COVID-19 vaccines: Good intent must come with good strategy

The past few weeks have been highlighted by the initial rollout of the COVID-19 Moderna and Pfizer vaccinations.

Last week, the Biden administration announced their intent to release heravailable vaccination doses to facilitate widespread immunization and curtail rates of spread of the disease. As emergency medicine physicians, we have reasons to celebrate. COVID-19 has taxed our medical system to its maximum capacity. Colleagues have contracted the disease, some have even died.

Yet our celebration can only be complete once we can be assured that the rest of the world is vaccinated. It has been estimated that about 70 percent of the population would have to acquire immunity to stop the pandemic. With only 10 percent of the global population having immunity after being infected, this leaves a considerable gap to fill by vaccination. And the quicker we vaccinate, the quicker we reach herd immunity. 

In order for the Biden administration’s strategy to be most effective, we must increase vaccine production, but we also have to ensure better distribution. While the Defense Production Act can help accelerate production, distribution efforts may be more challenging. Thus far, efforts have been slow, starting within our own ranks within health care. Many hospital employees were left out of vaccine distribution plans and others have witnessed shaky rollouts. At Stanford, residents protested after failure to be included in initial vaccination efforts, with some providers without direct patient care receiving the vaccine before them. In other cases, health care colleagues have expressed a sense of their own concerns about receiving the vaccine. A survey by the Kaiser Family Foundation last month showed that a third of health care workers would get the vaccine if offered. 

Vaccine hesitancy, or the public’s unwillingness to get vaccinated, is not a phenomenon unique to the United States. According to the World Health Organization (WHO), it is a global health threat. It has been described in more than 90 percent of the countries in the world and pervasive across different socioeconomic statuses. International estimates suggest that only 69 percent of the population worldwide is willing to receive a COVID-19 vaccination.

There are many reasons at the root of this resistance. Trust in large corporations responsible for manufacturing vaccines and confidence in the governments that buy and promote vaccines are at major challenges. Many Americans worry that the vaccine development was rushed by this administration. As consumerism has increased, patients want to handle their own health and take an active role in decision making and many often view requirements to get vaccinated as “paternalistic medicine.” Access to misinformation through print, broadcast and electronic media has also contributed to the spread of controversial or inaccurate stories. In the Black community, there appears to be an even larger hesitance towards vaccination. Even before the pandemic, Blacks have expressed distrust of government motives for influenza vaccination stemming from a long history of medical racism.

Achieving herd immunity in an environment where the herd seems more split than ever may prove difficult. As vaccines become available outside of the medical community vaccine rollouts must be well-executed to ensure that patients feel safe and trust the process. Not only does this involve systems that appear to be working effectively but also involves effective public health messaging. People are impacted by public figures and take their opinions into account when making health decisions for themselves. Vaccine confidence metrics are very sensitive to the political context. Americans look to key public figures, such as Dr. Anthony Fauci, Speaker of the House Nancy Pelosi (D-Calif.) and the president himself, for guidance on if they should get the shot.

As providers, we must make a collective effort to work with public health agencies and grassroots organizations to ensure that the public and our colleagues are well educated. We must seek to understand circulating myths and rumors about the vaccine and address them head on. If we do not understand the source of hesitancy, how can we effectively seek to change the issue? Once vaccine mistruths are disseminated, they are difficult to disrupt. As an example, the anti-vaccine movement, started by a small and poorly executed study of just 12 patients fueled a worldwide hesitation. Educational interventions should emphasize widespread education of the benefits of vaccination prior to the opportunity for the introduction of such conspiracies.

It is the beginning of a new year, but we continue to fight the same enemy: the COVID-19 virus with areas of the country running out of intensive care unit (ICU) beds. We must also contend with the recent events at the Capitol, which threaten to destabilize trust in political figures in certain groups and shift public attention away from the still-uncontrolled pandemic. It is time that we come together to promote the safe, equitable and trustworthy distribution of this vaccination.

Dr. Christopher Payette is a resident physician at George Washington University. Dr. Janice Blanchard is a professor of Emergency Medicine at George Washington University. The opinions expressed here are their own.