with Alexandra Ellerbeck

Fifteen percent of Americans in a new Kaiser Family Foundation poll say they definitely won’t take coronavirus vaccines.

But they may not be a sizable enough group to seriously undermine the nation’s battle with covid-19, the disease caused by the coronavirus. It all depends on who they are and where they live.

Getting the most vulnerable immunized is key to reducing covid-19 deaths.

These include the elderly, health-care workers and people with underlying health conditions like obesity or diabetes, who have died at far higher rates than the general public.

Getting the nation to the point of herd immunity, with around 70 percent of Americans inoculated against the virus, is the overarching goal. But once high rates of immunization are achieved among the most vulnerable, experts say there will be a substantial reduction in deaths — even before lower-priority groups are able to get the shots.

“With this vaccine, herd immunity is going to be important, but a lot of the benefits will be felt when we vaccinate our most vulnerable populations,” said Amesh Adalja, senior scholar at the Johns Hopkins Center for Health Security.

There’s some overlap between vulnerable groups and those who are hesitant about vaccines.

And that’s where things get especially troubling.

The Kaiser poll found slightly higher-than-average levels of vaccine hesitancy among health-care workers. Twenty-nine percent said they probably or definitely would not get a coronavirus vaccine even if it was safe and free, compared with 27 percent of all poll respondents. Health-care workers are in the highest tier for getting the vaccines right away, because of their central role amid the pandemic. If enough refuse to get vaccinated, it could blow a major hole in the nation’s strategy of cutting down on covid-19 deaths and cases as quickly as possible.

“That gets scary because then you are just going to leave a lot of people vulnerable in a group you don’t want to be vulnerable,” Adalja said.

Essential workers, another group likely to be deemed high-priority, also tend to be more resistant to vaccines. These include the nation’s grocery store and plant workers, plumbers and electricians, police officers and firefighters. According to the Kaiser poll, 33 percent of essential workers said they probably or definitely wouldn’t get vaccinated.

But here’s some encouraging news: vaccine resistance is less of a concern among the elderly. 

People over age 65 had the lowest rate of vaccine hesitancy among any other demographic group, with the exception of Democrats.

Vaccine hesitancy is also a problem when it’s concentrated in communities.

In theory, having 15 percent of Americans refuse the vaccines wouldn’t be a barrier to reaching herd immunity — as long as they were spread out around the country.

But those against vaccinations tend to hang out with each other. The 2019 measles outbreaks occurred largely in pockets of the Pacific Northwest and among New York’s Orthodox Jewish community, where it had become commonplace for parents to refuse childhood vaccines.

It’s easy to imagine communities where coronavirus immunization levels are far below recommended levels and the virus could still spread rapidly if there’s an outbreak.

Willingness to take the vaccines is on the rise, but many are still resistant.

The most likely demographic groups to express hesitancy about taking the coronavirus vaccines are people who identify as Republican, live in rural areas, are in their 30s and 40s, and are Black. 

The link between political affiliation and openness to the vaccines is particularly striking. One in 3 GOP voters said they would definitely not get the vaccine or only get it if it’s required, compared with 1 in 10 Democratic voters.

The top reason Republicans gave for vaccine hesitancy is that they believe the risks of covid-19 are being exaggerated. The second was that they don’t trust the government to make sure the vaccine is safe and effective.

“Nearly 1 in 4 Republicans don’t want to get vaccinated because they don’t believe covid poses a serious threat,” KFF Executive Vice President Mollyann Brodie said. “It will be a real challenge to undo covid denialism among this slice of President Trump’s political base.”

Regardless, it’s go time for the vaccines.

Medical workers were shown dancing and applauding as the first vaccine doses reached hospitals across the United States yesterday.

Kate Walsh, president of Boston Medical Center:

"Vaccinations rolled out across the country Monday, with doctors and nurses at hospitals nationwide injecting one another as part of a federal plan to prioritize front-line health-care workers,” The Washington Post’s Ben Guarino, Ariana Eunjung Cha, Josh Wood and Griff Witte report.

The first batches shipped overnight Sunday following emergency use approval over the weekend, with hospital administrators eagerly checking online tracking tools for arrival updates," they write. "In several states, governors were on hand at hospital loading docks as crates of the vaccine, packed in dry ice, were delivered to doctors and nurses who cheered their arrival.

Illinois Gov. J.B. Pritzker:

Sandra Lindsay, a critical-care nurse at Long Island Jewish Medical Center, is believed to be the first American to receive the coronavirus vaccine outside a clinical trial.

“Many American hospitals on Monday were wasting no time getting the process underway, administering doses nearly as soon as they had been delivered,” my colleagues write.

Anthony Fauci may get vaccinated as soon as this week.

The National Institute for Allergy and Infectious Diseases director told our colleague Jacqueline Alemany he expects to recieve the vaccine on-camera, as a way of boosting Americans' confidence that it's safe to take.

“When I am vaccinated, that will be public so people can see that I'm vaccinating myself, and I encourage others to get vaccinated,” Fauci told Power Up.

He noted there is a “hardcore group” of people who “no matter what you say, they don't want to get vaccinated." “But there are also a lot of people who are expressing reluctance and skepticism about getting vaccinated that you can win over," he added.

One key way is by “having people like myself, like the president, like the president-elect, sports figures and entertainment figures, publicly getting vaccinated so that people see that those who they look up to and believe are getting vaccinated, so that you can get them to change their mind and overcome their own skepticism,” Fauci said.

Tune in to Washington Post Live this afternoon for a conversation with Eli Lilly’s CEO.

The Post’s David Ignatius will interview David Ricks, whose pharmaceutical company’s experimental coronavirus therapy, bamlanivimab, has received emergency approval from the Food and Drug Administration. Ricks will discuss the progress and latest developments on the program beginning at 1:13 p.m. Register here.

Ahh, oof and ouch

AHH: For all his pandemic missteps, President Trump quickly saw a vaccine would be crucial to ending it.

He supported and signed on to the $14 billion investment from the federal government that would become Operation Warp Speed, boasting at a White House summit last week that it is "one of the greatest miracles in the history of modern-day medicine’ or any other medicine — any other age of medicine.”

“The lifelong businessman who refused to wear a mask himself was able to understand vaccines as something else entirely: a deliverable that he could make happen with money. Unlike a mask, a vaccine represented a display of American technological prowess, an appealing solution that didn’t require painful steps like closing small businesses,” The Post’s Yasmeen Abutaleb, Laurie McGinley and Carolyn Y. Johnson report.

Yet Trump has developed an uneasy relationship with many of the scientists and executives behind the unprecedented vaccine achievement. Neither of the leading vaccine companies appeared at the White House summit. And Operation Warp Speed was mostly walled off from the White House, in a concerted effort to insulate it from political pressure. 

“In fact, the lightning-fast development of two leading coronavirus vaccines happened both because of and despite Trump — perhaps the most anti-science president in modern history, who has previously flirted with anti-vaccine views and savaged those who cited scientific evidence to press for basic public health measures in response to the pandemic,” Yasmeen, Laurie and Carolyn write.

OOF: A White House official spent three months in the hospital fighting covid-19.

“Crede Bailey, the director of the White House security office, was the most severely ill among dozens of Covid-19 cases known to be connected to the White House,” Bloomberg News’s Jennifer Jacobs reports. Bailey will leave the hospital with medical bills and a permanent disability, according to friends who have raised more than $30,000 for his rehabilitation on a GoFundMe account. 

“Crede beat COVID-19 but it came at a significant cost: his big toe on his left foot as well as his right foot and lower leg had to be amputated,” Dawn McCrobie, who organized the GoFundMe effort for Bailey, wrote Dec. 7.

According to Jacobs, Bailey’s family has asked for privacy and urged the White House not to publicize his condition. President Trump has not publicly acknowledged Bailey’s illness, and the White House declined to comment on whether Trump had contributed to the GoFundMe effort.

OUCH: At least 181 public health leaders have resigned, retired or been fired since the beginning of the pandemic.

“One in 8 Americans — 40 million people — lives in a community that has lost its local public health department leader during the pandemic. Top public health officials in 20 states have left state-level departments, and an untold number of lower-level staffers have also departed,” the Associated Press and Kaiser Health News report in a joint investigation

Many public health workers have become the targets of right-wing activists and anti-vaccination extremists, with some officials reporting threats of personal violence. In Idaho, hundreds of protesters, some armed, swarmed the health board members’ homes. 

Idaho's Central District Health's Board of Health canceled their Dec. 8 meeting as protesters gathered outside the homes and offices of the board members. (The Washington Post)

Activists have also pressured state legislatures across the country to adopt laws stripping health officials of their authority. Lawmakers in at least 24 states have crafted legislation aimed at weakening public health powers.

Amid the backlash, some public health leaders have retired or moved to other roles, resulting in what experts call the largest public health exodus in American history.

“The departures are a further erosion of the nation’s already fragile public health infrastructure ahead of the largest vaccination campaign in U.S. history," the Associated Press’s Michelle R. Smith and KHN’s Anna Maria Barry-Jester, Hannah Recht and Lauren Weber write. Amid declining spending for public health, “at least 38,000 state and local public health jobs have disappeared since the 2008 recession.”

More in coronavirus

Scientists have identified gene variants linked to severe coronavirus infections.

A team of scientists examining more than 2,000 covid-19 patients across Britain pinpointed spots on chromosomes where certain genetic variants were more common among covid-19 patients in intensive care. While it’s not possible to prove cause-and-effect with this study, researchers think that the genes may play a role in making people more susceptible to the virus, perhaps by interfering with the immune system’s response, The Post’s Ben Guarino reports. 

The researchers hope the findings, published in the journal Nature, can help develop better treatments for the virus, although they stress the identification of genetic variants is just a starting point. 

“Translating results from these types of investigations into successful therapies has, generally, been a struggle. The process often requires lengthy research even before drugs are ready to be tested in people,” Ben writes.

The research aligns with earlier reports that also found genetic variations among patients who suffered severe illness from covid-19, but the latest report is the biggest of its kind published to date. 

California is suing Amazon for information about coronavirus outbreaks.

“California Attorney General Xavier Becerra filed suit against Amazon on Monday, accusing the e-commerce giant of months of foot-dragging as the state seeks information about the outbreak of coronavirus cases and safety measures at warehouses in the state,” The Post’s Jay Greene reports.

The lawsuit claims that Amazon has failed to provide detailed information related to the number of warehouse workers who have contracted the virus, as well as steps the company has taken to reduce risk for its workers. Becerra, who was recently named as President-elect Joe Biden’s pick to lead the Department of Health and Human Services, alleges that Amazon made no mention of employees who died of covid-19 and worked in facilities in Irvine.

Amazon claims that it has been working with Becerra’s office and that the lawsuit took it by surprise. (Amazon chief executive Jeff Bezos owns The Washington Post.)