What do frontline health care workers and first responders know about COVID-19 vaccines that politicians and their public health advisers don’t?

According to a January analysis by Gallup, 51 percent of health care workers and first responders polled in December were unconvinced of the merits of getting vaccinated, even if the vaccine “was free, available, FDA approved and 90% effective.”

Gallup found these results especially concerning since those at highest risk of exposure to COVID-19—the professionals required to meet America’s health, safety, and critical economic needs whom the National Academies of Engineering, Science and Medicine define as “Tier 1A workers”—were the likeliest to refuse vaccination (34 percent).

The frontline workers proved to be as defiant as Gallup’s survey of their intentions anticipated. In California, over half of Tehama County’s hospital workers at St. Elizabeth Community Hospital, an estimated 50 percent of frontline workers in Riverside County, and 20 percent to 40 percent in L.A. County refused the vaccine, according to a report in the Los Angeles Times.

In Georgia, according to an estimate in the Atlanta Journal-Constitution, only 30 percent of health care workers have been inoculated. In Ohio, Gov. Mike DeWine reported that 60 percent of nursing-home workers refused the vaccine. In Texas, the Texas Tribune reported in February that home-health and assisted-living agencies may not be able to service their clients because so many caregivers are refusing to be vaccinated. A CDC survey of skilled-nursing facilities published in early February found that fewer than 40 percent of staff took at least one dose of a COVID-19 vaccine.

Outside the United States, frontline workers are likewise skeptical. On March 2, Reuters reported that at most half of the nursing staff in Switzerland’s medical sector, only 30 percent of the staff at Germany’s BeneVit Group care-home operator, and about half of the health workers in French care homes were willing to be vaccinated.

PBS on the same day reported that since “India started administering the second vaccine dose two weeks ago, half of the frontline workers and nearly 40 percent of health care workers have not shown up.” In Canada, CTV provided an anecdotal report that many long-term-care workers in Montreal are “flat-out refusing” to be inoculated.

For health care workers around the world, their dilemma is who to believe. Their government employers and the pharmaceutical companies, who insist the vaccines’ benefits far outweigh the risks? Or their own eyes?

Many frontline workers see first-hand those who fall sick or die after receiving a COVID-19 vaccine, and in the absence of independent analyses judge for themselves whether the vaccine is implicated. They noted 23 nursing-home deaths in Norway and hundreds of hospitalizations in Israel following vaccination.

Frontline workers also suffer from vaccinations themselves. As Reuters reported in February in an article entitled “AstraZeneca Vaccine Faces Resistance in Europe After Health Workers Suffer Side-Effects,” the adverse effects hitting health care workers have unexpectedly left large numbers unable to work, forcing hospitals to scramble to maintain services.

In France, the safety agency advised hospitals to stagger the inoculation of team members, to avoid disabling team functions.

In Sweden, two of the country’s 21 health care regions paused vaccinating their staff after 25 percent of the vaccinated suffered fever or flu-like symptoms.

In Austria, inoculations with a batch of vaccines were suspended after one vaccinated nurses died and another required hospitalization.

The Wall Street Journal reports that, to avoid getting vaccinated, half of the health professionals scheduled in the German state of Saarland failed to show up for their appointment.

In response to the many concerns raised by frontline workers, the vaccine manufacturers, care-home operators, and the public-health authorities in all these countries offer bland reassurances, such as AstraZeneca’s statement that “the reactions reported are as we would expect” and the German Health Minister’s claim that “I would be vaccinated with it immediately.”

They also plan a plethora of public education campaigns. Partnership for Medicaid Home-Based Care, an industry advocacy group, launched a “Be Wise, Immunize” campaign to educate its workforce.

And all urge media and social media to be more vigilant in policing negative vaccination news. In offering pointers on how to debunk critics, the Columbia Journalism Review on March 5, told media companies that “The first rule of reporting on mis/disinformation [is] don’t talk about the mis/disinformation” and suggested they “consider the practice of ‘pre-bunking’—that is, actively debunking or anticipating public questions and concerns rather than only reacting once false narratives have been popularized.”

Although studies show that such assurances and public-education campaigns—also known as propaganda—can reduce vaccine hesitancy, Gallup finds their effect is marginal: “The limited COVID-19 vaccine acceptance rates among all occupation groups show little movement since November 2020.”

A Centers for Disease Control and Prevention (CDC) analysis agrees, and concludes that barriers to “staff member vaccination need to be overcome with continued development and implementation of focused communication and outreach strategies.”

Yet the CDC doesn’t explain why continued focused communication and outreach—i.e., more of the same—would overcome worker hesitancy, when workers don’t fully trust the data, or those who deliver the data. To overcome that trust barrier and win over the frontline workers—people who have every incentive to protect themselves—the media would need to lift the censorship, industry would need to subject its studies to independent scrutiny, and all would need to engage in reasoned debate rather than “trust-us” assurances.