A syringe inserted in a bottle of liquid vaccine

Since the coronavirus first started spreading in the U.S., many Americans have hung their hopes on the possibility that a safe and effective vaccine could help our upended lives return to some semblance of normal. But while encouraging preliminary results from late-stage vaccine trials are emerging, a nationally representative survey from Consumer Reports conducted in October found that a large share of Americans are wary.

Less than a third of the 2,670 U.S. respondents said they are “very likely” to get a coronavirus vaccine. 

Meanwhile, Pfizer on Monday announced that early, unpublished data indicated that its COVID-19 vaccine appeared to be more than 90 percent effective. More data will be needed to confirm those results, assess whether protection is lasting, evaluate efficacy in different groups (such as seniors), and ensure that the product is safe.

Pfizer is not alone. Other pharmaceutical manufacturers are also getting closer to turning a hypothetical vaccine for the coronavirus into a reality, with new evidence expected in the coming weeks and months.

Yet CR’s survey suggests that as a potential vaccine gets closer and closer to market, Americans appear to be less and less eager to get it—perhaps because of the unprecedented speed at which development has unfolded. In July, 42 percent of Americans told CR they were “very likely” to get a COVID-19 vaccine; in our latest survey, conducted from Oct. 8 to Oct. 26, that number had dropped to 29 percent. 

More on the Coronavirus

Since our survey was conducted in October, it’s unclear whether announcements by Pfizer, the election results, or other news have had an impact on Americans’ willingness to get vaccinated. 

But having questions at this point is reasonable. Before the public can be confident that a vaccine is effective, independent scientists need to review safety and efficacy data in larger samples than the first preliminary ones, says Scott Ratzan, MD, a distinguished lecturer in the department of community health and social sciences at City University of New York School of Public Health.

At the same time, vaccine manufacturers, regulatory agencies, and the medical community all need to build trust, he says, so that once a coronavirus vaccine is found to be safe and effective, people actually get it.

Ongoing Hesitations About a Vaccine

Before the pandemic began in late 2019, the World Health Organization had listed vaccine hesitancy as one of the greatest threats to global health. Factors influencing this include growing social media interest in the anti-vaccination movement, conspiracy theories and disinformation campaigns spreading misleading messages, and general disenchantment with experts and science overall, according to Ratzan.

Certain demographic groups also have historical reasons for being concerned about a vaccine or being involved in a vaccine trial. And people are far more wary about a coronavirus vaccine than they are about vaccines in general, according to a September nationally representative CR survey of 2,303 U.S. adults. This may be because the coronavirus is so new and people are continually reading that there are so many unknowns about the disease, according to Lilly Immergluck, MD, a pediatrician and a professor in the department of microbiology, biochemistry, immunology, and pediatrics who is involved in COVID-19 vaccine development at the Morehouse School of Medicine in Atlanta.

And in the U.S., messages about vaccine development have been politicized, says Ratzan, who along with colleagues has been tracking U.S. and global attitudes toward vaccines. Still, it’s important to note that these trials are being carried out in the standard way they should be, Immergluck says. An unprecedented effort has led to fast development, but safety steps are not being skipped, she says.

“There’s a lot of eyes watching how these vaccine trials are conducted,” she says. “We’re monitoring the safety. When something doesn’t seem like it’s within a normal side effect for getting a vaccine, that raises red flags for everybody and we all pause.” 

What CR’s Survey Found

When asked when they’d feel comfortable getting vaccinated if a COVID-19 vaccine came out today, most respondents in CR’s October survey said they would get one eventually. But most Americans did not want to be the first in line.

Twelve percent told CR that they would be comfortable getting vaccinated immediately, 21 percent said in less than three months, 26 percent said in three months to a year, 22 percent said after a year, and 18 percent said never.

Still, on a practical level, it’s worth noting that after approval, a vaccine won’t be immediately available to everyone. An approved vaccine will almost certainly be rolled out to high-risk workers and vulnerable populations first, meaning it may take months before the average American can get vaccinated.

Men were more willing than women to say they were somewhat or very likely to get a vaccine (66 percent vs. 56 percent), and a larger share of older Americans said they were very likely to get a vaccine compared with younger respondents (34 percent of those 60 and older vs. 27 percent of those under 60). People with a household income of $60,000 per year or more were also significantly more likely to say they were “very likely” to get a vaccine than people in households that made under that threshold (34 percent to 25 percent).

Black Americans are particularly skeptical about a coronavirus vaccine, according to CR’s survey data. A growing percentage of Black adults—36 percent, up from 31 percent in our September survey—said they were “not at all likely” to get a vaccine. Seventy-nine percent of Black survey respondents said they were “not too confident” or “not confident at all” that a COVID-19 vaccine would be safe, compared with 55 percent of all adults. This is particularly significant because vaccine manufacturers and regulatory agencies have stressed that it’s important for Black people to be adequately represented in vaccine trials, since these populations have been disproportionately affected by the pandemic. Pfizer, for instance, has reported that 10 percent of the participants in its vaccine trial so far are Black; about 42 percent have “diverse backgrounds.”

There’s a long list of historical reasons the Black community is skeptical about getting involved in medical research, including vaccine trials, says Rueben Warren, a doctor of public health and the director of the Tuskegee University National Center for Bioethics in Research and Health Care in Alabama, who has written about this reluctance in the New England Journal of Medicine.

Perhaps the most well-known example was the United States Public Health Service Syphilis Study at Tuskegee, from 1932 to 1972, when hundreds of Black men were deceived into thinking they were being treated for what was then called “bad blood.” They were actually being observed to see the progression of untreated syphilis, Warren says. Treatment was withheld for study participants, even after penicillin became the standard of treatment for the disease.

“If that was it and that was only it, it’d be a different issue, but there are continuous bioethics and public health ethics violations to disproportionately people of African descent,” he says. Even now, throughout the pandemic, Black Americans and other people of color have been disproportionately affected by the disease. Black Americans have died from COVID-19 at twice the rate of white Americans, according to the Centers for Disease Control and Prevention. More needs to be done to address this disparity, Warren says, and all these factors—historical and coronavirus-specific—affect trust in a vaccine and in clinical trials.

Building Trust

For enough people to have immunity to stop the coronavirus from spreading, experts think around 70 percent of the population will need to be vaccinated, Ratzan says. That will help ensure that even if some people can’t get a vaccine for health reasons, there will be enough community protection to stop the virus.

And while there may be skepticism about a hypothetical vaccine right now, experts hope it will be possible to build the trust that’s necessary to convince people that they should get vaccinated once there is a safe and effective real product on the market, Immergluck says. (In the meantime, she stressed that it’s important to get a flu shot, to avoid an even greater risk of potential complications if people do get COVID-19.)

Primary care doctors and nurses need to be informed about coronavirus vaccines as they are developed, Ratzan says, because their advice is often among the most trusted by the public.

Companies developing vaccines and regulatory agencies should work to build trustworthiness, Warren says. To do so with the Black community, they can work with trusted groups, including health and education organizations, faith groups, and civic society groups like the Urban League and the NAACP.

“We’ve got to rely on the science and rely on the scientists who produced it, and we cannot forget the ethics in the conversation,” he says.

At Morehouse, Immergluck says the school’s community outreach programs involve talking to different community groups from various sectors of the population so that questions and concerns are addressed ahead of time.

That way, she says, “when that vaccine becomes available, a real product for the general population, [everyone] will be more informed about what it is.”