AURORA | Long before the COVID-19 pandemic and the surge of people hesitant to receive a potentially life-saving vaccine, University of Colorado Anschutz professor of pediatrics Dr. Joshua Williams found himself drawn to investigating why people decline routine inoculations.
In 2012, his final year of medical school, Williams spent six weeks in Papua New Guinea, where he was working in a hospital that served an area the size of Kentucky. Part of the hospital’s work included traveling by prop plane to parts of the country inaccessible by land to do vaccination outreach to inoculate people against measles, polio and other deadly diseases.
“It was a significant experience to watch people travel through thick jungle for miles to come and get vaccines and witness their gratitude,” he said.
Williams’ next endeavour would be in Aurora to begin his pediatric residency at Children’s Hospital Colorado, where he experienced a nearly-opposite phenomenon. He very quickly encountered families refusing vaccines.
That juxtaposition — of people trekking through challenging terrain to receive a shot that people in America decline — intrigued him, and set him on a path of researching what drives vaccine hesitancy. A conversation at his church with a retired clergyperson who was skeptical of the flu vaccine spurred him to focus on communities of faith.
After conducting an initial survey of Colorado clergy’s perspectives on vaccines, Williams partnered with Colorado Council of Churches executive director Adrian Miller to conduct a series of listening sessions in faith communities about vaccines.
The Colorado Council of Churches consists of 800 faith communities across the state, mostly in liberal denominations. Miller said that for the most part member churches are supportive of the vaccine, “but we definitely have churches where the congregations may be more vaccine hesitant than the pastor.”
Since churches rely so much on in-person gathering the council has been invested in vaccine education, Miller said, which made Williams’ research a natural fit.
Williams and Miller received a pilot grant for the project from the Colorado Clinical and Translational Sciences Institute. Beginning in 2019 the two conducted five listening sessions in Christian, Buddhist and Jewish faith communities in Colorado, where they asked participants what questions they had about vaccines.
Dhi Good, a head teacher at the Denver Shambhala Center at the time of the listening circle, said that she enthusiastically agreed to participate when Williams first contacted her.
“Having conversations in people’s own communities where they feel accepted and safe makes a lot of sense,” she said.
Williams and Miller were very knowledgeable and did a great job listening to people’s questions and concerns, Good said. She already thought the issue of vaccine hesitancy was important to study, but when the pandemic arrived that feeling was magnified.
“It felt very fortunate that this research had already been underway,” she said.
What the listening circles found was that people’s concerns about vaccines were overwhelmingly secular. Williams documented 102 individual questions about vaccines that came up, and only three were explicitly religious: is aborted fetal tissue used in vaccines, are vaccines kosher and do specific religious passages give reasons to vaccinate?
The majority of questions, listed in a study Williams and Miller published in the journal Vaccine last fall, centered around the health benefits and risks of vaccines and what kind of side effects they could cause.
“Surprisingly, religious concerns about vaccines did not arise spontaneously,” the study said. “Even after we specifically asked, ‘Do you have any religious concerns or questions about vaccines?’ participants at three congregations had no religious objections and were unable to think of theoretical ones.”
“In short, participants in our sample were preoccupied by secular concerns about vaccines, not religious ones,” the study said.
Those findings bear out with research Williams conducted about the nationwide rates of religious-based vaccine exemptions, which found that people are more likely to seek out religious exemptions when other options aren’t available.
All but five states offer religious-based exemptions for the vaccines that students need to attend public school, while 15 states also offer exemptions on the basis of personal belief (Colorado has both).
Williams found that in states where both types of exemptions were offered, usage of religious exemptions were very low. During the time he was conducting research, the state of Vermont, one of the least religious states in the nation, rescinded its personal belief exemption. Beforehand, Williams said about .5% of Vermont families requested a religious exemption — afterwards the rate increased sevenfold.
“If you remove an option that’s available to people, they’re going to choose something else if they’re really intent on exempting themselves from the vaccine,” he said.
Even though most people’s concerns about vaccines aren’t religious in nature, Williams said that clergy still play an important role in encouraging their parishioners to get vaccinated by fostering conversations and inviting medical and public health officials to speak to their congregation. He noted the historical example of 18th century British traveling preacher Rowland Hill, who championed the smallpox vaccine and would take people, especially children and the poor, to get vaccinated after his sermons.
“During times of confusion and public health crisis people are looking to trusted leaders,” Williams said. “Faith leaders are certainly trusted community leaders and I think they have a big role to play.”
“Many people will listen to their pastor before they listen to a politician,” Miller noted.
“That gives faith leaders a very important role in terms of influence,” he said.
Both the Tri-County Health Department and the Colorado Department of Public Health and Environment have reached out to faith communities as part of their vaccine outreach.
“Colorado faith leaders are critical partners in Colorado’s vaccination efforts, utilizing their positions of leadership and trust to connect their communities with vaccines and vaccine information,” CDPHE spokesperson Kristen Stewart said in an email.
The original set of listening sessions had to stop with the outbreak of the pandemic last spring. Miller and Williams received a second round of funding and recently began a second set of listening sessions focusing on Black faith communities’ perspectives on the COVID-19 vaccine.
Black Americans have suffered disproportionately from COVID-19, and have also been specifically targeted by anti-vaccine activists, Williams said. From a health equity standpoint, they are an important demographic to focus in on.
Ultimately, the pair hopes the listening circles will glean more insight into what the main factors driving vaccine hesitancy are and how best to address them.
Williams said the listening sessions have taught him that addressing vaccine hesitancy needs to be approached as a conversation.
“The best way to address hesitancy, whether you’re a pediatrician or a pastor, is to keep an ongoing dialogue,” he said.