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Reminders to stay cautious aren’t the biggest reasons for COVID-19 vaccine hesitancy

Playing it safe for now doesn’t mean it’s forever

Illustration by Alex Castro / The Verge

Esther Cohen is 91, vaccinated against COVID-19, and wants to play mahjong with her friends — who are also vaccinated. She asked Anthony Fauci if they could get back to their games after he spoke at the American Association for the Advancement of Science annual meeting this month.

Fauci, director of the National Institute of Allergy and Infectious Diseases, said she should wait a bit longer and urged her to be patient. The Centers for Disease Control and Prevention was working on guidelines for people who’d been vaccinated because lots of people were asking the same question, he said — why get vaccinated if you can’t get back to normal?

Epidemiologists say the 44 million people in the United States with at least one dose of the COVID-19 vaccine should keep wearing masks and keep their distance from others, at least for now. Some experts are worried that type of messaging is too pessimistic and undersells the vaccines. They think it could make people less interested in getting vaccinated. If the predominant message is that life can’t go back to normal immediately, they reason, some eligible people might decide the considerable effort to track down a shot isn’t worth it.

That’s a real concern, says Melanie Kornides, an assistant professor at the University of Pennsylvania School of Nursing who studies vaccine hesitancy. But she thinks it’s a less pressing problem than the other reasons people decline vaccinations and that once the shots are more widely available, people will be ready to roll up their sleeves.

Right now, there’s a good reason to tell people to keep wearing masks and avoid gathering indoors. The vaccines aren’t 100 percent effective, and there’s still a lot of coronavirus circulating through the country. The vast majority of people still aren’t vaccinated. Although early data indicates that people who get vaccinated are probably less likely to pass the virus to someone else even if they do get infected, experts don’t know that for sure.

“Messaging that you still have to be careful after you’ve been vaccinated is important because it’s true,” Kornides says.

Even if some people do balk at vaccination because of the continued precautions, they probably only make up a small portion of people who say they would hold off on getting a shot. Kornides is surveying nurses, nursing students, and nurse educators about vaccines, and in early survey data, just 10 percent said that they thought it was unlikely that getting the shot could let them go back to their regular activities.

That tracks with the results of other, larger surveys. Most people who say they want to “wait and see” before getting a COVID-19 vaccine are worried about side effects from the shots, or about the speed of the vaccine development process, a Kaiser Family Foundation survey found.

“We’ve been seeing all along, even before the vaccine came out, that they’re worried about long term safety, that they’re worried that the process was rushed, and that there are political motivations for not wanting to be vaccinated,” Kornides says. “Those continue to be the large majority of the concerns.”

People who feel less enthusiastic about vaccines if they can’t return to their normal life may also be younger, Kornides says, and not eligible to get vaccinated yet anyway. “It’s a pretty long stretch from saying that you’re not sure if you want to get vaccinated when you can’t, to saying you don’t want to get vaccinated when it becomes available,” Kornides says. “If you have the opportunity to be vaccinated, you’re more likely to take it.”

Right now, the main challenge with the vaccination campaign is supply. There aren’t enough shots for everyone who wants them. Once supply catches up with demand, researchers and officials will start to get an even clearer picture of who is holding out and why. At that point, public health officials can tailor messages to specific groups to help people understand why it’s important to be vaccinated, she says.

As the vaccine rollout continues, the CDC and other public health groups will develop more guidelines about what people can do once they’re vaccinated. Earlier this month, the agency said that people who are fully vaccinated don’t have to quarantine if they’re exposed to someone sick with COVID-19. Other changes are sure to follow. People will also start seeing the experiences of peers and others in their community who have the shots and who can adjust in subtle, comforting ways.

One of Kornides’ nursing students who was vaccinated was able to end a quarantine earlier than her roommates. “These little bits of normality will make it worthwhile,” she says. The student may be able to ease up on some other precautions or have more peace of mind during everyday tasks like going to the store — and she may tell her friends about those small victories. “That can be a powerful message,” Kornides says.