What will get the unvaccinated off the fence? Here’s what our survey found

By Bruce Green, M.D., managing director and chief medical officer, Deloitte Consulting LLP.

We are in the midst of what is likely the biggest vaccination campaign in the history of the world. So far, more than 7.15 billion doses of a COVID-19 vaccine have been administered across 184 countries.¹ While a majority of US adults are now fully vaccinated,² about 65 million vaccine-eligible people have not received it.³ And although children ages five to 11 are now eligible to receive a vaccine, many parents are hesitant or resistant to vaccinating their kids, according to a recent poll.⁴

I head Deloitte’s Federal Health Practice and previously served as the Surgeon General for the US Air Force. I have friends and family members in rural Kansas (where I grew up) and in Tennessee (where I live now) who have not been vaccinated. Although I’ve successfully swayed some life-long friends and family members to change their minds, others won’t budge.

The Deloitte Center for Health Solutions recently concluded a nation-wide survey of 3,000 adults. We wanted to understand how people are making their vaccination decisions. We know that geography, income, race, and education have an influence. But we also wanted to identify barriers that keep people from being vaccinated in hopes that those obstacles might be removed. Our survey included an oversampling of unvaccinated or partially vaccinated respondents. Some of them want the vaccine but can’t get it (or have only received one of two doses). Others are undecided, medically ineligible, or intend to get it only if required. More than 20% of respondents remain staunchly opposed.

In a blog last December, my colleague Jitinder Kohli suggested that historically low influenza vaccination rates might foreshadow acceptance of COVID-19 vaccines. He suggested that a fear of side-effects—particularly among those who view vaccinations as ineffective or risky—could spark misinformation and reluctance. According to our survey results, he was correct. Nearly 30% of unvaccinated people who want the vaccine said fear and anxiety about safety and possible side-effects has kept them on the fence.

While side effects certainly have been reported, severe reactions to the vaccine—relative to the vast number of people who have received it—is miniscule.⁵ The risk of suffering severe symptoms from the virus far outweighs the small risk of side-effects. In addition, some survey respondents said they were concerned that the vaccine could negatively affect their pregnancy. In August, the Centers for Disease Control and Prevention (CDC) urged pregnant people to get vaccinated. Pregnant people are at higher risk of death and miscarriage if they are infected with the virus, according to the CDC.

Four factors that can influence vaccination decisions

Here’s a look at four factors that can influence the decision to get a COVID-19 vaccination, based on our survey:

• Trust: Nearly 40% of unvaccinated adults listed "mistrust of the government" as a top reason for avoiding the shot, according to a report from the Kaiser Family Foundation. However, the vast majority of our survey respondents (70%) said they do trust their doctor as a source of information on public health issues. Survey respondents who refuse to be vaccinated, or who are undecided, were less likely to than vaccinated people to turn to their doctor for information about the vaccine. According to our survey results, 25% of people who refuse to get the vaccine sought information from their doctor (versus 50% among the vaccinated). About 30% of vaccine refusers said they relied on information from friends and family when making decisions about the vaccine (versus 25% among the fully vaccinated). More than half of people who are on the fence said they would be willing to get vaccinated if it were offered during a routine doctor visit. Even 17% of people who oppose the vaccine said they would likely get it if offered during a doctor visit. These results indicate that active outreach by doctors could have a significant impact on vaccination rates among their patients. However, not everyone has a regular physician. Many people rely on walk-in clinics, urgent care facilities, and emergency departments for their health care. The clinicians who staff these organizations could help boost vaccination rates by explaining the vaccines, the risks, and the benefits to patients.
• Friends and family: Nearly 30% of vaccinated people (who were previously on the fence) said a conversation with a trusted person prompted them to get the vaccine. The majority of those respondents said the conversation was with a friend, family member, or coworker. Nearly half of these once-hesitant respondents (49%) said they decided to get the vaccine to protect family and friends, while one-third said seeing others being safely vaccinated helped to sway them. We see this as an encouraging trend. Sometimes just one or two trusted people in a community can have a significant influence on those around them.

• Convenience: Transportation appears to be the biggest barrier keeping lower-income consumers from getting vaccinated, but it was also an issue for some higher-income individuals. Unvaccinated respondents who said they want the vaccine also pointed to inconvenient hours and scheduling challenges as barriers. More than half of respondents who missed a vaccination appointment said no one contacted them to reschedule. About 30% of people who did get the shot credited user-friendly scheduling, such as an email that listed available dates and times. Some people might not realize that vaccines are often available at their local pharmacy or grocery store, sometimes without an appointment. During the flu season, pharmacy chains go out of their way to promote flu shots—some offer coupons as an incentive. We haven’t seen that level of on-site promotion of the COVID-19 vaccines. Stores, clinics, and public health offices should strive to make vaccinations as convenient as possible, and make sure the public knows the shots are available.
• Information: Many people appear to have reached a level of information exhaustion. They are tired of hearing about COVID-19 and vaccinations. Nearly 40% of people who are not vaccinated said their friends and family members are their top source of information. On average, white consumers were more likely to go to their doctor (44%) for information compared to Black consumers (31%). Respondents who identified as Hispanic were more likely than Black, white or Asian respondents to turn to friends and family for information. Additionally, social media such as Facebook groups and Twitter, were relied upon more by Black respondents (24%), Asian (26%), and Hispanic (24%), compared to white consumers (16%).

A majority of the US population has been vaccinated against COVID-19, and that is good news. But the virus remains very much of a threat to the unvaccinated as well as the vaccinated.

Our survey results show that health care stakeholders should try to remove barriers that make it difficult for people to get the vaccine if they want it. For those who are opposed to vaccines or on the fence, stakeholders should provide accurate information to help dispel myths and reduce fear and anxiety. We also should encourage doctors and other health care workers to educate their patients about the risks of COVID-19 and the safety and effectiveness of the vaccines.

The recent approval of COVID-19 vaccines for children has already spurred some stakeholders to think strategically about ways to boost vaccine uptake. While our survey did not focus on children specifically, there are key takeaways and lessons learned that might help parents feel more confident about vaccinating their children.

According to our survey results, family and friends can be highly influential. Within my own circle of family and friends, I will continue the conversation by sharing factual information and my own experiences.

How are we using our survey results in the field?

• The Deloitte Health Equity Institute (DHEI) is using insights from our research and applying it in the field with an array of community collaborations. We are working to increase access to COVID-19 vaccines for underserved populations and utilize innovative strategies to address vaccine hesitancy.
• In the Greater Washington, D.C. area, DHEI is collaborating with United Way of the National Capital area to increase vaccination rates among Black and Brown communities by hosting various events at community and faith-based centers to promote vaccination access, awareness, and education. DHEI is also collaborating with Mary’s Center, a community health clinic serving the D.C. metro area, to launch a mobile COVID-19 vaccination pod in areas where cases of COVID-19 per capita have been disproportionately high.
• In New York City, DHEI is collaborating with the Robin Hood Foundation and local Federally Qualified Health Centers to increase access to vaccines in underserved areas, while simultaneously strengthening the underlying public health infrastructure for community outreach/engagement.
• At the national level, DHEI’s work with CommonSpirit Health is using technology to engage rural communities on the importance of getting vaccinated and to help remove barriers that prevent people from receiving the vaccine.

1. More than 7.15 billion shots given: COVID-19 tracker, Bloomberg, November 4, 2021

2. COVID Data Tracker, Centers for Disease Control and Prevention, November 10, 2021

3. US vaccine mandates are working, Biden says, but 66 million still don’t have shot, Reuters, October 14, 2021

4. KFF COVID-19 vaccine monitor, Kaiser Family Foundation, October 28, 2021

5. Vaccines & Immunizations/Reactions & Adverse Events, CDC, November 2021

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