77% of American adults have been vaccinated against COVID (66.4% fully). What about the other 23%? What’s leading them to refuse to get vaccinated? Here’s a rough typology, with no attempt to estimate the relative proportions between the various groups (Also some people are going to belong to two or more groups to greater and lesser extents):
(1) Procrastinators. These are people who just haven’t gotten around to it. The extent to which procrastinating about getting the vaccine is irrational if — and this is the crucial caveat — you’re just indifferent to the effect of your decision on other people, varies enormously by individual.
By far the biggest factor in whether somebody gets seriously ill or dies from COVID is age. This remains overwhelmingly more relevant than any other risk factor. A 60-year-old is 30 times more likely to die from COVID than a 25-year-old, a 70-year-old is 90 times more likely, an 80-year old is 220 times more likely, and somebody over 85 is 570 times more likely to die of COVID than a young adult. The risk ratios for hospitalization for these groups relative to a 25-year-old are, respectively, four, five, nine, and 15 times greater.
Obviously even from the self-interested perspective of an otherwise healthy 25-year-old getting vaccinated still makes sense from a cost-benefit perspective — a free vaccine with mild side effects is worth getting, rather than running a tiny risk of death, and a non-trivial risk of hospitalization, and possible long-term health consequences. But young adults who are procrastinating are doing so in a context in which the risks they’re running are vastly lower than those faced by older Americans, which helps explain why such procrastination exists. Not completely of course: no doubt there are some middle aged and even elderly procrastinators, who are being profoundly irrational in even a purely self-interested sense, but procrastination is a very powerful and often under-rated factor in human behavior.
(2) People who are phobic about needles. This seems to be a common phobia, which is probably connected to anxieties about bodily integrity, control, etc. (The actual pain from a vaccine shot is trivial). An oral vaccine might make a real difference here at the margin, plus it would be easier to distribute in any case. IIRC at least one is in the works.
(3) People who genuinely don’t understand statistics at even a rudimentary level. These are people who, more or less sincerely, hear that it’s possible to get sick from COVID or even die from it after being fully vaccinated, and conclude that this means the vaccines don’t work. As incredible as it may seem to a reasonably intelligent and educated audience, there are actually a lot of people who think this way, which is to say they’re not real good at thinking. Oops my condescension and elitism just produced several new fascists, sorry about that, but thems the facts. (As a friend of mine used to remind me back in the day whenever I was ranting about something like this, the average IQ is 100).
(4) People who believe they are immune because they’re “healthy,” and only weak people get seriously sick. This is your basic fascist-adjacent mentality about superior versus inferior people, life unworthy of life, and so forth. All the totally unscientific discourse about how only fat people die from COVID is the primary current example of this mentality.
(5) Full blown paranoid conspiracy types, who believe the QAnon-style garbage about Bill Gates and microchips and magnetism. Again, there are distressingly large numbers of these people, obviously. See U.S. history in general but especially since 2015 onward.
(6) I don’t believe the government’s statistics types. This could be thought of a subgroup of (5), but I think of these people as a sort of softer subgroup, that doesn’t buy into the more florid craziness of the QAnon/pizzagate etc. world, but is made up of the sort of people who are reflexively anti-government and anti-authority in general. These are the I’m doing my own research on Facebook people.
(7) People who understand the vaccine is safe and effective, and understand that it makes perfect sense from a personal cost-benefit perspective to get it, let alone from a societal health perspective, but still won’t get it because political tribal identity is more important to them than their own health or that of others. I suspect there’s a depressingly large number of such people.
(8) People who have the same level of understanding as the people in (7), and would like to get the vaccine, but are afraid of being ostracized from their community. I suppose this is just a special subcategory of (7), but is worth breaking out because these people will get vaccinated if there’s an efficient way of doing it covertly, or if they can be given the excuse that they’re being forced to by the government (This is one of many reasons why mandates are good).
That nearly a quarter of the US adult population remains in one or more of these groups is a daunting thought, but obviously a lot of these people can be coerced into getting the vaccine, and should be.
For example I flew on a plane earlier this month for the first time since January of 2020, and during the whole experience I was struck by the utter perversity of the fact that the federal government still isn’t requiring proof of vaccination as a requirement for commercial air travel. But here we are.