While 65% of American adults say they have received at least one Covid-19 vaccine dose, more than 80 million adults are still currently unvaccinated, the New York Times reports—and new polling reveals they're refusing the vaccines for myriad reasons.

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Who is refusing the vaccines—and why

According to a recent Kaiser Family Foundation (KFF) poll of 1,888 U.S. adults, 65% of adults say they have received at least one vaccine dose, 10% still plan to "wait and see," 14% said they will "definitely not" get vaccinated, and 6% said they would so only if required.

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KFF found that at least 50% of the members of most demographic groups said they've received a vaccine dose—including those who identify as Democrat (86%), independent (61%), or Republican (52%); white (67%), Hispanic (63%), or Black (60%); and female (70%) or male (61%).

Among the 572 respondents who are still unvaccinated, KFF found that:

• 53% are concerned the vaccine is too new;
• 53% are worried about side effects;
• 43% simply "don't want to get the vaccine";
• 38% don't trust the government;
• 38% don't think they need the Covid-19 vaccine;
• 37% don't believe the Covid-19 vaccines are safe; and
• 26% don't trust vaccines in general.

How to incentivize vaccinations—and how not to

According to the New York Times, because "the unvaccinated and their motivations are complex and heterogeneous," some strategies to improve vaccinations rates may "have little effect."

For instance, although polling indicates that a slight majority of Americans support the general idea of employers requiring vaccination, 61% oppose their own employer issuing such a requirement. Similarly, while 52% of Americans overall said they support vaccine mandates in school, just 37% of parents with children under age 18 said the same—and just 45% of people who identify as Democrat and have children under 12 years of age plan to vaccinate those children as soon as a vaccine is available.

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So what persuasive strategies would be most effective? According to the KFF poll, unvaccinated Americans said they would be more likely to get a Covid-19 vaccine if:

• One of the vaccines currently authorized for emergency use received full FDA approval (31%);
• They were entered into a lottery with a chance to win $1 million (23%);
• A mobile vaccination clinic came to their neighborhood (17%); or
• They were provided with free childcare while they get vaccinated and recover from any side effects (13%).

In addition, a recent Axios-Ipsos poll found that while about 50% of unvaccinated respondents said nothing would convince them to get the shot, 26% of those who said they could be convinced said the leading incentive would be to receive the vaccine at their doctor's office. That finding was underscored in another poll by the Commonwealth Fund, which found 53% of unvaccinated Americans said they would prefer to get vaccinated at their doctors' offices.

"There's a part of [the unvaccinated] population [who] are nudge-able, and another part [who] are unbudge-able," said Cliff Young, president of Ipsos U.S. Public Affairs. "From a public health standpoint they've got to figure out how you nudge the nudge-able."

Why it's so hard to distribute vaccines in primary care offices

According to MedPage Today, another survey found that 74% of primary care physicians (PCPs) reported that they are willing to vaccinate their patients. However, 54% of PCPs reported that their local health departments had not engaged them to help with vaccine distribution, and only 9% said they had a "reliable vaccine vendor" and knew when doses would arrive.

Ann Greiner—president and CEO of the Primary Care Collaborative, which helped conduct the poll— said there is an disconnect between public health and primary care. She emphasized the need for stronger information exchange between state health departments and PCP offices.

Although PCPs want to help reach vaccination goals, they "frankly are … challenged in many states to even know who in their patient population is vaccinated," she said.

Separately, Rebecca Weintraub, assistant professor of global health and social medicine at Harvard Medical School, recommended PCPs treat vaccination like a "family event." She explained that when a vaccine becomes available to younger children, PCPs should be prepared to offer vaccination to anyone accompanying the child who many not yet be vaccinated themselves, such as grandparents or guardians.

More broadly, she said, PCPs should initiate broad conversations with their patients on how the pandemic has affected them, and should treat vaccination as only "one element of re-engaging with your preventive care." (Douthat, New York Times, 7/20; Firth, MedPage Today, 7/8; Hamel et al., KFF, 6/30; Talev, Axios, 7/20)