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Skepticism of the COVID-19 vaccine is intensifying in Hawaii, a troubling trend that could undermine historic efforts underway to inoculate the majority of the population.

A November survey from the University of Hawaii’s Public Policy Center found that just when it becomes available.

That’s down 7 percentage points from an earlier survey in August.

Women, Republicans and people in poorer households are least likely to say they will get the vaccine, the survey shows. 

“I think it has a lot to do with fears about the safety of the vaccine, and that is wrapped up in anxiety and distrust of the federal government,” said Colin Moore, director of the Public Policy Center.

Even Honolulu Police Chief Susan Ballard said Wednesday that she was “on the fence” about getting the vaccine. “I don’t even get flu shots,” she told the Honolulu Police Commission. “I’m worried about upsetting the balance of the body.”

So far, the federal Centers for Disease Control and Prevention has to educate Americans about the public health importance of getting the shot.

But that’s likely to change with the arrival of a new administration, experts say. Meanwhile, the window to influence popular opinion on vaccinations is narrowing.

The Hawaii Department of Health did not respond to requests for information about whether it’s planning to launch a public messaging campaign to promote vaccination.

“If there’s one thing we know, it’s that disinformation on social media spreads like a virus,” Moore said. “If you don’t have a head start on the messaging, it can be so hard to catch up. Even in a blue state like Hawaii there’s a lot of work to do and we’re super, super behind.”

For the state to achieve the goal of herd immunity — when a large portion of a population is immune to an infectious disease, greatly reducing the likelihood that even those who are not vaccinated will catch it — about 70% of the population will need to get vaccinated, state officials say.

Hawaii is far from achieving that threshold, the UH survey data shows.

“There’s a big difference between being completely anti-vax and being hesitant.” — Emily Brunson, medical anthropologist 

But there’s a silver lining in the numbers. All told, 37% of Hawaii residents are still unsure about whether they will choose to get vaccinated, according to the survey results. 

This means there are still plenty of people on the fence who might yet be persuaded that the vaccine is not only safe but beneficial in reducing new infections and restarting the economy.

“Although it seems like overwhelmingly it’s a very safe vaccine and that people are probably at much greater risk if they don’t get it than if they do, I think the challenge for our health authorities is to try to communicate that in a way that’s transparent,” Moore said.

The first person to be inoculated in Hawaii on Tuesday was Dr. Lester Morehead, a hospitalist at The Queen’s Medical Center who said his biggest fear about the vaccine is that people will choose not to take it.

“Don’t just think about yourself,” Morehead said. “Think about your entire family. It’s OK to be concerned. But I’m confident in the science.”

Vaccine opposition is to some degree powered by conspiracy and myth. But many people who are hesitant to roll up a sleeve for the vaccine have valid concerns about the blistering speed at which it was developed or potential side effects. 

“This is an important distinction to make: there’s a big difference between being completely anti-vax and being hesitant,” said Emily Brunson, a medical anthropologist at Texas State University who studies vaccine skepticism. 

“It’s complicated because some of the things you’re seeing on social media are definitely alien conspiracy level things,” Brunson said. “But then there are other people who are concerned that there isn’t any long-term safety data for this vaccine — and that’s an actual, factual point.” 

Should pregnant or breastfeeding women get the vaccine? The CDC recommends that and their health care providers, as this demographic was not included in clinical trials of the vaccine. 

The CDC has not issued any vaccine guidance for people who’ve already .

Distrust in the vaccine is particularly high in Black, Latino and other minority communities, even though these populations are disproportionately being sickened by the virus. 

This doubt is historically rooted in the legacy of poor and even that these communities have suffered in the name of drug development.

Legitimate concerns like these, Brunson said, need to be dealt with head-on through targeted messaging that clears up misconceptions.

An attempt to do just that was made in New York on Monday when a Black nurse became . A Black doctor who was at the forefront of vaccine research administered the immunization.

The moment was broadcast around the nation, sending a powerful message to counteract the Black community’s engrained suspicions of the medical establishment. 

Hawaii officials need to be thinking about the unique vaccine concerns of its own residents and develop a communications plan to address them and clear up misconceptions, Brunson said.

But she said community groups shouldn’t wait to start coordinating their own grassroots efforts to promote vaccination.

“This is something that really has to be addressed at the local level because someone’s concern in Honolulu may be really different than someone’s concern in Texas,” she said.