Closing the vaccination gap will take new methods, study finds

Oregon could make further inroads in vaccinating residents against COVID-19 if officials shift their method for reaching those who remain hesitant to get the shots, a new UO study finds.

A recent survey conducted by two UO faculty members, “Achieving Covid-19 Herd Immunity in Oregon: Progress & Challenges,” showed that a notable number of those who are yet unvaccinated could still be persuaded to do so using the right approach; the key is finding which would be most effective, the study’s authors wrote.

Oregon is ahead of most states when it comes to COVID-19 vaccination rates, with more than 70 percent of adults at least partially vaccinated. But the rates vary widely around the state, ranging for more than 70 percent vaccinated in certain counties to less than 40 percent in others.

Ben Clark and Robert Parker of the College of Design’s Institute for Policy Research and Engagement surveyed 686 Oregonians, divided nearly equally among urban and rural settings. They asked respondents about their vaccination status, what factors are prompting those to decline the vaccination and what might motivate them to take the vaccine, among other topics.

Clark and Parker then offer six recommendations that might get more residents vaccinated and move the state closer to stamping out the coronavirus in Oregon.

“Our aim is to get us over the finish line,” said Clark, an associate professor in the School of Planning, Public Policy and Administration. “And we've come a long, long way. It's just that it's uneven across the state.”

“Oregon has a much higher percentage of people who are fully vaccinated than most states at this point,” Parker added. “I think that's pretty remarkable and needs to be celebrated at some level. There's still obviously a lot of work to do.”

To help sway the undecided or vaccine hesitant, Clark and Parker recommend offering cash incentives, using Gov. Kate Brown less in COVID messaging because she is divisive among some Oregonians, reinforcing messaging that the vaccine is free, implementing door-to-door vaccination campaigns, using evidence-based communication strategies, more effectively illustrating the virus’ effect on the unvaccinated, and continuing to battle misinformation.

“We're saying you need to do all of these things because each of these, when you look at the segments of the population and the people who won't get vaccinated, there are some things that might work for portions of the population that won't work for others,” Parker said.

Among those who were open to getting vaccinated, the offer of $100 was more effective than the chance at a $1 million or $100,000 lottery prize, with more than 30 percent saying the guaranteed cash would be enough for them to get the shot.

“That shows how the incentives could be really, really useful, because they're getting something very tangible as opposed to something that's a little bit less tangible, which is not getting COVID,” Clark said.

Still, the offer of incentives didn’t spark many unvaccinated people to change their minds.

“The one thing that was maybe most surprising was that the million-dollar lottery was not the one thing that really got people excited,” Parker said. “A higher percentage would prefer a cash incentive, but it still was a pretty small push.”

Nearly 35 percent of unvaccinated respondents said nothing could convince them to get vaccinated. The top two reasons respondents cited included concerns about side effects and that the vaccines were developed too quickly.

“It's a public health tragedy in a lot of ways because it feels very unnecessary to me that people are still at that level of risk, and a lot of it has to do with misinformation, frankly. Politics,” Parker said.

“People were just saying, I'm not doing this, there's nothing you can do to convince me,” Parker added.

One positive is that 70 percent of state residents 18 and older have received at least one dose of the vaccine. However, the percentages of vaccinated residents ranged from a high of around 70-plus percent in Washington and Multnomah counties to as low as 35 percent in Lake County. Most counties with higher rates are in the northwestern part of Oregon.

“The other quadrants of the state are in a much different position, and that's really what our recommendations focus on,” Clark said.

The survey results indicated that about 47 percent of rural residents are not vaccinated, compared with only about 21 percent of urban residents.

In the state’s most sparsely populated counties, it might take only a few dozen people to get vaccinated to push the county’s vaccination rate above 70 percent.

“The people there are very isolated socially, economically,” Clark said. “A door-to-door campaign might work, but there's also a significant anti-government, anti-institutional mindset that's going on there. There may be some strong hesitancy on their part for a medical practitioner that show up at their home uninvited.”

He said the information has to be tailored in the right way to reach that audience.

“What we were trying to recommend is the Oregon Health Authority and local public health officials get their message out through those who these populations trust a lot more than the government,” Clark said.

“One other thing about people who live in extreme rural areas is they may feel less at risk because they don't interact with other people that much,” Parker said. “And that level of complacency is pretty dangerous because we've seen it now with the Delta variant being more virulent than the previous variants.”

The gaps between unvaccinated urban and rural residents are most notable for people between the ages of 25 and 59, with more rural residents going unvaccinated. People in those groups also have the highest overall rate of nonvaccination.

“One thing that seems consistent nationwide is once people were 60, 65 years old, the politics begin to evaporate,” Parker said. “The health risk is perceived high enough that there are greater levels of vaccination regardless of their political disposition. Maybe something you get to recognize a little more when you're older is that you're not immortal.”

Among parents who are vaccinated, 79 percent said they will vaccinate their children while 68 percent of unvaccinated parents said they will not vaccinate their child.

The source of information on the virus and vaccine mattered greatly as well. A solid majority of the unvaccinated had little trust in any source, whether it was traditionally liberal or conservative media, talk radio or local news.

The most highly trusted messenger from the survey options was National Public Radio/Oregon Public Broadcasting, where 38 percent of unvaccinated respondents indicated at least ‘some’ trust. President Biden has the second-highest level of trust amongst the unvaccinated, with 32 percent indicating at least ‘some’ trust in the president, according to the report.

Parker said that getting additional Oregonians vaccinated will require more effort going forward.

“I think we're talking about another 15 or so percent that that are in play,” Parker said. “So could the state get another 5 percent? I think so. Could they get 10 percent? Maybe. But the bigger concern that the report uncovers is that it's a geographic issue. I think we'll continue to see a lot of virus spread in rural areas of Oregon as we are seeing in other places.”

By Jim Murez, University Communications