The hesitancy of millions of Americans to get vaccinated against the coronavirus most certainly is a public health concern – but it also threatens economic development in those regions that are in dire need of a boost to their recovery.

The rebound from the shutdown has been remarkable thus far – with unemployment dropping nationally from 14.8 percent in early 2020 to 5.4 percent in July and gross domestic product – which declined by record levels in 2020 – rising 6.4 percent in the first quarter of 2021.

One big reason the economy has surged back is the success of COVID vaccines in preventing serious illness and allowing regions to resume more typical activities while nurturing economic development to get more people back to work.

“Getting vaccinated against the coronavirus provides immediate and measurable health benefits. It is also a critical component of the United States’ economic recovery,” said a recent report from the Center for American Progress. “More widespread vaccinations not only keep people healthier but they also lower health care costs, make it easier for people to return to work, and increase overall economic activity.”

The think tank noted a strong correlation between rising vaccination rates over the last several months and companies investing in workforce development and putting more people on the rolls. But in a troubling trend, vaccination hesitancy among millions of Americans is hardening.

The most recent Gallup poll on the issue from late July found nearly one in five U.S. adults, 18 percent, is vaccine-resistant and stress they are unlikely to change their mind. The percentage holding these views has been stable in recent months. Another 5 percent of Americans also don’t want to be vaccinated but say they could change their mind. So, nearly 60 million U.S. adults are digging in against vaccines just as regions are struggling to put millions back to work.

The dynamic of economic recovery generally tracking vaccination portends worrisome problems for those U.S. regions that already have among the nation’s lowest economic activity and among the greatest vaccine hesitancy. New serious outbreaks of COVID, resulting in greater hospitalization rates and death, could cause businesses in those areas to curtail operations, jeopardizing economic progress and slamming the disadvantaged, who already are struggling to pay the bills.

While a large swath of Americans may be hesitant to get vaccinated, companies are very much focused on investing in those regions that can best meet their needs. And one of those needs is a healthy workforce inoculated against the coronavirus.

The National Retail Federation, which represents department stores, internet retailers, and chain restaurants among others, stresses the importance of vaccination for businesses to succeed.

“Vaccination is the key to further economic recovery, reopening, and rebuilding,” said Jack Kleinhenz, NRF’s chief economist. “With the outlook for the global economy continuing to hinge on public health, vaccine numbers are extremely important, not just for the United States but for the whole world.”

Numerous companies around the country such as Google, Cisco, Disney, Walmart, United Airlines, and Tysons Foods also are beginning to mandate vaccinations for staff. A corollary to that is any region seeking an economic investment and jobs from those companies and others would need to overcome lingering vaccine hesitancy.

At the local and regional level, economic development agencies tasked with enticing corporate investment to create jobs are on top of this emerging trend. Like the organization I lead, they are pressing their staff to get vaccinated and are working with local companies and job seekers to do so as well. “Until we get as many people as possible vaccinated, we can’t rebuild the Detroit regional economy to pre-COVID levels. And it is our goal to be much better than that,” said Maureen Donohue Krauss, president and CEO of the Detroit Regional Partnership.

Approximately 8.7 million Americans are currently unemployed. Attracting investment into hard-hit regions will put many back to work. But to gain widespread economic development, all states must first re-double efforts that make covid vaccination a top priority.