The COVID-19 Vaccine: Why the Hesitancy?

The international impact on public health pushed a variety of private and governmental organizations to work together to address the pandemic. Great investment was seen by The National Institute of Health who led the science, Centers for Disease Control led the investigation of the infection's impact on public health, the Food and Drug Administration addressed the regulatory pathways, the World Health Organization (WHO) served as an international resource, and the US Department of Defense used their research and development division. These government agencies worked closely with public and private organizations worldwide to provide communities with necessary supplies and work toward the development of vaccines that would protect against the COVID-19 virus. Vaccines historically took up to 10 years for development and approval. In 2020, the organizations involved in COVID-19 vaccine research and development benefitted from years of prior research on DNA/RNA sequencing (previously used in the fight against cancer). Expedited processing of documentation, increased access to resources (such as funding, experts, and materials), and a worldwide focus on COVID-19 over other viruses allowed safe and successful vaccines to be developed in as little as a year (WHO, 2021a, World Health Organization, 2020b). According to the WHO, there are currently over 74 COVID-19 vaccines in clinical development and over 180 COVID-19 vaccines in preclinical development (WHO, 2021a).

The anticipation of a COVID-19 vaccine was seen by many as a “light at the end of the tunnel.” Social media was ablaze with excitement as those early adopters looked forward to the development and approval of a vaccine to protect not only themselves but also their friends, families, and the patients they serve. The first mRNA vaccines to be introduced were put through rigorous trials; over 43,000 people participated in the Pfizer vaccine trial and 30,000 in the Moderna vaccine trial, with half of those involved receiving the vaccine and half receiving a placebo. There was an average efficacy rate >94% at preventing the COVID-19 illness in those who received the vaccine. There were no deaths from those trials, and in both trials, the severe cases of COVID-19 occurred in participants who received the placebo (Baden, 2021, Polack, 2020). On the horizon are also viral vector vaccines (i.e., Johnson & Johnson) that use a live yet harmless COVID-19 virus to stimulate the recipient's immune response: early results are showing an efficacy rate of >85% without serious adverse reactions (Sadoff, 2021).

Very quickly, although, a flood of misinformation influenced many around the world, slowed their acceptance of a COVID-19 vaccine, and even prevented their acceptance of it. Opposing opinions further divided groups of people and created near hostile attitudes toward the COVID-19 vaccine. Social media allowed constant sharing of inaccurate information from any source with a voice and a message (most lacking scientific evidence). Conspiracy theories, paranoia, finger-pointing, and radical theories became daily reminders to those who were easily influenced or were otherwise uncertain about the COVID-19 vaccine. Politics, racism, inequality, discrimination, and xenophobia fueled the incivility of many to turn against those with different opinions, religions, lifestyles, or cultures. The WHO warned of a second epidemic occurring called an “infodemic”: the rapid and excessive spread of inaccurate information that is fake, lacks scientific evidence, is often used to advance an agenda, and ultimately delays achievement of a solution to the problem at hand (Vergara, 2021; Naeem, 2021). The COVID-19 infodemic is a public health crisis that has been difficult to control because it is responsible for the dangerous spread of conspiracy theories, pseudoscientific therapies, and other misinformation (WHO, 2020b). Sadly, some of those in the forefront of the infodemic are public figures, such as religious leaders, government leaders, celebrities, sports stars, theorists, pseudoexperts, journalists, and health care workers (HCWs).

In December of 2020, a review of 30 studies from 33 countries showed countries with the highest vaccination rates were Ecuador (97%) and Malaysia (94%), whereas those countries with the lowest vaccination rates were Kuwait (24%) and Jordan (28%). Eight surveys of HCWs revealed a wide range of COVID-19 vaccine acceptance rates from a high rate in Israel (78%) to a low of 28% in the Democratic Republic of the Congo (Sallam, 2020). Other studies reported vaccine hesitancy among HCWs averaged around 30% (Detoc, 2020; Khullar, 2021). One study of 3,479 American HCWs found that only 35% of the respondents were eager to receive the vaccine, whereas 56% were hesitant (Shekhar, 2021). In a different study of 672 adults in the United States, 67% responded they would accept a COVID-19 vaccine (Malik, 2020). Sadly, there are at least 125 countries yet to receive any vaccine at all (Besheer, 2021).

Individual beliefs regarding the vaccine safety stem from knowledge of real and theoretical risks to those based in propaganda and unfounded claims. Social media platforms and certain media outlets have been particularly damaging to the scientific knowledge dissemination during this pandemic. Mistrust of some leaders has occurred, especially when those without authority or scientific expertise speak to the issues of the pandemic. Figure 1 lists some examples of why people are hesitant or resistant to be vaccinated.

Figure 1

Reasons for COVID-19 vaccine hesitancy. Ahuja et al., 2020, Ali, 2020, Attwell et al., 2021, Batchelor, 2021, CDC, 2021, Editorial, 2020, Ho, 2021, Khan et al., 2020, Lichtenstein, 2020, Mallapaty, 2021, Marshall and Salahi, 2021, Milko, 2020, O’Neill, 2021, OpIndia Staff, 2020a, OpIndia Staff, 2020b, Park et al., 2020, Patel, 2021, Pradhan et al., 2020, Reiter et al., 2020, Wen and Su, 2021, Whatley and Shodiya, 2020, Wong et al., 2021, Xu, 2021.

Reasons for COVID-19 vaccine hesitancy

The pandemic will continue well into 2021. Solutions to the problem of vaccination hesitancy are needed. This includes a global effort that will address the infodemic and improve education to increase the vaccination rates. Figure 2 outlines some key actions that will be necessary.

Figure 2

Key actions to improve vaccine usage. Attwell et al., 2021, Detoc et al., 2020, Shekhar et al., 2021, Whatley and Shodiya, 2020, Malik et al., 2020, Naeem et al., 2021.

Key actions to improve vaccine usage

Since the beginning of the pandemic in 2019, our world has changed prompting most people to have a dream of returning to “normal”. Increasing the vaccine rates is an important step toward protecting our communities, building herd immunity, and controlling the pandemic. Some employers, governing agencies, and countries have discussed the possibility of mandating the COVID-19 vaccine. Legally, this is a difficult discussion with many variables that can be argued. Most legal experts agree that as long as it is still under “emergency use authorization”, it could be argued to be “experimental” and would be tied up in the courts for a very long time (Rothstein, 2020; Flood, 2021; Khullar, 2021; Vergara, 2021). It is our most favorable option available to continue to flood the listeners with accurate information regarding the COVID-19 vaccine and keep the momentum going until this pandemic is a distant memory.