Everyone over 16 can now get the COVID vaccine. How do we make sure they get it?

There is no single approach to helping those hesitant to vaccines make an informed decision.

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America’s COVID-19 vaccination efforts are well under way: More than 76 million people are fully vaccinated and more than 100 million have received their first dose.  As of today, all Americans 16 years and over are eligible to receive the vaccine.

But don’t throw away your mask just yet. While fully vaccinated people, and those they interact with, are safer, there’s still a long way to go to reach levels of immunity that will significantly bring case counts down and allow us to resume relatively normal public life. Concern that a critical portion of the population won’t ever be vaccinated is rising among public health professionals, who say that getting people vaccinated will become harder and harder as we run through the large demographic of people proactively seeking out vaccinations. 

Research suggests that about 67 percent of Americans were prepared to get vaccinated last year, which means that even if every single one of them gets the shots, millions of eligible adults won’t be vaccinated. 

“Herd immunity, that’s the ultimate goal, but where we currently sit it’s going to be probably impossible to achieve,” says Glen Nowak, director of the University of Georgia’s Center for Health & Risk Communication. Nowak was previously the CDC’s first director of communications for the National Immunization Program. Though it’s hard to nail down exactly how many people need to be vaccinated to reach herd immunity, a number of factors stand in the way: Eligible people who choose not to get vaccinated, children who aren’t eligible, plus other issues that have yet to be resolved such as whether vaccines prevent transmission of the virus, how long immunity lasts, and how variants will affect vaccine efficacy. But every vaccination we can achieve gets us closer and makes us safer.

Some people have the resources and the willingness to get vaccinated on their own or with minimal help. But the next group of people that public health officials need to reach are those who are not actively trying to get vaccinated but would have no objection to being vaccinated when their health practitioner advises them to, says Scott Ratzan, a public health professor at CUNY. 

[Read more: Should vaccinated people still get COVID tests?]

Vaccine hesitancy—when people hold off on getting a vaccine or actively refuse one when it’s offered—is an ongoing issue in achieving high levels of vaccination. For this group, researchers say there isn’t one method that could or should work for everyone to combat it. “There isn’t an elevator pitch, because everybody’s different,” Ratzan says. 

Vaccine hesitancy is nothing new. “Anytime there’s a new vaccine that’s made available … it does take a couple of years for large numbers of people to accept [it],” says Nowak. “New vaccines are often welcome, but too many people take a wait-and-see attitude.” 

In the context of a global pandemic, however, waiting will cost lives. Years of fragmentation, defunding, and lack of attention to false information have left our healthcare systems ill-prepared to successfully administer a vaccine campaign on this scale, both in practical terms and in terms of reaching high enough levels of vaccine acceptance.

This attitude is particularly prevalent if you don’t have anyone to suggest you get vaccinated. “There’s the people that are outside of the whole system,” Nowak says. Whether because of lack of access to healthcare or the choice to not seek out healthcare professionals, millions of Americans don’t regularly interact with the healthcare system at all. That’s the cohort that will be hardest to reach, he says, because they have no reason to trust or interact with medical professionals and are vulnerable to anti-vaccine false information. 

The COVID-19 vaccines are effective and have a high safety profile (including the currently paused Johnson & Johnson vaccine). But it’s absolutely reasonable to have questions, especially given the unprecedented timeline over which they were produced and tested. 

Nowak says personalization, patience, and persistence are key to providing the right information for individuals to make an informed decision. It’s important to ask different groups of people what they would need to know in order to be comfortable with vaccination and help them get that information, he says. 

The CDC has a list of questions and answers about the COVID-19 vaccines that addresses many common misconceptions. But the personal touch is key when it comes to driving those messages home, both experts say—in other words, getting your questions answered by someone you trust, like a community leader or a family doctor.

The Biden administration has poured resources into getting people vaccinated since taking office, from releasing CDC guidelines on what you can do after getting vaccinated to reaching out to Americans through pop culture. The federal effort has been helped by some state and community leaders such as clergy, although the white evangelical community and the military are notable exceptions. 

But more needs to be done, says Ratzan. “I think we just need a better trusted source of information,” he says. To him, setting up a COVID-19 information bureau that brings together sources like the CDC with non-governmental sources to present a unified message on the vaccine’s efficacy and safety would be a good start. In the meantime, he says, the more Biden can speak about the vaccine and get others to speak about it, the better.