For how available the COVID vaccine has become, it has been a slow climb to getting Americans vaccinated. Now almost roughly 54 percent are vaccinated, but the obstacles to reaching higher levels are well-documented. And myriad reasons exist for it, with the problem, at times, portrayed as insurmountable.

Recognizing the climate of vaccine hesitancy, a team from the Perelman School of Medicine at the University of Pennsylvania — led by Benjamin S. Abella, MD, vice chair for research in Emergency Medicine — decided to come at the problem from a slightly different angle: determining who people trust when it comes to the shot.

Stemming from surveys conducted among approximately 1,000 emergency department patients who had not yet been vaccinated, this research confirmed some popular lines of thinking about vaccine-hesitant people, while at the same time uncovering some potential myths. Here's some of the important points that they found:

1. Family and friends remain the greatest potential influencers

Roughly a third of those surveyed indicated that they were hesitant about getting the COVID-19 vaccine. And — far and away — the group they indicated that they were most likely to be influenced by was the people closest to them. More than half (about 51 percent) of the respondents ranked family and friends as being trustworthy when it came to the COVID vaccine. That wasn’t far off the proportion of trust showed toward friends and family among those who had interest in the vaccine — roughly 61 percent.

“The people who are hesitant of the vaccines do trust their family and friends more than anything,” Abella said. “This shows us that having more local, community champions is key to making progress on more people getting the vaccines themselves.”

Within Penn Medicine’s existing community vaccine efforts, there have been efforts to facilitate and encourage community members who were found to get multiple family members and friends signed up for the vaccine. Christina O’Malley, director of Telemedicine at Penn Medicine, and Deirdre Darragh, director of Communications and Engagement at the Center for Health Care Innovation, where O’Malley had been an innovation manager, helped lead that program and said these community members were informally nicknamed “super-referrers” because of their ability to get so many people signed up. The super-referrers did everything from helping to navigate the sign-up process to encouraging others to have interest in the shot.

2. Social media may not be the boogeyman we imagined

When asked whether they trusted social media for information on the vaccines, there was actually very little support shown for this online information. Among both vaccine-hesitant individuals and those who expressed interest in getting the shot, just about 1 in 10 said they looked to social media for information on the shots.

There is a lot of concern about the fake information that spreads online and how that could branch out into general disinterest in the COVID-19 vaccine and slow uptake. And while misinformation could filter through social media to the family and friends who patients indicated that they trusted, it’s possible that more attention should be focused on messaging and fighting misinformation elsewhere, or through other means.

“To combat hesitancy, we will need to be more creative about micro-targeting through trusted individuals and local organizations in communities,” Abella said. “Using social media to spread information may not be as easy as we might guess.”

3. Emergency departments present an opportunity for vaccine distribution

Almost all — 90 percent — of those who expressed some interest in getting a COVID-19 vaccine said that they’d take it if it were made available in the emergency department.

Since early summer, Penn Medicine has made those shots available to patients upon their discharge. Julie Uspal, MD, an assistant professor of Emergency Medicine who was a co-author on Abella’s survey study, helps run the program. This is especially important because emergency departments are often the only point of contact many people — particularly those in underserved communities — have with health systems.

“We’ve had a successful program,” Uspal said. “We're particularly proud that we have been able to reach a very at-risk population who may not otherwise have access to health care."

While COVID vaccines seem ubiquitous now, some people still have difficulty getting them due to circumstances such as limited mobility. Having shots readily available in the emergency department — the most frequently traveled part of the hospital for many people — could go a long way for a difficult-to-reach, albeit willing, population.

4. There’s no silver bullet

The survey analysis made it clear that one specific method would not work universally for everyone who is hesitant of the vaccine.

While family and friends were a highly trusted group, and trust in social media was seemingly low, there were sizable groups of people who still did trust one but not the other. And both the government and news organizations both enjoyed less than 40 percent of the vaccine-hesitant respondents’ trust.

“To us, this is a warning for the government and their planners: Making a multimillion dollar CDC-sponsored ad campaign isn’t going to work on its own,” Abella said. “We can make progress. We’ve shown in this study several different areas we can focus on, but this is going to be a win of a thousand little victories, not one big punch.”