Overcoming COVID-19 Vaccine Hesitancy
During the first week in June, it was estimated that 40% of the U.S. population has been fully vaccinated against COVID-19 and 60% have received one dose. The Biden Administration has set a goal of vaccinating 70% of the U.S. population by July 4, since in the region of 75-80% of our population should be immune to the predominant strain and variants of SARS-CoV-2 virus. Experience in South Africa, India and the European Union has demonstrated that a population with a high level of susceptibility and with an increasing incidence rate will result in the evolution of mutants. These may be more infectious and have greater pathogenicity than the original January 2020 strain, thereby delaying effective control of the pandemic.
A number of surveys have been conducted to determine the acceptability of the two mRNA vaccines (Pfizer and Moderna) and the adenovirus-vectored single-dose Johnson&Johnson product. Among all three major ethnic groups, 13-16% have stated that they absolutely are unwilling to receive the vaccine. Approximately 25% of our population is following a wait-and-see approach, and about 15%, especially those under 30 years of age, will receive a vaccine “when convenient.” It is incumbent for scientists to convey that these vaccines are not new. The recombinant vaccine found in the Johnson&Johnson and AstraZeneca vaccines were developed after the first SARs epidemic in 2002, and the mRNA vaccines found in the Pfizer and Moderna vaccine were developed after the MERs coronavirus epidemic in 2012. All vaccines were tested in a small population of humans and found safe and effective. In addition, the three vaccines now available in the U.S. have undergone rigorous testing in a large number of people over a nine-month period, and currently more than 500 million people have been safely vaccinated worldwide. It is apparent that a relatively high proportion the African American population is hesitant to receive any of the vaccines. Rural residents are more likely to be opposed to vaccination, as are populations in the Southeastern states. The FDA has approved vaccination of children 12 years of age and up, and even though the vaccination of this age group is safe and provides 100% efficacy, only a third of parents are willing to have their children vaccinated. Pfizer and Moderna have applied for permanent FDA approval to allow vaccination of all age Americans. It is evident that the only way to have “herd immunity” in the U.S. is to have 70-80% of the entire population fully vaccinated. It is also evident that infection with the current SARs coronavirus will provide immunity for no more than six months and that a significant number of unvaccinated individuals have become infected for the second time, whereas reinfection has not been reported in fully vaccinated individuals.
Vaccine reluctance is evident in the declining number of vaccinations on a daily basis. At the peak, three million doses were administered in a single day, mainly through mass vaccination sites. Currently the daily vaccination rate is hovering at one million. The Biden Administration is now relying on approximately 40,000 pharmacies and primary care facilities, including rural clinics and mobile vaccine units. Various companies are providing days off work and/or $100 in saving bonds to incentivize vaccination. Some states are providing monthly $1 million dollar lotteries and colleges holding free tuition lotteries for individuals who have been vaccinated. However, with the number of those categorically opposed to receiving vaccine, children under the age of 12 and individuals who are ineligible for vaccination based on health considerations, it appears doubtful that “herd immunity” will be ever achieved in the U.S. unless those not wishing to be vaccinated can be convinced to transition to the recipient column. Although the curve of new infections is being “flattened,” it will remain at a background level, and therefore, vaccine boosting will be required at a yet undetermined interval.
In a recent interview, the Surgeon General, Dr. Vivek Murthy, provided a perspective on how the Biden Administration will convince the hesitant to receive a vaccine. He believes that it is important to de-politicize vaccination. To this end, it would be extremely beneficial for President Biden to credit former President Trump and his administration with the foresight to establish Operation Warp Speed. This made vaccine available at the end of December 2020 and contributed to an adequate supply by the second quarter of 2021. Concurrently it would be helpful for former President Trump to encourage the hesitant, especially among his supporters, to receive a vaccine as a patriotic and public-spirited gesture to expedite control of infection. A joint statement of both administrations appears unlikely, but separate messages of encouragement in the form of alternating sequential public service announcements on mainstream and social media would be extremely helpful in defusing opposition to vaccination.
It is pointed out that 90% of the Congressional Physicians’ Caucus has been vaccinated along with the former president and first lady and members of both administrations. All living former presidents received their vaccines in public and have consistently promoted acceptance. It is generally considered that establishing trust in the three vaccines that have received emergency-use authorization are all safe and effective. Reasons advanced for COVID-19 vaccine hesitancy include political, restriction of “civil liberties,” a precipitous drop of infection, hospitalization and deaths due to COVID-19 and unsubstantiated news that pregnant females can miscarry and young females become infertile after receiving the vaccine. Appropriate counter arguments based on established and incontrovertible scientific knowledge need to be circulated.
It is important to recognize that, although we have made progress in reducing the impact of COVID-19 over 13 months, on June 1 there were 41,000 new cases diagnosed. On May 9, one million COVID-19 tests were administered, with the national positive rate below 5%, although regional “hot-spots” persist. Notwithstanding progress in control, there are still 39,000 people in hospitals being treated for acute COVID-19 and 667 people died on May 9, adding to the total of 581,000 confirmed deaths from COVID-19 in the U.S., although it is recognized that this figure is an underestimate.
Despite relaxation of masking and other social modalities, COVID-19 must be regarded as a serious disease given the number of cases and fatalities and long-term effects. The disease will not simply disappear, and the emergence of variant COVID-19 viruses will persist with continuing impacts on our way of life and economy. Vaccination not only effectively protects the recipient, but it also reduces the possibility of spreading infection to family members and the community. The virus does not respect location, political or religious persuasion or ethnicity. We have a collective responsibility to be vaccinated and in the intermediate term to practice common sense measures to prevent dissemination of virus. Adherence to the recommendations of the Centers for Disease Control and Prevention and following the advice of responsible physicians will hasten the end of the pandemic that represents the worst public health crisis in 100 years.
Joseph Giambrone is a professor emeritus in Auburn University’s Department of Poultry Science with a joint appointment in the Department of Pathobiology in the College of Veterinary Medicine.
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