With COVID-19 vaccines now available to all American adults, the vaccine landscape has changed since anticipation for vaccine rollout began in January. But according to a new report from the Kaiser Family Foundation’s COVID-19 Vaccine Monitor project, opinions about the COVID-19 vaccine mostly have not. Still, the report found shifts — both toward and away from vaccination — that offer insight into how Americans are thinking about this public health priority.

The report, released last week, is based on two interviews with a group of 878 American adults. The group was first interviewed on vaccine intentions in January, and then again in June about whether they ultimately got vaccinated, allowing the researchers to figure out who had stuck with their original intentions and who had changed their mind.

In January, nearly half of the people surveyed had either already been vaccinated or wanted to get vaccinated as soon as possible. Since then, 92% of those surveyed received at least one dose by June — most even got it months earlier. Recent vaccinations tend to be among those who were initially taking a “wait-and-see” approach. Over half of them have now also gotten at least one dose.

That fits with what Maya Bass, a family medicine physician and assistant professor at Drexel College of Medicine and Tower Health, has seen. “A couple of my patients wanted to see others get it first,” Bass said. “Now that we’re six months out, many of them are starting to set up appointments to get it done.”

Meanwhile, 23% of survey respondents said in January that they would either get the vaccine only if required to do so — for work, school, or other activities — or not at all. Vaccination rates have remained low in this group: About a quarter of them reported receiving a dose of the vaccine when interviewed in June, and 67% were still not planning on getting vaccinated.

For those who changed their minds and rolled up their sleeves, the people around them were the main motivation. Some saw family and friends get vaccinated safely, while others realized they would need to get vaccinated to spend time with high-risk loved ones. Two-thirds of vaccinated Americans reported trying to convince more hesitant people around them, and their efforts paid off: 36% of adults who ultimately got vaccinated even though they were originally hesitant were convinced by others.

Delana Wardlaw, a family medicine physician at Temple Physicians at Nicetown who conducts outreach with her sister through Twin Sister Docs, said it is important to note that physicians are still among the most trusted sources of vaccine information. The poll found doctors convinced 11% of those who were swayed to get vaccinated. Bass has persuaded some of her patients to get vaccinated, although it has taken time to “slowly chip away at the anxieties that they have.”

But there are still holdouts. “Some people have problems trusting the information that I give them, despite trusting me with all their other care,” Bass said.

Among the people who remained unwilling to get vaccinated or would only do so if required, side effects were the main deterrent. Nearly one-quarter of those with no plans to get the shot expressed concern about side effects, though experts say most people don’t get anything worse than mild flu-like symptoms that quickly resolve. Social media, however, has been awash in more severe claims that the data don’t bear out. This was also a major reason why roughly one in 10 people who initially wanted to get vaccinated later changed their minds.

“Vaccine hesitancy doesn’t have to be a negative term,” Wardlaw said. “It simply means that patients have questions or issues that they need to have addressed before they can make an informed decision.” Wardlaw talks with patients about anticipated side effects and makes it clear that they are normal and treatable.

Bass also noted that some people can’t take time off from work if they have side effects, and she recommends that these patients get their vaccine before a day off so that they can rest. Side effects generally last no more than 24 hours, experts say.

Comments from survey respondents reveal more of their anxieties about safety. When people with no plans to get vaccinated were asked what would convince them, one person replied, “Time and proof that it is working and has no lasting negative effects on the body.” Others asked for full FDA approval (though this is expected soon after the agency completes its lengthy process, the vaccines still are being distributed under emergency authorization) and a 100% guarantee of safety.

Bass said it’s hard for physicians to compete with online misinformation. “Even if I see a patient once a month, I’m just there for 15 minutes compared to the hours they spend on the internet.” Some people who reported being more hesitant in June said they don’t trust regulatory agencies or vaccine incentives and that the vaccine is too new.

One person said they would get vaccinated “if [COVID-19] became a huge problem again.” With case counts ticking upward nationwide, Wardlaw has already seen the delta variant changing minds.

“At my practice, I have noticed those who still have concerns about moving forward with the vaccine,” Wardlaw said. “With the delta variant, I have seen a turn of the tide in those patients.”

Not everyone who wants a vaccine has received one. The KFF report found that 3% of people who wanted to get vaccinated as soon as possible in January still feel the same way but haven’t been vaccinated. Access-related obstacles have decreased substantially since earlier in the year, Wardlaw said, but there are still some patients who don’t know where to get the vaccine.

Bass sees the report as a helpful guide for doctors to understand the bigger picture of patients’ concerns about the vaccine.

“It was reassuring that my patients are asking questions that were similar to patients that they talked to,” Bass said. “It now gives me a bit of an outline for my spiel.”