HOUSTON, Texas -- When Julieta Hernandez began hearing the first rumblings about a COVID-19 vaccine soon arriving in Texas, the Rockport writer and bartender had no doubts that she would get her shot when her time came.
And then she sat down to breakfast with her vegetarian parents, lifelong believers in homeopathic treatments with a deep skepticism for vaccines and mistrust in the government.
"You're not planning on getting that, are you?" they asked her.
Now, Hernandez, 22, is on the fence, feeling guilty because she knows "it's the right thing to do" but wanting to trust her parents and her own naturalistic upbringing.
"There's a lot of mistrust that comes from an honest place," Hernandez said. "I think people have to realize that for a lot of people, this kind of goes against their way of living. I think they have a right to second guess or decide what they want to do."
Hernandez and millions like her are balking at the idea of a new vaccine pushed by a government they don't entirely trust, and that's causing concern among health officials who say that the virus won't be stopped until at least 70% - and some say 80% - of the population is immune.
"The unprecedented nature of the pandemic and the challenges involved in quickly getting a COVID-19 vaccine to market have raised some questions" in the public about the trustworthiness of the vaccination program, said Dr. Susan Bailey, a Fort Worth immunologist and president of the American Medical Association. "It is so important that we educate the public about coronavirus vaccines in a responsible way without unintentionally fueling vaccine hesitancy."
A study by the Pew Research Center shows that confidence in COVID-19 vaccines are increasing as more people get the shot with few reported issues, but other groups have found that acceptance rate is still under 70% for some groups, including conservatives, rural residents and Black adults.
A tracker created by the Kaiser Family Foundation to trace confidence in the vaccine showed in early December that 71% of the public says they definitely or probably would get a vaccine, up from 63% in September. But the same survey found that about 27% of Americans say they definitely or probably would not get the vaccine even if it were free and deemed safe by scientists.
An October University of Texas/Texas Tribune Poll found that if a vaccine against the coronavirus became available at a low cost, 42% of Texas registered voters said they would try to get it and 36% said they wouldn't - a significant drop from the 59% who said in a UT/Texas Politics Project poll in June that they would get vaccinated against the disease.
The hurdle of what experts call "vaccine hesitancy" or "vaccine skepticism" remains a huge challenge for health authorities who are trying to overcome mistrust by communities of color, a small but vocal anti-vaxxer crowd, social media-fueled conspiracy theories and general dubiousness on the part of a traumatized nation.
Retiree Carolyn Brown Voyles of Terrell has always gotten her flu shot, as well as a pneumonia vaccine, but said she is hesitant about the COVID-19 vaccine because it's so new. She's afraid of the virus, but worried about vaccine side effects, having heard confusing information.
"Not sure if that's just the media or people forming their own opinion," said Voyles, 67. "I have had about half of my friends say they will take it and half say they will not until it's been around longer."
Because it is likely to take between six and nine months for the vaccine to be available to everyone who wants it, the rollout must be done in a way that inspires confidence in those who are on the fence, said Dr. Sam Sun of the Baylor College of Medicine in Houston, director of inDemic, a nonprofit pandemic think tank.
"People are watching," Sun said. "I feel like in the short term, we have a bunch of other issues related to the pandemic and to the deployment of the vaccines. If we get them right, it'll make the medium-term issue of vaccine hesitancy that much easier to deal with."
Leading by example
Last weekend, Texas Sen. Eddie Lucio, Jr., a Brownsville Democrat and a senior citizen, took heat for getting his vaccine on Saturday, before the vaccine was supposed to be available for people like him.
But Lucio Jr., whose border constituents have been hard hit by the virus, said that part of his motivation was to combat what he called a "shocking" amount of hesitancy.
"I hope that by demonstrating to everyone that there is nothing to fear, I can help set the tone for getting vaccinated so that more Texans will accept the vaccine as it becomes available," said Lucio Jr., who has represented his Rio Grande Valley district for 30 years.
Similar messaging has been coming from the top down in recent days. President-elect Joe Biden and outgoing Vice President Mike Pence both got their COVID-19 shots in front of TV cameras in the past few days.
On Tuesday, Texas Gov. Greg Abbott and Texas Health Commissioner Dr. John Hellerstedt got their injections in a live streamed event, which Abbott said was advised by U.S. Health and Human Services Secretary Alex Azar and Dr. Robert Redfield, director of the Centers for Disease Control and Prevention.
"It's very important for leaders like governors to step up and make sure they show the public, by getting a vaccine in front of a TV camera ... that this is a very safe and very easy process," Abbott said, moments before receiving the shot. "I will never ask any Texan to do something that I'm not willing to do myself. So I'm going to step up, I'm going to take the vaccine, and show you everything is going to be just fine."
After the injection, Abbott held out his arms and smiled behind his mask.
"It's that easy," he said.
For some, that message is unlikely to resonate any time soon - particularly for members of a anti-vaccination movement that is decades old, but has surged in recent years "under the banner of health freedom and medical freedom," said Dr. Peter Hotez, dean for the National School of Tropical Medicine at Baylor College of Medicine in Houston and co-director of Texas Children's Hospital Center for Vaccine Development.
During the pandemic, anti-mask and anti-shutdown protests have helped fuel fears of the vaccine, he said.
"I've been on Zoom calls all year about how we're going to amplify the message (about the importance of vaccines), let's get the message out," Hotez said. But he said the medical community's messages "are messages in bottles floating in the Atlantic Ocean. We've got to do something about the Atlantic Ocean."
Reaching out to communities of color
People of color have been hardest hit by the pandemic, for reasons ranging from their prevalence in essential and high-risk jobs to lack of access to healthcare and a cultural history of being abused by government medical programs.
"There are a number of mishaps, unfortunate painful historical events as it pertains to research that speaks to the need to build these coalitions involving Black people in the process," said Dr. Leon McDougle, president of the National Medical Association, the country's oldest and largest organization dedicated to Black doctors and their patients.
The Black community is still reeling from historic events such as the Tuskegee syphilis experiment, but they have also been affected by their personal experiences just in the last year, said Ruqaiijah Yearby, a law professor and executive director and co-founder of the Institute for Healing Justice and Equity at St. Louis University.
"Public health officials are very slow to provide support and access to testing and treatment for African Americans and Latinos, even as their numbers continued to show that they were being disproportionately harmed" by the virus, Yearby said. "You can actually just look at what has happened over the last nine months and see why people would be hesitant ... You're not providing them with (personal protective equipment) at their workplace or protections for workplace infections. And now all of a sudden you want to say hey, we have this vaccine for you."
Nationally, a $250 million public information campaign by national health officials is underway to build public confidence in the vaccine, with part of that effort directed at communities of color.
Texas officials have not outlined a strategy for reaching Black residents within their vaccine rollout plan, according to a recent investigation by ProPublica.
Local hospitals, doctors, politicians and community members are taking up that mantle where they can.
At the Houston Methodist health system, officials are monitoring which employees voluntarily vaccinated and said staffers of color are underrepresented, said Roberta Schwartz, Houston Methodist chief innovation officer.
About 30% of the staff are white, she said, but they account for 40% of the initial sign-ups, although the numbers are improving and it's still too early in the process to "raise huge alarm flags yet."
"It's just something that we as a society really need to be aware of. If that trend continues, it would be very concerning to me," she said.
In order to reach the Black community and other residents who may be hesitant about the vaccine, the system is partnering with churches and other local groups that advocate for people of color to hold town hall-style meetings and use other communication strategies to answer questions and address concerns, said Arianne Dowdell, the chief diversity, equity and inclusion officer at Houston Methodist.
In Austin, a vaccine distribution coalition that includes providers as well as community organizations, faith-based groups, universities, schools and others is aimed at reaching those who may be hesitant or who have difficulty accessing the vaccine, said Cassandra DeLeon, Austin Public Health interim assistant director for disease prevention and health promotion.
"We definitely see that if we're going to really flatten the curve with COVID-19, we've got to make sure that we're doing our due diligence with our disparate populations," she said.
To do this, Austin is using systems it has been developing for many years to get health services and information to its residents of color, said Adrienne Sturrup, assistant director over the city's Health Equity and Community Engagement Division.
The city has been using tools like virtual town halls and community healthcare provider networks to communicate with this group during the pandemic and will continue to do so as the vaccine is rolled out, she said.
'My plea to you'
In the Rio Grande Valley, where some areas have death tolls rivaling the state's most populous counties, skepticism and conspiracy theories are galloping through the community, said Hidalgo County Health Authority Dr. Ivan Melendez, a COVID-19 survivor who also treats patients with the virus.
"Even though, as you know, Black, Latino and older people have disproportionately suffered, you would expect that most people here would say, 'Sign me up," Melendez said. "But even though the media every single day is explaining to people that this is the safest vaccine ever, there are still a lot of incredible conspiracy theories, this nonsense about the government trying to trace you. It's quite frustrating."
At two of the biggest medical facilities in the Rio Grande Valley, where Hispanics account for upwards of 90% of the population, the acceptance rate of the vaccine among healthcare workers tops out at 60%, officials at those hospitals said.
On Tuesday, Dr. John Krouse, dean of the University of Texas Rio Grande Valley School of Medicine, took to Facebook Live to answer questions and combat rumors and skepticism about COVID-19 vaccines in the face of "a lot of misinformation going on in the public about that."
"What I want to really state up front is that when it is your time, and you are prioritized to receive the vaccine, you should do so," Krouse said. "We really know that the vaccine is the way that all of us are going to be able to get back to a more normal life ... This is my plea to you."
The Texas Tribune is a nonprofit, nonpartisan media organization that informs Texans - and engages with them - about public policy, politics, government and statewide issues.
Some Texans are hesitant to get vaccinated for COVID-19, here's how health officials are countering skepticism