Hesitant: Vignettes from the Front Lines of Vaccine Promotion

By now, most of us know that the reasons that people are “opting out” of getting vaccinated against the virus that causes COVID-19 are varied. We might even admit that they are complex.  

But we still use the shorthand moniker of “vaccine-hesitant” to summarize the statistics that show—despite vaccines being free, widely available, not requiring an appointment, and despite gift cards and lotteries—about half of our neighbors across the US are not getting the vaccine.

They are vaccine-hesitant.

Over the past five weeks or so, I have been part of an effort, supported by our County, to mobilize community-based organizations to do outreach to promote vaccine uptake.

I work for a food bank, so our approach has been to meet people while they wait to pick up food (we are still doing large-group distributions due to COVID). In that time, I and a handful of dedicated volunteers have gone car to car or person to person to offer information on vaccine clinics nearby, answer questions, and generally encourage people to get vaccinated.

Over time I have evolved from basically handing out brochures to pausing to engage with those who have not yet gotten the vaccine. The conversations have been unexpectedly personal and, often, quite emotive. 

“Have you been able to get the vaccine yet?” is how I start every conversation. I like this formulation—less direct than “Are you vaccinated?” but more probing than “Can I give you some information about vaccine clinics?”

What follows are four vignettes that get at the meaning of “hesitancy,” as I have experienced it in those with whom I have spoken.

1. “This is NOT a conspiracy theory!”

“Have you been able to get the vaccine yet?”  

“Yes, I got it.”

“Did you know that anyone over twelve can get it now?” A pause and then…

“Any parent that lets their kid get that should be arrested…” and off we went.

It turns out he had lied about getting the vaccine and explained in some detail why the whole thing was fake and that there was not a thing called COVID-19. He explained that this will all be coming out in about a week (that was three weeks ago) and that everyone would be brought down with the lies. He predicted chaos on a global scale. A message would be broadcast soon…

I agreed to read his “evidence” (“This is not a conspiracy theory, you know. It’s not. It’s real”), and he has continued to send me web links that have very little to do with COVID-19 and lots to do with the “truth” that Donald Trump is still president. 

He is not vaccine-hesitant. He is not hesitating about anything. He is fully active. He is fully engaged.

2. “I’m scared”

“Have you been able to get the vaccine yet?”

“Well, everyone in my family but me… I am so scared.”

And then I paused. Where should I take this? And in the silence, she sighed and said that it had all happened so fast, and everything seemed so uncertain, so new, so confusing. 

She was thankful that her mom (sitting in the back seat) had gotten it, and she was relieved that her children and sisters had too. She was the lone holdout and could not explain why.

“When I think about it, I just get afraid. I just don’t know why. I know I need to, and I know I will, but I am not ready yet, and I just get so nervous when I think about it.”

Needle fear? Apparently not.  

Fear of side effects? Maybe a bit.

“It’s just so new… so fast.”

She is not vaccine-hesitant. She is grappling with a fear she cannot describe. It has something to do with the fact that the disease came out of nowhere and that the vaccines did the same. Like time has been compressed, and she just needs a moment to step back and take time to think. I have had students like her in courses I taught: “Just give me a few minutes to think about what you just said—don’t ask me to DO anything. I just need to think, dammit!”

(A bit of a post-script: I saw her again this week, and she said she was still scared. But she said she wanted the information about local clinics because she was going to do it soon. As I left her car, she said: “Next week I will surprise you. I really want to.”)

3. “I have too many people who need me.”

“Have you been able to get the vaccine yet?”

“No, I am not sure I will—it is only for emergency use, you know. Maybe when it is approved.”

Her story was far more complex in some ways. She was highly knowledgeable about the vaccines. She did not believe it was all made up. She was not a victim of misinformation. But she had concerns.

“They say the side effects don’t last, but I have a friend who still gets chills two weeks later.” (No idea how to respond). “I know you can still get the virus even if you are vaccinated, and I have to care for my mom, and I have a two-year-old, and I care for about five other older people, and I cannot take a chance.”

Okay, I have a choice here. I can rehearse the responses: the probability of transmission very low, the chance of getting a severe case much higher without the vaccine, EUA is based on solid evidence… I have a feeling she knows all of that, and she does.  

She says they are all locked down and that that has kept them safe, and she just wants to do that as long as she can. “I know I can’t do it forever.”

So, I tell her about my daughter. I mention her age, and she says she is the same age. I tell her about her job in child protective services and that she has little children too. The connection to my daughter moves her (a little). It almost seems that my daughter’s experience matters to her as just one more example of why it might be okay. I can see her thinking through all the evidence and the doubts.

I suggest that it can’t be easy to have the burden of caring for an elderly parent and refer to my own family’s experience with Alzheimer’s. I talk to her about “sandwich women” (always women) called upon to care for people at the generational extremes. She says, “that’s me.”

She is not vaccine-hesitant. I mean, she would probably be classified that way if she were surveyed, but her story cannot fit that quickly into the category. The bottom line is that she has found a way to survive this thing, and it is working for her. Any deviation from the tried and true holds risks that, however minimal, feel too big to bear. She has people—lots of people—who depend on her.  

She did not come across as a martyr, merely as a woman whose life had brought her here, and she was going to BE ABSOLUTELY SURE before she deviated from the proven path.

4. They mistrust the government

I have not talked to this last person—this last group of people actually—but they have the lowest vaccination rates in the County as a group. They will not show up on any demographic profile because we do not capture data on ethnicity that way. They are refugees. More specifically, they are refugees from a world that no longer exists—the USSR.

I have not been able to talk to them at all over these weeks because they do not speak English, and I do not speak Russian. And so they take my papers or say no, and I smile and walk to the next car. I HAVE TRIED to get a Russian speaker out for weeks, and finally, I got lucky.

She asked me to walk with her for a while, and so I did and what I saw was an opening of the eyes and the face and smiles that only come when someone who does not expect to understand what you are saying realizes that they do!

She spoke to nearly 30 people, listening to them respectfully and offering them information. Most did not take it. Of the 30, only three had been vaccinated (we need to go back and better understand these “positive deviants”).

As a first-generation US citizen with refugee parents, her insight is that the Russian-speaking population is not merely “mistrustful” of the government. Instead, due to their experience in the USSR, she believes they are living with deep trauma that has never been dealt with.  

They are mostly Baptist Christians which means that in Soviet times they were actively persecuted and made to choose between making a living or holding to their faith. The distrust of government flows from a deep fear that the government will force them to give up their faith—force them to lose that precious thing upon which life itself hangs. 

It is almost as if… “If we can just disappear. If we can just become invisible. If we can just keep our heads down, practice our faith, stay out of government engagement, keep to ourselves… If we can just disappear…. Then we will be safe.”

Trauma is a thing that conditions us to expect disaster when none is imminent. It tells us to fly when there is no reason to run. It instructs us to fight when there is no enemy. This much we know.  

And what do we do when we have people who have lived half or more of their lives, never having had the chance to heal. Will our vaccines save them?

They are not vaccine-hesitant, and this is not about a vaccine. This is about surviving in a world that has already proven that it will take everything from you and then send you to the gulag because you have nothing. 

I do not have a solution, but I wonder if we need to start with healing of a different kind first.

Vaccine hesitancy, whatever it is, is not a single thing. It is a syndrome that we barely understand. There will be no magic key that unlocks the door that leads to “the hesitant” receiving the vaccine.  

But there is a path. It is the path of listening, being present, engaging the doubts, and the fear, trauma, and questions. At the end of the path is the fork, and some will say yes and others no.  

I am at the place where I believe that our job right now is to walk that path with those who must decide—to walk it with the “hesitant.”

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