Why People Might Reject a COVID-19 Vaccine

What leaders should know about Americans' hesitation to be vaccinated.

Posted Feb 27, 2021 | Reviewed by Kaja Perina

  • Less than 50 percent of Americans have received or want to receive a Covid-19 vaccine. 
  • 31 percent intend to “wait and see” and  20 percent of Americans do not want to be vaccinated.
  • Americans' perception that leaders are incompetent, untruthful, and uncaring may be a factor in the hesitation or refusal to be vaccinated.
  • Leaders who demonstrate competence, character and caring are needed to improve the number of Americans who are willing to be vaccinated. 

Safe and effective vaccinations for Covid-19 are here and more are on the way. The supply of vaccines is increasing and in the coming months anyone who wants to be vaccinated will be able to do so. To quell the pandemic, experts say that 80 to 90 percent of the population must become immune either through vaccination or by prior infection.[i] Given the massive effort to develop and distribute vaccines, this goal is achievable but only if enough people agree to be vaccinated.

Alachuo County, Florida, public domain
Covid-19 vaccine
Source: Alachuo County, Florida, public domain

A significant obstacle to attaining this goal is lack of trust in vaccinations. According to one recent poll, just 47 percent of Americans have received a vaccination or plan to get one as soon as possible. Another 31 percent intend to “wait and see” before getting vaccinated. The remaining 20 percent indicate they will be vaccinated only if required to do so or say they will definitely not get the vaccination.[ii] While these numbers are improving somewhat compared to earlier surveys, they still make reaching the 80–90 percent criterion challenging without reaching that goal through prior infections which, of course, will result in thousands of additional deaths.

Racial and Political Disparities in Willingness to Be Vaccinated

There are significant racial disparities in intention to vaccinate. White Americans (51%) are more likely to indicate they want the vaccine immediately than Black (38%) and Hispanic (42%) Americans. Differences in vaccination intent is also linked to political identification. Only 32 percent of Republicans report having been vaccinated or intending to do so at the earliest opportunity.[iii]

On the face of it, reluctance to receive the Covid-19 vaccination seems to run counter to common sense, given the vast amount of scientific evidence demonstrating both the effectiveness and safety of these vaccines. Why would anyone risk getting a severe disease, one that has resulted in the deaths of over 500,000 Americans and in lingering and severe symptoms in many hundreds of thousands more people? The vaccine is free to all who want it, and despite early challenges the distribution process is gaining momentum.

Resistance to receiving the vaccine is just part of the problem. Some people believe that Covid-19 is a conspiracy and deny that Covid-19 exits, or if it does, that it is no worse than the common cold or the flu. Some believe that reports of Covid-19 deaths are greatly exaggerated. They refuse to wear a mask and may confront those who do. There are even Covid-19 vaccination protests. In Los Angeles, protesters delayed vaccinations, claiming the pandemic is a scam.[iv]

How a Breakdown in Trust Contributes to Opinions About Vaccination

This resistance to the vaccine and belief in conspiracy theories about Covid-19 result from, at least in part, a breakdown of trust. Trust in science and trust in elected leaders is necessary for people to accept the reality of the pandemic and the necessity of getting vaccinated. One way to understand this breakdown of trust, is to look at the elements of trust identified by psychologists and other researchers.

One of the most convincing studies of trust was conducted by military psychologist Patrick Sweeney, who surveyed US troops during the initial invasion of Iraq in March 2003. In the crucible of combat, subordinates must trust their leaders. Their very lives depend upon it. Sweeney found three factors necessary for trust. Trusted military leaders were competent, of high character, and were genuinely caring of their soldiers.[v] They knew their job inside and out, were honest, fair, and modest, and always had the welfare of their soldiers foremost in mind. Other studies of trust in military contexts reveal two additional leader attributes — commitment and communication — to be critical in establishing and maintaining trust.[vi] 

When it comes to trusting the Covid-19 vaccine, evaluating national leaders — those responsible for ensuring the health of all Americans — on the attributes of competency, character, caring, commitment, and communication reveal why so many people have concerns about being vaccinated. In the first year of the pandemic leaders failed, to some extent, in all these dimensions. Too many leaders were perceived as incompetent, untruthful, and uncaring. Rather than committing all national resources to address the pandemic, they politicized the national response, often focusing on their own personal political goals and ambitions rather than on the health and welfare of the people. Communication was woeful, resulting in the dissemination of false information, conflicting information, or no information at all. Leaders openly contradicted the advice of scientists and medical experts, further eroding effective communication. Failures in these five domains resulted in an unknown increase in numbers of infections and deaths.

Leaders Must Communicate Clearly and  Be Empathetic to Those Who Are Reluctant

Going forward, what should national local leaders do to address this problem? First, they must demonstrate clear mastery and confidence in the science of Covid-19. They must demonstrate character by providing honest appraisals of the disease, even when the news is bad. Rather than denying the scope and impact of the pandemic, they must show genuine caring and empathy for those affected and their families. Leaders should communicate clearly and regularly the status of the disease, vaccination progress, and current and future actions needed to combat the disease. And, finally, they must publicly commit to defeating the pandemic, no matter the cost. They must be especially diligent in these efforts for populations that are particularly resistant to being vaccinated.

Finally, leaders must be sensitive and empathetic to those who are reluctant to be vaccinated. Black Americans remember the travesty of the Tuskegee study of syphilis in which Black participants were misinformed and misled about the study and those infected were not given adequate treatment, even after penicillin was introduced as an effective treatment in 1947.[vii] This, coupled with systemic inequities in healthcare, contribute to an understandable mistrust of the vaccine. Only through clearly and decisively demonstrating competence, character, caring, commitment, and communication can this mistrust be alleviated for all Americans, regardless of race or political affiliation.

Note: The views expressed herein are those of the author and do not reflect the position of the United States Military Academy, the Department of the Army, or the Department of Defense.

[i] University of Missouri Health Care, COVID-19 Vaccine Key to Reaching ‘Herd Immunity’ , https://www.muhealth.org/our-stories/covid-19-vaccine-key-reaching-herd-...

[ii] Phil Galewitz, Kaiser Family Foundation, January 27, 2021, Poll: Nearly Half of American Adults Now Want the Covid Vaccine — ASAPhttps://khn.org/news/article/poll-nearly-half-of-american-adults-now-wan...

[iii] Ibid

[iv] Matthews S Schwartz, NPR, January 31, 2021, “LA COVID-19 Vaccinations Delayed By Protesters” https://www.npr.org/sections/coronavirus-live-updates/2021/01/31/9625954...

[v] For more on the 3 Cs of trust, see my May 3, 2016 blog post “The 3 C’s of Trust” https://www.psychologytoday.com/za/blog/head-strong/201605/the-3-c-s-trust

[vi] See The Character Edge: Leading and Winning with Integrity by Robert L. Caslen, Jr. and Michael D. Matthews, St. Martin’s Press, 2020.

[vii] See The Tuskegee Timeline at the Centers for Disease Control and Prevention website: https://www.cdc.gov/tuskegee/timeline.htm