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"A 69-year-old UC Berkeley public health graduate who voted for Bernie Sanders. A 28-year-old Fremont digital designer and COVID-19 survivor. An immigrant from India, 26, who fixes phones in a Fairfield mall. These wildly diverse Bay Area residents share at least one significant decision: They are refusing coronavirus vaccinations, and their reasons for doing so often are rooted in fear of the unknown and skepticism around the well-established science of vaccines. \"All these vaccines were created really quickly and it's kinda like frightening, thinking about being injected with god knows what's in there,\" said Row Elias, the digital designer. \"How do we know that in a month or two, or a year or two, these people will not have higher incidences of cancer, or neurological disease, or allergies?\" said Dana Ullman of Berkeley, a homeopath with a master's degree in public health. Experts in public health and human behavior say it's natural for some people to have doubts about highly touted vaccines that were accelerated to market. These skeptics and naysayers - who account for millions of people across the country - could stand in the way of entirely stamping out the disease that has killed more than 576,000 people in the U.S. alone. But by definition, those people are the hardest to persuade, and some may never take the vaccine. Others have just been unable to get the shots or slow to accept them and are more likely to be vaccinated through outreach and education efforts. State and federal officials are modifying their vaccination strategy away from mass sites and toward walk-in sites at pharmacies, and pop-up clinics to reach the reluctant. \"Unfortunately, people turn to the world of the internet and find all kinds of reasons to be scared,\" said Dr. Salli Tazuke, co-medical director of CCRM Fertility clinic in San Francisco, who hears those doubts from women seeking fertility help. Yet clients tend to accept that vaccination benefits far outweigh any risk once her clinic presents material from the Centers for Disease Control and Prevention and other scientific sources, she said. \"That motivates a lot of women,\" Tazuke said. \"If you get COVID, the effects on your health last much longer.\" Multiple studies reviewed by both government and independent scientists have verified the safety of the three vaccines approved for use in the United States. More than 1 billion vaccine doses have been administered worldwide, including more than 250 million shots in the U.S., and severe side effects are exceedingly rare. By contrast, studies show that COVID-19 can cause long-term symptoms in roughly a third of those infected, a phenomenon known as post-acute COVID syndrome. A cough that won't quit, shortness of breath, exhaustion, headaches and brain fog are the most common symptoms reported by these \"long-haulers\" - people who no longer test positive for the coronavirus yet, months later, still feel ill. The vaccines were developed in record time, roughly 11 months, but not by cutting corners, National Institutes of Health Director Dr. Francis Collins said in a recent public service announcement meant to address such fears. He said the scientists simply eliminated the down time typically involved when vaccines are developed over years. \"This was a crisis, with millions of people's lives at risk,\" Collins told Curtis Chang, a theologian based in San Jose who spoke with the NIH director for an awareness campaign Chang is producing for the nonprofit Ad Council to help evangelicals better understand vaccination. In the history of vaccine development, any serious side effects have shown up within the first couple of months, Collins said. That's why, during large-scale trials for the COVID vaccines, the U.S. Food and Drug Administration required two months to pass before considering the vaccines for approval, he said. The Moderna and Pfizer vaccines may cause a serious allergic reaction, but no deaths have been reported. U.S. officials paused Johnson & Johnson's vaccine after the CDC identified six cases of blood clots out of some 8 million shots administered. An additional nine cases have since shown up. The CDC reviewed the situation and gave the drug a green light after 10 days. \"To put this in perspective, your chances of developing a blood clot with the J&J vaccine is roughly equivalent to being hit by lightning in the next year,\" said Dr. Warner Greene, an expert in virology and immunology with the Gladstone Institutes research institution. Greene said it is understandable why, \"given the sudden and disruptive assault of COVID-19 on every aspect of our lives,\" some people have doubts about the rapid development of vaccines. But when compared to the adverse effects of COVID, he said, including the potential for long-term problems even after mild infection, \"my medical advice is that you should make getting vaccinated the highest priority in your life.\" The Bay Area overall is strong on vaccine acceptance: Just 13% of Bay Area adults say they \"definitely\" or \"probably\" won't get vaccinated against the deadly virus, a March survey by the Public Policy Institute of California found, compared with 18-20% in Southern California regions, and 26% and 28% in the Central Valley and Inland Empire, respectively. But that's still more than 800,000 of the Bay Area's 6.2 million adults who are dubious about the vaccines, and this may be an undercount because the poll did not include 16- and 17-year-olds, who also are vaccine eligible. Some people who want a shot can't go to a vaccination site or have trouble scheduling an appointment online, said Dr. Marina Martin, chief of geriatric medicine at Stanford. Nationwide, 18% of people over 65 have yet to do so. In California and across the country, well over half of adults are at least partially vaccinated, data shows. But many, including 54% of Republicans nationally and 49% of white evangelical Christians, told the Kaiser Family Foundation last month that they will either refuse a shot, get it only if required, or will wait and see. Vaccine-related conspiracy theories resonate with some Christian evangelicals, in part due to a cultural tendency to be \"on guard\" against secular institutions and their values, said Chang, the theologian and former pastor whose job is to help fellow evangelicals see past those ideas. \"Even if evangelicals are a relatively small minority in the Bay Area, there is no such thing as little pockets of safety\" from the virus' spread, Chang said. Others want more data than the existing suite of scientific studies. \"There are literally no long-term studies,\" said Ullman, who has practiced homeopathy for decades. \"It's very important for some people not to get vaccinated, so we can have a reasonable control group.\" Ullman contends a healthy diet and taking vitamins and zinc supplements can beat back COVID, and acknowledges that is at odds with scientific consensus. Mohamed Jaffar, too, is wary, especially given the recent temporary pause on use of Johnson & Johnson's vaccine. Without more data, \"I don't want to do it,\" Jaffer said, standing at the Fairfield iPhone repair kiosk where he works. \"There's good and bad in it, so I don't know yet.\" \"Nobody wants to give their life for the vaccine,\" he continued. \"Someone has to take it; otherwise no one will, and we won't know what the effects are. But we are not lab rats.\" It took two medical doctors to persuade Nate Tyler, 24, to get a shot. But the doctors - his parents - succeeded, and Tyler bared his arm on Monday, despite his concerns about long-term side effects. \"If I roll up to the vaccine place and they offer me a Johnson & Johnson, I'll probably drive away,\" Tyler, a gun store salesman in San Carlos, said before heading out for his vaccination. COVID-19 Map: Data on trends in the Bay Area and across California Mask FAQ: What you need to know about the latest rules Latest news: Complete coverage of the coronavirus pandemic Tyler got a Pfizer shot. Elias and her parents, living together in Fremont, contracted the coronavirus in January. They are not heeding government guidance urging that even people who were previously infected get vaccinated: It's unclear how long immunity lasts from previous exposure or how well people are protected from reinfection, and vaccines are believed to provide a more durable immune response. One thing holding Elias back is what \"friends that are in the medical industry\" have told her: \"You don't really have to worry too much that you can contract it again. But it is a possibility.\" Elias said she'll research her questions in the coming months. A core group of people known as \"anti-vaxxers\" for opposing vaccines of all types \"will not be satisfied with answers, and will continue to come up with additional reasons to doubt vaccines,\" said Dr. Yvonne Maldonado, an infectious disease expert at Stanford. Nevertheless, she said, coronavirus vaccines have been \"exquisitely reviewed by hundreds of scientists around the world\" who have found no reason to doubt their long-term safety. And because of FDA safeguards, the U.S. has \"the best national safety procedures for vaccines, drugs and other biologics in the world.\" This story has been updated to clarify that Gladstone Institutes is an independent research institution. Nanette Asimov, Aidin Vaziri and Meghan Bobrowsky are San Francisco Chronicle staff writers. Email: nasimov@sfchronicle.com, avaziri@sfchronicle.com, meghan.bobrowsky@sfchronicle.com Twitter: @NanetteAsimov, @MusicSF, @MeghanBobrowsky"
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