Why Are People Resistant to Vaccination? And What’s the Solution? [Public Health]

A 'Cultural Ambassador' reaches out to people who have doubts about the COVID-19 vaccines.

Many people think of the COVID-19 vaccines as hope in a dark time—but others aren’t even sure they want to get vaccinated. In an effort to better understand the hesitancy that many feel about this and other medical research topics, the Yale Center for Clinical Investigation’s (YCCI) Cultural Ambassadors program links researchers at Yale to people in the community to help them make that decision—giving them the facts they need and answering difficult questions.

“It’s a great responsibility to make sure we continue to address the elephant in the room, which is mistrust with regard to the vaccines,” says Sandra Trevino, LCSW, a founding member of the Cultural Ambassadors program. The 10-year-old organization has a mission that extends beyond the pandemic, to broaden community participation in clinical trials at YCCI and to ensure that minorities are not only represented in medical research but also have a voice and a seat at the table in planning it.

In December, around the time that both Pfizer’s and Moderna’s vaccines were granted emergency use authorization by the Food and Drug Administration (FDA), the Kaiser Family Foundation released results of a survey in which more than one-quarter of Americans said they would probably or definitely not get the vaccine. Republicans, and rural and Black Americans were most hesitant in the Kaiser survey. Trevino, who is a former executive director of Junta for Progressive Action in New Haven, is unsurprised and says that many of the Hispanic people she knows feel the same—as do others who are members of an underserved and underrepresented community.

She wants to encourage everyone to get the vaccine—two doses, given three or four weeks apart for full protection (the timing varies depending on the vaccine). Trevino also urges people she knows to continue taking precautions, like wearing masks and social distancing, even after they’ve been vaccinated. 

In a recent interview, she explained why and talked about her own family’s experience with COVID-19 and the vaccine.  

What has the pandemic been like for you and people close to you?

The impact has been devastating. One American dies from this illness every 33 seconds. In my family, both of my sisters tested positive. One is still in treatment and her entire family is suffering from it as well. I have several friends of different ages who passed away due to COVID-19. It has torn individuals and their loved ones apart. There is a huge loss for those of us who have lost loved ones.

Why are some people hesitant to get vaccinated?

As a Cultural Ambassador, I’ve heard from people looking for answers from the beginning. What is the virus? How long will it be here? There has been a desperate need to find answers. And people sensed there was a lot of information coming out in the news and on social media that wasn't necessarily true, and that is playing with their minds and thoughts and decisions about whether they should get the vaccine. I’ve seen this in the Latino community. People have sent me texts, asking, “Is it true that the vaccine can change your DNA?” And, of course, that is a myth. It’s not true.

Have you gotten the vaccine?

I have. I didn’t have any side effects other than soreness at the injection site. I know there can be side effects like pain and swelling where you get the shot, and fever, chills, headache, and tiredness. They are normal signs your body is building protection, and those side effects go away in a few days. But I did not have those side effects.

Did you have reservations before you got the vaccine?

I did have concerns. In the spring, when we didn’t yet have an FDA-approved vaccine, people were asking me, “Are you going to get it?” I told them I planned to, once it was approved. I told them that they would need to make a decision about getting the vaccine based on accurate information from the Centers for Disease Control and Prevention [CDC], the FDA, and the Yale Medicine and Yale New Haven Health websites. I told them, “Don’t just listen and believe what people around you are telling you if you're not truly doing your own homework and paying attention to trustworthy news sources and the research.”

You mention the CDC and FDA. As a health care provider, were you listening to any other sources?

Town halls. From those I learned that we all have our own questions and doubts—but then there are questions that might not have occurred to you. When somebody else is given the chance to ask a question, you're thinking, "Oh my God, I wasn't even thinking about that." 

Especially those who might have other illnesses. There was worry about asthma, or [with the recent news that a small number of people with severe allergies may have a reaction to the vaccines] concerns around seafood allergies. I have a seafood allergy, a severe one. So that was another of my concerns about how the vaccine was going to impact me, or other individuals who are in the same boat. As a Cultural Ambassador, I want to help people get answers to their specific questions.

When did you feel comfortable about getting the vaccine?

The more I learned about how many people were losing their lives, the more important the vaccine became to me. Then I wanted people to know that I got the vaccine. Afterwards, I took a picture and put it up on my personal social media page with the comment, “Is it the vaccine or the virus? You decide.”

I wanted people to respond with their thoughts and feelings. If they expressed concerns, I reached out to them personally. I sent them articles from trusted sources about how many people have had the virus and how many have died, and explained that the vaccine is a way to avoid that. I don't think everyone understands. Some people don’t know the vaccine will help their bodies develop an immunity to the virus that causes COVID-19, without them having to get the actual illness. 

For people who still aren’t sure, how do you explain how the vaccine works?

My greatest asset has been my cell phone. When people ask me questions, by text or during a phone call, I say, “I'm going to send you some information." I take snapshots from articles or websites, and I send those to them, because I don't want them to come back and say, "Hey, well, this is what Sandra told me." I don't want anyone to misunderstand what I say. I want them to read the articles first, and then they can call me, and we can discuss it.

Some conversations are quite difficult, especially when I’m talking to someone who hasn't been affected by COVID-19 and doesn’t trust vaccines or the research world. Those conversations can get pretty harsh, with people using nasty words. I just remember that for them it’s about trust—they had an unpleasant experience, or they know that, back in the day, research wasn't beneficial for everyone because there weren't good guidelines in place. 

I think this is where the social worker in me is helpful. I always say community work is like a relationship—like a marriage. You have to be patient, and you’re not always going to agree on everything, but it's certainly worth working on those types of relationships. To me this is a big responsibility, because I don't want people to come back later and say, "I listened to you and now somebody I love has died." 

You work a lot with the Latino community. Why is this information important for this group in particular?

There are ideas among Latinos like, “We don’t need to get the vaccine because we have stronger genes or a better immunity.” Latinos, like some other groups, are also very close to their family, so it’s also difficult for them to stay away from their families, which we sometimes have to do to protect elderly relatives and others. I'm not trying to say that other communities don’t feel that way. But I do know that all of this has been difficult for most Latinos.

We also have recent immigrants who think getting them scheduled for the vaccine will be a way of checking on their status. This tactic has been used by anti-immigrant groups in the past. It’s shameful, it's unethical, but it has been put out there by anti-immigrant groups to create fear and to discourage individuals from seeking medical services, as well as from taking a vaccine that could save their life.

What else do you want people in the community to know?

I’m encouraging people to continue to protect themselves and others, even if they have already had the vaccine. I constantly tell people to wear their masks and wash their hands. We need to follow the CDC guidelines, and the CDC has not yet recommended that people stop taking these precautions after they are vaccinated. 

I've heard some people say, "Well, I'm not a mask person." I say, "Well, then you're literally digging your own grave." I get looks like, "Oh, you're so dramatic." But I'm not being dramatic. I understand people are in pandemic fatigue, but the virus is still out there, and it's worse now than it was before. I want them to know that this is the reality of what we're living, and the vaccine is now available.

Visit Yale Medicine's Vaccine Content Center for more stories on COVID-19 vaccines.