Discarded Covid-19 vaccines are seen in a sharps container at Cape Fear Valley Medical Center in Fayetteville on Jan. 20. Melissa Sue Gerrits / Carolina Public Press

Before the coronavirus pandemic, “anti-vaxxers,” or those who oppose vaccinations, were viewed as a small and vocal fringe group, mostly concerned with debunked links between childhood vaccinations and autism.

But in the current pandemic, anti-vaxxers are just one of several communities hesitant or resistant to receiving a COVID-19 vaccine. 

While those who outright dispute the merit of a vaccine may be few, many people are vaccine hesitant. In a December poll published by Pew Research, nearly 40% of those surveyed said they would “probably not” or “definitely not” choose to receive a vaccine for the coronavirus. But around half reported that they were potentially open to receiving the vaccine after other people had gotten it and more information became available. 

These reservations could have deadly consequences as epidemiologists have estimated at least 60%-70% of Americans will need to be immunized before there is any level of population immunity. 

Vaccine hesitancy can come from a variety of sources, but misinformation leads the list. A preprint survey study in the United States and the United Kingdom found that people exposed to misinformation are more likely to express hesitancy for the COVID-19 vaccine than those who are not.

Misinformation is problematic, not only because it offers unreliable science, but because it also creates a web of confusion, distrust and distress, according to one U.K. study also currently in preprint.

Scott Brennen, a researcher who studies science misinformation as a senior policy associate at the Center on Science and Technology Policy at Duke University, said he thinks of misinformation not as a root cause, but as a piece of much larger issues. 

“Misinformation speaks to people because of underlying issues of trust that were already there,” he said.

One study found that as many as 25% of people surveyed found false statements about COVID-19 to be credible and that susceptibility to misinformation was a significant predictor of vaccine hesitancy,  

The challenges are compounded when misinformation moves beyond social media and propels false information into individual lives, generating echo chambers that reinforce false beliefs, a decreased likelihood of engaging in public health measures and an increase in vaccine hesitation.

Understanding vulnerable populations

Some populations are more reluctant to get a COVID-19 vaccine than others. 

In the United States, older individuals, Black and Latino people, conservatives and women tend to express higher levels of vaccine hesitancy, according to surveys conducted by Texas A&M and Sienna College Research Institute.

“Often when we talk about COVID misinformation and misinformation in general, it’s not one thing,” Brennen said. “We’re really talking about a whole lot of different problems, and they have different populations.”  

Certain demographics are more likely to express vaccine hesitancy, but for different reasons.

In minority communities, the ghosts of the Tuskegee experiment, a study wherein scientists deceived Black men with syphilis without providing them access to effective treatments, and a history of medical experimentation are often cited as reasons for lingering doubt in communities.

“But it’s not just history,” Brennen said. “Health outcomes for people of color in a lot of areas are still far below what they are for white people, so a certain level of mistrust is understandable.” 

Those involved in anti-vaccination campaigns were well aware of this history and leveraged it even before the pandemic to seed vaccine concerns in communities of color. 

“That history is particularly resonant for Black and Brown communities,” said Cindy Gay, who led the phase 3 clinical trials for the Moderna vaccine at the UNC School of Medicine.

“We have a lot to answer for, but it is for that very reason that it would be a tragedy for them not to benefit from this vaccine for a virus that is impacting those communities,” she said. 

Along with fears of safety, the survey conducted by Texas A&M also found that Black Americans tended to respond that lack of health insurance and cost of health care were factors behind their responses, indicating that more communication needs to focus on the fact that vaccines are currently free for everyone, regardless of insurance. 

In that same survey, other groups that tend to show higher levels of hesitancy, such as women and conservatives, often attributed their hesitancy to concerns over safety and a lack of trust in institutions and medical experts. 

Like people of color, the mistrust by conservatives and women may be grounded in historical context. 

In the 20th century, psychologists and doctors blamed “refrigerator mothers,” those with cold demeanors toward their children, as the source of autism. Years later, a false link between autism and vaccines would spur the modern anti-vax movement to be spearheaded by mothers now concerned that it was the doctors who were harming their children. 

As for conservatives, there is no smoking-gun historical precedent for vaccine hesitancy, but some point to the opioid epidemic, which was driven by large pharmaceutical companies and has disproportionately affected white Americans living in rural areas — people who tend to lean conservative.

In 2018, according to the latest data available through the Kaiser Family Foundation, a staggering 84% of North Carolinians who died from an opioid overdose were white. 

The resulting distrust in Big Pharma dovetails with numerous studies and surveys, which have found self-described conservatives tend to distrust government, scientists and other experts in their fields at greater levels than independents and liberals, likely contributing to their distrust in vaccines created and distributed by the government and scientists at major pharmaceutical companies. 

“Ultimately, there is value in increasing our transparency, admitting the limitations of what we know, and acknowledging these difficult histories,” Brennen said. “It’s difficult to capture all of that in short and punchy communication strategies. That takes real time and effort.” 

Changing minds

Dispelling myths about vaccination requires distribution of accessible evidence from trustworthy sources. 

For example, individuals concerned with the safety of the Moderna and Pfizer-BioNTech vaccines often point to the speed of the production, claiming the safety may be compromised because the trials were rushed, and the long-term effects of the vaccines are still unknown. 

John Sanders, who oversaw the U.S. Navy’s worldwide infectious disease research programs as the commanding officer of the Naval Medical Research Center and is now the lead investigator for the Moderna phase 3 clinical trials at Wake Forest Baptist Medical Center in Winston-Salem, said the COVID-19 vaccines are just as safe as any other. 

“The only difference between this trial and those trials was the urgency, the efficiency and the leadership behind this one,” he said. “Operation Warp Speed deserves enormous credit for moving things along as quickly as possible while doing so at the highest possible safety standards.”

Gay, of UNC, echoed the same position. “It’s just not possible to have a vaccine even enter phase 3 without having gone through all the proper safety steps,” she said. “The timeline was condensed to be more efficient, but all the parts are still there.” 

Other false claims include that the messenger RNA, or mRNA, technology the two currently approved vaccines use is an untested new technology that will manipulate DNA permanently and that the vaccines may be linked to infertility. 

Neither of these claims is true. 

DNA is housed safely in the nucleus of each cell to protect it from damage. Messenger RNA is created within the nucleus and then transported out to the rest of the cell specifically to protect DNA. Once out of the nucleus, mRNA is read by ribosomes, which create proteins, and then degrades. In short, mRNA vaccine never enters the nucleus or alters DNA.

“I appreciate that mRNA can sound scary, but the truth is that this is not truly brand-new technology,” said Sanders. “When we talk about the speed of these vaccines, we ignore the decades of research on mRNA vaccines and other technologies that laid the foundation for them.”

The feared link to infertility comes from debunked claims that the coronavirus’s spike protein is genetically similar to a protein involved in creating the placenta. 

But the human body creates the same antibodies to the spike protein when a person naturally recovers from COVID-19, meaning that if antibodies did lead to infertility, there would likely be evidence of the harm from the millions of women who have already contracted and recovered from COVID-19. 

Fear of adverse effects

Future effects of the vaccine are only part of the hesitation. Some people fear an adverse reaction to the vaccine, including Bell’s palsy and severe allergic reactions

But these incidents are either likely unrelated to the vaccine, as is the case with Bell’s palsy, or are very rare.

Adverse effects of any vaccine are reported to a central system in the United States, the Vaccine Adverse Event Reporting System, or VAERS. Providers are required to report serious reactions to a vaccine, and patients can also self-report their reactions. The data is publicly available. 

An analysis of VAERS data conducted by the CDC found that of 4 million people who received the Moderna vaccine between Dec. 21 and Jan. 10, only 10 reported a severe reaction. A similar analysis was conducted of people who received the Pfizer vaccine from Dec. 14-23. In that study, the CDC found 21 cases of anaphylaxis in 1.9 million doses, or around 11 cases per million doses.  

Analysis of VAERS data conducted by Carolina Public Press shows that of the 812,586 vaccine doses administered in North Carolina as of Jan. 25, only 150 people reported an adverse reaction, approximately 0.02% of all doses administered. Of those 150, only 10 events were labeled as serious, and none of them described an anaphylactic reaction. 

“We tend to err on the side of being overly conservative in those cases,” Gay said. “If I can’t explicitly rule something out as unrelated, then I’m going to include it.”

The vast majority of the 150 reported reactions in North Carolina were extremely mild and expected reactions. The most common reports were headaches, general fatigue and soreness around the site of injection. Some of the “adverse events” included an individual who reported having strange dreams and one person who summarized the entire reaction as “I was tired and took a two-hour nap.” 

Of the more than 800,000 doses administered in North Carolina, four people reported vomiting, two people reported diarrhea, and one person reported a stroke. Four people were reported as having died within a week of receiving the vaccine, though in each case, the individual was listed as being over 65 years old and having multiple preexisting conditions such as cancer or Alzheimer’s disease.

“In science we have a phrase for these things,” Gay said. “’True, true and unrelated.’ … If the timing is right, maybe you receive the vaccine and you have a headache later that day. We believe you, that both of those things are true, but it doesn’t mean that’s automatically related to the vaccine.” 

Given the millions of people who have been vaccinated around the world so far, it is highly likely that some coincidences will exist. 

Regardless of the evidence, some people point to coincidences as a basis for vaccine hesitancy, deterring others from seeking the vaccine.

In the same study that found that exposure to misinformation reduced some people’s likelihood to vaccinate, the authors said misinformation that veiled itself as science was the most effective at dissuading people from receiving a vaccine. 

Though misinformation can be powerful, research is being done to discover the best methods for countering it. One consistent finding: The more often people are exposed to false headlines, the more likely they are to later report them as being true. 

One study found it was most effective to debunk false information after someone has fully digested it. The findings cast doubt on the effectiveness of actions by major social media companies to label posts deemed false in the moment.

A more efficient method may be to fact-check in way that is as memorable or even more memorable than the original false information. 

When asked about debunking misinformation, Brennen said people who believe the most extreme conspiracy theories are likely not open to changing their mind, but it does appear that offering factual information to counter misinformation has the chance to sway some people if it’s done correctly.

“You don’t want to just say, ‘That is wrong,’” Brennen said. “You want to provide an explanation or place the claim in some context. … And show them a level of empathy and understanding.”

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Christian Green is the lead Carolina Public Press contributing writer reporting on healthcare and health policy in North Carolina. He obtained a master’s degree in neuroscience at Wake Forest University’s Graduate School for the Arts and Sciences, where he worked in the Laboratory for Complex Brain Networks. He is based in Raleigh. Contact him at cgreen@carolinapublicpress.org.

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  1. Name-calling and suppression of facts about vaccines will not inspire the public to accept vaccine information. People should study all the information they can find and make a decision based on their situation

  2. So, if there is such great trust in the “vaccine “; then, why have all liability been removed from the table, Big Pharma’s table?
    They should be required to stand by all the damage that may come from all that “good” they developed!

  3. In connection with clearer communication, the following paragraph could use some judicial editing:

    “Messenger RNA is created within the nucleus and then transported out to the rest of the cell specifically to protect DNA. Once out of the nucleus, mRNA is read by ribosomes, which create proteins, and then degrades. In short, mRNA vaccine never enters the nucleus or alters DNA.”

    The first sentence states the mRNA is created in the nucleus. The last sentence indicates the mRNA never enters the nucleus. Huh? If it’s created in the nucleus how can it never enter enter the nucleus? Does the wording sound just a little confusing?

    I’m not discounting your efforts. You’re performing a public service combating misinformation. I’ve seen other reports which use wording similar or identical to that in your article. I even understand what it means. Nevertheless, the wording could be construed incorrectly to the point it seems like a non sequitur. Perhaps this example highlights the challenge with such communications.

    Thank you for all your great work!