With more than 5 million cases of coronavirus in the United States, deaths exceeding 163,000 and upticks in disease rivaling India and Brazil, one in three American adults say they would refuse to be vaccinated today, even if the vaccine had FDA approval and was free.

From late July to early August, Gallup asked 7,632 respondents the following question: “If an FDA-approved vaccine to prevent coronavirus/COVID-19 was available right now at no cost, would you agree to be vaccinated?”

Although 35% of the overall respondents said they would not get the vaccine, the numbers are more dramatic around party affiliation and age.

Among respondents who identified as Republican, 53% said they would not get the shot compared to 19% of responders who are Democrats. Among Independents, 41% said no.

And more than four out of 10 people of color (41%) also said they would not get the vaccine compared to 33% of people reported as white.

On the age spectrum, 24% of 18-29 year-olds were against it compared to 30% of those 65 and older.

“I’m not surprised,” said Dr. David Mirvis, a cardiologist who is a professor emeritus at the University of Tennessee Health Science Center and senior research fellow at the University of Memphis.

“People are skeptical, both for the general anti-vaxxer sorts of arguments and the general distrust of government and science,” he said. “I think the level of distrust is at an all-time high, from government in general to the particular government to the role of science.

“Not to get too political, but when the president is disagreeing with top scientists, who do you believe?” Mirvis said. “I think that shows in the breakdown between political parties in the survey.” 

Last Friday, Dr. Andrew Fauci, White House coronavirus adviser, said the chances of a vaccine offering protection for 98% or more of the population were “not great,” noting that scientists are hoping for 75% effectiveness but that 50-60% would be acceptable.

Because the vaccine likely will not be a silver bullet, Fauci says public health directives - masks, distancing and hand-washing - can’t be abandoned.

He has also said the vaccine will be available in early 2021.

Experts say a 65% vaccination rate, coupled with the percentage of people who will have had the virus by then and will be immune, should be enough to create herd immunity. Epidemiologists use that term to describe the point where enough people are immune to keep that a virus or disease can’t get a foothold.

“We suspect we need 60-70% for herd immunity,” said Dr. Manoj Jain, infectious disease expert in private practice here and affiliated with UTHSC and Emory University Rollins School of Public Health.

“If we can get two out of three, that may be sufficient, although outbreaks will still occur amongst those that did not get vaccinated.”

That spotty coverage will create dilemmas for employers, Jain said, noting that some may have to make COVID vaccinations mandatory.

“It may be up to an employer to decide if individuals are customer-facing,” he said. “It will be very important at that time to have those people vaccinated. Otherwise, they are a public health threat.”

What people say they would do now compared to when the vaccine is actually available may be very different things, says Dr. Sara Cross, infectious disease expert at Regional One Health and associate professor in medicine at UTHSC.

“The longer we live with this without a vaccine, the more people are going to know someone who died from it,” Cross said. “When you see someone dying from this and then a vaccine comes out that could protect you - that is not going to harm you in any way - I think people will realize that they should be getting this vaccine. It can only help them and the people around them.”

The higher the contagion rate of the disease, the more critical it is that people get vaccines to protect herd immunity, Cross said, pointing to measles, where outbreaks have occurred in the last several years because there are gaps in vaccination rates.

“Every person with measles can infect 12-18 people,” she said. “A person with coronavirus is going to infect 2-3 people. The number of people who need to be vaccinated in order for us to achieve herd immunity depends on the level of contagiousness of that virus.”

By the time the vaccine comes out, she says immunity from those who have the virus could mean that as little as 45-65% of the U.S. population will need the vaccine.

“We are going to get there.”

Besides a rural/urban divide on the COVID vaccine, Gallup found people of color are wary of the vaccine and can be expected to get it in small numbers.

Mirvis isn’t surprised, saying medicine’s racist history runs deep in the United States, including a history of experimentation.

“It gets back to trust,” he said.

Opinion: UTHSC experts outline hurdles to vaccine

Gallup found men and women were equally (65%) inclined to receive the shot. The largest enthusiasm was among 18-29 years old; 76% of them said they would get the vaccine today, higher than any other age group.

“You usually think of that age group as the invincibles,” Mirvis said. “They are convinced they can’t get sick; they are strong, healthy, whatever, ‘So don’t bother me with this.’”

Pandemic disrupts vaccination schedules; 700 need shots in Frayser alone

But he says young people may see the vaccine as something that will help them specifically as opposed to masks, which protect other people.

In a separate Gallup Poll conducted in the same timeframe, 46% of respondents, ages 18-44, said they wear a mask outside when it is not possible to socially distance. Among those 65 and older, 60% said they mask up in those situations.

“To me, the issue is not just what I am missing, it’s if I don’t behave, what am going to make someone else miss in their lives,” said Mirvis, 74.

Although he has no proof, he suspects the way he thinks is the discipline of his generation.

His only forays from home since the pandemic began are walks in the neighborhood.

“When I take walks around the block, I always wear a mask. There are three reasons I do. One, it keeps me in the habit. Second, you don’t know who you are going to run into around the block. The third is a pedagogical reason: When people see someone in a mask, it reminds them about masks,” he said.

That’s important, he says.

Deborah Overall, a registered nurse and manager at The Shot Nurse Immunization & Wellness Service, expects the vaccine will be met with the response she sees every year with the flu vaccine.

“Most will get it and a percentage will not,” she said in a text Monday.

“I will not hesitate and the same for my family. Vaccines work.”

Cross, the only person on Gov. Bill Lee’s 15-member, statewide COVID task force from Memphis, expects no blurring of political lines associated with the virus or vaccine until after the November election.

“After that, it’s possible.”