CLEVELAND, Ohio — What happens if there is a COVID-19 vaccine, but not enough people want to take it?
Survey data suggests that nearly four out of 10 Americans say they won’t be signing up for the vaccines when their turn comes. Their reasons range from mistrust of the medical community, to bad information they read on social media, to fear of how the vaccine works, how quickly it was developed and the effect it will have on their bodies.
Some Black patients aren’t in a rush to get the COVID-19 vaccine because of deep-seated mistrust of the medical community. Yvonka Hall, executive director of the Northeast Ohio Black Health Coalition, a social justice organization that advocates for health equity in underserved communities, encourages those who want to take the vaccine to do so. At the same time, she says, “I can’t force Black people to have trust in the system.”
The Ad Council, CVS Health, Ohio Department of Health and other agencies and individuals are working to counteract misinformation and persuade people that the vaccines are safe. If those efforts fail, it could hinder efforts to reach herd immunity and make the country safe to fully reopen.
What vaccine refusal looks like
In Ohio, elderly people 75 and older are desperately scrambling to book vaccination appointments. But skeptics have their reasons for being hesitant to take the COVID-19 vaccine:
Some, especially people of color, don’t trust the medical profession.
Some worry about what the vaccine will do to their bodies.
Some fear safety was compromised during a rushed vaccine development process.
Some believe misinformation on the Internet that makes the vaccine sound scary and dangerous.
The politicization of how the pandemic was handled “has not allowed science to lead the way,” said Dr. Lee Kirksey, vice chairman in the department of vascular surgery at the Cleveland Clinic. “That lets people feel uncertain about what they read and see. Confused people say no.”
Nearly 40% of Americans say they will “definitely not” or “probably not” get the COVID-19 vaccine when it becomes available to them, according to a December poll from the Pew Research Center.
The number of Americans saying they will get the vaccine “as soon as it’s available” has increased by double digits since last month, and 60% of Americans say they are likely to get it, according to the Jan. 12 Axios-Ipsos Coronavirus Index.
If that number doesn’t rise, it will be impossible for the country to reach herd immunity, which is the point when enough people are vaccinated that a spreading virus can’t find enough new hosts.
Dr. Anthony Fauci, head of the National Institute for Allergy and Infectious Diseases, has revised the number of immunized Americans needed for herd immunity upward, from 60%-70% to 85%.
Roots of distrust
In a focus group conducted in early October by Kaiser and The Undefeated, Black participants cited systemic racism for their vaccine hesitancy. They noted the infamous, government-backed Tuskegee Syphilis Study, a decades-long federal health study that withheld syphilis treatment from hundreds of poor Black men.
More recently, tennis star Serena Williams has spoken out about having her symptoms discounted and almost dying after giving birth to her daughter. Her story is held up as an example of how racial bias in medicine harms Black women.
“All of these things lead people to understand that for minority and poor communities, the playing field is not even,” said Kirksey, who is Black. “There are historical underpinnings which I fully am aware of and grew up with.”
According to a December poll from the Kaiser Family Foundation, 35% of Black adults said they definitely or probably would not be immunized, and Black respondents were more likely than other groups to have worries about side effects and the newness of the vaccine.
Yet Black people are almost three times more likely to die of COVID-19 than white people, due to pre-existing conditions, health care disparities and increased exposure on essential jobs that cannot be done from home, according to the Centers for Disease Control and Prevention.
“It’s a paradox,” said Robert Hecht, professor of clinical epidemiology at the Yale School of Public Health at Yale University. “We need so badly to vaccinate in those communities.”
Misinformation overshadows science
Social media is filled with professional-looking videos spouting bad information that discourages people from getting the vaccine, said Dr. Leon McDougle, president of the National Medical Association. The organization, based in Silver Springs, Maryland, serves as the voice of 50,000 African-American doctors and their patients.
These videos and other social media posts spread incorrect allegations that immunization’s goal is to control Americans through microchips in our brains; that the vaccine causes infertility; and that COVID-19 is a money grab perpetrated by Big Pharma.
This flood of misinformation makes it harder for accurate vaccine information to be heard, McDougle said.
The Mayo Clinic has a blog debunking popular myths about the vaccines and giving scientifically based reasons why the myths are inaccurate.
mRNA is misunderstood
The mRNA platform used to make the Pfizer/BioNTecH and Moderna vaccines is widely misunderstood, which leads people to fear that it will alter their genes.
Messenger RNA, or mRNA, prompts prompt the body to produce a coronavirus spike protein, which then triggers an immune response. These mRNA vaccines are produced in a lab, and they leave the body over time. Immunization does not involve injecting live coronavirus into the body.
Another piece of bad information claims that antibodies produced by COVID-19 vaccines will bind to placental proteins and prevent pregnancy. In reality, there are no indications that the mRNA platform leads to infertility, health experts at a number of organizations focused on women’s health said.
“Scientific advancement has exceeded the health literacy of many people in this country,” McDougle said. “The health care community needs to work harder to get the word out on the safety and effectiveness of the vaccine.”
Fears it was rushed
Just the name of the Trump Administration’s public-private partnership to develop COVID-19 vaccines — Operation Warp Speed — has led to apprehension that the vaccines were rushed through development and testing.
A process that usually takes several years was compressed into a few months to meet the pandemic’s ever-rising death toll, but federal health experts, along with the Food and Drug Administration, reviewed data from the vaccine trials and found the drugs safe.
“The speed of it is a reflection of the extraordinary scientific advances that have been made in platform technologies for vaccines,” Fauci said during a recent CNBC interview. “It was not at the expense of safety, nor was it at the expense of scientific integrity. It was purely a reflection of years of work, which antedated this outbreak, which allowed us to do things in a matter of months that formerly a decade ago would have taken several years.
“Hundreds of millions if not billions of dollars were put into the development and the production of vaccine doses, so that they would be ready to give to people,” Fauci added.
The CDC and the Food and Drug Administration continue to closely monitor vaccine safety, the Mayo Clinic said.
Efforts to educate
Education campaigns to spread facts about the vaccine and overcome hesitancy are being planned on the national and local level. Here’s a sample:
This month, the Ad Council kicked off a $50 million advertising campaign aimed at increasing public confidence in getting immunized against COVID-19. During a Jan. 13 media briefing at the National Press Club, the nonprofit organization said it plans to focus the campaign on communities of color. The Ad Council has raised $37 million of the campaign’s budget.
Ad Council TV spots currently on the website offer thanks to essential workers, discuss the need to keep wearing masks, and similar topics.
The federal government released in December a draft plan for a $250 million advertising campaign, set to run through September 2021. Its goal is convincing the public to keep wearing masks, social distance and wash hands, and to make government information about COVID-19 available. The national ad campaign launched in December with ads on YouTube.
CVS Health has posted two YouTube videos explaining how the COVID-19 vaccines work, while the World Health Organization has a video on a similar topic on Facebook.
Celebrities are doing their part. Then-Vice President-elect Kamala Harris, “Today” weatherman Al Roker, President Joe Biden and other nationally known figures have publicly rolled up their sleeves for the shot.
State of Ohio
The state will soon begin an ongoing vaccine education strategies aimed at minority communities, DeWine said in his coronavirus update Tuesday.
The campaign includes town halls, media spots and a toolkit that the state’s community partners can use to address vaccine hesitancy among their constituents, DeWine said.
The Cuyahoga County Board of Health is planning a multi-pronged education campaign aimed at reaching all county residents, spokesman Kevin Brennan said. This includes content for social media and websites and webinars for COVID-19-related topics. “We anticipate doing the same for vaccination as requested,” Brennan said.
The heath board’s Equity, Diversity and Inclusion committee is gathering input from community partners about concerns, so that the county can supply trusted information, Brennan said.
“It is critical that we promote vaccination as our safest and quickest way back to normal,” Brennan said.
The Cleveland Clinic’s video on vaccine safety can be found on YouTube.
Primary care physicians who are people of color, or who have cultural competency, can help carry the message about the vaccines to their patients, Kirksey said.
When physicians talk to patients, they should take pains not to talk down to them or sound paternalistic, Kirksey said. He typically asks patients about their objections, and recognizes that it may take two or three conversations with him and others to convince patients to get immunized.
When friends ask him about the COVID-19 vaccine, Kirksey is quick to tell them that he has received it. “I’m your guinea pig,” he wrote in a social media post about his experience with the vaccine. He had no side effect other than a sore arm, and was playing basketball with his kids that night.
He’s confident that when Black Americans understand the consequences of severe COVID-19, they will see compelling reasons to get the vaccine.
“I’m certain we can get Black Americans to do what is in their best interest to reduce COVID-19′s impact on our community, Kirksey said.
“I don’t think about the alternative.”