Overcoming Vaccine Hesitancy

By Stewart Lonky, M.D.

If ever a government project lived up to its moniker, Operation Warp Speed would be it.

 

The first coronavirus vaccines arrived less than a year after the pandemic began and blew away the previous delivery record of four years, a distinction held by the MMR vaccine.

 

Now, here’s the tricky part: compliance. It’s one thing to have a vaccine. It’s another matter to convince people to take it. This point is critical because somewhere between 60 and 90 percent of U.S. adults and children must be vaccinated or have antibodies resulting from infection to arrive at the herd immunity safe harbor.

 

Writing in the Wall Street Journal, Marty Makary, a professor at the Johns Hopkins School of Medicine and Bloomberg School of Public Health, says a recent drop in cases—77 percent in just six weeks—means we’re on course to achieving herd immunity by April, allowing most people to return to normal life.

 

Dr. Makary believes cases are dropping because far more people than previously thought—55 percent to be exact—have a natural immunity to the virus. Now add to that figure the millions of already vaccinated Americans—about 15 percent—and it’s easy to see why herd immunity is within reach.

 

If we accept Dr. Marakay’s 55 percent estimate—and there’s no reason not to—we still have to be mindful of the remaining 45 percent. For these folks, the vaccine is paramount.

 

However, how do we ensure that enough people get the vaccine?

 

After nearly a year of lockdowns, shuttered schools, rising death tolls, a collapsing economy, illness anxiety, activity restrictions, and other extreme limitations on our freedoms, you’d think that Americans would be chomping at the bit for protection against the novel coronavirus.

 

Indeed, a nationally representative Kaiser Family Foundation (KFF) survey of 1,676 U.S. adults conducted late last year found that 71 percent said they’d get the COVID_19 vaccine. A Pew Research Center survey yielded a similar result, with 60 percent saying they'd get the vaccine.

 

However, large segments of the U.S. population are reluctant or opposed to receiving the COVID_19 vaccine. With the vaccine rollout now well underway, educating the vaccine-hesitant population is paramount.

 

As healthcare professionals, we need to understand where these people are and the reasons for their mistrust. As the saying goes, “Public health moves at the speed of trust.”  Much of the Covid_19 vaccine hesitation stems from distrust of the health care system, suspicion of pharmaceutical companies’ motives, which did bring the vaccines to market in record time, and a lack of faith in our government to act in our best interests.

 

Fortunately, there are ways to build trust and encourage vaccination.

 

However, narrowing this gulf requires addressing vaccination concerns. It entails providing people with a positive and stress-free experience before, during, and after vaccination as possible. Here’s my framework for accomplishing that goal.

 

First, COVID_19 is a real virus. You might have heard or read somewhere that severe acute respiratory syndrome coronavirus 2, or SARS-CoV-2, the virus that causes COVID_19, isn’t a real virus or that it’s a regular flu virus. There are some clinical similarities, but they’re not the same. Both influenza (flu) and COVID_19 are contagious respiratory illnesses. However, different viruses cause them. The novel coronavirus (SARS-CoV-2) causes COVID_19 just as the influenza virus causes the flu.

 

SARS-CoV-2 is part of a virus family that causes illnesses such as the common cold, severe acute respiratory syndrome (SARS), and Middle East respiratory syndrome (MERS).

 

Coronaviruses exist in nature and can and do infect many different animals. Bats, pigs, cats, and ferrets, and other animals harbor SARS-like coronaviruses.

 

The most widely agreed upon SARS-CoV-2 origin, based on genetics, is that its ancestors moved around wild animals before they jumped into humans. The virus may have passed through an intermediate animal before evolving to become better at infecting humans. Or it may have made the jump directly from bats to humans, given past examples of such occurrences.

 

At this point, uncovering the coronavirus’s origins would be difficult because it would require a large-scale sampling of animals—including bat and human populations—to trace its evolution. You simply need to know that this virus is real and deadly for some population segments.

 

Second, the vaccine protects against new SARS-CoV-2 strains. All viruses mutate, and eventually, these changes could make them more infectious and more deadly. The new U.K. strain is at least 50 percent more adept at spreading from person to person, and the South African strain has mutations in critical areas that could help the virus evade immune cells generated to fight it.

 

That’s the bad news.

 

 The good news is that Moderna’s COVID_19 vaccine protects against the U.K. and South African mutant SARS-CoV-2 strains.

 

I should point out that blood sampled from people who received the Moderna vaccine did not generate as many immune antibodies against the mutant strains as they did against the non-mutant virus. This blood contained about six-fold lower antibody levels. However, in a just-published study co-authored by Moderna and the NIAID, the antibody levels remained high enough to provide sufficient COVID_19 disease protection.

 

Since we can’t stop viruses from mutating, the best we can do is stay on top of these changes. As an example, Moderna has been tracking SARS-CoV-2 mutations since August, when the first significant change (called D614G) from the original virus appeared.

 

Suppose an existing new variant break through the current vaccine-provided protection. In that case, one option could be to add a third booster dose of the existing vaccine to increase the immune response and make up for any antibody decline that a mutated variant might cause. The booster would likely be recommended for six months to a year after the second current shot.

 

Another option would be to boost with a new vaccine. The virus’s genetic sequence is the basis for Moderna’s mRNA technology. Thus, developing an additional vaccine against a new variant would be a matter of copying and pasting—pasting the South African strain mutations into the existing vaccine and possibly have shots ready to test for safety and efficacy in just a few weeks.

 

Third, if side effects happen, they will be mild. Let me dispel one myth: No medical procedure is 100 percent safe. They all entail some risk. Anyone who tells you otherwise hasn’t a clue or isn’t being honest. That said, it’s clear that coronavirus vaccines are safe and effective for most people who receive them. However, as the rollout continues, we’re learning about the extent and nature of the coronavirus vaccine side effects.

Thus far, there have been reports of mild, temporary side effects such as headaches, chills, joint pain, injection-site pain (standard with most vaccines), and fevers for the two available messenger RNA (mRNA) vaccines. These vaccines deliver RNA bits that code for coronavirus proteins, against which the body mounts a response.

We expected side effects — vaccine clinical-trial data suggested as much. There are also reports of rare allergic reactions and even a blood disorder surfacing following the shot.

According to data from the U.S. Vaccine Adverse Event Reporting System (VAERS), about 372 out of every million, or 0.0372 percent of administered mRNA vaccine doses, lead to a non-serious reaction report. This number is lower than expected from clinical-trial data, indicating that at least 80 percent of people would experience injection-site pain. Researchers running trials monitor patients closely and record every reaction. VAERS, meanwhile, relies on healthcare workers and vaccinated individuals to self-report side effects.

 

In the United Kingdom, three million doses of another vaccine, developed by the University of Oxford and pharmaceutical giant AstraZeneca, have been doled out. This vaccine, which also requires a two-dose regimen, contains an inactivated cold-causing adenovirus. It comes with genetic instructions to make coronavirus proteins trigger immunity. According to a British safety monitoring system, about 4,000 doses out of every million administered lead to adverse reactions.

 

After studying all the data, I’m here to say that severe reaction risk is minimal and far outweighed by the protection offered against COVID_19.  

 

Fourth, the sooner people get vaccinated, the sooner we can reopen society. However, there’s a small catch. I’m sure you’ve heard that the pandemic will end once a SARS-CoV-2 vaccine becomes widely available. Given that vaccination has drastically reduced deadly disease incidence, this is a reasonable assumption. Let me be clear: We cannot end the pandemic without vaccines. However, we need to focus not just on how vaccines prevent disease but how they prevent transmission.

 

We need vaccines that protect us from disease and curb or prevent transmission on the broader population, which prevents pathogens from being passed between people.

 

Many vaccines do this, including the HPV vaccine, which not only prevents cervical cancer in women who receive it but prevents those vaccinated from transmitting the virus. If a virus can’t gain a foothold in a host and reproduce, it will not infect other people, a process known as sterilizing immunity.

 

Not all vaccines work this way. The Pertussis (whooping cough) vaccine prevents people from developing disease symptoms and dying, but they can still harbor the pathogen and transmit it to others. Such vaccines provide important individual protection, but a high proportion of the population must be vaccinated to protect those who can’t or won’t be vaccinated. Herd immunity works in this way.

 

While a vaccine would go a long way to ending the pandemic and opening up society, without a

a vaccine that prevents transmission is that immunized people could unwittingly pass the virus to those who cannot be vaccinated or those whose immune systems are too weak to generate a protective response.

 

What we need are vaccines that prevent people from getting and spreading the virus. Thus, an ideal COVID_19 vaccine would achieve at least 70 percent efficacy – meaning a 70 percent disease incidence reduction in a vaccinated population, compared with an unvaccinated one – with consistent results in older people and immunity lasting for at least a year.

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As we try to end the pandemic and reopen the world, it’s critical to examine all vaccine candidates and ensure that those with the greatest potential to protect the wider population move to the top of the vaccine food chain.

 

We urgently need a vaccine to end the pandemic, but to achieve this, it must protect the many, and not just a few.

 

Final thoughts: overcoming vaccine hesitancy. If you have friends who are still on the fence about the vaccine, here are a few points to remember:

 

1. Be supportive. Don’t dismiss another person’s feelings about the vaccines, even if they seem irrational. It doesn’t cost anything to acknowledge uncertainty, “There are no guarantees with this vaccine, but this is a scary disease. I got the vaccine (or I’m planning to). I want it for you, my family, and friends.” You’re tapping into the basic human need to feel safe.

 

2. Acknowledge uncertainty. Most people are risk-averse. However, it’s impossible to go through life without facing risk: we face it every time we drive our car or even cross a busy intersection. It’s reasonable to wonder about the vaccine or seek more information from reliable sources before deciding to get vaccinated. However, getting vaccinated will reduce risk to yourself, your loved ones, and society as a whole. There’s no dispute about this.

 

3. Discuss known risks. Let people know what to expect from vaccines, including the side-effects I outlined above.

 

4. Provide credible information for information-seekers. Share articles from reputable sources to combat vaccine misinformation. My general rule about medical information is never to take advice from someone not in a position to give it. Your trainer might be great at helping you lose weight or tone your thighs, but unless he or she has a medical degree, look for advice elsewhere. Indeed, reporters have received input from as many unreliable sources as reliable ones as we have learned.

 

5. Share your vaccine experience. Saying “get the vaccine” is one thing; showing that you are willing to do it is even more powerful. Practice what you preach.

 

Final thoughts. I need to close by saying that if you are otherwise healthy and get infected with COVID_19, you will recover and be just fine. However, here’s the bad news. I have now treated over 30 patients who were victims of this virus, did well, stayed home, and were never hospitalized. Over 75 percent of them have lingering symptoms, what is becoming known as “Post-COVID_19 Syndrome.” Mental fog, memory loss, persistent fatigue, shortness of breath with routine activities are just a few of the reported side-effects. Trust me; you do NOT want to join this group.

 

Get your vaccine!