This story is part of Doubting the Dose, a series that examines anti-vaccine sentiment and the role of misinformation in supercharging it. Read more here.
Julie Brown is intimately familiar with the pain wrought by the coronavirus. As a licensed practical nurse, Brown has spent the last year tending to residents at long-term care facilities—ground zero for the COVID-19 outbreak in the U.S. The deaths linked to nursing homes and other long-term care facilities account for a third of the total COVID-19 death toll, which crossed half a million in late February.
In January, Brown’s own mother succumbed to the virus, after being hospitalized. Due to the strict restrictions at New York hospitals, Brown and her family couldn’t even visit her mother in the hospital until three weeks after she was admitted. By then, she was on a ventilator.
Around the time her mother fell sick, Brown also contracted the virus, along with her husband and youngest daughter. “I had worse symptoms than the rest of my family, probably because I have a preexisting health condition,” she says. “I spent two full days sleeping on my bathroom floor because I didn’t know if I was going to throw up or have diarrhea.”
- What the science says about 7 common COVID-19 vaccine myths
- The next big challenge in the COVID-19 vaccine rollout: tackling hesitancy
Before the virus ravaged her family, Brown had made up her mind to decline the COVID-19 vaccine, despite her eligibility as a frontline worker. “I was dead set against getting the vaccine at first,” she says, citing concerns over the long-term effects and the expedited FDA review process. “And then I went through all that, and I was like, it’s time to get the vaccine. It’s time to not have to worry about whether I’m going to get it myself again, or give it to somebody I love or one of my residents.”
In January, a Kaiser Family Foundation study found that nearly a third of healthcare workers were hesitant about the vaccine.
In January, a Kaiser Family Foundation study found that nearly a third of healthcare workers were hesitant about the vaccine, as compared to less than a quarter of the overall population, according to a recent Census survey. Governor Andrew Cuomo cited a similar estimate for the number of healthcare workers in New York who are expected to decline the vaccine.
Nursing homes, in particular, have struggled to vaccinate their employees: According to the CDC, a median of 37.5% of nursing home workers were vaccinated in the first month of the rollout, as compared to 77.8% of residents. In Ohio, about 60% of nursing home staff opted out of getting vaccinated in December, on par with rates at long-term care facilities across Georgia and Utah. (Despite this hesitancy, the number of new COVID-19 cases among nursing home staff dropped by 83% between December 20 and February 14, according to a Kaiser Health News report.)
This skepticism has also manifested in other essential workers, such as those who have sustained our food supply and stocked convenience stores. In a Morning Consult poll, employees in sectors such as hospitality, retail, and food service all reported higher rates of vaccine hesitancy than the average employed adult.
More than 106,000 prison workers have been vaccinated, according to a new report by the Marshall Project and Associated Press, but correctional officers across the country are still declining the vaccine at high rates. In Massachusetts and California, half of all correctional officers have declined the vaccine or said they plan to wait. And while many farmworkers are anxious to become eligible for the vaccine, some have been swayed by misinformation on social media, while others worry that getting vaccinated might reveal their immigration status. The same issues contribute to hesitancy among meatpackers.
For people of color, vaccine skepticism can stem from the legacy of medical racism and the discrimination many experience as they try to navigate the healthcare system. “Many folks in essential roles are from communities of color,” says Lavanya Vasudevan, an assistant professor at Duke University and a member of the Duke Human Vaccine Institute. “But at the same time, many of them live in healthcare deserts. They may also be more susceptible to misinformation.”
The circumstances of the pandemic have exacerbated the lack of confidence that is typical of new vaccines, one of the factors that tend to contribute to vaccine hesitancy. “Everyone has this question: How was this done in [just] a year?” says Rupali J. Limaye, who studies vaccine behavior at Johns Hopkins University. “The perception is that it was rushed, even though there was no cutting corners. Number two, it’s a new product. We saw a very similar kind of hesitancy when the HPV vaccine came out—people wanting to [take] a wait-and-see approach. And then number three, there’s this heightened area of distrust among communities of color because there’s concerns about how the trials were conducted. Was it really representative?” (While drugs in the U.S. “tend to be tested among white people,” as Limaye says, there was a concerted effort to diversify the clinical trials for the COVID-19 vaccine.)
Limaye, who has been conducting information sessions at Black churches across the country, has found that one of the most frequent questions is whether it’s safe to get the vaccine when they have a specific preexisting condition. “I can tell you broadly what comorbidities were included in the trials and the outcomes related to if people with comorbidities got the vaccine,” Limaye says. “However, I’m not a medical doctor. So we’re usually like: You should go to your doctor. And a lot of people are like, ‘We don’t have a doctor.'” Sometimes, Limaye is their first and only source of accurate information about the vaccine.
I am worried about side effects. I’m a new mom, and everything is not about me anymore. If it does affect me, who’s going to care for my kid?”
But Kabia is rethinking her stance now that Texas has lifted its statewide mask mandate. “I’m at a crossroads,” she says. “At first I was like, I can just protect myself and my kid. But a lot of people are about to be exposed.”
A lack of trust in employers
Many of the people I heard from shared concerns about the impact of the vaccine on their health. But essential workers have also felt slighted by their employers or lost faith in the government, amid the devastation of the pandemic. For some of them, the sentiment is hardly new: Nursing home staff and homecare workers have toiled under difficult conditions with poverty wages since well before COVID-19 became a threat. And amid the pandemic, countless employees were expected to continue doing their jobs under increasingly dangerous circumstances, often without adequate protective gear.
“I know that in the beginning of the pandemic, there was a lot of difficulty establishing trust because the recommendations kept changing,” says Melody Butler, the founder of Nurses Who Vaccinate, a nonprofit group that seeks to educate nurses on vaccinations. “When you lose that rapport, it’s really hard to gain it back. But I do feel the organizations that had the most transparency with their staff—those are the institutions that have a better rapport. If you’ve been able to maintain your relationship with your staff, you’re going to have an easier time recommending the vaccine. But if you never really handled your initial problems from early in the pandemic, you can’t blame the staff for doubting your recommendations.”
One caregiver who asked to remain anonymous told me that what she heard anecdotally about the side effects—namely the incidence of dizziness—had worried her. As a nursing student, she says she can’t afford to miss classes or fall sick after getting the vaccine. “Nobody’s going to be there to take care of me,” she says. “Right now, I need all my strength.” Still, she concedes that as someone who is becoming a nurse, she may have little choice in the matter. At this point, it’s likely more a question of when she will get the vaccine, rather than if.
But she adds that the overtures from her employer haven’t been especially convincing. “They try a lot,” she says. “But sometimes I feel because I’m working for [them], they want me to get it.” What might actually get her comfortable with vaccination is hearing directly from a medical professional. “I’ve done my research, but I can’t really trust the internet like that,” she says. “If I could hear from the horse’s mouth, I think I’ll be fine.”
Among essential workers who aren’t in healthcare—many of whom are still waiting to become eligible for the vaccine—this lack of trust could prove even more challenging. During the pandemic, restaurant staff and grocery-store workers have been forced to assume the role of public health marshal and enforce mask mandates on disgruntled and sometimes belligerent customers, often with limited support from employers and no hazard pay.
All this means employers may not be the most effective mouthpieces for vaccine advocacy in some workplaces, even if they might be anxious to get their workers vaccinated. That’s where groups such as Nurses Who Vaccinate, which focus on peer-to-peer education, may have some influence.
Butler started the group in 2011, after her own brush with vaccine hesitancy. Butler was initially led astray by misinformation about the effects of the H1N1 vaccine on pregnant women, until a fellow nurse took time to educate her. Working in healthcare doesn’t make nurses experts on the science behind all manner of vaccines, Butler points out—and especially during the pandemic, many nurses may not have the time or energy to wade through misinformation and adequately educate themselves.
“It really comes down to education,” she says. “There are nurses who’ve had COVID. And it’s a matter of educating them so they know that we’re getting reports and studies that natural immunity does not last as long as we had hoped. And showing this evidence that the vaccine has a longer protection, especially with the variants that are coming out. It may not prevent the virus 100%, but maybe the vaccine will help you make sure you don’t end up in the ICU if you catch COVID again.”
One concern that has come up repeatedly is whether the vaccine has any bearing on fertility or could be unsafe for pregnant women, though there is no evidence of any adverse effects. “A majority of [women] make up the nursing profession,” Butler says. “This is an issue that affects the nursing community really strongly, so it’s important that we’re giving out the right recommendation.”
In the absence of trust—and perhaps out of desperation—some workplaces have resorted to incentivizing workers to get vaccinated by dangling $500 bonuses, extra days of paid time off, or even gift cards to Waffle House. A handful of employers, such as the long-term care organizations Juniper Communities and Atria Senior Living, have even mandated the vaccine, following guidance from the Equal Employment Opportunity Commission that gave them the ability to do so.
“The issue of mandates is even more complicated,” Vasudevan says. Sometimes, mandating vaccines can help combat complacency because people are more likely to put off or decline vaccines that aren’t required. But the COVID-19 vaccine is still too new, and some workers have already quit over vaccine mandates. “It’s okay to mandate vaccines that have been around for a while, because we have established data,” she adds. “But we’re not there yet with COVID.”
The right incentives, on the other hand, might be a persuasive argument for getting employees vaccinated. If accessibility is the greatest barrier to getting vaccinated, promising paid time off could make all the difference. But it’s hard to see how this approach would endear employers to their workers or help establish trust. “I just have concerns about this from an ethical perspective, because you’re also dealing with people who are making minimum wage,” Limaye says. “Fifty dollars to someone who’s making $7 an hour is a lot of money. My biggest concern is we need to make sure that whatever education employers are providing is not coercive.”
Are workers coming around?
Three months into the vaccine rollout, sentiment appears to be shifting slowly among vaccine skeptics. “We’re seeing a drop in hesitancy,” Vasudevan says. With 115 million vaccine doses administered—and the release of a single-shot vaccine—some essential workers who were initially against getting the vaccine seem to be coming around, even if they remain reluctant.
Our approach is similar to that of a political campaign—our community health workers are going out into the field and knocking on doors.”
Then there are unions such as 1199SEIU United Healthcare Workers East, which represents half a million healthcare workers up and down the East Coast and has played a significant role in assuaging the concerns of hesitant workers. “We represent largely women and people of color,” says 1199SEIU political director Gabby Seay. “We knew this was going to be an uphill challenge for members.” In December, 1199SEIU surveyed its workers and found that about half of their workers were comfortable getting vaccinated; the rest were either on the fence or vehemently opposed. The union then staged a campaign to educate its members through digital ads, video content, and Q&A sessions. As members started getting vaccinated, 1199SEIU would share firsthand accounts from them. “Our members had so many questions about the vaccine—the process it underwent, how effective it is, and what the side effects are,” Seay says. “They just wanted their questions answered.”
Perhaps the most effective piece of their outreach campaign was hosting webinars that gave members unfettered access to the union’s chief medical officer. “We’d be on for two or three hours, and our chief medical officer would answer every single question,” she says. “Sometimes the same question over and over.”
For Susan Philip, a physician assistant in the surgery department at Richmond University Medical Center, the union’s efforts were a critical part of her decision to eventually get the vaccine. “I’ll be honest with you: I don’t even take the flu vaccination every year, so deciding to take this vaccination was a big step,” Philip told me. “A few of my coworkers had taken it, and the surgeons that I work with had taken it, so I discussed it with them. And then the union was definitely promoting it.”
Philip was also convinced by her elderly parents, who live with her and encouraged her to get the vaccine—particularly because she was often exposed to COVID-19 patients on a daily basis, if not multiple times a day. “If a trauma comes in, you don’t know if a patient has COVID or not,” she says. “You would be in the trauma bay trying to stabilize a patient and then find out hours later that they were COVID-positive.”
Employers may be impatient to vaccinate their workers—but like Philip, some of them just needed time to come around. “There was such a rush to get everybody vaccinated right away,” Seay says. “As a campaigner, what I know about persuasion is that you can’t guilt somebody into it. You can’t shame them into it. You can’t coerce them into it. You have to allow people to take the time to make a decision.”
Of course, many other essential workers, from meatpackers to childcare workers, are still waiting their turn. The United Food and Commercial Workers International Union (UFCW), which represents more than 1.3 million essential food workers, says 70% of its workers are ready to get vaccinated. And in a recent survey by childcare marketplace Winnie, more than 83% of the 900 respondents said they planned to get vaccinated or already had.
In the majority of states, these workers are still not being prioritized—but in Kansas, the local chapter of the UFCW has fought to get its members prioritized for vaccinations. So far, the state has allocated about 12,000 vaccines for meatpacking workers. (UFCW Local 2 also represents meatpackers in Oklahoma and Missouri but has not had the same luck there.) Of the union’s 14,000 members who work in meatpacking, about 80% are immigrants, according to UFCW Local 2 president Martín Rosas.
Meatpacking plants were home to some of the most devastating COVID-19 outbreaks, with more than 50,000 cases and at least 250 deaths, according to a ProPublica report. In southwest Kansas, Rosas says, the incidence of COVID-19 at meatpacking plants sparked one of the biggest clusters in the state, which led to the deaths of multiple UFCW members. Yet many of these workers have been targeted by rampant misinformation across social media, perhaps the greatest vector for vaccine skepticism in their ranks. “For the last month or so, we’ve been trying to engage heavily with our membership and pass information in various languages about the merits of the vaccine,” Rosas says. “We’re sensing that they’re becoming more receptive to the vaccine.”
As the vaccine becomes more widely available—and as social distancing measures are relaxed over time—it’s even more crucial that employers and public health officials address the hesitancy that will almost certainly persist among some workers. Some experts argue that the real culprit behind low vaccination rates is lack of access, not vaccine hesitancy, and the efforts to vaccinate Kansas meatpacking workers appear to support the theory that making the vaccine more accessible could encourage even workers who are on the fence about vaccinations.
In recent weeks, UFCW has offered vaccinations right outside of meatpacking plants, which has drawn even workers who were the targets of outright misinformation. The union has since moved the vaccinations to the inside of plants to reach even more workers.
Rosas is optimistic that UFCW can get more than 80% of its members vaccinated. Many of them won’t quickly forget what they experienced at the height of the pandemic—and Rosas hopes that will be their guide. “We lost 12 of our members between four meatpacking plants in southwest Kansas,” he adds. “One [death] is one too many. They witnessed their coworkers dying from COVID. That should and will have a lasting impact on their decision.”