Vaccine “Hesitancy” Threatens COVID Immunization Efforts

While scientists around the world are striving to discover, produce, and distribute safe and effective vaccines to halt the coronovirus outbreak, cadres of anti-vacciners are revving up misinformation campaigns to undermine public confidence in such preventives. Despite the clear danger of COVID-19 to global health, vaccine opponents have gained ground, as fearful populations lose faith in the capabilities of industry and government to protect public health.

The latest tactic of anti-vaccine forces is to align with protests against government lock-down policies and restrictions on business and daily life. The “Reopen America” campaign has attracted groups fighting state vaccine requirements for school-age children. Despite strong childhood vaccination rates (over 90%) in the United States, notable pockets of resistance dot the nation, as anti-vacciners show considerable savvy in communicating their message through social media to fuel more widespread “vaccine hesitancy.” A recent poll by the Associated Press and NORC at the University of Chicago found that while 49% of respondents plan to get vaccinated against COVID-19, 20% say they will not and 31% are not sure. Hesitant responders cite fear of side effects, of getting infected from the vaccine, belief that the new vaccines don’t work well, and reduced concern about getting sick-issues that need to be addressed clearly by manufacturers and health authorities.

Speed breeds suspicions

Ironically, the high-profile US campaign to develop and produce vaccines against COVID-19 quickly, as promoted by the Trump Administration’s Operation Warp Speed initiative, may fuel such objections. Instead of undergoing five or 10 years of pre-clinical and clinical testing involving tens of thousands of individuals, current experimental COVID-19 vaccines are moving quickly through the development and approval process. Although such accelerated discovery is widely applauded, it also opens the door to fears that resulting preventives may be inadequately tested and less safe.

Related to this is the rise in novel technologies being explored to expedite vaccine development and production. Among some 150 COVID-19 vaccines in development, early front-runners utilize mRNA, DNA, new gene therapies, and additional adenovirus vectors to trigger an immune response. Anti-vacciners describe these approaches as “synthetic” and “unnatural” and likely to generate adverse events more lethal than the virus itself.

Suspicions in vaccines also stem from charges that biopharma companies and international organizations are foisting risky treatments on the world just to make huge profits. Anti-vaccine crusaders have levelled conspiracy charges for years, particularly at the Bill and Melinda Gates Foundation and the World Health Organization for seeking to control the global health system in ways to track individuals’ activities. Such accusations have undermined international efforts to expand vaccine access to developing nations and to vulnerable populations.

Pharma critics also oppose industry patents on pandemic treatments, particularly those discovered and tested with significant financial support from government and public agencies. Although manufacturers of early experimental therapies have provided some treatments at no cost, and analysts have calculated fairly high values for vaccines that save lives and help restore the world economy, the debate over cost and access will continue.

Mandates and misinformation

Policy makers face further disagreement over the extent that anti-COVID-19 vaccination will be required for individuals to engage in activities involving greater personal interaction. With clear evidence that COVID-19 is highly contagious and dangerous, local and state governments may move beyond requiring certain vaccinations for children to attend school to mandating or recommending vaccination for those in certain jobs, to attend public events, and to utilize public facilities. Employers and service firms may impose similar requirements on staff, while the federal government could require vaccination for travel in and out of the country. Medical authorities estimate that 60–70% of the population would need to be vaccinated or found immune to achieve “herd immunity,” a high number that will require millions of vaccine doses fairly quickly.

The Centers for Disease Control and Prevention (CDC) has launched a “vaccinate with confidence” campaign to address concerns of those hesitant about vaccination, as opposed to the relatively few vocal vaccine opponents, explained Nancy Messionnier, director of CDC’s National Center for Immunization & Respiratory Diseases, in a recent virtual meeting on tackling vaccine access and hesitancy issues organized by the Forum on Microbial Threats at the National Academies of Sciences, Engineering and Medicine (NASEM). The group will further examine the impact of declining vaccine confidence at a public workshop August 19–20, 2020.

CDC also is concerned that scheduled vaccinations for young children have declined in recent months, largely because parents have delayed routine doctors’ appointments for fear of infection at medical facilities. While vaccination rates are expected to return to normal, the current drop raises fears of measles and meningitis and other outbreaks in coming months. Health authorities already are pressing for widespread seasonal influenza vaccination in the fall to reduce health risks from a second COVID-19 outbreak when cold weather returns.

Transparency and full disclosure of vaccine benefits and risks are important for overcoming public fears of new preventives. Manufacturers and regulators need to clearly communicate potential adverse events, while moving away from the long lists of possible side effects that confuse and scare the public. Clear assurance of product quality and safety also will be critical, especially for any vaccine produced overseas.