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Roughly 68% of Americans age 12 and up are now fully vaccinated against COVID-19. And now that federal regulators have cleared the Pfizer vaccine for children age 5 to 11, the number of people in this country who are immunized against the virus will only continue to climb.

But new data published in the journal Nature suggests that convincing vaccine holdouts could be difficult, if not impossible.

A detailed 36-question survey of more than 6,000 adults from across the United States found that 21% were unwilling to get vaccinated and among those, nearly half said that nothing would change their mind.

So what does vaccine hesitancy mean for the course of the pandemic, and what can we do about it? Heres what you need to know.

What Vaccine Hesitancy Means For Herd Immunity

For months now, epidemiologists and public health experts have been warning that national herd immunity meaning that a large enough portion of a community is immune to a disease, leaving it few places to spread is unlikely. Herd immunity does not mean a virus or disease is completely eliminated. Rather, its just contained and manageable, with smaller, local outbreaks possible from time to time.

The highly contagious delta variant has pushed the threshold of people who need to be vaccinated in order to achieve herd immunity higher and higher. Scientists initially believed that herd immunity might be achieved when 60 or 70% of the national population was vaccinated; now some believe 85% to 90% of a population in any given area may need to be immune to COVID either through a recent infection or vaccination though even that is a best guess.

Without herd immunity, COVID will likely become an endemic disease, like the flu. That means it will continue to be with us, but it will not disrupt daily life to the extent it has. Experts say well likely experience a return to relative normalcy. However, even then, the unvaccinated still could get very sick and die. One recent report found that the unvaccinated in Texas were 40 times more likely to die from COVID than the fully vaccinated.

The colder winter months will be a critical test of whether our current immunity levels are enough to stave off another surge or to prevent new variants from circulating. As Anthony Fauci, the nations top infectious disease expert, recently said: We can get through this if we really put a lot of effort into getting as many people vaccinated as we possibly can.

How To Talk To The Vaccine Entrenched

First, its important to note that the survey though published in early November was conducted last April, so its possible that peoples minds have changed since then. But it is also possible they have dug in more.

We know that the longer that people are hesitant, the longer they will continue to be hesitant. It becomes what we call a commitment consistency issue where the longer you say this is not something Im going to do, or this is something I disagree with, the more it becomes ingrained in your personality, said Rebecca Ortiz, who researches health communication and social marketing at Syracuse University.

However, Ortiz stressed that people who are vaccine hesitant are by no means a lost cause. And anecdotally, theres certainly evidence that vaccine holdouts can be convinced to roll up their sleeves. Recent data also suggests that one-third of people who were vaccine hesitant in late 2020 were willing to get vaccinated by early 2021.

Notably, the new survey found much as plenty of other data has at this point that people who hold conservative political views are more likely to be vaccine hesitant. The less we can turn this into a political conversation, the more we can talk to people about whats really holding them back, and whats really making them hesitant about this, Ortiz said.

Of course, changing the discourse is a complex problem. In one-on-one conversations with friends, family or acquaintances who are vaccine hesitant, the primary focus should be to make space for opposing views, Ortiz urged even if that feels challenging.

Its a tricky thing. We have to let people speak what it is thats holding them back. We have to give people space to process that, Ortiz said.

Eventually, by making space for them to express their concerns, you might be able to share information youve found and learned in a collaborative way. Ask what would make them feel more secure or comfortable about getting vaccinated, Ortiz said.

There are some people who will never change their minds about the COVID-19 vaccine, but experts are hopeful there are still holdouts who are hesitant but not dug in who can and will make a different decision. So its important to remain open, and to approach people with a mix of curiosity and facts, not judgement.

Experts are still learning about COVID-19. The information in this story is what was known or available as of publication, but guidance can change as scientists discover more about the virus. Please check the Centers for Disease Control and Prevention for the most updated recommendations.

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COVID Vaccine Holdouts Say Nothing Will Change Their Minds. Now What? - HuffPost