Most people who have not gotten the COVID vaccine are not Anti-Vaxxers. Please stop shaming them and ask how you can help.

A recent survey done by SURGO Ventures and reported in The New York Times this month is summarized in the graphic above. They were able to aggregate people who had not yet gotten the COVID vaccine into four major demographic groups. The Watchful, the Cost-Anxious, the System Distrusters, and the COVID Skeptics. (By the way, the fifth group, the Enthusiasts, those who wanted to get the vaccine as soon as possible, are not included in the graphic and comprise about 65% of respondents.)

The Watchful: Those who have been following the news may have been disturbed by events such as the Johnson and Johnson “pause” and periodic reports of side effects due to COVID vaccine that are under investigation. Frankly, the news media have done a pretty bad job of explaining why side effects are being investigated and how common, or rather how vanishingly uncommon, those side effects are. Nevertheless, it can give someone pause, and they just want to see how other people are doing before they commit to getting the vaccine, especially if they have no personal experience of someone getting very sick or dying of COVID.

Response: Talk honestly with your friends who have not gotten the vaccine about your own experience of getting vaccinated, what side effects you might have had, and your own feeling of relief at having gotten it to protect yourself and your family

The Cost-Anxious: Many people are concerned about the cost of the vaccine. While every single dose of COVID vaccine in this country is given absolutely free, some people still don’t know that. Beyond that, there is a time cost to getting vaccinated: If you are a single parent who has three kids and is working two minimum wage jobs and doesn’t have a car so you have to take the bus to those jobs, you simply may not have enough time to get this done if your understanding is that you need to go somewhere and wait for an hour to get your vaccine. The availability of vaccines, while much more widespread, is still far from universal. For the most part, people still have to go to a doctor’s office, a Health Center, a vaccine site, or a pharmacy.

Response: Advocate for making vaccines available at work sites and/or giving people paid time off to get vaccinated.

The System Distrusters: Many marginalized groups based on race, ethnicity, and financial status have a historically fraught relationship with the health care system, particularly when it comes to health programs administered by and promoted by the federal government. Every Black person in this country knows about the Tuskegee Syphilis Experiments where Black men in Tuskegee, Alabama, were promised free healthcare the rest of their lives by U S Public Health Service if they participated in a study to follow the effects of syphilis across the lifespan. When penicillin was discovered in the 1940s and could have either cured men who in the early stages pf the disease or prevented further deterioration in these with more advanced disease, these men were not informed about it and some of them continued in this study undergoing appalling neurological effects into the 1970s. This is just one of many examples of how marginalized people have been exploited by the health system. In that context, it makes sense culturally to be wary of a new program that is being given to everybody until you can be sure that it is safe.

Response: Acknowledge this horrific history and work with influential members of these communities to help people make their decision about COVID vaccination.

The COVID Skeptics: These are the ones who believe that COVID doesn’t exist, that it’s a hoax, that it’s overblown, that it’s a conspiracy, that the vaccine has microchips in it, et. al. These are the hardest to reach and will be hardest to convince and they are the ones with whom discussion is least likely to be useful. While this group comprises a minority of all people not vaccinated, they do seem to be the target of the most anger on social media. This is certainly understandable since they are also the ones most likely to promote antagonistic posts on social media which almost beg for an answer.

Response: Frankly, there may not be one for many of these people. Personally, I often just need to walk away. Still, I have found that if I do simply listen and reflect back the fear that I hear from them, endorsing that their emotions are valid even if there are facts are not, there is very occasionally room for discussion and movement.

As many of you know, I am a doctor, and so I am well aware of the urgency and the immediate threat to life of our current situation. I fervently wish that people would move forward more quickly than they have. Nevertheless, people are acting like human beings. Back in the 1980s when AIDS was killing many of my friends in the gay community, it took literally years for some people to move beyond these categories — especially as AIDS Skeptics — to a place of belief and of action.

And one clarification: I have a great deal of patience and empathy for “civilians,” i.e., people who are wrestling with whether to get vaccinated or not and may be living in a media and social ecosystem that reinforces negative messages about science in general and vaccination in particular. I am happy to listen, to understand, to respond based on where they are at and to meet them in their fear.

However, I have absolutely no qualms about shaming and blaming people in the public sphere — whether it be politics, government, or media — who have the resources and the information to know better. What is remarkable and, of course, not at all surprising is that the vast majority of people who are fomenting fear about vaccine have themselves been vaccinated. I have no sympathy for cynicism and hypocrisy, and I have no problem calling that out in this space or anywhere else

So as much as I wish that all human beings would act rationally in a crisis, that’s not the way we’re wired. For those of us who have accepted and sought out the COVID vaccine as soon as possible , we will not move people by shaming, blaming, and pointing fingers. That is, of course, an understandable response, and yes, is also a deeply human one.

If, however, our goal is to move people to a place of safety, we would do well to take time to listen, find out which of these groups our friends may dwell in, and craft our response to address where they’re coming from. Sadly, in some cases, that may require us, for our own mental health, to simply walk away. This is the only way that as many of us as possible are going to get through this safely while helping those many people who are still truly open to change.