As COVID-19 has become a fact of life, public health officials have had to work increasingly hard to get people to bare their arms for a protective jab.
While nearly 80% of Long Beach residents have received at least one dose of a COVID-19 vaccine and more than 70% are considered fully vaccinated, the numbers fall dramatically for additional shots: about 41% have gotten a booster dose, and just shy of 16% of residents have had a second booster, according to Long Beach Health Department data.
And it wasn’t always easy getting that first dose into the vast majority of people in the city. Some were mistrustful because the government was urging the injections, and others worried that the rapidly-developed vaccines were experimental and potentially dangerous, city Health Department Director Kelly Colopy said.
“There were a lot of different reasons (people had) to mistrust what was happening in such a quick timeframe,” she said. And even as data piles up showing the vaccines are safe, “it’s become more and more difficult to convince people.”
Now, with the help of a $100,000 grant, city health officials are preparing to take a closer look at the reasons holding people back from getting inoculated against COVID-19 and possibly skipping or delaying other vaccines.
The grant to Long Beach is funded by the Centers for Disease Control and Prevention and administered by the National Association of County and City Health Officials (NACCHO), which selected the city and two other jurisdictions to take part in its “Vaccine Hesitancy Project.”
Trusted sources
Before the COVID-19 pandemic, most people were either generally accepting of vaccines or staunchly opposed, but now health officials are seeing more people who are unsure or reluctant and not firmly in either camp, said Lori Freeman, CEO of NACCHO. In response, the organization launched the vaccine hesitancy initiative with the hope of increasing the number of people getting COVID-19, flu and other vaccinations.
Health professionals say the reasons people may delay or avoid getting inoculated can vary based on ethnic, economic and cultural differences, but it sometimes comes down to whether they’re given clear information, and who’s delivering it to them.
“Initially I think some of the hesitancy was that it was very complicated to understand,” said Dr. Elisa Nicholas, who is a pediatrician and CEO of Long Beach’s TCC Family Health. “We spent a lot of time explaining what vaccinations were in general and then what this new vaccine is and how they could develop it so quickly.”
And once vaccines were widely available and the pandemic seemed on the wane, there’s been a string of booster shots and new formulations, so “people got kind of burned out on vaccines,” Nicholas said.
Whether people feel they can trust the information they’re getting is another factor, said Dr. Stephanie Booth, a Long Beach-based doctor who works all over the region filling in when other physicians are on leave.
When she sees a patient for the first time, she’ll suggest they speak to their regular doctor if they still have questions or concerns about getting a vaccine, she said.
“It basically was a matter of being able to trust what they were hearing,” Booth said, adding, “if they trusted me from previous experience, they’d be more likely to take it.”
That meshes with what public health officials in one Florida county learned in 2020 when they received the same grant Long Beach is getting.
The Manatee County branch of the Florida Department of Health hired a consultant specifically to look at vaccine hesitancy and collaborate with other agencies and community groups to better communicate vaccine information to people they wanted to reach, said Clinical Director Dr. Edwin Hernandez, who oversaw the project.
What his staff learned from the project helped them increase the vaccination rate of Manatee County adults from 61% to about 80%, he said.
“It’s education through reputable sources — that’s what I think really makes a difference,” Hernandez said.
Why it matters
Long Beach health officials will soon put out a survey about attitudes and concerns about vaccines with a focus on reaching parents of school-age children, and it will also be available to all residents online. They’ll also hold focus groups to hear directly from people from communities with lower vaccination rates, said Sandy Wedgeworth, the city Health Department’s bureau manager for communicable disease and emergency response.
Colopy and Wedgeworth said the city already has tried to remove barriers and overcome concerns by in some cases bringing vaccinations directly to people who couldn’t get to a clinic, and working with trusted faith-based and community groups.
“What we want to understand is what else is there, what else is that hesitancy that we weren’t able to overcome,” Colopy said.
Now that COVID-19 is less of a day-to-day concern for many, why is learning about hesitancy useful?
Longer-term, health officials want to be prepared for the next pandemic, and for now they want to be prepared for new COVID variants and also get families back on track with routine childhood vaccinations they may have missed in the past three years.
While Wedgeworth said it’s been less of an issue in Long Beach, Freeman said there were “very significant declines” nationally in the rate of childhood vaccinations during the pandemic. At least some of it is likely due to people being unable to see their doctors regularly rather than vaccine concerns, Freeman said, but racial and socioeconomic disparities in vaccination rates have deepened — and regardless of the cause, the result of fewer people being vaccinated is the same.
When enough people are unvaccinated, herd immunity can fade, Freeman said, and “that’s why we’re seeing measles make its grand return here; it’s why we’re seeing polio.”