As Maine accelerates eligibility for younger residents to get COVID-19 vaccines, concern is growing that hesitancy to get inoculated may hamper the ability to reach herd immunity.

While there is scant public data about vaccine hesitancy, there is evidence that it could become a problem. For one, the wide availability of vaccine appointments at clinics is part of the reason Maine is moving up its timeline to make people over 50 eligible this week. For another, vaccination rates among key groups – such as health care workers and first responders – are struggling to reach 70 percent, considered the low end of the threshold for herd immunity.

In Maine’s Department of Corrections, just 54 percent of employees who have been offered the vaccine have accepted it. At the Department of Public Safety, whose staff includes state troopers and dispatchers, the vaccination rate is 61 percent. Among eligible employees in the Department of Health and Human Services, which includes Riverview Psychiatric Center and Dorothea Dix Psychiatric Center, 78 percent of individuals have accepted vaccinations.

The vaccination rate among staff of the Northern Light Health hospital network is only 66 percent, although some are still waiting to be offered vaccine when they become eligible under state guidelines. At MaineHealth, whose network includes Maine Medical Center, 77 percent of employees had received at least one dose as of Friday. Neither health care organization requires employees to formally decline, so the true number of those who don’t plan to get vaccinated at any point is unknown.

There has been a gradual but steady shift in attitudes about COVID-19 vaccines, particularly among people who didn’t want to be first in line. As more people have gotten the vaccine, more have accepted that it’s safe and effective.

Yet there remains a sizable percentage of the population who simply won’t get vaccinated, and recent surveys suggests that group doesn’t appear to be budging. Opinion polls released this month by CNN, NPR and the Pew Research Center suggest Republican men, supporters of former President Donald Trump and evangelical Christians are most likely to decline a vaccine.

But the reasons behind vaccine hesitancy aren’t strictly political. Some people want to be reassured that it’s safe. Some say they don’t have enough information. Some are being fed misinformation. Concerns among some immigrants and people of color are rooted in a sordid history of forced medical interventions.

Dr. Nirav Shah, director of the Maine Center for Disease Control and Prevention, cautioned against viewing vaccine hesitancy as a monolith.

“We assume anyone who doesn’t want it must be hesitant in some way, but that isn’t really clear,” he said in an interview. “There is a spectrum of beliefs.”

Shah said he has been encouraged by the evolution of attitudes, particularly among groups that were offered vaccines early. He said he’s heard stories of health care workers or corrections officers who did not get vaccinated when first eligible but later did so. The vaccination rates among those groups have been increasing, albeit slowly.

He said he’ll continue to try to reach those who are most resistant but acknowledged it will be challenging. What he won’t do is shame them or “try to dunk on them.”

“In the history of recorded thought, that has never changed a single mind,” he said. “You have to start the conversation differently: What can we agree on? That too many have lost their lives? OK, how can we address that?”

‘MAKING THE PUBLIC SAFE’

The first people eligible for vaccines after they were authorized by the U.S. Food and Drug Administration were health care workers and residents and staff of long-term care facilities.

Rick Erb and Nadine Grosso, president and vice president of the Maine Health Care Association, which represents nursing homes and long-term care facilities, said many staff members had concerns about being first in line. The most recent data collected by the association shows 90 percent of residents have been vaccinated while 65 percent of staff have gotten their shots. The second number has been climbing, though.

“At the association level, that’s been one of our goals all along, to provide as much education as we can,” Grosso said.

Erb said nursing homes are used to advocating for flu vaccines, given how serious the flu can be to older individuals. The same rules apply now, even if the stakes are greater.

“We know we’re not going to reach everyone,” he said.

In the Portland Police Department, 123 of 156 sworn officers, or 79 percent, have been vaccinated, department spokesman David Singer said. Among public safety dispatchers, the rate is 89 percent. Both rates are higher than in the Maine Department of Public Safety.

Of the city’s more than 200 firefighters, 86 percent have been vaccinated, according to Capt. John Brennan. He said there were various reasons the remaining 14 percent opted out, but he said if any change their mind, they will be set up with appointments immediately. One firefighter who was initially reluctant recently got a shot, Brennan said.

Portland police Sgt. Chris Dyer was offered the COVID-19 vaccine in early February. He barely hesitated before signing up.

“Honestly, it felt like the first thing I could control throughout this whole pandemic,” said Dyer, 37, a 12-year police veteran.

Dyer is young and healthy. His chances of beating COVID-19, were he to get infected, are high. But he said he wasn’t thinking of himself when the needle entered his arm.

“That’s what our job is about, making the public safe,” he said. “With the amount of contact we have with people, and the diversity of people we encounter, this seems like a place where we can serve as an example.”

Others feel differently. Karen Harrington, a registered nurse from Clinton, said her concerns stem from the fact that the vaccines have not been studied long term.

“It can be very easy for advocates of the vaccine to vilify those who have chosen not to be vaccinated or not to be vaccinated at this time,” she said. “This creates a very dangerous ‘us versus them’ mentality. That is why I think intelligent and respectful dialogue on this topic is incredibly important. I also want to dispel any notion that those of us who are declining the vaccine at this time are ‘anti-science,’ ‘anti-medicine,’ ‘conspiracy theorists.'”

Dr. Laura Blaisdell, a pediatrician who helped lead the campaign last year to preserve Maine’s new law eliminating religious and philosophical exemptions for childhood vaccinations, worries that people are in denial about the need for herd immunity – the point where enough people have been vaccinated that it makes it difficult for the disease to spread.

“I hope that increasingly people are understanding why we need community immunity, why personal immunity isn’t enough,” Blaisdell said.

Herd immunity protects the most vulnerable, including those who cannot get vaccinated for health reasons. It’s how polio, smallpox and other contagious diseases have been eradicated.

Older people and those with high-risk conditions have been most eager to get the vaccines because they fear the virus will kill them. Younger people who don’t share that fear might feel like they don’t need the vaccine, Blaisdell said.

“We still are learning about this disease,” she said. “People, even young people, have long-term symptoms. And we do still have severe outcomes in young individuals who are healthy. So it’s somewhat of a Russian roulette to say this disease isn’t going to affect me.”

POLITICIZING PUBLIC HEALTH

The 2020 presidential election did little to remove politics from the pandemic. In fact, surveys show more and more Trump supporters resist getting the vaccine.

The trend has drawn the attention of veteran Republican pollster Frank Luntz, who convened a focus group this month with 20 vaccine-skeptical Trump voters to try to figure out if they could be persuaded.

“The overarching message from this session is it’s going to be very, very hard,” Luntz told The Associated Press. “The people who voted for Trump and don’t want to take the vaccine are committed in their opposition. They don’t trust the science. They don’t believe the media, and they think everything is politicized.”

Trump, for his part, told Fox Business host Maria Bartiromo in an interview last week that the vaccine was “great” and “safe.”

“I would recommend it to a lot of people that don’t want to get it – and a lot of those people voted for me, frankly,” said the former president.

But Trump received the vaccine privately and was the only living former president who didn’t take part in a public service announcement encouraging people to get vaccinated. Also, his words have been directly contradicted by unfounded claims about vaccines made by high-profile conservative commentators, Fox News host Tucker Carlson chief among them.

In an NPR poll of 1,227 adults conducted March 3-8, 49 percent of Republican men said they did not plan to get the shot, compared with just 6 percent of Democratic men.

“I am surprised that a public health event has been politicized,” said Dr. Evan Benjamin, chief medical officer at Ariadne Labs, a joint center for health systems innovation at Boston’s Brigham and Women’s Hospital and the Harvard T.H. Chan School of Public Health. “The politics sort of set the stage early on, with masks and other measures, and we’re paying the price.”

Liz Hamel, director of public opinion and survey research at the Kaiser Family Foundation, a national health care nonprofit, has been leading monthly surveys since December and said her findings match the other public surveys, but said politics don’t tell the whole story.

In general, Hamel said people fall into  four categories: those who want a vaccine as soon as possible; those who want to wait; those who will get vaccinated only if it’s required; and those who definitely won’t.

Although the percentage of people surveyed by Kaiser who say they won’t get the vaccine or will only get it if it’s required has dropped by just 2 points since December, the percentage in the “wait and see” category has fallen from 39 percent to 22 percent. Perceived side effects remain the top concern among that group.

“What we’ve seen over time – as more and more people see friends and family members get vaccinated – is people moving from a position of ‘I’m going to wait and see’ to ‘I’m ready,’” Hamel said.

Cara Sacks, spokesperson for Mainers for Health and Parental Rights, which opposes mandatory vaccines, said safety concerns and distrust of the pharmaceutical industry are the primary reasons she sees for hesitation.

“We have never seen a vaccine brought to market so quickly and with new mRNA (messenger RNA) technology,” she said. “The public has legitimate concerns about whether the vaccines are truly safe, reliable and effective.”

The three vaccines in use in the United States have all been through rigorous trials, have received emergency use authorization by the FDA and have not shown any significant side effects. The COVID-19 vaccines do not contain a live virus and do not carry a risk of causing disease.

Sacks said what matters most to her is that people have the freedom to choose.

Asked whether widespread vaccine skepticism threatens a return to normal life, Sacks said, “If the COVID-19 vaccines are shown to be truly safe, effective, and reliable, we don’t expect there will be any problem reaching the hypothesized 70-85 percent threshold while at the same time upholding Americans’ freedom to choose what gets injected into their bodies.”

ATTAINING HERD IMMUNITY

Benjamin, the medical officer for the Brigham Women’s/Harvard Chan School of Public Health collaborative, said he remains optimistic that we will reach herd immunity.

“Our approach to this is to really listen to people’s concerns, because they are very real,” he said. “I think most people who have concerns when they are presented with accurate information, that doesn’t come from pharmaceutical companies or from government, are going to choose to get the vaccine.”

Willy Ritch, former staff member to U.S. Rep. Chellie Pingree of Maine, is involved with a public service effort called “Do Our Part.” It involves using social media to reach individuals in Maine who are reluctant, or skeptical. So far, the project has targeted seniors, immigrants and suburban mothers. The biggest challenge, he said, is fighting misinformation.

“We live in a world where institutions are just not believed or respected anymore. That’s why we want to get neighbors and other real people out there saying, ‘I got it,’” Ritch said. “Without efforts like this, the anti-vaccination side is able to have free reign on what’s out there.”

Dr. James Jarvis, COVID-19 incident commander for Northern Light Health – the parent of Eastern Maine Medical Center in Bangor, Mercy Hospital in Portland and others – said last week that he’s noticed more vaccine hesitancy among people in their 60s than he did among those over 70. He said one of the best ways to address vaccine hesitancy is through the doctor-patient relationship. He said people are more likely to respond to a medical professional they trust.

Jarvis said when he talks to patients, he asks them: “Who’s the most important person in your life? That’s who you’re getting vaccinated for.”

Shah said his first advice for people who are hesitant is to ask their doctor what they would do.

“When most doctors have been offered the vaccine, they take it,” he said. “What that means is: Experts find it to be safe.”

Shah said he sees similarities between vaccines and masks. For many months, people were reluctant to embrace masks but have come around to see their benefit. Of course, masks have been mandated in most public places. There are no plans to mandate vaccinations.

Shah also said he’s been trying to emphasize the things that will change, or become easier, for people who get vaccinated. Travel, for instance.

“Spelling out the benefits matters,” he said. “The words we use are really critical. I try to speak about the positives of things, … about the benefits of doing something rather than hazards of not doing it.”

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