Why Young Adult Vaccination Rates Are Stagnating

 
The failure of the U.S. to vaccinate more of its youngest adults against COVID-19 is, on one level, a study in the risks of mixed messaging. It also throws light on the toxic effects of disinformation and underscores how difficult it can be for boomer-oriented public agencies to reshape their pitches to fit a TikTok world.

At the moment, though, the failure is a national concern, not a theoretical one. For the country to tamp down the virus’s worst effects and prevent more dangerous permutations, more young adults need to be vaccinated. Instead, the numbers are stagnating — and a determined minority may keep it that way.

“I think our messaging for young people is less powerful because the benefits of vaccination for them are just not as clear,” said Dr. Jeanne Noble, an emergency care physician who directs COVID response at Zuckerberg San Francisco General Hospital.

A recent study by researchers at the University of California, San Francisco, puts the issue into bold relief. Using data from the U.S. Census Bureau’s Household Pulse Survey, they found that 83% of respondents in the 18-25 age group said they weren’t vaccinated — and nearly a quarter of them didn’t plan on doing so.

The survey was conducted in March, and in an event as dynamic as a global pandemic, such moment-in-time data points can change rapidly. Some health experts are holding out hope that the growth and severity of the Delta variant, now the dominant strain of the virus in the U.S., will prompt more young adults to become vaccinated.
 

Although younger adults tend to experience milder cases of COVID, their unvaccinated ranks can become vectors of the disease.

 
But recent numbers aren’t encouraging. According to the Kaiser Family Foundation’s vaccine monitor in June, those ages 18 to 29 account for 29% of all unvaccinated adults in the country but only 17% of the vaccinated ones, a striking disparity. On balance, “The unvaccinated group (in the U.S.) are younger, more likely to identify as Republicans or be Republican-leaning, and more likely to have lower levels of education and lower incomes than the vaccinated population,” the KFF monitor’s authors wrote.

The stakes are high. Although younger adults tend to experience milder cases of COVID, their unvaccinated ranks can become vectors of the disease, especially to older unvaccinated people, who will suffer far worse medical outcomes.

Meanwhile, the virus itself may be “just a few mutations potentially away” from establishing a variant that evades the current vaccines, said Dr. Rochelle Walensky, director of the Centers for Disease Control and Prevention. On the day Walensky spoke, July 27, the U.S. seven-day average of new daily cases had quintupled to nearly 57,000 from just a month earlier.

A new strain of COVID that the vaccines won’t stop is certainly a worst-case scenario, and the current vaccines continue to work well against all existing strains. But none of that matters if younger people aren’t motivated to get inoculated — and it will take more than an Olivia Rodrigo visit to the White House to jump-start the slow moving process.

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To hear some experts tell it, the story of how we got here goes back to the public information disseminated in the early months of the virus’s U.S. spread, and particularly to the campaigns that occurred right after shipments of vaccines began to be allocated in California and around the country. In both cases, the message was the same: Older people are more at risk. Older people should be treated first.

That conclusion was reasonable and backed by the numbers. Americans over 65 account for 16% of the population but 80% of the nation’s COVID-related deaths, according to data compiled by KFF, and 20 states have death rates even higher than that for the age group. (In California, those 65 and over account for 76% of COVID deaths.)

For many weeks, in fact, younger adults weren’t even eligible for the vaccine. It was not until April that all age groups over 12 were finally included. By then, the frightening peak infection rates of winter were long gone, and many young people likely felt no urgency to become vaccinated.

“I think that for the younger generation, we really have to build the case for them to be vaccinated,” Dr. Sarah Van Orman, chief health officer of student health at the University of Southern California, told the New York Times. “I think we have a long ways to go for that.”

In its most recent survey, the KFF monitor found that among unvaccinated 18 to 29 year olds, 15% said they would definitely not receive a vaccine, 12% said they’d do so only if required (at their jobs or schools, for example), and 15% said they would wait and see. While more than 600 college campuses will require vaccinations of students, staff or both, that push will reach only so many people within the demographic. The rest is legwork.
 

While death rates for 18-29 adults with COVID remain low, other possible long-term effects include respiratory issues, loss of smell and brain fog.

 
Part of the issue is the constantly changing guidance from federal and local health authorities. Those shifts are understandable, researchers say, given how little was known about COVID-19 when the pandemic began, but they’re distracting and confusing to young adults who already may have a sense that their own immune systems should be strong enough to withstand the virus. (Some health experts refer to this as the “immortality factor.”)

“Most young people do not get particularly sick from COVID, and our most vulnerable (older adults) have already been vaccinated or had the opportunity to do so,” Noble said. “So the argument to vax in order to protect others is less robust now than it was previously.”

Further, health officials in several cities and counties have renewed recommendations that people mask up when indoors even if they’ve been vaccinated, and the CDC has reversed its earlier advice and joined their ranks. To Noble, the move undermines faith in the efficacy of vaccines and makes the advantages of getting a shot less clear. “If we don’t get to change our behavior because we are vaccinated, and if we were not particularly concerned about illness (in the first place), the motivation to get vaxxed is sluggish,” she said.

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San Francisco General, where Noble works, has not seen a rise in the number of admitted young adults with COVID cases, she said. Anecdotally, at least, many other areas are experiencing sharp increases in the percentage of younger people contracting the disease. In Sacramento County, the 20-29 cohort now represents the most infected group.

While death rates for 18-29 adults with COVID remain low, Sally Adams, one of the researchers who led the UCSF study, noted other possible long-term effects. These include respiratory issues, loss of smell and brain fog, all of which are often referred to by the umbrella term “long COVID.” “Estimates range from 10% to 50% for (experiencing) long COVID symptoms, which is a serious concern for young adults given their high infection rates and low vaccination rates,” Adams said.

But reaching that group with a message has proved a significant challenge for health systems and government agencies accustomed to traditional modes of communication. That’s a problem if you’re trying to connect with people who consume Instagram and TikTok throughout the day, and who have seen plenty of misinformation course through those sites already. Earlier this year, the 18-29 and 30-49 age groups were found to be the most likely to believe one or more COVID myths — that the vaccines contain fetal cells, for example, or have been shown to cause infertility. (Both are untrue.)

“There isn’t anything that is consumable and/or targeted at our demographic,” 22-year-old Washington, D.C., resident Gabrielle Kalisz told the health journalism site STAT. “All the messaging online isn’t targeted toward our age group — it doesn’t explain why, if you’re a healthy 19-year-old, you should get this vaccine.”

Enthusiast Gaming, a company that specializes in marketing campaigns aimed at Gen Z audiences, was hired by President Joe Biden’s team to help mobilize turnout among young voters in the 2020 presidential election. Its CEO, Adrian Montgomery, argues that an entirely different approach is needed to turn the tide on vaccinations among the 18-29 group.

These social media users tend to regard influencers as peers, Montgomery wrote in a column for USA Today. For that reason, they’re unlikely to respond to simply being told to get vaccinated. Instead, “In the coming weeks, young adults will see more and more (influencers) talk up the importance of learning about vaccines, including information on their safety despite rare side effects,” Montgomery wrote. “Members of Gen Z are independent thinkers, and often feel that older generations didn’t do enough about the issues they care about the most.”

In other words, young adults are perhaps the group least likely to let older generations tell them how to avoid COVID. They’ll need to be offered the information, which they may then consume for themselves. If that sounds like a painstaking process, it is — but it may offer the best chance for America to increase its percentage of young adults willing to be vaccinated, and to blunt the virus’s latest national spread.

 
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