Fear and Falsehoods Fill the Premier League’s Vaccination Gap

The report spread like wildfire. Premier League players shared the link among their peers. Some passed it to their family members and closest confidantes. A handful were sufficiently troubled by what it seemed to suggest that they presented it to their clubs’ in-house medical teams, seeking advice.

It had been produced by a website that says it tracks the number of “young athletes who had major medical issues in 2021 after receiving one or more Covid vaccines.” The report claimed to list 19 “athletes” — mostly in the United States — who it said had experienced heart attacks after being inoculated. Some of the attacks, the site noted ominously, had been fatal.

Almost immediately, the doctors and others spotted the glaring flaws in the research. One of the examples cited was Hank Aaron, the Hall of Fame baseball player, who had died in January. He was 86. Another name on the list, a former N.B.A. player, had been 64. The most cursory research showed that many of the younger athletes, too, had documented, underlying conditions.

But that did not matter. Nor did the fact that the report was subsequently and comprehensively debunked. It had made the soccer players question whether they should agree to be vaccinated. The damage, at least in the view of medical experts, had been done.

These are not easy weeks for the Premier League, which is currently enduring a surge in virus cases, a glut of postponements and calls even from within its ranks to take at least a temporary pause in the season. Those troubles have placed its lagging vaccination record under fierce scrutiny, and prompted questions as to why the richest league in the world has had such trouble convincing its stars to get the shot.

In one light, the league and its teams have had considerable success: The Premier League has released figures suggesting that 84 percent of its stars are on their “vaccination journey,” meaning they have had at least one of a potential three shots since becoming eligible in the spring. The remaining 16 percent, though — around 100 players — has become a cause of concern.

Six of the 10 Premier League games scheduled to be played last weekend were postponed after clubs were struck by Covid outbreaks. At least one of those matches is reported to have been called off not because of a raft of positive tests, but because a number of unvaccinated players were self-isolating, as British law requires, after being identified as close contacts of a confirmed case.

The lost weekend highlighted the Premier League’s struggle to keep its vaccination figures on par with the rest of Europe’s major domestic competitions, and other top sports leagues around the world.

Serie A, the Italian top flight, has vaccinated 98 percent of its players. In France, the figure stands at 95 percent, and in Germany 94 percent — numbers on par with the N.F.L., N.B.A. and N.H.L. in North America. Spain’s soccer authorities reported that, taking into account both vaccination and naturally-acquired immunity, 97 percent of players were fully covered. The comparison with England, then, is stark: In the Premier League, only 77 percent of players have had two vaccinations.

Establishing the reason for that divergence is not straightforward. The New York Times spoke with an array of players, advisers, executives, officials and medical staff members, most on condition of anonymity because they are not permitted to discuss private health matters. Those interviews painted a complex, inchoate portrait of why vaccine hesitancy has been allowed to become so embedded in the richest soccer league in the world.

“It’s tough to say there is one thing,” said Maheta Molango, the chief executive of the Professional Footballers’ Association, Britain’s players’ union. “It really is on a case-by-case basis.”

Concern about possible side effects has, certainly, become widespread. A spate of recent, high-profile incidents involving players enduring heart problems while on the field — including Christian Eriksen, the Denmark midfielder who collapsed at last summer’s European Championship, and Sergio Agüero, the Barcelona striker who just retired — has fueled suspicion of the vaccines among some players.

Some medical staff at clubs contend the suspicion has been encouraged by a handful of retired players — including the former England midfielder Matt Le Tissier and Trevor Sinclair, once of Manchester City and West Ham — who have publicly identified on-field incidents as a possible consequence of vaccination. That Eriksen had not been vaccinated when he collapsed on a field during the Euros in June has made little difference.

But incidents involving others are far from the only source of skepticism. According to reporting by The Times, several players have expressed concern that the vaccine might reduce their sperm count, and a number of doctors revealed they had faced questions about links to decreased virility particularly after the musician Nicki Minaj tweeted that a family friend had suffered “swollen testicles” as a result of the vaccine. (Both theories are unfounded.)

Molango suggested that some players may have “concerns around religion,” too. Earlier this year, the P.F.A. and the Premier League arranged for Jonathan Van Tam, England’s deputy chief medical officer — who has regularly used soccer-themed metaphors during his public statements — to address the captains of the league’s 20 clubs in a bid to encourage more players to be vaccinated.

During the meeting, he was asked if it was true the vaccines contained alcohol — a concern for Muslim players. He confirmed that the Pfizer-BioNTech shot was alcohol-free, but acknowledged that others could contain trace amounts. But the amounts were so minuscule, he told the captains, that “there was probably more alcohol in the bread you ate this morning.”

Others have “questions around the credibility” of those encouraging them to be vaccinated, Molango said. Some players have noted, too, that it was deemed safe for them to return to work last year, before the vaccines had been developed, and that they did not appreciate now being told to be vaccinated in order to keep on playing.

In some cases, that has crystallized into something more implacable: an ideological refusal to have the shot. Most players, though, are more hesitant than opposed, team employees said — inclined to think that as healthy young men, they will not suffer even if they contract the virus, and therefore do not need to take whatever risk there may or may not be in a vaccine. Their bodies are their livelihoods, after all, and many have told medical staff members at their clubs that they would not take anything that is not irrefutably safe.

And yet that does not fully explain why players in the Premier League — the overwhelming majority of whom are not British, let alone English — should be more resistant than their peers in other major leagues.

While the proportion of Premier League players vaccinated is broadly similar to the number of people in their age group to have been inoculated in England, elite soccer is hardly a representative sample. It is, after all, gleefully international. The more apt parallel, then, may be with Serie A and La Liga and the others, where the mix of professionals is almost as global as it is in the Premier League, and where vaccination rates are far higher.

The Premier League contends it has done as much as it reasonably can do to persuade its players to accept the inoculations. Van Tam not only addressed the captains of the league’s clubs but also released a video, highlighting the importance of vaccination and dispelling myths, to reinforce the message. He has visited teams in person. Other clubs, struggling to persuade their holdouts to be vaccinated, have been offered visits from experts eager to answer questions and allay fears.

The clubs, too, have “played their part,” as Molango put it. Many have invited medical teams into their training facilities to make it as easy as possible for players to get a shot. At Liverpool, Jürgen Klopp has been an outspoken advocate of the “moral” imperative to be vaccinated. Leeds United officials have made vaccination a nonnegotiable part of a player’s duty to his teammates, and at other teams players have embraced vaccinations after being shaken by the experiences of teammates who tested positive, or the effect that Covid-related deaths have had on friends and colleagues.

Other clubs, though, have been accused of being too light a touch, of not offering enough guidance to players early on, of giving the illusion that there was no real urgency. That, critics say, created a space in which misinformation could flourish. One Premier League team initially encouraged players to be vaccinated on their own time. When that did not receive much response, executives dropped the hint again. It was only after a few weeks that the club, realizing it had hit a wall, took the step of inviting a vaccination team to the training facility.

Clubs’ approaches, though, are starting to shift. This summer, a number of transfer deals included clauses written into player contracts stating that vaccination was mandatory. Agents expect that to become the norm over the next few months: Klopp, like Aston Villa’s Steven Gerrard and Arsenal’s Mikel Arteta, has made it clear that his club would prefer not to sign unvaccinated players.

Internal measures are growing more strict, too. At least one Premier League club no longer permits unvaccinated players to dine with their teammates, and requires them to change into their training gear either before arriving or in their car, instead of in the dressing room. The Premier League is now considering adapting its protocols to make similar precautions more widespread.

The hope, among those charged with keeping the players safe, is that a more active, more draconian stance will prove decisive among all but a few ardent holdouts. Until then, all the league can do is try to counteract the misinformation, change all the minds it can, and hope that the games can go on.