Table 2 Critical themes for COVID-19 vaccine hesitancy with public health implications among Georgia residents, Feburary to June 2021. (N = 29)

Changing vaccine beliefs

Well, to be honest with you, my opinion of it has been somewhat a roller coaster: positive, negative, positive, negative… Kind of middle of the road. (#5, Black male, age 42)

• Vaccine messaging and boosters offers should continue, as people make their decisions over time.

I think everyone (in my work community) questioned how fast it was made, how safe it would be. But I now see that people are changing their minds and they actually are taking that extra step to go ahead and get vaccinated. (#12, Black female, age 55)

I have to read, and I have to study and get more information before I just to and be like “Okay, I want a COVID-19 vaccine.” (#8, Black female, age 33)

News media and social media as important vaccine information sources

I watch the news a lot. But then I will still research and look things up after I watch the news. (#8, Black female, age 33)

• Facilitate pro-vaccination norms by addressing misinformation and misperceptions on social media.

• Increase public health social media presence, emphasizing positive narratives of COVID-19 vaccination success.

• Leverage all social media platforms for vaccine messaging, because use is disparate across the platforms (e.g. YouTube, Facebook, WhatsApp).

I think that sometimes, people are scared because of everything we hear on TV. (#13, Hispanic male, age 54)

I watch TV so much, I know everything. I listen to the doctors and the nurses, all the first responders. (#15, Black female, age 76)

We’re looking for more data, we’re looking for more information. … None of the stuff that you hear on all the social media. … I get my information basically from the news. (#24, Hispanic male, age 45)

You read your Facebook feed or whatever, you’re going to get all ends of the spectrum. So, some people love it. Some people hate it. “It’s the best thing ever and everyone should do it” versus “It’s a tool of the government trying to control our minds” and all points in between. So, I’m nowhere near either end of it. (#2, White male, age 47)

YouTube. I don’t think it was any personal experience for them (my friends). It was just this election came and lots of conspiracy theories about everything. (#7, Black male, age 59)

A lot of people especially in my community they were very skeptical about the vaccine because of things you hear on the internet and people… I guess their generation (my parents) is influenced a lot by the media…like Facebook, WhatsApp, stuff like that. (#9, Hispanic male, age 39)

Barriers

Limited trust in the government

Everyone’s saying different things based on their political view about how effective it they think it is. (#2, White male, age 47)

• Include community in vaccine promotion, making implicitly clear that COVID-19 vaccines are not solely supported by the government.

• Promote bipartisan efforts to encourage vaccine access.

(I trust) The CDC. The government. Well, not the government…Well, the government now…(not) Trump’s administration. (#3, Hispanic female, age 53)

Trump. I don’t trust his information… I just don’t trust the things he says because he’ll be rambling. (#8, Black female, age 33)

I think people in the ‘60 s were more in tune and more dedicated to keeping the country and each other safe. This time around I don’t feel like it was, that we were all on board with the same stuff. Unfortunately, it’s bad to me but it happened during the political campaigning and stuff. Because I think it was used, both sides instead of more political analyst. When the polio was out, vaccine. I don’t think we were like this one says get it, this one says hold off, this one says it’s not so bad…You just said, “Here’s the vaccine” and people went to get it. (#6, White female, age 77)

Skepticism about COVID-19 vaccine safety

Frankly, I’m more likely to let someone else be the first person to jump off the high dive to see what it’s like…I’m going to let you make sure that cord bounces back up before I’m willing to strap it around my ankles and take a leap.

If it's not effective it's a big waste of time and a bunch of people are in bad shape because of it… Everyone’s saying different things based on their political view about how effective it they think it is. (#2, White male, age 47)

• Disseminate public health messaging from trusted scientific experts and trusted community members.

• Provide accurate scientific evidence on vaccine safety and effectiveness.

• Emphasize in communication that COVID-19 vaccines and boosters are not new, and they are established and trusted throughout the world.

Well, there’s just some concern because it was developed so quick. There’s not a lot of information about the differences between the different brands. I’ve read up some things that they’re not really sure about certain side effects. (#5, Black male, age 42)

I mean everybody is skeptical about something because it’s new. Because it’s new. It ain’t been tested for five or ten years and you have all these studies like all right. (#4, Black male, age 43)

So, this rush job that you got Fauci doing and Trump who was trying to I guess…beat him to the punch, all people that he paid to do it. …they rushing to throw this stuff together and you supposed to be cool with 70 percent and chemicals that I don’t understand the definitions of that I’m throwing in my body. (#10, Black Male, age 40)

Overgeneralization of anecdotal adverse events and the lack of positive counter-narratives

I was watching something on the news and I think it was a nurse, she got the shot and then she just passed out. That was on TV. It was live. They gave her the vaccine and she was just talking and then she was like “Uh…” and just passed out. I was like “Ah! They’re trying to kill us.” (#8, Black female, age 33)

• Collect and disseminate compelling positive narratives about getting vaccinated and having no/minor side effects.

• Clinicians should communicate transparently and clearly about the cause and chance of adverse events.

I don’t know why different people get reactions…I see that one of the vaccines…on TV, on the news and online, they say that it causes blood clots in certain cases and they stopped manufacturing it…I don’t know which one it was. (#13, Hispanic male, age 54)

Well, look what happened this past couple of weeks with the ladies, you know? That was something with the blood clots. That was something that we were like, “oh, snap.” … Not to say that was going to be her (my wife) case, but it could have been. Who knows? (#24, Hispanic male, age 45)

Conspiracy theories on COVID virus and vaccine intention

I believe that this (COVID virus) is something that was made up in a lab…it might have been meant for us to get this mess… I believe there are forces in the back somewhere that are just taking things the way that they want them to go. I’m just a believer in that. I’ve been studying stuff like that…

They’ve got so many conspiracy theories going on now about zombies, and how your heart will stop after about eight months of this vaccine. (#15, Black female, age 76)

• Efforts to counter conspiracy theories must be led by trusted community members.

• Acknowledge historic racism as leading to mistrust of current medical system.

• Promote trust in modern COVID-19 vaccines and treatment as ways to actively overcome health inequities.

(I’ve heard that) Bill Gates wants to kill everybody. The vaccine is not for Black people. They want to sterilize all Black people. (#7, Black male, age 59)

I was probably talking to my boy…he’s 100 percent against it. He was calling it the poison gas… my wife she’s talking about the news reporter that died in Detroit that took the vaccine. (#10, Black male, age 40)

I don’t want to sound crazy, but I really believe in the Zombie Apocalypse and I feel like that’s (vaccine) going to add to the Zombie Apocalypse… Population, population control…They (the government) got to eliminate some of us and they putting something in there (vaccine). (#27, Black male, age 35)

When I say control, I mean people getting microchipped. What Bill Gates is creating is a microchip…for the COVID vaccine. If you get the vaccine shot, go home and put a metal thing on where you got your vaccine shot, and I guarantee you the metal thing will stick to you. … That’s a chip to track you and always control you and see where you at and know what’s going on. … It’s something evil.

The vaccine is not going to affect people in this generation. It’s for the next generation. It’s going to affect the women that’s going to birth their kids. Something’s going to be in that kid to where they can control something in their brains. (#28, Black male, age 29)

I feel like the government is conspiring to control us in any way possible, and I feel like they will do so through controlling the weather, controlling businesses and people… the whole COVID virus is maybe a plan…the vaccine may be something that potentially could affect us in the long run…Whether the full conspiracy is believable or not, every idea derives from fact(s). (#29, Black female, age 23)

Facilitators

Positive vaccine promotion from trusted members within the community, such as healthcare workers, political and community leadership, and trusted community members

Because he (my doctor) sat there and gave himself one (flu vaccine) in front of me…The nurse gave him his shot, and then I said, “Okay, come on. Come on with it.”

Word of mouth, maybe. I would like to see some of the people that represent us who took the vaccine and nothing has happened to them, they’re in good shape and all of that. (#15, Black female, age 76)

• Emphasizing that trusted members of local and national communities are receiving vaccines may be a promising vaccine promotion strategy.

When I saw that the numbers were coming down, and I started hearing a lot of positive reports from other people that had gotten it, and my doctor started giving me some positive reports. (#25, Black female, age 60)

But my thing is look at who’s getting it (the COVID-19 vaccine). The president is getting it, the vice president, people with influence and money and power are getting it. They’re not actually segregating it and putting it just to low income people. If they did I would think it would be a test. But since majority of people on TV I see doing it so I think it’s a good thing. (#4, Black male, age 43)

When I say people I can relate to I’m talking about people in my neighborhood, brothers I know… (describe a person he knows) He stays not far from here. Somebody like him I would trust. (#10, Black male, age 40)

Mobilizing support for vaccination through work communities

Because she (my sister) works in a bakery and she’s around children…for people to feel safe around her, she had to go ahead and do that (vaccination)…for her, it’s more of a business move, and she’s a conspiracist like me…but her business is more important to her. (#29, Black female, age 23)

• Prioritize vaccine promotion through work communities.

• Besides mandatory vaccination programs for workplaces, encourage employers to provide vaccine information, facilitate vaccination experiences sharing and conversations, and offer vaccines on-site.

I think I heard some of my colleagues at work talking about getting it (COVID-19 vaccine). (#7, Black male, age 59)

My community and my neighborhood I wouldn’t know, but my community at my job I think a lot of people were hesitant…But I now see that people are changing their minds and they actually are taking that extra step to go ahead and get vaccinated. (#12, Black female, age 55)

I was just iffy about it. … I got it, I’m fine; everyone I work with got it, they’re fine. I haven’t heard any very negative side effects. (#21, White female, age 33)

Altruistic protection

I was going to take it because I want to be around my mom and dad. (#25, Black female, age 60)

• Public health messaging should emphasize altruistic aspects of vaccination and boosters (e.g. protecting others by reducing the risk of transmitting COVID-19).

I mean especially the older people. My boss is old, she's old, my mom. It makes me feel good knowing I can't get it and give it to them…I don't mind getting it if it's something that's going to help people feel safe and protect other people. I'm not that selfless. (#21, White female, age 33)

Providing vaccine access at local and familiar sites at convenient times

(I won’t go to) anything that I have to drive more than ten minutes. My life is around here. I mean, I don't want to drive 30 min to (get COVID-19 vaccine)… my hope is that it will be available in all pharmacies, and then I have one in the corner. (#3, Hispanic female, age 53)

• Increase vaccine access, such as distributing vaccines through neighborhood pharmacies, retailers, churches, recreation centers, and mobile vaccination sites.

Well, I’ve been going on the site that the governor of Georgia gave for us to go on. But I also take a look at who’s giving it, the different places, like Walgreens, CVS, Sam’s Club, Kroger, so I do look to see other medical offices that are taking appointments. (#12, Black female, age 55)

I was with all those people trying to find some place to get it. I was on the phone every day when they had them popping up at the health department. Basically, it was the public health department seemed like the only ones that had it first and then Publix and some of the other Walgreens and stuff started getting it after a month. (#6, White female, 77 years)