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The Moveable Middle. How Can Public Health Sway This Illusive Population to Get the COVID-19 Vaccination?

As of October 21, 2021, COVID-19 vaccinations have been increasing. According to the U.S. Centers for Disease Control and Prevention (CDC), more than 189 million people aged 12 and over (57 percent) have received their complete vaccination. Nevertheless, 57 percent is far below the 75-80 percent vaccination rate necessary for herd immunity.

The country’s inability to reach the 70 percent vaccination rate could partly be because of the failure to reach the moveable middle. This group consists of about 30-40 percent of the U.S. population who are ambivalent, at best, about getting the COVID-19 vaccine. Public health officials and educators have increasingly argued for understanding who these people are, what keeps them cautious, and what ultimately moves them to get the shot.

Who Are the Moveable Middle?

Also called the late majority, the moveable middle comprises of about 55 million unvaccinated adults, many of whom are under 30 years of age. Some of these individuals take an independent political stance and do not have a college degree. The moveable middle also includes many Latinx and African American adults.

Generally, the moveable middle is not against getting the COVID vaccine. However, their motivations for being skeptical include political reasons, being “not sure,” and fears that the vaccines were developed and approved “too quickly.” Some worry about vaccine side effects and claim they want to wait for more data to come out, even though close to 200 million people have received their vaccinations.

The skepticism among people of color stems mainly from years of being mistreated by the medical community. Unethical research, medical mistreatment, discounting reports of pain, and forced sterilizations have left marginalized people fractured and distrustful of doctors. In addition, trauma at the hands of medical providers, police, and other authority figures has eroded minorities’ trust in the system for generations.

Medical mistrust still exists among marginalized populations, which helps explain why African Americans have had more than twice the death rate from COVID-19 as white and Asian Americans. Also, among all ethnic groups in the U.S., Hispanics are the least likely to visit a doctor or get any vaccine.

There is good reason to focus more effort and campaign dollars on the moveable middle than so-called “anti-vaxxers.” Unlike many of the latter, moveable middlers are not necessarily discouraged because of politics or ideology. Instead, they remain unsure about the vaccines and continue to be skeptical of some medical information.

Because of the relative size of the moveable middle, reaching enough of them can push the U.S. population toward herd immunity. The key is identifying what kinds of messaging strategies resonate most with this subgroup and utilizing credible messengers.

What Strategies Work Best with the Moveable Middle?

So far, the results of current strategies to move the middle have been mixed. For instance, some messages come from public figures who appear unable to “read the room.” When First Lady Dr. Jill Biden made appearances in Mississippi last June, she said, “Vaccines might feel like a miracle, but there’s no faith required.” Some citizens remained unmoved and claimed that her comments were insulting to the faithful and did not address why people who have recovered from COVID still needed the vaccine.

Early wins with vaccinations might have created a challenge. Because COVID cases have dropped, it has become more difficult to convince some unvaccinated people to take the shot. Among those unconvinced are younger individuals not as likely to develop serious COVID-related conditions.

Persuading the moveable middle requires messaging strategies that resonate with them. Public health communicators can learn from environmental advocacy groups like the National Environmental Education Foundation (NEEF). This organization helps target audiences feel like they are part of the effort to partner with groups that that these audiences trust and already interact with.

Establishing a connection with communities of color is essential. Public health advocates who work with local organizations and faith-based groups to sponsor vaccination events can reach people in smaller groups and interpersonal settings to address some of their skepticism. Public health advocates can listen to their objections with empathy and then talk about the science and benefits of the vaccine in relatable ways. They can also recruit their local “vaccine partners” from hospitals and higher education institutions to participate in the conversations and help unvaccinated individuals work through their doubts without feeling guilty or fearful.

Research and materials for this article were compiled, written, and distributed on behalf of the National Public Health Information Coalition. The views and opinions expressed in this blog are those of the various authors and do not necessarily reflect the official policy or position of the National Public Health Information Coalition or its members.