The United States will likely fail to reach herd immunity to COVID-19 anytime soon—or perhaps ever, health officials say. This is partly because the coronavirus is mutating rapidly, but it’s also because a lot of Americans are hesitant to get vaccinated. After more than a year of the pandemic—with more than a year of shuttered schools and businesses, more than 23 million jobs lost, and nearly 600,000 deaths—why are millions of Americans reluctant about the vaccine?

According to Timothy Caulfield, the Canada Research Chair in Health Law and Policy at the University of Alberta, the reasons run along a spectrum from those who are minimally hesitant—people with questions about the vaccines, the complacent, and the busy—to those who zealously reject COVID-19 vaccination altogether. Misinformation, frequently amplified on social media, has significantly increased skepticism of vaccination for all these people, Caulfield says. As he sees it, material incentives could help convince some people to get vaccinated; anyone can counter misinformation effectively by presenting, without rancor, evidence showing vaccine’s safety and efficacy.

Michael Bluhm: Why are so many people so skittish about the vaccine?

Timothy Caulfield: People fall on a continuum. There is not just one reason why they’re hesitant. At one end of that continuum are hardcore deniers. These are people who have bought into conspiracy theories. They're people who may have ideological reasons for why they are hesitant and are spreading misinformation about vaccines. Then there are people who might still be quite hesitant, but they have some genuine questions about safety. Perhaps they’re concerned about the risk-benefit ratio to getting the vaccine. Then there are people who are simply complacent. Perhaps they don’t feel compelled to get the vaccine, but they don’t have strong feelings against it. Then there are people who may be interested in getting the vaccine, but they’re busy. There are access barriers for them.

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