New York City hospital administrators always knew that some members of the general public would hesitate to get coronavirus vaccines, but they anticipated that resistance among their own employees would be modest. After all, their staff all work in the medical arena, and many see themselves as guardians of science.

But to the surprise of many New York health care leaders, more than half of their eligible employees have so far declined to get inoculated.

"It's taken me off guard," said LaRay Brown, the CEO of One Brooklyn Health, a network of three hospitals in central Brooklyn. "I would've thought with so many people having seen, having experienced, lived through, cared for patients with COVID that we would've had a much more enthusiastic response initially—and it hasn't been."

Many factors have contributed to the slow uptake in hospitals, which along with nursing homes are the only institutions in New York distributing the vaccine at this point. As of the beginning of the week, hospitals across New York State had on average only injected 46% of the vaccine doses they've received, and some large networks, such as NYC Health and Hospitals and Montefiore, had used much less, according to Governor Andrew Cuomo

Hospital leaders said they have had to grapple with ultra-cold freezers required for the vaccines, which then have ultra-brief shelf lives once thawed; with long intervals needed to explain the injections to people awaiting shots and then observe them afterwards. They said they have also been slowed by the state prioritization guidelines, which initially limited which departments could inoculate personnel. 

But the reluctance of many workers to get vaccinated also appears to be a major driver of the low usage. One national survey last month estimated 29% of health care workers definitely or probably would not get the vaccine. Some New York City-area hospital administrators are reporting even higher proportions in the first few weeks since vaccination began.

Dr. Jeremy Boal, chief clinical officer of the Mount Sinai Health System, said that among high-priority staff members offered the vaccine, acceptance ranges from 25% at one of the network’s eight campuses to 65% at another. (He declined to name the specific facilities.)

"In critical care units, emergency departments, and those kinds of places, the uptake rates tend to be very high," Boal told Gothamist. "We're not seeing the same degree of uptake in many of our support departments, such as engineering services and environmental services."

He said deferral does not mean refusal.

"A lot of them are taking their time to make the decision," Boal said.

At Interfaith Hospital, where LaRay Brown is based, workers each day use an electronic kiosk to check-in, which includes getting their temperatures taken and being asked both about possible COVID exposures and their willingness to get vaccinated. On Monday, about 33% of employees  said they were willing to get the shots, up from 20% the first week. About one-third of the staff has already been vaccinated.

"I think when we get to 50%, we'll start to see a tipping point, a greater acceleration," she said.

Gemma John, the first nurse at Brookdale Hospital to be vaccinated, getting an injection from nurse Mary Mitchel.

Dr. Mitchell Katz, CEO of the city's public hospital system, estimated that about 30% of employees have deferred vaccination. He said the hesitancy is understandable, given all the changes in guidance health care workers have experienced since last March.

"How many times has science corrected itself? How many times it's turned out that there was some new wrinkle?" Katz said at a press conference on Tuesday. 

Katz said that, typically, for every person who's an “early adopter,” many others want to wait and see. Dr. William Lowe, head of occupational health at Northwell Health, agrees.

"I do still hear things like, 'Well, this is experimental,' or 'I don't want to be a guinea pig,'" Lowe said. "People are just wanting to see what the experience of others is."

Brown said many on her staff share the same mistrust found in the broader community, even if they work for the medical establishment.

"Most of our staff are people of color, and they have learned about historic ways in which the US government has not done so well by people of color," she said, alluding to the infamous Tuskegee experiment and chronic neglect of minorities' health needs. 

She and Boal said some staff members who contracted COVID also did not feel a sense of urgency to get vaccinated, since they have antibodies which, in theory, confer at least some immunity.

"We try to make sure that we disabuse them of that," Brown said, citing the federal Centers for Disease Control and Prevention's recommendation that previously sick people still get vaccinated.

All the hospital administrators say they are taking a respectful and multi-pronged approach to persuading the hesitant. 

"We're making sure we respond to people's questions, concerns, and fears," Brown said. "We're putting up posters, sending out overhead messages on the PA system throughout the day, daily emails, et cetera, to the point of being annoying, to remind people that they have this unprecedented opportunity to be the first to get the vaccine."

Lowe, at Northwell, added to the list of persuasion techniques town halls, informational sessions and special computer screen-saver pop-ups urging people to get vaccinated.

But Boal said his system is emphasizing a long, slow "ground game of dialog," with staff educators working their way from floor to floor, having small-group and one-on-one conversations in hallways, breakrooms, any place they can.

"I am convinced that pressure doesn't work, that the harder you reach, the less you're able to actually win hearts and minds," Boal said. "Humans are exquisitely sensitive to being pressured, especially when they think that you have an agenda. If my agenda is to get you vaccinated, that's different than my agenda being to make sure you have the information you need to make a decision." 

Katz, at the city's Health and Hospitals Corporation, concurred.

"We don't need to harangue them at this moment," he said. "I have no doubt that after millions of people across the country are vaccinated, the safety record is shown, and months have gone by, and the consensus remains that this vaccine is safe, people will go and get it."