Auburn University professors discuss vaccine hesitancy, stress importance of inoculation

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As the COVID-19 global pandemic persists and the country slowly inches its way toward herd immunity, many Americans remain reluctant to get the vaccine and demand for the much sought-after inoculation has waned in recent weeks. Everything from skepticism, personal beliefs, a “wait and see” mentality and even misinformation have contributed to the waning of numbers of those signing up to get the vaccine.

Auburn University professors Joanna Sztuba-Solinska, Spencer Durham and Danilea Werner weighed in on the topic, giving their thoughts about what the rest of the spring and summer may look like as the second year of the pandemic marches on.

Sztuba-Solinska is an assistant professor of biological sciences in the College of Sciences and Mathematics who has spent years researching viruses, including human coronaviruses such as SARS CoV-2—the virus that causes the COVID-19 disease. Werner is an associate professor of social work in the College of Liberal Arts who worked on the interprofessional vaccine distribution team at Auburn.

Durham is an associate clinical professor in Auburn’s Harrison School of Pharmacy, practices as the infectious diseases clinical pharmacist at the Central Alabama Veterans Health Care System and is actively educating health care professionals on topics related to infectious diseases and antimicrobial stewardship.

It has been widely reported in the news that many Americans are hesitant to get the vaccine and that the numbers of people being vaccinated are tapering off as spring arrives. What are your thoughts on that, and how can mass vaccinations help get our communities closer to achieving herd immunity?

Sztuba-Solinska: Meeting no resistance, the virus spread rapidly across the human population. Stopping it will require a substantial percentage of people to be immune. Measles, polio and chicken pox are known examples of infectious diseases that were once common but are now sporadic in the U.S. because vaccines helped establish herd immunity. It is currently estimated that for stopping SARS-CoV-2 infections, we need to achieve at least 75% herd immunity. For infections without a vaccine, even if many adults have developed immunity because of past infection, the disease can still circulate among children and infect those with compromised immune systems.

I would strongly recommend for everyone not to “miss their shot.” We are in a truly fortunate situation having access to two types of mRNA-based vaccines, Pfizer and Moderna, with a third one from Johnson & Johnson being introduced on the market relatively recently. These vaccines are the most assured way to finally end this pandemic and go back to our everyday lives.

On a personal note, I am 31 weeks pregnant, and I decided to vaccinate to protect myself and my baby. My mom, who lives in my old country, Poland, was not that lucky. She signed up to receive her vaccine as soon as it was available for her age group. The date was set for April 12, but a few days ago, unfortunately, she was diagnosed with COVID-19.

Werner: There are many reasons someone may be hesitant to get the COVID vaccine. We have watched vaccine hesitancy grow over the past few years, even before the COVID outbreak. Misinformation and mistrust are major contributors to vaccine hesitancy. In March, Carnegie Mellon released a report on vaccine hesitancy.  They found that the percentage of Americans willing to be vaccinated grew from 72% in January to 77% by the end of February. However, there remains a core group of approximately 23% who remain vaccine hesitant, citing concerns about vaccine efficacy, fear of side effects and an array of conspiracy theories.

Currently, the Center for Disease Control reports that approximately 32% of Americans have received one dose and a little over 18% are fully vaccinated. With many states opening up eligibility to anyone over 16, the hope is that we will see more of the population getting vaccinated by early summer. Public health experts estimate that we need to have between 70-90% of the population vaccinated to achieve herd immunity, and to do this, we need to spread the message of safe and effective vaccination.

Some of the people who are hesitant say they are waiting to see how others react to the vaccine before they consider getting it themselves. But won’t that slow down progress toward herd immunity?

Durham: It is important to know that the studies used to bring the Pfizer, Moderna and Johnson & Johnson vaccines to market included many thousands of patients, and none of these vaccines were associated with any major or serious adverse effects. They were all shown to be very safe. At this point, because the vaccines have now been available for weeks and months, millions of people have already received doses, and the safety of all the vaccines has been overwhelmingly confirmed. The longer people delay in getting the vaccine, the longer it will take to reach herd immunity, which we really need to reach for things to “get back to normal.” I would strongly encourage everyone to go ahead and get whichever vaccine they are to get as quickly as possible.

What will it mean if/when we achieve herd immunity, both for ending the threat of spreading the virus and for practical things like wearing masks?

Sztuba-Solinska: As with any viral infection, there are two ways to reach herd immunity: A large proportion of the population either gets infected or receives a protective vaccine. I have met people saying they prefer going through “natural infection.” Trust me, there is nothing natural about going through COVID-19, and it is a very unsafe way of handling this pandemic. Not only you do not know what long-term side effect you may experience (so-called COVID tail), but also you facilitate the viral spread among people who not necessarily can vaccinate, e.g., immunocompromised people and children, and you accelerate the emergence of new SARS-CoV-2 variants, as the virus needs to infect to mutate.

The other option to achieve herd immunity is global vaccination, but this will take a concerted effort on the entire population, with some level of continued physical distancing and wearing masks for an extended period. We are currently experiencing middle ground in this pandemic, i.e., the hospitalization rates dropped, but the infection rates fluctuate, depending on the state and their local regulations. We may relax physical distancing measures when numbers of infections fall and then may need to re-implement these measures as numbers increase again.

The prolonged effort will be required to prevent major outbreaks until the majority of the population is vaccinated. Even then, SARS-CoV-2 could still infect children before they can be vaccinated or adults after their immunity wanes. But it is unlikely in the long term to have the explosive spread that we see right now because much of the population will be immune in the future.

Some people may be waiting on an updated “version 2.0 or 3.0” of the COVID-19 vaccines before they are immunized. Do you think there will be more effective versions of the vaccine in six to nine months, or are the current options as fine-tuned and efficient as the vaccine will get?

Sztuba-Solinska: Currently, developed COVID-19 vaccines are highly effective, with Pfizer and Moderna providing 93-95% protection from the disease, so there is no need to wait for “better options.” I’m sure in the near future, there will be other vaccines available that would, for example, require single-dose shot, like Johnson & Johnson, or that do not require specific storage conditions, but as far as I’m concerned, these improvements really should not affect anyone’s decision on receiving the vaccine as soon as possible.

People worry about the COVID-19 vaccine side-effects, which for some are quite unpleasant. To be clear, these side effects are an indication of an immune system kicking into gear. They do not signal that the vaccine is unsafe. To date, there are no serious, long-term side effects associated with receipt of these vaccines. Personally, I had no side effect with the first dose of my Pfizer vaccine, while the second shot gave me mild fever and chills that lasted six hours. Now, we need to figure out how long the protection will last, but that will take time and will involve periodic monitoring from some volunteers to see what their antibody levels look like.

Durham: Unfortunately, there is no vaccine that is going to have 100% efficacy. However, all the vaccines currently available do have strong efficacy at not just preventing SARS-CoV-2 infection, but preventing severe illness, hospitalization and death associated with SARS-CoV-2. In other words, even if you receive a vaccine but still acquire COVID-19, the vaccine helps you from not getting as sick as you would if you had not received the vaccine. This is also why I would strongly recommend anyone receive one of the vaccines as soon as they are able. 

Why do you think certain groups in particular have been reluctant to get the vaccine, and what would you say to them and others about the benefits of getting the vaccine?

Werner: I would tell anyone who is reluctant to get the vaccine that I understand their concern. We have been living in time of uncertainty and fear. I know that people react strongly to change, new risks and especially risks with which we have no experience. However, I think we can all help vaccine-hesitant individuals and groups by implementing three key messages.

First, make sure you can provide facts and sources that are creditable, such as the CDC's COVID-19 website. The scientists and public health experts who have studied and trained to handle this type of pandemic need us to spread truth and aid in the recovery.

Second, be clear about what to expect from the vaccine and the potential side effects. The CDC confirms that individuals may experience side effects from the vaccine, but the effects should go away in a couple of days. Remember, side effects are a sign that your body is building protection against the virus.

Finally, if you are comfortable, share your experience with the vaccination. Personally, I have found this to be one of the most effective conversation starters and greatest influence for those who may be vaccine hesitant.

Can you talk about your experience, if any, working with vaccine distribution here at Auburn and what your thoughts are on the response from the Auburn Family?

Werner: It has been my honor and pleasure to work on the interprofessional vaccine distribution team at Auburn. I am so proud of the Auburn Family and how Pharmacy, Nursing, Social Work, the Medical Clinic and Campus Safety came together to organize and operate the closed vaccine POD. The professionals at Auburn University are truly unmatched and are living examples of the Auburn Creed. The pandemic has reinforced how important it is to work together, across disciplines, to maximize efficiency and effectiveness.

Being a part of the vaccine distribution team has been inspiring, as newly vaccinated people say thank you and smile on their way out of the door while taking selfies with their vaccine card. This experience has reminded me that what we have in common is more than our differences and that we always work better together.

Some of the people who are hesitant say they don’t trust any of the vaccines because they were developed so quickly. What do you say to that?

Durham: This is certainly an understandable concern, given how apparently quickly the vaccines came to the market. However, it is important to realize that the main reason they could be brought to the market so quickly was that the government removed most of the “red tape” that would normally require a lot of time to work through. The actual studies performed on the vaccines still assessed safety and efficacy the same way they normally would. Additionally, the vaccine manufacturers were able to apply the way they make other vaccines to making a COVID vaccine, which helped to speed up the process. For example, Moderna was already developing a vaccine for MERS, which is also caused by a coronavirus. They were able to take what they were already working on and substitute the SARS CoV-2 virus for the MERS virus, so this also allowed the vaccine to be created much faster than it would typically be required.

What would you say to a pregnant woman about getting vaccinated?

Durham: While the vaccines have not yet been directly studied in pregnancy, we know that most vaccines are very safe during pregnancy. In looking at how the COVID-19 vaccines work, we have no reason to think they would be unsafe in pregnancy. There are many advantages to receiving the vaccine in pregnancy, including the possibility of passing antibodies to the baby to help protect them against COVID-19. But, given that they have not been directly studied during pregnancy, it is understandable that someone who is pregnant would be nervous to receive the vaccine. The decision about whether to receive one of the vaccines in pregnancy is something that I recommend discussing with your health care provider to have a more in-depth discussion of the benefits and risks of receiving the vaccine. 

What would you say to an older person?

Durham: Older patients, particularly those who are older than 65 years, are at a higher risk of having complications and severe disease from SARS CoV-2. This is primarily because the immune system naturally weakens as you age, so older patients cannot fight off the virus as well as younger patients. All of the vaccines have shown strong efficacy in older patients, so getting vaccinated is their best chance at protecting themselves from getting very sick due to SARS CoV-2 infection. 

What would you say to a person with an underlying medical condition?

Durham: Similar to our older adult population, patients with underlying medical problems are at a higher risk of experiencing complications and severe disease from SARS CoV-2 infection. All of the currently available vaccines have strong efficacy in people with underlying, chronic medical conditions.

What would you say to a healthy middle-aged adult who isn’t an essential worker about the vaccines when they are eligible?

Durham: In order to achieve herd immunity, as many people as possible must be vaccinated. Getting vaccinated will protect not only themselves, but all of their loved ones and anyone else they may come into contact with who might be at a high risk for having complications or severe disease due to SARS CoV-2 infection. So, I would definitely recommend everyone receive one of the vaccines as soon as possible, even if they themselves are healthy and not at a high risk for severe disease. 

We discussed Pfizer and Moderna before and talked mRNA, but what about Johnson & Johnson and others? Do they have similar technology, how are they similar, how are they different?

Durham: The vaccine from Johnson & Johnson that was recently approved in the United States uses “viral vector” technology, which basically utilizes an inactivated cold virus to tell your immune system how to make antibodies to SARS CoV-2. This type of technology is more traditionally used for creating vaccines compared to the mRNA technology used by the Pfizer and Moderna vaccines. In those vaccines, the mRNA is like a code that tells your immune system how to make antibodies against SARS CoV-2.

All of the vaccines are similar in that they are ultimately trying to get the body to produce antibodies against SARS CoV-2 so that a person who is later exposed to the disease will not get sick. All of the vaccines show strong efficacy in preventing COVID-19 illness, and in particular are very effective at preventing death from COVID-19 and from having severe disease that requires hospitalization. Additionally, all of the vaccines are very safe and not associated with serious side effects.

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