To fight COVID vaccine hesitancy, hold outs make access convenient


  • Soon, it will be a lot easier to get an appointment for a COVID vaccine.
  • But after that, vaccination will become even easier: Walk into CVS, no appointment, like a flu shot.
  • Extremely convenient vaccines will help win over the vaccine hesitant.
  • This is an opinion column. The thoughts expressed are those of the author.
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Right now, getting a COVID vaccine can be very difficult. Appointments are booked far in advance, and people refresh and refresh appointment websites looking for cancellations. (This is one reason the rollout has tilted in favor of people who can spend all day at a screen.) And while vaccine eligibility has expanded rapidly — all states should offer it to all adults by May 1 — many Americans remain ineligible under their states’ rules, including all children under the age of 16.

Soon, this situation will be different. Vaccine supply will outstrip demand, and getting an appointment will be easy. In addition to being more fair, this will also win over some people who have been hesitant to get the vaccine in part because getting an appointment seemed really hard.

But I want to talk about the phase after that phase. I look forward to a future where vaccines are really easy to get. Not just “appointments are easily available” easy, but “people keep offering me a vaccine in places I have already gone” easy.

Vaccines should be stocked in doctors’ offices and offered to patients at medical appointments they make for other purposes. They should be available on-demand at CVS, even if you just went there to buy a quart of milk. They should continue to be free of charge. And I don’t just mean this as a vision — I expect this will be the case quite soon.

No-appointment vaccines on demand should be here in a few months

“Like mid-June,” said Dr. Ashish Jha, the dean of Brown University’s school of public health, when I asked when it would be feasible for an adult to walk into a CVS or other pharmacy and get a shot with no appointment. That timing might vary some with geography, he said, and it might be longer before you can easily get a vaccine from some medical practices.

“Doctors’ offices is always a bit of a tricky situation in my mind,” he said, noting the complicated handling requirements for the Pfizer and Moderna vaccines and the need to consume an entire vial of vaccine within a short time after opening. He did note that the Johnson & Johnson vaccine, which is easier to handle, might eventually become widely available in doctors’ offices.

To be clear, I’m not saying you should wait until June to be vaccinated. You should get the vaccine as soon as it is available to you. But widespread, easy availability is going to be important for getting as large a fraction of the population vaccinated as possible.

That’s because many people are not adamantly opposed to being vaccinated but also not as eager as you might be to get it. The more those people are confronted with convenient opportunities to get the shot, the more likely they will choose to get it.

Hesitancy has a lot of drivers

The World Health Organization’s working group on vaccine hesitancy offers a three-factor model to understand its causes: confidence, complacency, and convenience.

Confidence refers to people’s belief that the vaccine works and is safe, and more broadly to their trust in medical and government authorities that are encouraging vaccination. Complacency refers to their level of concern about getting the disease that is being vaccinated against. And convenience refers to how easy and pleasant it is to get a vaccine, factoring in considerations like cost, availability, and the cultural context in which the vaccine is offered.

Improving public confidence in the vaccines and discouraging complacency about COVID are important messaging challenges. Given surveys showing higher levels of hesitancy among white Republicans, it is good that former President Donald Trump again encouraged his supporters to get vaccinated (he already made similar comments in Februarythat drew less notice than I think they should have). Positive messages about vaccines, not just from national leaders but from people trusted in local communities — including peers who have been vaccinated — are important to increase vaccine confidence.

But working the convenience lever can also improve vaccine uptake.

Many people are ambivalent about the vaccine

There has been a lot of (warranted) attention to surveys showing significant numbers of people saying they don’t want the vaccine or aren’t sure whether they will get it. A lot of this coverage focuses on particularly hesitant subgroups — Black Americans appeared more hesitant than white Americans in earlier surveys, though that gap appears to have greatly shrunk as the rollout continued. Republicans still report high levels of resistance. One recent CBS/YouGov survey found a third saying they wouldn’t get the vaccine and 20% more saying they weren’t sure they would.

I do want to point to a couple of reasons that the Republican hesitancy issue, though real, may be smaller than it appears.

David Shor and Michael Sadowsky of OpenLabs point to results from their own survey — approximately 5,000 online interviews over the last month — finding that party affiliation was a significantly stronger predictor of expressed willingness to get a vaccine than of actually having gotten a vaccine. That is, Republicans being less likely to say they would get vaccinated is so far only partly borne out in their actual vaccination rates.

Especially since Trump’s emergence in politics, a lot of theoretically issue-specific questions have become polarized around opinions of Trump and political parties — that is even nominally non-political issues have become politicized. So statements that downplay (or emphasize) the seriousness of the COVID pandemic — including statements about one’s own intention to be vaccinated — may partly reflect a desire to align with a “side” of a political dispute in addition to the respondent’s actual likely behavior.

Convenience makes it easier to close the sale

The other mitigating factor applies to all hesitancy. Many of the hesitant are ambivalent and therefore persuadable. Even the list of reasons that people who say they “definitely” won’t get vaccinated offered in a recent Carnegie Mellon survey on vaccine hesitancy includes statements that are temporary (such as waiting to see if the vaccine is safe) or that could be addressed by a trusted authority such as a medical provider (such as being worried about side effects).

That persuasive approach can work especially well if the medical provider is logistically able to administer the vaccine right after making persuading — and especially if it’s a one-dose vaccine.

“For the vaccine hesitant, it’s a very easy, ‘You’re here, I have some J&J in the back, can I just give you a shot and then you’re done?'” said Dr. Jha. That’s fewer steps than persuading someone to feel more positively about the vaccine and then persuading them to make an appointment elsewhere to get it and then to show up at least once to get vaccinated.

Eventually, we will likely need to persuade people to get booster shots. But the key public health challenge with hesitancy right now is to get people to agree to get vaccinated, which is a reason to make sure that vaccines are easy to get on-demand at any time that an unvaccinated person is feeling willing.

After all, they can’t un-get the shot the next day.



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