By Sala Thanassi

On the corner of Canal St. and N Norman C Francis Parkway, a bright red scrawl obscures a letter board outside the First Grace United Methodist Church. Where the sign once read, “Love Thy Neighbor, get vaccinated,” spray-paint now covers the message and in its place reads “faith over fear.” Similar anti-vaccine attitudes have been seen all over Louisiana for nearly two years, since the beginning of the COVID-19 pandemic. These sentiments don’t surprise Dr. Shilpa Gowda, employee of the Southeast Louisiana Veterans Healthcare System. 

“You know, it’s pretty common to talk about vaccination,” Gowda says. “I think that there has been a lot of hesitancy – probably more so in the past, before the mandate – but surprisingly now, and surprisingly even amongst physicians and nurses.” 

The World Health Organization defines vaccine hesitancy as ‘a delay in acceptance or refusal of vaccines despite availability of vaccine services.” Before the COVID-19 pandemic arrived, it listed vaccine hesitancy as one of the top 10 threats to global health. According to a recent issue brief published by the Assistant Secretary for Planning and Evaluation in the US Department of Health and Human Services, the percent of respondents indicating that they will ‘definitely not’ get a vaccine – referred to as the ‘strongly hesitant’ – has remained relatively unchanged over time. 

“You know, it’s actually shocking,” says Dr. Peter Krause, referring to the levels of vaccine hesitancy amongst his patients. Krause is a professor of orthopedic surgery at LSU Health Sciences in New Orleans, working primarily at University Medical Center as a specialist in orthopedic trauma. “As it became clearer and clearer that we had a vaccine hesitancy problem in Louisiana in particular, I started being more proactive about asking my patients, ‘Hey, have you been vaccinated, do you want to get vaccinated, what do you think about it?’ and having that conversation. I wasn’t asking that question initially, but probably in the last 3, 4 months I’ve been asking that a lot more. And there’s a large number of patients saying ‘Yeah, no. I’m not interested. I’ve done the research.’”

Nearly a year after the release of the COVID-19 vaccines in the United States, a significant portion of the population remains hesitant to get vaccinated. In a list measuring the 10 states with the lowest vaccination rates in the country, Louisiana sits at number 6, with a vaccination rate of 52.51%. This hesitancy is not unique to the general public, but is shared in healthcare workers as well. In a push to encourage vaccination within the state, Ochsner Health has said all employees must be vaccinated by October 29 or risk losing their jobs. Ochsner also announced they would charge employees a monthly premium of $200 if a spouse or family member covered under the system’s benefits plan is unvaccinated. Despite efforts like these, the deep mistrust fueled by conservative news outlets and rampant online misinformation remains powerful – even for those employed in healthcare positions within the state.

“I was like, how did they develop a vaccine this quick? I don’t know how safe this is,” says Tiffiny Hayes, a nurse who specializes in testing unvaccinated employees within the VA health system. “So I waited, like – I think it came out in the last quarter of last year, I was like ‘absolutely not.’ It wasn’t until maybe February that I said, ‘all right, everything’s okay, we’re not having a lot of physical ailments,’ so I took it.”

Krause also notes seeing hesitancy amongst co-workers during the initial vaccine rollout. “That’s been a little bit surprising to me as well,” he says. “Initially there was a lot of hesitancy amongst nurses, and some of that changed over time. Some of it was pretty rational, like I remember one of the nurses was either pregnant or had just delivered a baby and was breastfeeding at the time – and when the vaccine came out she was like ‘I think I’m going to wait, I need to see more data.’ And I think at the time it was first introduced that wasn’t unreasonable – and she subsequently got vaccinated. But I’ve seen a lot of nurses.”

Just two months ago, Louisiana hospitals faced a risk of overload as record-breaking numbers of COVID-19 patients overwhelmed facilities that were short-staffed. According to state health department data, ninety-one percent of hospitalized COVID-19 patients are unvaccinated. Wasted shots are also commonplace, with spikes into the tens of thousands due to an inability to find willing parties fast enough. According to Kaiser Family Foundation survey data, roughly three in ten healthcare workers demonstrate hesitancy about getting the COVID-19 vaccine, and reasons for hesitancy vary across demographic groups. 

“The hesitancy about the vaccine did not surprise me,” says Hayes. “What did surprise me was healthcare workers not taking the vaccine. That was a little disappointing because, with the amount of training that we’ve had, and the amount of things that we’ve seen, and the patients that are either dying or having long-term physical ailments, we should know better. Because in my opinion, if I don’t take the vaccine and I’m a nurse, that is not okay for me to put others at risk because I’m choosing to not be vaccinated. To me, that seems selfish.”

The American Academy of Family Physicians recently published an article relaying four prominent reasons for vaccine hesitancy amongst healthcare workers, as well as ways to counter them. The reasons listed were safety and efficacy concerns, preference for physiological immunity, distrust in government and health organizations, and autonomy and personal freedom. 

Gowda has heard the reasoning behind her unvaccinated coworkers’ choice to abstain from the shot. “I think a lot of the worries have been related to the vaccine being new,” Shilpa says. “Now, too, a lot of the things that I hear when I’m initiating the conversation with employees about getting vaccinated concern natural immunity – say, they’ve had an exposure that they feel may be more protective than vaccine-based immunity, and they wonder if they’ve had the infection in the past, or perhaps at the time of the discussion they’re going through an infection, is that superior?” 

In looking for potential reasons why vaccine hesitancy has presented itself as such a widespread issue, some researchers turn to social media platforms. A Reuters Health study which focused on Twitter found that each 1-point increase in efforts by foreign vaccine disinformation campaigns on social media was associated with a 15% annual increase in the number of negative tweets about vaccination. Others attribute an increasing lack of faith in government officials: one RAND study concluded that public trust in the Centers for Disease Control and Prevention declined 10 percent from May to October 2020, a critical period in the pandemic.

“I think there’s a lot of people who are just really skeptical about the government,” says Krause. “There are some people who have religious objections, but I haven’t seen that too much. It’s just deep skepticism about something they don’t understand because it seems new. There’s a lot of things on social media that they’re reading – TikToks and things like that – that just are very anti-vax and I guess they believe those people.”

A recent CDC study concluded that unvaccinated individuals are more than twice as likely to be reinfected with COVID-19 than those who were fully vaccinated after initially contracting the virus. It also indicates that COVID-19 vaccines offer better protection than natural immunity alone. Hayes says natural immunity was on her mind in the months she waited to get the vaccine, but when data began coming out she made the decision to go ahead – and that her decision had a ripple effect on the decisions of her family members.

“After about two or three months, I’m like, you know, maybe they’re doing it right. I think, especially with healthcare workers, the more of us talked about it with our family members with the right educated information that we were receiving, it’s much better. I had a lot of family and friends who did not want to take it. So I shared with them my hesitancy in the beginning and that I still took it and I was fine, then they were able to do it with no problem.”

Hayes, Gowda and Krause all work directly with people who express their discomfort with trusting a vaccine that is relatively new and was made relatively fast. They are familiarized with the rationale, reasonings, and justifications of the unvaccinated every day. Two years into the COVID-19 pandemic, all three agree that getting vaccinated is the best option for healthcare workers and citizens alike. 

“I think the biggest thing is, this pandemic is not impacting one race, one culture, one age group, it is impacting everybody,” Hayes says. “I don’t really understand the true level of why so many people are still hesitant almost a year later with getting the vaccine. I can tell you, from a VA perspective, a lot of our vets older than 50 are asking for it. So, it’s the younger people that are a little more concerning for me. When I think of being in my 20s, I don’t know if I would’ve felt the same way that I do now about being responsible.”