Enough With the Hand Wringing Over Covid-19 Vaccine Hesitancy
Overdramatizing hesitancy can actually reduce confidence for others
For the past several months, headlines have announced one survey after another about how many Americans say they will or won’t get the Covid-19 vaccine — which doesn’t actually exist yet. The implication, voiced in June by Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, is that vaccine hesitancy will be a major obstacle to fighting Covid-19 once a vaccine is available because not enough people will be willing to get it to create herd immunity.
But there are problems with this popular narrative. For one thing, vaccine hesitancy isn’t actually likely to be a major problem with the yet-to-be vaccine—at least not yet. It’s possible hesitancy about a Covid-19 vaccine could become an issue later on as the vaccine becomes more widely available and recommended, but there are too many other more urgent logistical issues that take priority right now.
Besides, it’s entirely reasonable for people to be skeptical about a new vaccine. In fact, concern about a potential Covid-19 vaccine is healthy, particularly given the speed of its development, and is shared by many scientists and public health experts. Even vaccine researchers cannot say right now that they will definitely get whatever Covid-19 vaccine is developed.
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“People should be skeptical about anything they put into their bodies, especially a vaccine that’s being developed faster than any vaccine in history and that has language surrounding it that’s a little scary, like ‘warp speed’ and ‘race for a vaccine,’” says Paul Offit, MD, director of the Vaccine Education Center and an infectious disease pediatrician at Children’s Hospital of Philadelphia, who co-developed the rotavirus vaccine. “People wonder whether timelines are being unreasonably compressed, the trial phases are being skipped, that safety guidelines are being ignored — those are understandable questions.”
Further, what people say they’ll do in a poll and what they actually do often diverge substantially.
“Publicizing and dramatizing these percentages of people who would not accept the vaccine runs the risk of reducing confidence in a vaccine that is eventually available.”
Surveys about vaccine hesitancy are practically meaningless
All the experts I spoke to for this story see little value in public surveys about Covid-19 vaccine uptake.
“I don’t think there’s a lot of value in asking hypothetical questions about hypothetical vaccines that don’t exist, that haven’t finished all their scientific evaluations yet,” said Holly Witteman, PhD, an associate professor of medicine at Laval University in Quebec City, Canada, who studies vaccine hesitancy. “What it does is it creates dramatic headlines, but it doesn’t actually serve the public in any meaningful way.”
In fact, the repetition of such headlines runs the risk of creating or enhancing the problem they claim exists. “Publicizing and dramatizing these percentages of people who would not accept the vaccine runs the risk of reducing confidence in a vaccine that is eventually available,” Witteman says. That appears to already be happening in the latest poll from Pew Research, which showed a sharp drop between May and September in the percentage of Americans who say they would get the Covid-19 vaccine. Some of that could be due to a loss of trust in public health institutions, such the Centers for Disease Control and Prevention (CDC) and the Food and Drug Administration (FDA), in recent weeks, but it’s impossible to rule out the influence of constantly seeing headlines trumpeting how many people have concerns about the vaccine.
Also, research has shown that general surveys like these aren’t very accurate predictors of what people think or do, according to Maya Goldenberg, PhD, an associate professor of philosophy at the University of Guelph in Ontario, Canada. Goldberg specializes in vaccine hesitancy research and has a book on it coming out in spring 2021.
“Research on these kinds of surveys suggest that when people answer these kinds of surveys, they’re not always telling you what they think; they’re actually demonstrating allegiance to ideas or worldview,” Goldenberg says. And as any social psychology researcher can attest, people’s beliefs, intention, and behavior are each different measures. “We know from other contexts, including pediatric immunization surveys, that intention and action often don’t line up,” Goldenberg says.
Most importantly, it’s unhelpful to ask people what they think of a vaccine without data on it.
“If you asked me the question that the Boston Globe and CNN asked, which was ‘Would you get a Covid-19 vaccine if offered,’ my answer would be ‘Not until I see the data,’” Offit says. “If you ask a question where you know what the characteristics of the vaccine are, like ‘Would you get a vaccine that’s 75% effective, that prevented you from being hospitalized, that prevented you from dying, that’s been tested in 20,000 people and has been shown to be safe, and there’s 1,000 people dying a day, would you get that vaccine,’ that’s a different question, and I’d give a different answer.”
Vaccine hesitancy is low on the list of obstacles
It’s understandable that public health experts and the public at large might be concerned about vaccine hesitancy. After all, the increase in disease outbreaks, especially measles, in recent years has resulted directly from pockets of low immunization rates in the country. And less than half of U.S. adults get the flu vaccine each year.
But there are bigger fish to fry with the Covid-19 vaccine.
“Vaccines have never been manufactured and distributed at this scale, so the number of hiccups along the way is going to be huge,” Goldenberg says. Just one example is the global shortage of glass vials for the vaccine — and even the glass itself needed to manufacture them. “When you’re dealing with minutiae like that, that means that vaccine hesitancy and refusals is a down-the-road problem,” Goldenberg says. “People who want it are going to want it right away. Chances are, it’s going to be hard to keep up with that demand.”
Offit and Witteman agreed, citing the challenges of manufacturing enough vaccines for a country of more than 300 million people, storing the vaccine at the appropriate temperature and finding ways to safely distribute it. Plus, the earliest batches of the vaccine will likely go to specific populations, such as health care workers, factory workers, retail workers, teachers, and other essential workers, Offit said.
In the near term, demand will be a bigger issue than hesitancy for Covid-19 vaccines that become available.
Could vaccine hesitancy eventually be a problem for Covid-19?
Just because vaccine hesitancy isn’t likely to be an immediate issue for a Covid-19 vaccine doesn’t mean it won’t ever be a problem, especially since “we’re already starting in an environment where vaccine hesitancy exists, usually around influenza vaccine and pediatric vaccines,” Goldenberg says. “We’ve already got a base of people who harbor some kind of hesitancy around vaccines. Add to the mix that this is a new vaccine, so we don’t have the long-term data, and it’s been rushed to market, and you’ve got all kinds of reasons for people to hesitate even more.”
But not all low vaccination rates occur because of hesitancy, Witteman says. It has to be easy for people to get the vaccine in their daily lives. If it’s not free or available during times that it’s easy to get, people won’t get it. According to a recent briefing by Paul Mango, deputy chief of staff for policy at U.S. Health and Human Services, the federal government’s goal is that “no American has to pay a single dime out of pocket to get a vaccine.” Assuming the administration follows through on that promise, it will also need to be convenient to get if the government wants as many people as possible to receive it.
In the near term, however, demand will be a bigger issue than hesitancy for Covid-19 vaccines that become available. It makes sense for public health officials to be aware of the potential for vaccine hesitancy and refusal and have strategies in mind for addressing them down the road. But given how many other challenges face the U.S. between now and then — both within and outside of public health — it would be nice to set the surveys about Americans’ attitudes toward the vaccine aside and cross that bridge when we come to it.