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Ask someone if they’ve had the COVID vaccine and the answer is sure to be emphatic, regardless of which way it goes. 

For those who’ve received their shots, the opportunity to protect themselves, their families, their colleagues and neighbors is both relief and responsibility. For those who consider the vaccine untested, unnecessary, or an untenable infringement on their personal freedom, the resolution is just as absolute. And for medical professionals and others in charge of ensuring public health, navigating that deepening chasm is truly complex.

Ongoing research by the Kaiser Family Foundation (KFF) indicates that those most enthusiastic about the new vaccines tend to be insured, older, better educated, Democratic-leaning and living in urban and suburban areas. Those hesitant about (or outright resistant to) the vaccination are often younger, persons of color, less educated, Republican-leaning and living in rural areas. Delve further into the fascinating array of information on the KFF website, though, and you’ll see that it’s not that simple, as matters of accessibility, availability of credible information and other considerations factor in. And demographic data from the National Institutes of Health’s National Center for Biotechnology Information suggests that those with overall vaccine-hesitant thoughts and behaviors are more likely to be older, educated mothers with higher socioeconomic status.

Here in the metro Milwaukee area, Health Commissioner Kirsten Johnson, MPH, and her colleagues track that evolving data to drive targeted vaccination efforts and messaging in hopes of overcoming hesitancy, particularly in those most at risk for COVID-19 and its most harrowing complications. We recently spoke with Commissioner Johnson about those efforts.

MKE Lifestyle: Much of the “anti-vax” debate has been relegated to vaccinating children, but the pandemic really brought to light the intensity and diversity of people’s emotions around this issue. What has it been like for you and your colleagues to watch this unfold?

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Commissioner of Health Kirsten Johnson

Commissioner Johnson: It has played out as we anticipated to some extent. We knew, especially since the vaccines are new and there was new technology involved, there would be a percentage of the population that was really eager to be vaccinated, which is absolutely what we saw early on when the vaccine was first available. We knew demand was going to be great, and it was, so we were able to vaccinate the population that was eager to be vaccinated quite quickly. We also recognized that there was going to be vaccine hesitancy, but I don’t know if we fully understood the extent of the hesitation, or who would be hesitant and why. 

Do you feel the response to this public health crisis and the ensuing vaccination efforts might have been different had the pandemic arrived in a less intensely divisive time in the country?

I do think that politics and that division have played into people’s decision-making around the vaccine and the misinformation and the way it’s being shared. We know that there’s a lot of information shared on social media. We know that with those algorithms, if you search for one thing, you’ll only see the things that you’re looking for. It’s really unfortunate, because people are very strong in their beliefs and over the past five years — but particularly the past year — that has really played to those political divisions. It’s really done a disservice to public health and to prevention.

How do you overcome that aspect and reassure vaccine-hesitant people that the vaccines are safe, effective and the best way to ensure individual and public health, and our one true common ground: a return to pre-pandemic life?

Absolutely there are people who’ve had adverse reactions or vaccine injuries, but they’re really rare, so the safety of the vaccine has been proven and also that they are very effective. So the hardest part for us in public health is knowing that there is a percentage of the population that could become sick, will be hospitalized and will potentially even die, and that could be prevented with the vaccine. That’s really hard to message, knowing that many, many people in our country have paid a significant price, but to also be sensitive and understand that people are hesitant for absolutely valid reasons, at the same time, knowing that there’s a lot of misinformation. To strike that balance is certainly challenging.

From our perspective, my perspective, from the public health perspective, we want people to be able to take off our masks. We don’t want to have to put health orders back in place. We don’t want people to be hospitalized. We don’t want people to die. This is preventable, but how we get over that hurdle of the politics that have played into decision-making is really hard.

Especially frustrating because history shows that the efficacy of vaccines is pretty compelling, right down to the eradication of truly horrifying diseases.

In public health, even prior to COVID, I think we all felt some level of frustration with the anti-vax movement, because vaccines are effective. I was a Peace Corps volunteer in West Africa, and … one of my jobs was to help coordinate polio vaccine distribution across a number of villages. One of the things I did was a door-to-door vaccination campaign. It’s heartbreaking knowing that it’s preventable and to see the burden of disease on populations that are unprotected. Having had that experience and now seeing it play out here, 20 years later, is really challenging. 

But it’s the same methodology of making sure that you’re allowing people to ask questions, respecting their opinion, answering questions with the best science and data, meeting people where they are and literally bringing it to their door, knowing that it’s contingent on our ability as a country, as an economy, to move forward. 

Some of the COVID conspiracy theories are pretty extreme.

Certainly, and all of our vaccinators can speak to this. We’ve heard the gamut. “It’s a disease that’s made up and this is all for naught.” “We’re putting microchips in people’s arms so we can control them.” “We’re going to change DNA” — which is not that simple. Observing the misunderstanding of an mRNA vaccine that truly had been in development for a long time, and that this just happened to be the first time that it could be utilized and used effectively, is hard. … So

much [suffering] could be avoided with two needle sticks.

Does the number of folks within the medical community itself who also are vaccine-hesitant surprise you?

It’s been a huge challenge for hospital systems in terms of how to message and how to assure their staff that this is safe. If you look at the breakdown in data, the percentage of physicians who become vaccinated versus the percentage of nurses versus the percentage of CNAs, over 90 percent of physicians have a vaccine and then it goes down from there. So we absolutely need to have our frontline workers advocating and encouraging their patients to be vaccinated. 

The next phase of vaccination is going to be heavily reliant on our healthcare providers. We are doing what we can in the community and in the neighborhoods, and offering vaccines in every space that we can imagine, making it as available as we can. But the next piece is really going to be when people have that touchpoint in a trusted healthcare provider versus a community event or from someone who knocks on their door.

Are you also working with the medical community to recognize and ease the impact of this new facet of vaccine hesitation in tandem with those longstanding ones?

Yes, we are. There’s the Milwaukee Health Care Partnership that we’re a member of that has representation from all the healthcare systems. As we’ve been moving through the pandemic, the focus has been heavily on the COVID vaccine. But we’re now also recognizing the numbers of children who have potentially missed their immunizations because of COVID, because they haven’t gotten to their annual checkups or because people just haven’t been doing that sort of prevention. And we are working collectively to address that, to catch everyone back up. Part of that conversation is COVID, but also just immunizations in general, speaking to the hesitancy piece and trying to ensure that people are protected.

I really think the message is that if you have questions or if you are concerned, talk to people you know and love and trust, and get in touch with your medical provider, because we need people to be vaccinated so we can all be safe. We just want shots in arms. MKE

Learn more at kff.org/coronavirus-covid-19/dashboard

What Worries You?

According to the National Institutes of Health, there are several types of biases that can impact vaccine hesitancy.

Biases of omission — believing something despite a scarcity of evidence.

Confirmation bias — favoring arguments that support a pre-established position.

False or imagined correlations between events

Availability bias — giving excess credibility to more recent and easily recalled events and information. 

Cognitive dissonance — in which perceived “conflicting evidence” may lead one to choose an incorrect but seemingly less dangerous solution.

Naturalist bias — the belief that vaccines are manmade

and therefore unnatural, so their immunity is inferior to natural immunity. 

Vaccines and social media

• Half of all tweets about vaccines convey an anti-vax viewpoint.

• In 2019, YouTube demonetized anti-vax channels by removing their advertising. In the past year, YouTube removed more than 800,000 videos for coronavirus misinformation. 

• Pinterest now limits “vaccine” search results to pins from internationally recognized health organizations such as the World Health Organization and the Centers for Disease Control and Prevention.