New Jersey ranks among the top 10 states in getting COVID-19 shots into people’s arms, but vaccination rates in some rural and urban municipalities remain stubbornly low. Researchers say understanding exactly why someone won’t or can’t get the shot is key to ramping up vaccinations, but hesitancy can mean different things in different communities.

In New Jersey, this reluctance has more to do with concerns about drugmakers, side effects and access rather than whether people think it can protect them against COVID-19, according to a new study.

The report, conducted by Summit Medical Group Foundation in partnership with Mathematica, surveyed predominantly Black and Latino residents who use food pantries across nine North Jersey counties and via flyers in Paterson and Jersey City. The team then compared those responses to ones from white patients at doctor's offices.

It categorized hesitant feelings into four areas: the effectiveness and safety of the shots, the underlying motivations of the vaccine companies and accessibility. Concerns about unknown effects ranked highest, followed closely by worries over the speed of the vaccines’ development. Both trends mirror national polling.

But another worry expressed by Black and Latino residents—who have disproportionately higher rates of heart disease and diabetes—was whether the vaccine could affect underlying medical conditions, though no evidence suggests that this happens.

As of May 17th and more than 272 million doses administered, the Centers for Disease Control and Prevention has observed “only two serious types of health problems after vaccination, both of which are rare.” Anaphylaxis has happened in 2 to 5 people per million vaccinated in the United States, or fewer than 1,500 people. And the atypical blood clots, witnessed only with the Johnson & Johnson vaccine, have occurred only 30 times and mostly in young women. The rate is about 7 per 1 million vaccinated adult women younger than 50 years old.

“Everybody has their own reasons, and we have to be able to address them if we want to get back to normalcy,” said So O’Neil, a senior researcher at Mathematica. “Without understanding the reasons behind why people feel the way they do about getting the vaccine, you're not going to be able to tailor those messages to be effective.”

The Summit study found that among unvaccinated respondents at food pantries, 20% said they would definitely not get vaccinated. Another 36% said they definitely would, while 43% said they either probably would or would not.

A quarter of Black and Latino residents surveyed were also unaware of how to get a vaccine. A fifth don’t know the shots are free and voiced concerns about having to pay. The study also found Black and Latino residents mistrust institutions and government motivations to promote the vaccine. They're more likely to trust information from health providers, friends and family, and the CDC. They put less faith in the news media, religious leaders or the federal government officials outside of the CDC.

The study comes as more than 4 million New Jersey residents are fully vaccinated—a little under half the population—but wide racial and ethnic disparities persist. Statewide, white residents received doses at 2.17 times the rate of Black people and 1.75 times that of Latinos, as of the middle of May.

New Jersey Governor Phil Murphy announced earlier this month he would direct an additional $8 million toward getting more “boots on the ground” to reach communities with low vaccination rates. State health officials told WNYC/Gothamist on Friday that the money would be used to expand an existing group of volunteers known as the “COVID-19 Community Corps.” They are trained to educate residents about the vaccine and help them register for a shot.

The funds will be used to hire outreach workers to supplement the 900 corps volunteers and provide additional training, department of health spokeswoman Nancy Kearney said.

Kearney added that volunteers had targeted cities with the lowest vaccination rates, including Newark, East Orange, Perth Amboy, New Brunswick, North Brunswick, Passaic and Trenton, but couldn’t immediately provide information on the results of those efforts.

“Our study shows that friends and family members are trusted messengers among the population that we were surveying. And so in general, if the folks that are boots on the ground are from the community, then they will be likely more trusted than somebody not from the community,” O’Neil said.

State-run pulse surveys, conducted when residents call into the 211 helpline, suggest a rising rate of reluctance in recent weeks. In mid-April, 18% of callers said they would not get COVID-19 vaccines, but by May, the proportion moved to 23%. The surveys involved 1,400 and 1,200 people, respectively. The percentage of unsure people remained the same at 10%.

But O’Neil said hyperlocal surveys like hers could help officials learn why people are hesitant and what kind of vaccine education communities need, particularly for those who are borderline.

“It really goes out and tries to engage with the community to hear their voices,” she said.

Murphy wants to vaccinate 70% of the eligible population by the end of June. On Monday, he announced the state would drop indoor masking and social distancing requirements by Memorial Day weekend and drop all indoor capacity limits by June 4th.