Some just haven't gotten around to it yet, and the state's new $115 million lottery — which rewards vaccination with cash rewards — will surely push some off the fence and into vaccination clinics.
But it is clear that misinformation, not money, has often driven vaccination decisions.
A survey performed in mid-April by the Kaiser Family Foundation, a nonprofit and nonpartisan health research organization, estimates that 54 percent of Americans believe "common misinformation" about coronavirus vaccines.
Potential impacts on fertility are among the biggest concerns among those age 18 to 29, with 42 percent telling pollsters they have heard that COVID-19 vaccines "have been shown to cause infertility."
That concern surfaced in San Diego one week ago when several Padres players cited infertility concerns as a main reason why they remain unvaccinated.
There have been suggestions that coronavirus vaccines may affect male fertility or the placentas of pregnant women, noted Dr. Sigal Klipstein, a Chicago fertility specialist and chair of the ethics committee at the American Society for Reproductive Medicine.
But, with hundreds of millions of doses now administered, none of those suggestions are backed by evidence.
However, there is solid evidence that the coronavirus itself — not the vaccine — can cause some fertility effects.
"Someone who was thinking about having a baby, male or female, should want the vaccine," Klipstein said. "From a male perspective, you don't want to get a high fever because that could affect your sperm production, and we know that people who get COVID can have prolonged high fevers and that can be detrimental to fertility.
"From a woman's perspective, we know that the anti-COVID antibodies that are prompted by the the vaccine go into the breast milk and into the umbilical cord to protect the baby. I think it's a wonderful thing."
Those assurances, though they have been made by many medical societies, have not convinced everyone.
Many of the vaccine reluctant have expressed vague concerns that, perhaps, the trials have simply failed to identify dangerous side effects that will suddenly appear round about the time that most of the population is fully vaccinated.
Paul Offit, director of the Vaccine Education Center at Children's Hospital of Philadelphia, called those assertions highly unlikely. In the history of vaccines, he noted, side effects have always appeared within two months of administration.
"There are no long-term effects where you find that one year, two years, later your child or you develop some problem that wasn't picked up initially," Offit said. "It has never happened."
That's not to say that clinical trials, even those with many thousands of participants, will necessarily spot every rare complication.
As was the case with a very small number of blood clots among the recipients of the Johnson & Johnson coronavirus vaccine, it is possible for indications to crop up only when a very wide swath of the general population has been inoculated.
But, especially where the Pfizer and Moderna vaccines — available for longer than Johnson & Johnson doses — are concerned, we're now way past the point where even very, very rare side effects should be visible.
As of Mar. 28 — two months ago — the nation had administered 140 million doses with nearly 400 million put in arms worldwide. Offit, a member of the independent panel of experts that reviewed and approved all three novel coronavirus vaccines, said that such a large sample size should reveal the rarest of complications.
And they have. Researchers have recently detected an increase in case reports of pericarditis — swelling of the tissue surrounding the heart — and myocarditis — inflammation of the heart muscle — among the vaccinated population.
A recent update from the U.S. Centers for Disease Control and Prevention indicates that reports of these conditions have begun to show up in its Vaccine Adverse Event Reporting System with 187 cases of pericarditis and 255 cases of myocarditis listed as of Friday.
Dr. Eric Topol, director of the Scripps Research Translational Institute and a cardiologist, has been tweeting about the evidence coming in on these conditions and said this week that he believes the conditions may indeed be related to vaccination.
But it's important to remember, he added, that these cases, most of which have not been confirmed in the VAERS database, occurred among more than 166 million Americans who have so far received one dose. And to date, he added, there is no evidence that medical consequences have gone beyond chest pain and breathing difficulties.
"We don't know the mechanism, but, so far, as far as I know, no one has had a rip-roaring case of myocarditis after vaccination," Topol said. "They've been very mild cases; I haven't yet seen a report where it became a serious issue for a person."
The nationally-known physician, author and technology advocate who once gave a digital ear exam entertainer Stephen Colbert on Comedy Central's Colbert Report, Topol cautioned the public against putting much stock in the VAERS database. That's because anyone can submit an adverse event without medical record verification and there is no guarantee that every event is reported.
Other countries with unified electronic health records, he added, tend to have a better handle on the true incidence rate of adverse events because supporting data from tests and other methods of health assessment can be broadly considered during analysis.
"You cannot rely on any information in VAERS, it's just completely questionable, and it should be made defunct now because it's unnecessarily misleading to people who are making decisions that are important," Topol said.
The rush to approval under emergency protocols is another oft-cited reason why some are uncomfortable getting vaccinated.
But Topol notes that the trial sizes involved — about 70,000 participants across the Pfizer and Moderna trials — was robust.
And, he added, claims that things were rushed is belied by the U.S. Food and Drug Administration's refusal to grant emergency approval in early November as the previous administration frequently claimed would occur.
That extra time, he said, proved effectiveness more thoroughly than would have been the case had trials been stopped in October.
"All of these trials went to completion, rather than being stopped early and getting an emergency authorization in October," Topol said. "The extra several weeks led to the most concrete evidence, the most extraordinary evidence, that has played out in the real world studies of real-world effectiveness. They keep coming out at 95 percent, 95 percent, on and on and on."
But, so far, that evidence is not translating to overwhelming public confidence.
UC San Diego Health said this week that it intends to close its vaccination super station at RIMAC Arena Tuesday and other local health systems said they will wind down their super station operations at the end of June.
Dr. Shira Ables, a university infectious disease specialist, said this week that the site often has 100 or fewer first-dose appointments each day, a far cry from the previous daily average of 5,000 when the operation was situated in a downtown lot near Petco Park.
"We built this site to be a super station with the intent of vaccinating thousands of people per day," Ables said. "I think those people are still out there, but they're not coming in with the same gusto that we experienced just a few months back."
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