This article is part of State of Health, a series about how Michigan communities are rising to address health challenges. It is made possible with funding from the Michigan Health Endowment Fund.

Although many people in Michigan and around the world have let out a collective sigh of relief as COVID-19 vaccines roll out, many are still hesitant about vaccination. They have questions: “What are the side effects?” “Did its fast development bypass safeguards?” “Can we trust it?”

Health care professionals across Michigan are doing their best to respond to Michiganders' concerns and deliver the vaccine to as many residents as possible.

“It’s OK for people to have questions,” says Dr. Joneigh Khaldun, chief medical executive and chief deputy director for health at the Michigan Department of Health and Human Services (MDHHS). “This vaccine is how we are going to end this pandemic. It’s how we’re going to get back some sense of normalcy here in Michigan and across the world. We want them to have trusted sources to go to for information and answers.”

Joneigh Khaldun.

Identifying pockets of skepticism

The University of Michigan's (U-M) Detroit Metro Area Communities Survey (DMACS) has done a series of surveys on COVID-19 topics, including views on vaccines. In October, nearly two-thirds of Detroit-area respondents reported that they were unlikely to get the vaccine.

“We obviously are very concerned about vaccine hesitancy,” Khaldun says. “We have set a goal of vaccinating 70% of Michiganders age 16 and up as quickly as possible. That means that we not only operationally have to make sure as many people as possible have access to the vaccine, but we also have to, and we also want to, make sure that people want to take it.”

Susan Grant administers the first dose of the COVID-19 vaccine to RN Saaja Rayford at Beaumont Service Center in Southfield on Dec. 15, 2020.

When broken down by race, the DMACS numbers reflect more hesitancy among the Black community. Only 32% of Black respondents said they were likely to get the vaccine, compared to 69% of white respondents.

“We are very concerned about hesitancy in the African-American community, specifically, and in other minority communities,” Khaldun says. “We understand that, especially for the African-American community, there are many reasons why there is mistrust of the health care system. There have been things that the health care systems generally, historically, have done. People talk about experiments, like Tuskegee, of course. There’s a mistrust in the community and, quite frankly, there’s still implicit bias in the health care system. There is systemic racism.”

Joann Hoganson.

However, the public has learned a lot more about COVID-19 vaccines since DMACS did its survey in October, and some health care professionals are seeing skepticism of the vaccines diminish.

“Overall, we have seen a great enthusiasm about getting vaccines," says Joann Hoganson, director of the Kent County Health Department's Community Wellness Division. "If we’ve seen any concern expressed, it has been that people don’t want to wait. They want to hurry up and get vaccinated. There are still pockets of resistance – those who are fearful, unsure, or don’t want to be at the beginning of the line.”

Hoganson concurs with Khaldun and the DMACS survey that a larger proportion of people of color are expressing hesitancy. She's also concerned about people who may not understand the importance of vaccination because they do not speak English, as well as immigrants. Undocumented residents and those with undocumented family members may fear that immigration officials might target vaccination sites.

Rural residents are another population of concern to health officials. In a study published on Jan. 7, the Kaiser Family Foundation found that “Rural residents are among the most vaccine hesitant groups."

“People living in the outskirts of the county like to stay there," Hoganson says. "They like to do their activities in the small towns around their communities rather than come into the heart of the city. Right now, we’re working hard to find ways to bring the vaccine to where people are. The more we can bombard the community with accurate information about the vaccine, the less reasons there will be to be hesitant.”

Combating skepticism

An August 2020 DMACS survey found that vaccine hesitancy diminished if people knew that the vaccine was at least 95% effective and that it was recommended by their health care provider or government health officials, or if they knew someone else who had gotten vaccinated.

“It really jumped out that for people of color in general, and Blacks specifically, how important it is to get a recommendation from a health care provider or government health officials. This was more important for people of color than whites,” says survey lead Jeffrey Morenoff, a sociology professor at U-M's Gerald R. Ford School of Public Policy. “The PR campaigns and trusted messages that say the vaccine is safe and effective are important."

Hoganson agrees.

“The more we can bombard the community with accurate information about the vaccine, the less reasons there will be to be hesitant," she says.

Elisabeth Gerber.

A DMACS survey currently underway will seek more details on why some people remain reluctant to get the COVID-19 vaccine and what would make them feel more comfortable getting it.

“We’re asking questions about what folks care about. This lends to a much richer portrayal of how real people are experiencing this unprecedented time,” says survey lead Elisabeth Gerber, the Jack L. Walker Jr. Professor of Public Policy at the Ford School of Public Policy. “Detroit has been exemplary in offering early, free, on-demand, widespread testing. The Detroit [COVID-19 case] numbers have gotten low. They’ve done a great job. I like to believe we contributed to that by sharing our data with the health department.”

"It doesn't matter where you live or what your race is"

On Dec. 10, 2020, Michigan Gov. Gretchen Whitmer created the Protect Michigan Commission within MDHHS. Part of the commission's work is to identify areas or groups in the state that are hesitant to get the COVID-19 vaccine, and to develop an outreach action plan that helps more Michiganders feel comfortable about vaccination.

“We are working with barber shops, beauty salons, gyms. It’s really important that we work with the communities to make sure that they have information,” Khaldun says. “These vaccines are 95% effective. They are safe and, again, this is the way that we are going to end this pandemic and this is the top priority for the state right now.”

Dr. Nick Gilpin gives a thumbs up after receiving the first dose of the COVID-19 vaccine at Beaumont Service Center in Southfield on Dec. 15, 2020.

In concert with the commission, MDHHS is implementing a broad strategy that includes social media, paid media, and recruiting messengers from trusted community partners like the Urban League, universities, small businesses, neighborhood associations, block clubs, and faith-based communities. The state’s coronavirus website provides the most up-to-date information on the virus and vaccines, including the latest facts from the Centers for Disease Control and Prevention (CDC).

Khaldun says she hopes skepticism will dissipate as people see their friends and family members get vaccinated.

“It’s important that everyone gets the vaccine," she says. "This is a new virus. It doesn’t matter where you live or what your race is.”

A freelance writer and editor, Estelle Slootmaker is happiest writing about social justice, wellness, and the arts. She is development news editor for Rapid Growth Media, communications manager for Our Kitchen Table, and chairs The Tree Amigos, City of Wyoming Tree Commission. Her finest accomplishment is her five amazing adult children. You can contact Estelle at Estelle.Slootmaker@gmail.com or www.constellations.biz.

Vaccination photos by Nic Antaya. All other photos courtesy of the subjects.