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Coronavirus pandemic

Stop talking about the possibility of <a href="https://www.washingtonpost.com/coronavirus/" target="_blank" class="contextual_link">coronavirus</a> booster shots. Don’t bully people who are vaccine holdouts. And if you’re trying to win over skeptics, show us anyone besides Dr. Fauci.

That’s what a focus group of vaccine-hesitant Trump voters urged politicians and pollsters during the weekend, as public health officials work to understand potential roadblocks in the campaign to inoculate Americans against the coronavirus. Among the most pressing questions are why so many GOP voters remain opposed to the shots and whether the recent decision to pause Johnson &amp; Johnson vaccinations was a factor.

Although more than half of U.S. adults have received at least one dose of coronavirus vaccine, more than 40 percent of Republicans have <a href="https://www.monmouth.edu/polling-institute/documents/monmouthpoll_us_041421.pdf/" target="_blank">consistently</a> told pollsters they’re not planning to be vaccinated — a group that could <a href="https://www.washingtonpost.com/health/2021/03/07/republicans-covid-vaccine/">threaten efforts</a> to tamp down the virus’s spread, public health officials fear.

Many vaccine-hesitant Americans are increasingly entrenched in their decisions to resist the shots, said Frank Luntz, a longtime GOP communications expert who convened Sunday’s focus group over Zoom.

“The further we go into the vaccination process, the more passionate the hesitancy is,” Luntz said after the session. “If you’ve refused to take the vaccine this long, it’s going to be hard to switch you.”

That was the case in the weekend’s focus group, the latest in a series Luntz has convened. It included 17 participants who heard pro-vaccine pitches from four doctors, including three Republican politicians and Tom Frieden, director of the Centers for Disease Control and Prevention in the Obama administration.

Unlike a <a href="https://www.washingtonpost.com/health/2021/03/15/vaccine-hesitant-republicans-focus-group/">similar focus group</a> five weeks ago, when most participants told Luntz and Frieden that the session persuaded them to get shots, attendees Sunday said they were swayed only moderately by doctors’ urging — or not moved at all.

“I was zero [on] the vaccine. I’m still a zero,” said a woman identified as Tammy from Virginia about an hour into Sunday’s focus group. Her comments came after Frieden repeatedly tried to calm attendees’ fears, which included questions about the vaccines’ unknown long-term effects and about baseless claims suggesting the shots would change recipients’ DNA even though that does not happen. Focus group attendees were identified only by their first name and state, although many participants volunteered additional biographical details.

While cautioning against drawing too many conclusions from a single focus group, public health experts said the nearly two-hour session offered insight on messages that could reach holdout Americans — and which messages didn’t.

For instance, the group largely shrugged off federal regulators’ decision last week to pause Johnson &amp; Johnson’s coronavirus vaccine for safety reviews, citing the risk of rare blood clots. Luntz and others had expected the pause to worsen hesitancy, but focus group participants instead asked why doctors were halting a potentially useful medical treatment, given that the reported side effects were so rare.

“A lot of people might want to take the Johnson &amp; Johnson vaccine versus the others, because it’s one shot versus two,” said a woman identified as Cathy from Pennsylvania.

Brian Castrucci, an epidemiologist who leads the <a href="https://debeaumont.org/" target=_blank>de Beaumont Foundation</a>, which helped convene the focus group, said: “Every public health person, me included, thought this would be a real hit to vaccine confidence. But we didn’t see folks really concerned with the pause in the J&amp;J vaccine.”

The foundation, which focuses on community public health, also issued a<a href="http://debeaumont.org/changing-the-covid-conversation/JJ"> poll Tuesday </a>with Luntz that found most Americans thought the Johnson &amp; Johnson pause shows that safety protocols are working. A federal advisory committee this week is expected to determine whether medical officials can resume administering the vaccine.

Instead, the focus group participants said they were far more concerned by recent news that they may need ongoing shots to ward off the coronavirus. Pfizer CEO Albert Bourla <a href="https://www.cnbc.com/2021/04/15/pfizer-ceo-says-third-covid-vaccine-dose-likely-needed-within-12-months.html">told CNBC</a> this month that Americans who received his company’s two-dose vaccine regimen probably will need a third shot within a year.

“I feel like this is not going to end. I mean, we’re just going to be shot up and shot up and shot up,” said a man identified as Erzen from New York. “We can’t live like this. This is not sustainable.”

Public health experts have said it is premature to assume Americans will need booster shots in the coming year, and Frieden framed Bourla’s claims as a business decision.

“I’m pissed off at Pfizer for talking about boosters. And I think they did that for their corporate benefit,” he told the group. Attendees later said that they appreciated Frieden’s blunt rhetoric.

Pfizer defended Bourla’s comments in a statement to The Washington Post, noting the company has repeatedly discussed the possibility of booster shots.

“Until we see a reduction in SARS-CoV-2 circulation and covid-19 disease, we think it is likely that a third dose, a boost of our vaccine, within 12 months after vaccine administration, will likely be needed to help provide protection against covid-19, subject to approval by regulatory authorities,” Pfizer spokeswoman Jerica Pitts said.

Castrucci said he had not expected Pfizer’s booster shot discussions to catalyze so much resistance.

“That’s the beauty of focus groups. You get to see the harbinger of things to come,” he said, arguing that participants’ concerns about a booster shot illustrated how coronavirus-weary Americans needed to know there would be an end to the pandemic.

The focus group revealed another unexpected development: Most participants said they would want a <a href="https://www.washingtonpost.com/health/2021/04/18/scams-coronavirus-vaccination-cards/" target=_blank>fake vaccination card</a> that would allow them to claim they had received shots, after Luntz granted them anonymity to speak honestly.

“One-thousand percent,” one woman said.

“If I have a fake vaccine card, yeah, I can go anywhere,” added a man who said he had turned down free New York Yankees tickets because of the team’s requirement to show proof of vaccination to attend games. Other participants said they wanted a fake card to attend concerts and go on trips, citing the growing number of organizations saying they will require proof of shots.

Even some participants who said they did not intend to get a fraudulent card acknowledged they were tempted. “My faith wouldn’t allow me to be deceitful. So what do I do?” one woman asked the group.

Federal officials have condemned the rising use of fake vaccination cards, warning that the scams are illegal and that they will prosecute Americans who make, sell or use the easily falsified cards. The use of fake cards could prolong the pandemic by allowing unvaccinated people to continue to spread the virus, officials have said.

'Ripe for fraud': Coronavirus vaccination cards support burgeoning scams

Several Republican politicians took turns pitching Sunday’s focus group to get shots, often with politically tinged rhetoric.

Sen. Roger Marshall (Kan.), an obstetrician, exhorted the Trump voters to get vaccinated out of respect for their former president.

“President [Donald] Trump busted his butt to get this vaccine for us. He kicked down doors that I’ve never seen kicked down before,” Marshall said. “And I think to respect him, would you take the vaccine? Would you honor it out of respect for him and his efforts and everything he did to get this country through this crisis?”

The senator's pitch fell flat with some attendees.

“I’m very thankful to Donald Trump, but all his efforts to make it happen don’t have anything to do with its continued or long-term efficacy,” said a man named Allen from Georgia.

Others said they agreed that Trump should be receiving more plaudits — and that the shots should even be called the “Trump vaccine” — but that alone didn’t appear to change their opinion.

Luntz said Trump bears responsibility for the tens of millions of hesitant GOP voters, having used his presidential podium to make political attacks while missing opportunities to promote vaccines to his political base.

“He wants to get the credit for developing the vaccine. Then he also gets the blame for so few of his voters taking it,” Luntz said in an interview. The longtime GOP pollster added that President Biden could be doing more to cross the aisle, such as making a joint appearance with Trump to tout the vaccines before promptly deferring to medical experts.

One figure was roundly panned at the focus group: Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases. Every participant said they preferred hearing from politicians over the medical expert, who has been pilloried by conservative media for months over his coronavirus warnings.

“The data have shown that unfortunately Dr. Fauci has been politicized, and we need different messengers, because even the right messages coming from the wrong messengers aren’t always helpful,” Castrucci said, noting his foundation’s polling found Americans trust their personal doctors more than the government’s top infectious-disease doctor.

Other complaints reflected opinions from previous focus groups and surveys, such as criticism of “vaccine passports” — documents that could be used to demonstrate proof of vaccination but have <a href="https://www.washingtonpost.com/politics/biden-vaccine-passports-desantis/2021/03/30/eeb41124-9171-11eb-9668-89be11273c09_story.html" target=_blank>become swiftly politicized</a> — and interventions characterized as overreach.

“I work for a university, and they’re really pressuring employees to take this vaccine, and they don’t pressure us near this hard for a flu shot each year,” a man identified as Michael from Iowa said.

Many participants blasted a media environment that they said was relentlessly negative.

“A lot of the hesitancy that’s coming from the right is just from being bullied, being humiliated, basically, by the media,” said a woman who identified herself as Leslie from California, who was one of the younger members of the group. “I don’t really see the point in getting it if nothing is going to change, and I haven’t gotten sick.”

Luntz said he would be closely watching <a href="https://www.washingtonpost.com/politics/pelosi-invites-biden-to-address-congress-on-april-28/2021/04/13/80e6030a-9cb6-11eb-b2f5-7d2f0182750d_story.html" target=_blank>Biden’s prime-time address</a> to Congress next week as a major opportunity to win over vaccine skeptics, particularly in communities of color. “Everything else he says is platitudes. What he says about covid can save lives,” the pollster said, arguing that Biden’s current popularity made him more effective than many politicians.

Given that vaccine-hesitant voters said their decisions were influenced by their personal doctors, Castrucci argued that all physicians could incorporate subtle questions about coronavirus vaccinations into their medical routines. That would hark back to <a href="https://www.cdc.gov/tobacco/campaign/tips/partners/health/materials/twyd-5a-2a-tobacco-intervention-pocket-card.pdf" target=_blank>successful anti-tobacco campaigns</a> in which doctors routinely asked patients about their tobacco use.

Meanwhile, Castrucci warned that some Democrats’ hectoring and ridicule of GOP vaccine holdouts had backfired, adding that it was wrong to argue with vaccine skeptics like a political debate: “If we don’t get this country vaccinated, it’s not a debate because there’s no winner, and we all lose.”

George Polk Award, 2020

Goldsmith Prize for Investigative Reporting finalist, 2021

University of Pennsylvania, BA in history

Dan Diamond is a national health reporter for The Washington Post. He joined The Post in 2021 after five years at Politico, where he won a George Polk award for investigating the Trump administration's response to the coronavirus pandemic.

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