In this Monday, July 27, 2020 file photo, a nurse...

In this Monday, July 27, 2020 file photo, a nurse prepares a syringe during a study of a possible COVID-19 vaccine, developed by the National Institutes of Health and Moderna Inc., in Binghamton, N.Y.  Credit: AP/Hans Pennink

The United States is awash in COVID-19: Nearly 15 million people are infected and more than 281,000 are dead. COVID-19 has now become America's leading cause of death. So the arrival of effective vaccines ought to be greeted with the kind of celebration associated with ticker tape parades. Nope.

Despite planning about who will first get the soon-to-be approved vaccines from Pfizer and Moderna with states jostling to get allotments from Washington and committees setting priorities for access, the strangest thing is happening. Many Americans, including many New Yorkers, say they don’t want any part of the vaccines.

Who wouldn't jump at the chance not to be disabled, hospitalized or killed by a plague? Are these Americans so exhausted by COVID-19's damage that they are seriously thinking about foregoing vaccines regulators deem safe and effective?

Typically, vaccine refusal is most prevalent among wealthy, white areas, but there are high levels of hesitancy among marginalized communities, too. Only a quarter of Blacks and 37% of Hispanics in an AP-NORC poll say they would commit to vaccinations. You might think the numbers are the usual anti-maskers of Trumpland. Surely, first-responders in this area will know better. Think again.

An August survey of MTA workers shows only 30% of 645 respondents are willing to be vaccinated. Thirty-eight percent are unsure and 32% would not take the vaccine, according to a poll of Transport Workers Union members done by the NYU School of Global Public Health. And in a recent internal survey of 2,053 members of the FDNY's firefighters union, 55% say they wouldn't get a vaccine.

So why the reluctance? It is complicated.

Some first responders have dealt with COVID-19 exposure for months. They got it, survived it and don’t think they need a vaccine. They are wrong because reinfection and infecting others can happen. Others read nonsense online and worry about safety. A vaccine wouldn't be approved without the FDA being convinced that it's safe and effective.

Poor minorities distrust the health care system having often been denied access to care. But vaccines have been tested, and America is doing the right thing for the poor by guaranteeing access.

And some think they can rely on zinc, vitamins, and probiotics, among other products. The virus laughs at those concoctions. Wearing masks, staying home and social distancing will work well, but our morgues tell us it's hard for many to adhere to those behaviors.

So will we turn to mandates to overcome poor choices about vaccination? I think so, but not in the way many think. It will be private organizations, not the government, that will turn to mandates to boost vaccine rates. And they will do so waving the banner of freedom.

Many Americans don’t trust politicians. Some don’t trust scientists. So they worry about the president, governor, Centers for Disease Control and Prevention or county executive mandating vaccines. I don’t think that’s going to happen.

Vaccines will be rolled out and first users will get protection with no serious side effects. Airlines, restaurants, sports executives, cruise ships, hair salons and gyms will see this and tell customers they need proof of vaccination to purchase their services. If they do, governments around the nation will allow those businesses to reopen. And health systems, the military, and many private employers also will insist on vaccination for employees, delivery personnel, maintenance workers and visitors. Vaccination, now associated with coercion and mistrust, will be understood as a key to freedom and a return to normalcy.

Yes, the polls showing vaccine resistance worry me. But, betting on the success of early vaccination, I am not worried that vaccine resistance will last long.

Arthur Caplan heads the Division of Medical Ethics at NYU Grossman School of Medicine.

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