Covid vaccines and self-fulfilling prophesies

Covid vaccines and self-fulfilling prophesies September 27, 2020

https://commons.wikimedia.org/wiki/File:Coronavirus_COVID-19_virus.jpg; Felipe Esquivel Reed / CC BY-SA (https://creativecommons.org/licenses/by-sa/4.0)

Will you get vaccinated against covid?

According to a variety of polling data, Americans aren’t as enthusiastic about a potential vaccine as would seem to be necessary to eliminate the virus, or to reduce its prevalence back down to the flu the like.

A May poll by AP/NORC found that 20% of Americans were unwilling to be vaccinated, and a further 31% said they were unsure.

Yes, in May — when we were mostly still locked down and talking about flattening the curve.  Also May, long before people were accusing Trump of politicizing vaccine research or approving a vaccine before it had been proven effective, to win the election.  Of course, to be fair, in May there were still hopes that over the summer covid would disappear, but at the same time, fears of a second wave in the fall.

And what the large numbers of “unsure” answers means isn’t clear to me.  Are they simply being cautious — not wanting to commit, even in the context of a poll, outside of the specific circumstances?  Were they imagining that by the time a vaccine came about, covid might have died down so it would be a non-issue?

Looked at by race:

40% of blacks said they would not get vaccinated and only 25% said they would.

23% of Hispanics said no, and only 37% yes.

And only 16% of whites said definitely no, while 56% said definitely yes.

By age,

67% of those age 60 and older would get vaccinated, and only 12% rejected a vaccine, compared to

40% vs. 23% of those under 60.

By party affiliation,

43% of Republicans definitely would and 26% definitely wouldn’t.

62% of Democrats definitely would and 14% definitely wouldn’t.

And 31% of independents definitely would and 20% definitely wouldn’t.

I suppose it makes a certain amount of sense that people who don’t take a strong stance on party affiliation would waffle on other issues, too, since independents are most likely to say they’re “not sure,” at 46%.

But these numbers are troubling, so much so that I spent really more time than I should have, trying to pin down patterns with the full dataset, downloadable at the above link.  My calculations don’t always match up with the “topline” results and I think this is a result of adjustments made to the data to ensure it is broadly representative, but I can’t say for sure, and, heck, for all I know, my math and pivot tables are wrong.

Here are some observations, with the proviso that when you start to look at results in a particularly granular fashion, statistical significance vanishes and you’re left with “this is interesting”:

The differences in likelihood of getting the vaccine, by race/ethnicity, are stark indeed, so I wanted to understand if I could break down the reasons.

We’re told that people are worried that Trump is rushing the vaccines, after all.  Was that a factor in the May survey?

The large majority of those surveyed expected a vaccine in 2021, at 64%, vs. 18% in 2020 and 16% in 2022.  Blacks were more likely to expect a vaccine earlier or later than this date — 21%/45%/27% — and Hispanics were more optimistic:  30%/53%/14%.

Did expecting the vaccine to be available sooner rather than later impact people’s expectations of whether or not they’d get it?  Interestingly, expecting it to come later did not lead to a greater likelihood, and those who expected it to come in 2022 were less likely to say they’d get vaccinated, presumably because they thought they wouldn’t need to any longer.  Blacks and whites (but not Hispanics) were somewhat more likely to say they definitely would get vaccinated, if the vaccine was available in 2021 instead of 2020 — 63% vs. 57% for whites and 37% vs. 29% for blacks.  But among those who expected the vaccine in 2022, only 51% of whites, 16% of blacks, and 25% of Hispanics say they would get vaccinated.

What’s more, they asked those who said they definitely wouldn’t get vaccinated, what their concerns were (they could choose more than one).  Overall, 70% said they would be concerned about side effects, 42% about getting the virus from the vaccine, 31% said they weren’t concerned about getting sick anyway, 30% were generally skeptical of vaccines, and smaller numbers chose other choices.

Interestingly, those who thought a vaccine would be available in 2020 were not more concerned about side effects or about getting infected: 59% of those who thought a vaccine would be ready in 2020 were concerned about side effects, compared to 73% who thought 2021 or 2022.  Essentially the same level of concern was expressed about getting the vaccine, by those who thought it would be 2020 (44%), 2021 (40%), or 2022 (41%), and the patterns are roughly the same for all three racial/ethnic groups.

 

What about other differences?

There is a pronounced sex difference:  65% of men but only 48% of women say they’ll get the vaccine.  In both cases, again, they’re most likely to agree if the vaccine comes out in 2021.  As to reasons why not, their concerns about side effects are roughly the same.  Women are more likely to be worried, if they expect the vaccine to be approved in 2020 or 2021, about getting the virus from the vaccine (33% vs. 48% for 2020 and 34% vs. 42% for 2021).

Those with more education are more likely to agree to a vaccine, 63% of the college educated vs. 43% – 45% of those without.  Knowing someone who had been diagnosed with covid did not make one more likely to agree to the vaccine, but instead less likely — 48% vs. 55%.

But what is most startling are the splits by ideology:

Of those who identified as very liberal, 72% said they would definitely get the vaccine.  Of those who considered themselves as very conservative, only 38% said they would.  Split out by race and ideology — and, again, this level of detail isn’t statistically significant, just interesting —

81% of very or moderately liberal whites, 63% of moderate whites, and 42% of very or moderately conservative whites said they would.

Among Hispanics, 45%/38%/31% (with, again 24% and 26% as liberal or conservative, respectively).

Among blacks, the percentages stood at 41%/29%/13% (and, yes, 28% of blacks identified as liberal, and 20% as conservative, so these aren’t the responses of lone individuals at the extremes).

Finally, let’s narrow down the reasons for not getting a vaccine by race and ideology:

Remembering that this question was asked only of definitive “no” answers, not the “don’t know” responses, so it’s a small group to start, the responses break down as follows:

Worried about side effects:

Whites:  72%

Blacks:  74%

Hispanics:  63%

Worried about getting coronavirus from the vaccine:

Whites:  34%

Blacks:  66%

Hispanics 47%.

In other words, a significantly larger percentage of blacks who rejected the vaccine thought that they could get covid from the vaccine.  Was there a pattern in which conservatives vs. liberals were more or less likely to identify one reason or the other as their motivation for not getting vaccinated?  Not that I could tell, and I squinted at the data very hard.  But, again, the “definitely no” group was small to begin with and I really wish they’d asked this question of the “not sures” as well.

Which finally gets me to the topic promised by my title:  self-fulfilling prophesies.  Here is the article from about a week ago that led me to start really worrying about this:  “Push is underway to test COVID-19 vaccines in diverse groups.”  The report featured efforts to recruit Hispanic and black volunteers for testing of the vaccines.

Scientists say a diverse group of test subjects is vital to determining whether a vaccine is safe and effective for everyone and instilling broad public confidence in the shots once they become available.

The expanded outreach by vaccine researchers and health officials is getting a late start in communities that, because of a history of scientific exploitation and racism, may be the most reluctant to roll up their sleeves. . . .

The hardest part, many experts say, is gaining trust.

“A white guy from NIH is probably not going to be as effective by far in convincing somebody from a minority community that this is the kind of science they might want to trust, as would a doctor from their own community,” said Dr. Francis Collins, director of the National Institutes of Health.

Recruiting African Americans in particular will be “a heavy, heavy lift,” Collins said, because of the legacy of mistrust after the infamous Tuskegee experiment, when Black men in Alabama were left untreated for syphilis as part of a study that ran from the 1930s into the ’70s. . . .

A lack of diversity in the research would have ripple effects once any vaccine is approved for widespread use. Even before final testing began, a poll from The Associated Press-NORC Center for Public Affairs Research found just 25% of African Americans and 37% of Hispanics would get a vaccine once it’s available, compared with 56% of whites.

“If and when we have a vaccine ready, if you didn’t have enrollment of minorities, then people are going to say, ‘Why should I put the vaccine in myself?’” said Dr. Carlos del Rio of Emory University, another study site.

Now, the report also mentions the far more important, scientifically speaking, reason to recruit testers from all demographic groups:

“It’s really important that this vaccine work for everyone, or if it doesn’t, that we understand why,” said Dr. Susanne Doblecki-Lewis of the University of Miami, who is helping to test the Moderna vaccine. Researchers might need to compare the different vaccines “and see how one might better fit a population than another.”

As much as we want to yammer on about “race is a social construct,” that’s only true in the sense that there’s a constructed nature around which groups are deemed “black” vs. “white” or “oriental” (to use the label in use at the time when everyone was more sure that there were three races).  But it is clear that there are physiological differences between someone whose ancestors come from sub-Saharan Africa vs. Greece vs. Sweden, or even northern vs. southern China.  Consider thalassemia, for instance, which in it’s “full-blown” form is a blood disorder and in its carrier form is “somewhat wonky bloodwork” — it is, if I understand correctly, the Mediterranean equivalent of sickle-cell anemia, an adaptation that’s protective against malaria in its “carrier” form; people with ancestors from Greece and parts of Italy are at risk.

At any rate, if it is the case that the vaccine is effective, or, rather, crosses the necessary threshold for sufficiently effective, for some but not all racial/ethnic groups, things could get messy.  (It would seem to be useful to collect such information as exactly what proportion of one’s ancestry is African or indigenous Latin American rather than using a one-drop rule, but presumably that’s not within the realms of what’s possible.)

But — ugh — I’d been mucking around with this off and on so I’d better finish even though it’s a lot of yammering:

This is an instance in which we as a country need for everyone who can get vaccinated, to do so.  It’s all the more important because of the likelihood, as we’re told, anyway, that a vaccine would be less than fully protective, so that we need “real” herd immunity rather than simply being able to say, “those who are worried can get vaccinated, and that’s good enough.”

It’s also the case that, as reported at the Trib last week, children won’t be a part of the initial waves of vaccinations.  Instead, once one or more vaccines are approved, they will then be tested in children, where new safety issues may be found, or where, in any case, the right dosage level will need to be identified to avoid side effects.  And in principle that’s the right thing to do, because children are much less at risk than adults.

But the problem is that it’s fairly easy to ensure kids get vaccinated — just mandate that it be required to enter school or daycare, as we do with routine childhood vaccines.

If we’re trying to get the adult population, focusing first on the elderly and their caregivers but eventually the rest of us, to get vaccinated, we don’t have the same stick.

Which means that I worry that the endless handwringing about Trump’s meddling with the FDA could end up with serious consequences, if the message “people won’t get vaccinated,” repeated often enough, tells people, “if you don’t want to get vaccinated, that’s OK, because you’re in the majority.”

And now it’s time to click “publish” and get on with my day.

 

 

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