Increasing resources and national efforts to target white evangelicals, the most COVID-19 vaccine-hesitant group in the country, could help end the pandemic sooner, a vaccine advocate said during a hearing of the Senate Health, Education, Labor, and Pensions (HELP) Committee on Tuesday.

Witnesses and lawmakers also weighed the risks and benefits of vaccinating children against COVID-19 and debated whether people with “natural immunity” still need a shot.

In his opening statement, Sen. Richard Burr (R-N.C.), the committee’s ranking member, noted that vaccination rates across the country recently fell to below 1 million doses per day for the first time since January, in comparison with a peak of 3.3 million doses in April.

Increasing vaccine confidence among a particular subset of Americans could help reverse this trend, pointed out Curtis Chang, a consulting professor at the Duke Divinity School and a senior fellow at Fuller Theological Seminary.

“Reaching every demographic in our country matters, but we are not ending the pandemic unless we convince more white evangelicals to get vaccinated,” he said.

Chang, co-founder of Christians and the Vaccine — a partnership with the Ad Council, the National Association of Evangelicals, and other stakeholders — noted that the states with the lowest vaccination rates track closely with a map of the “Bible Belt.” Evangelicals make up about 29% of the U.S. population.

In written testimony, he explained how in the last few years, evangelicals’ longstanding practice of “critical engagement” with secular institutions “mutated from caution into outright fear and hostility.”

The shift happened, at least in part, because of external forces, including conservative media, politicians, and conspiracy movements — such as QAnon and anti-vaxxers — exploiting evangelicals’ already deep-rooted skepticism toward such institutions, he said.

The reason that evangelicals are likely to distrust the vaccine is because “vaccine trust” is akin to “institutional trust,” Chang added.

“Every one of us only takes the vaccine to the extent we trust the FDA, the CDC, pharmaceutical companies, and public health,” he said, but distrust in large institutions among white evangelicals is now at “an all-time high.”

The good news, he continued, is that public health efforts targeting other faith-based communities have been successful. For instance, after only a few months of such outreach among Black protestants, vaccine acceptance jumped 10 points, he noted.

In addition, a recent study from the Public Religion Research Institute found that 44% of vaccine-hesitant white evangelicals could still be influenced by “faith-based efforts,” he added.

To that end, Chang urged lawmakers to foster partnerships between public health and evangelical faith leaders.

While the messaging needs to come from the faith leaders themselves, public health officials and experts can help by convening these leaders and providing resources to “amplify their voices,” he said.

He asked Congress to supplement the current state-based approach to building vaccine confidence with resources for national coordinated outreach, and pressed them to channel more of their outreach efforts to white evangelicals.

Risk-Benefit Analysis

Other witnesses, including Susan Bailey, MD, the immediate past president of the American Medical Association (AMA), spent much of the hearing defending the rationale for vaccinating more Americans, particularly to Republican senators, some of whom are physicians.

Sen. Roger Marshall, MD, (R-Kan.) asked whether there were currently enough data to advise parents about the risks and benefits of vaccinating children, given that the risk of COVID-19 to children under 21 is “pretty small.”

Bailey confirmed that there is enough evidence to advise parents about vaccine use in children.

“But I think there’s a general misconception … that children are at no risk, or that the risk is so small that it’s less than the risk of getting the vaccine, and that’s simply not true,” she noted.

Marshall interjected to ask whether she’d seen a side-by-side scientific comparison of the risks of complications from the virus versus the risk of complications from the vaccine for those under 21.

Bailey didn’t directly affirm or deny whether such a comparison was available, but said she’d be happy to share the data that the AMA does have.

“The risks of side effects in adolescents appears to be very, very small, but we know that the risks of long COVID in children can be quite significant,” she said.

Natural Versus Vaccine Immunity

Sen. Rand Paul, MD, (R-Ky.) who also pressed Bailey on the risks and benefits of vaccines in young people, mostly argued for the benefits of “natural immunity.”

Paul said that “dozens and dozens” of peer-reviewed articles have shown that immunity from prior COVID infection is “robust.”

He pointed to a study from the Washington University School of Medicine in St. Louis, which found that mild infection leads to a “robust antigen-specific long-lived humoral immune memory,” as well as a study of over 50,000 employees at the Cleveland Clinic, which found that those with a previous SARS-CoV-2 infection had “the same, if not better, immunity” than those who’d been vaccinated.

“If we deny this, and we say, ‘stick your head in the sand, everybody, be vaccinated’ … Guess what? … The people are going to have hesitancy because they think you’re not telling them the truth,” Paul said.

Bailey said that previous infections should be “considered,” but also stressed that a “previous infection is not as robust in protecting against new variants as the vaccine.”

Paul argued that that wasn’t true.

“[A]ll the testing on natural immunity and vaccinated [people] has shown that we have great immunity both with the vaccine and with natural immunity,” he said, cutting Bailey off.

Another senator later gave Bailey a chance to complete her response, and while she noted that there are thousands of studies in the literature, her understanding is that “adequate vaccination … with both mRNA vaccines or the Johnson & Johnson vaccine gives you better protection against variants than natural immunity.”

Throughout the hearing, Bailey also stressed physicians’ role as “vaccine ambassadors” and pressed lawmakers to make vaccines more available in doctors’ offices.

“It’s a lot easier to get shots in arms when your patients are actually in your office, and the vaccines are in your office,” she explained.