Who isn’t getting a COVID vaccine in North Carolina — and what’s stopping them?
Supply is beginning to outpace demand for the first time since the COVID-19 vaccine reached North Carolina — but nearly half of the state remains unvaccinated.
Many of the holdouts in the state are what experts call “COVID skeptics,” according to the nonprofit group Surgo Ventures.
In a new study based on a survey of more than 17,000 adults, Surgo grouped individuals based on their shared beliefs about the coronavirus vaccine. They broke down the results by five categories: enthusiasts, watchful, cost anxious, system distruster or COVID skeptics.
The goal was to determine not just who isn’t getting the vaccine, but why, Surgo’s co-founder and CEO Dr. Sema K. Sgaier wrote in an Op-Ed for The New York Times.
“Just knowing that Republicans are less likely to get vaccinated doesn’t tell us how to get them vaccinated,” said Sgaier, who is also an adjunct assistant professor at the Harvard T.H. Chan School of Public Health. “It’s more important to understand why people are still holding out, where those people live and how to reach them.”
Surgo conducted the 20-minute survey from Feb. 23 to April 14 and recruited respondents through Facebook. Using the answers collected, it mapped the percentage of vaccine holdouts across the U.S. according to the barriers cited that prevent them from getting the vaccine.
At the time Surgo compiled its results, 50.3% of adults in North Carolina had received at least one dose of the vaccine. Of the remaining adults who weren’t vaccinated, Surgo determined the highest percentage — 14.5% — could be classified as COVID skeptics. (Across the United States, the figure is 14%.)
Sgaier said COVID skeptics are among the least likely to get vaccinated. They might believe in pandemic conspiracy theories, from microchips in the vaccine to government control.
COVID skeptics are most often Republican and live in rural areas, Surgo determined. A recent study by the Centers for Disease Control and Prevention found that vaccine hesitancy is still a “major barrier” for people living in rural areas.
The second largest group of holdouts in North Carolina at 13.8% are what Surgo calls enthusiasts, or people who want to get the vaccine but haven’t yet.
North Carolina has among the highest proportion of enthusiasts across the U.S., according to the survey’s findings. The only state with a higher percentage is Vermont, with 18% of its vaccine holdouts classified as enthusiasts.
Enthusiasts often cite their primary barrier to access as a lack of appointments, the study found. In North Carolina, residents cited “no appointments available” as both their top experienced and expected barrier. Website crashes were the second most frequently cited barrier.
On the first day of sign-ups in Wake County, a spokesperson said both the phone lines and website became “temporarily overwhelmed” and crashed. Seniors who were first in line to get the shot complained of being stuck on hold for hours and sites crashing before they could book an appointment.
In Charlotte, shipping delays postponed appointments in early February as the state began to open up vaccine eligibility to more residents.
By its peak in early April, the N.C. Department of Health and Human Services was administering close to 700,000 shots in a week. But demand has dropped off dramatically since then.
Of the remaining holdouts in North Carolina who aren’t enthusiasts or skeptics, Surgo found a small fraction are watchful, meaning they want to see others get the vaccine first; cost-anxious, meaning time and financial cost prevent them from getting the vaccine; or system distrusters, meaning they don’t trust a healthcare system that previously mistreated them.
Just 2.5% of people in North Carolina who haven’t received the vaccine fall into the latter category, compared to 4% nationally.
State Health and Human Services Secretary Mandy Cohen said they knew before the rollout about vaccine hesitancy in Black, Hispanic and Latinx communities. The health department subsequently issued a training program to help dispel concerns.
Combined with community partnerships, The Charlotte Observer reported in March that some of that hesitancy has since gone down.
