Vaccine hesitancy: How much should we worry?

The results of a CBS News poll published in late February tell us that only half of Americans are willing to get a COVID-19 vaccine. According to a Pew Research poll in early February, 19 percent report already having gotten the vaccine, and 49 percent say they would probably or definitely get vaccinated.

Sadly, this is not enough. According to recent estimates, at least 75 percent of a population need to get the vaccine in order to achieve herd immunity. It is no surprise that many people are alarmed.

I am concerned, but it may be too soon for alarm. Half of Americans are willing to inject their bodies with a concoction that didn’t exist three months ago — and one in five have already done so. This is not inconsequential. Though this is not enough in total numbers, in context, it is remarkable.

The case for calm is supported by the fact that of the Americans who have shown hesitancy, not all are completely rejecting the notion of getting vaccinated. According to the same CBS News poll, one out of four Americans are not sure what they will do.

Hesitancy is not the same as refusal, nor is it the same as apathy.

So how worried should we really be about vaccine reluctance? To answer that, we need to look more closely at why people generally engage in decision hesitancy. The psychological and sociological drivers of indecision in other areas of life may shed some light. 

We are more likely to regret what we do than what we avoid.

No one likes making the wrong choice. It comes with regret, which feels terrible. As we make decisions, we think through different options and play them out in our heads. We assess each counterfactual and prefer the option that comes with the least amount of anticipated regret. If we think we will regret choice A more than choice B, we will probably choose B.

Research in psychology has suggested that anticipated regret is higher for outcomes that depart from the status quo. “Abnormal” situations evoke more powerful emotional responses (including regret) than typical ones, and decision makers have a tendency to associate regret with action more so than with inaction.

Making the decision to receive a COVID-19 vaccine is a classic example of an abnormal action.

What about the consequences of not getting vaccinated? Is there greater regret associated with that decision? Yes, if you believe the data, but there is more to consider.

Regret is more likely when uncertainty is greater. If we could predict the future and know all there is to know, then decision making would be easy, and regret would not be relevant. 

Arguably, we have enough scientific data about the COVID vaccines to be certain to the point of no regret. The decision should be straightforward, but it is not, because human decision-making is anything but straightforward. 

Data comes in many forms. Numerical data is only one form of information. Personal experiences are another. The human brain processes data in the form of stories or personal experiences more easily than it processes numbers. Compelling narratives are relatable and more likely to be internalized. While plenty of data points tell us that vaccines are safe and effective, personal stories of longer-term impact are yet to exist. Many Americans still have questions about what the vaccine will do to our bodies in the next months and years. There may be reason to worry about extreme side effects, but the point is clear: Data is well and good, but personal experiences can carry weight, and they are going to take time to develop.

According to the CBS News poll, 58 percent of those who might not or will not get the vaccine said they would like to “wait and see.” Perhaps seeing that few people have experienced life-altering side effects is the sort of information they are waiting for. 

Fortunately, social forces may shorten the wait. Consider the bandwagon effect: Stated simply, people often choose a course of action for little other reason than that the majority has already chosen it. The idea is that if everyone else has decided on something, it must be right. There is safety in numbers; following the bandwagon can minimize regret.

Half of Americans is a large proportion, but it may not be enough for a bandwagon. How decision makers define the “majority” also matters. Sometimes, we care what others in the country are doing; at times we care more about what people in our social networks or communities are doing. In minority communities or among Republicans, where hesitancy rates are higher, the bandwagon may not have yet emerged. 

The good news is that every individual hesitant mind need not be changed. Only a tipping point is needed to create the possibility for major progress. The bandwagon can take care of the rest.

Some Americans will simply never get vaccinated. Before the rest of us conclude that we are doomed, we need to take stock of what we have going for us. Many remain more open-minded than we might assume. We are also headed in the right direction: Research tells us that the proportion of people willing to get vaccinated went up by 10 points from September to December, and according to the Pew study, the proportion increased by 9 points from November to February.

We have already lost so much to COVID-19 that most of us want things to turn around right away. This is an understandable hope, though regrettably not realistic. That does not mean things are hopeless. If we understand the hesitant mind and give doubters what they need to avoid regret, then we will have accomplished a lot. The rest is up to them.

Nika Kabiri (JD PhD) is a decision science specialist with over 20 years of experience studying decision making in a variety of contexts. She is a consultant, University of Washington faculty member and best-selling book author. Follow her on Twitter @nikakabiri.