always be filled with informal information. For a significant portion of the pandemic, there wasn’t a lot of formal, official information coming out about transmission, prevention, severity of disease, or the importance of mask-wearing. Without clear information, there were opportunities for disinformation and misinformation to fill that gap. Some of it intended to mislead people, but much of it was shared and spread by people who just want to be able to help others make informed decisions.”

Are there steps individuals can take to persuade members of the family to get vaccinated?

“One way to think about this is what not to do: I don’t know of any situation in which yelling at people or calling them stupid has ever been persuasive. So, although it can be really frustrating to encounter people in our lives who reject vaccines, it’s also important to hear what their concerns are. One of the lessons public health agencies have learned is the importance of two-way communication, which gives people a chance to ask questions and receive informed answers. Finding ways for people to receive answers to their questions can go a long way in helping people make informed decisions that feel relevant to them and their families.”

What’s been done to improve vaccination rates among vaccine-hesitant populations and to improve equity in vaccine distribution?

“We know that one predictor of who doesn’t want to be vaccinated tends to be the number of people they know who also don’t want to be vaccinated. Vaccine hesitancy clusters, and that can be really important to understanding each other’s experiences.”

“The initial hesitation amongst BIPOC communities was informed by a few different factors. One was a very rational understanding of the frequency of medical racism, the experience of having health challenges not be taken seriously on a daily basis, in addition to the long history of medical experimentation that has played out on Brown and Black bodies unequally. Therefore, some of that hesitation was quite logically wait-and-see until after a sizable portion of the population had received the vaccine.”

“Considering how vaccine hesitancy clusters, it’s also worth noting that the initial rollout of the COVID vaccines drew heavily on social institutions. It was rolled out through large health insurance programs, to healthcare workers who are disproportionately white and educated. It was rolled out through corporate pharmacy chains that often don’t exist in rural communities. Unsurprisingly, it most benefited those for whom these same social institutions already work well. The result is that there were initially big gaps in terms of race, income, and education when evaluating whether someone was likely to know someone who had gotten a vaccine.”

“The good news is we have moved past that in a lot of ways, and the desire to wait and see among people who are Black and Hispanic has declined significantly in the last month. Also, as accessibility has increased, more people know someone who has been safely immunized and have been able to talk to them about their experience.”

“States like Colorado have done a good job of prioritizing equity in the allocation process. Colorado has taken 10–15% of every week’s vaccine allocation and placed it toward equity efforts, making the vaccine accessible to pop-up clinics, community organizations, churches, and nonprofits that do not usual provide direct healthcare services, but are established points of contact in their communities.”

What does this mean for the future?

“Many of us have grown up thinking of vaccines as something you get once or twice in your lifetime for a disease you’ve never seen or experienced firsthand. With COVID, it is likely that this is going to be a kind of vaccine that will require boosters on a semi-regular basis. It may not be annual in the way that influenza vaccines are, but it may be more frequent than people are accustomed to.”

“One of the challenges right now is that we have learned a great deal about this virus, but we still don’t know everything. There is a great deal of evidence that these vaccines are safe and highly effective in preventing hospitalization, serious illness, and death. But we really don’t yet know enough about how long protection will last, how well it prevents transmission, and how that’s going to fit into our long-term strategies.”

“It’s tempting when we don’t know everything to assume we don’t know anything, but that’s a mistake. We’ve learned a great deal and we are continuing to learn every day. Still, it’s worth acknowledging there are some uncertainties. Information will likely change as it often does with new vaccines. Dosing strategies—including whether some underlying health conditions or individual characteristics make a vaccine less safe and effective for some—booster strategies, and understanding how long protection lasts are almost always hard-won battles for information, and I don’t think this will be an exception. We will continue to learn about this virus, about the role of variants, and about the importance of boosters moving forward.”