It had been months since Tremellia Hobbs had an excuse to bring out the pompoms. Before the pandemic, they were a crowd favorite during movie nights and bingo tournaments that Hobbs organized as activities director at the nursing home.

It had been a difficult and sad year at the Brian Center Health & Retirement/Cabarrus. Over the summer, there had been an outbreak of the virus which had killed 10 residents and infected 30 staff members. For nearly a year, residents had been eating meals alone in their rooms, reminiscing about the days they shared popcorn while watching wrestling matches on TV.

But on Jan. 14, Hobbs finally had a reason to use the pompoms: the nursing home was hosting its first COVID-19 vaccine clinic. Hobbs shook the red and silver tassels and cheered as co-workers lined up to get shots from one of two visiting CVS pharmacists. "Stewart, Stewart, he's our man! If he can't do it, no one can! Goooo, Stewart!"

Hobbs had also decorated the dining hall with green and blue balloons, and had assembled goodie bags full of Life Savers gummies, as a 'thank you' for each person who got the shot that day. The candies came with a note that read, "thank you for being a life saver."

But even as Hobbs rooted for her colleagues, she knew she wouldn't be getting the vaccine herself. At least, not today.

"Being able to diagnose, come up with a vaccine and administer it all within the same year just seems a little puzzling," she says. "I would like to see, give it a little more time."

Hobbs' hesitancy has been echoed by nursing home staff members across the state and country. But her reasoning — as well as that of her colleagues who also opted against the vaccine that day — goes far beyond a simple yes or no. The decision is complicated and multifaceted, they say, which means convincing them to say yes will be, too.

In North Carolina, the health secretary has said more than half of nursing home workers are declining the vaccine. A national survey found that 15% of health care workers who had been offered the vaccine said no, with nursing home personnel more likely to refuse than hospital staffers.

New data shows nursing home residents are getting vaccinated at a higher rate than workers. The CDC analyzed more than 11,000 long-term care facilities which had received vaccines through a partnership between the federal government, CVS, and Walgreens. In the first month of the program, an estimated 77.8% of residents got at least one dose of a vaccine, but among staffers the rate was 37.5%.

Some nursing home staffers say their reluctance is being misconstrued. Most are not saying they'll never take the vaccine, but simply that they have concerns about such a new product. They understand it went through months of clinical trials, but what about possible long-term side effects, for instance? Or they wonder how politics played into the development process. For communities of color, their historical mistreatment by the medical system may also factor into the decision.

"We should stop saying that people are just saying no," says Dr. Kimberly Manning, a professor at Emory University School of Medicine who is participating in the Moderna vaccine trial. A Black physician herself, she has been speaking with many Black Americans about the vaccine and instead of calling people "vaccine hesitant" she prefers the phrase "slow yeses."

"We just are too impatient to get to the point where we let them get to their yes," she says. "We're like the used-car salesman. We're just trying to close the deal."

Human beings respond better to empathy and patience than to pressure, Manning explains. She tries to ask people about their individual concerns and work from there. Sometimes it's skepticism about the government's intentions. Other times it's worry about how the vaccine may interact with fertility treatments.

"It's important to not lump anybody into a group and say 'How dare you just not get vaccinated?' because you're a health care worker," she says. "You're still a person."

Hobbs, at the nursing home, is not against immunizations in general, she says, and her decision has nothing to do with distrusting the medical system as a Black woman.

"I totally trust the science. I love Dr. Fauci," Hobbs says. "My thing is the timing."

She wants to wait and see how others who get the shots fare. In the meantime, Hobbs says, she'll continue masking, physical distancing and sanitizing — all of which have kept her COVID-free for 10 months and which she hopes will continue to protect the residents, each of whom she knows by name and favorite activity.

Caitlyn Huneycutt, a certified nursing assistant at the center, also opted out of getting a shot — but for an entirely different set of reasons. She expects COVID vaccinations will be mandated for health workers in the future, much like other immunizations. And she'll get them then. But for now, she's still weighing the risks.

She recently started a new medication and is not sure how it'll interact with the vaccine. She doesn't want to bring COVID home to her 1-year-old daughter, but she's also heard of people who received the vaccine and fainted or developed kidney infections. (The Centers for Disease Control and Prevention does not list either of these as common side effects for the two COVID vaccines in use.)

"I want to make sure I'm going to be healthy if I take it," Huneycutt says.

Across the country, nursing homes are taking different approaches to persuade their staffs to get vaccinated. Sava Senior Care, which owns the Brian Center/Cabarrus, has offered cash to its 169 long-term care homes in 20 states to pay for gift cards, parties or other incentives. For over a month now, the company has also been hosting weekly phone calls to educate staffers about the vaccine, and making Sava doctors and pharmacists available to answer questions.

At least one nursing home chain in the U.S. announced it will require all employees to receive a vaccine, but most others, including Sava, have not yet done so.

Stewart Reed, administrator for the Brian Center/Cabarrus, is hoping to lead by example instead.

Reed experienced the harsh reality of COVID firsthand and was out of work for two weeks in the fall. On Jan. 14, he was among the first in line to get the vaccine. For the rest of the day, he popped in and out of the dining hall where shots were being administered to thank staff members for doing their part.

By the end of the day, about 48% of staff members and 64% of residents at the center had received their first dose of vaccine. The numbers are well below Sava's eventual goal of 90%, Reed said, but the pharmacists will return for two more clinics in the coming months.

"The people that didn't get it [today] will see that the guys that got the shot are OK," Reed says. "When the next clinic comes up, they will not hesitate to get their first shot. It ought to go much better."

KHN (Kaiser Health News) is a nonprofit news service covering health issues. It is an editorially independent program of KFF (Kaiser Family Foundation) that is not affiliated with Kaiser Permanente.

Copyright 2021 Kaiser Health News. To see more, visit Kaiser Health News.

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