By Michael Ross and Diem Pham, Founding Partners, ROAMcare
Every day, people are sickened, hospitalized, and succumb to preventable diseases. Vaccines Bring Us Closer was picked as the theme of this year’s recently celebrated World Immunization Week by The World Health Organization to show how vaccination connects us and improves our global health. Although the new coronavirus vaccines and the annual influenza vaccines may be the first to come to mind, there are many other vaccines and immunologic initiatives that have improved our lives and brought us closer. There are vaccines approved for use in the United States to protect us from 14 different diseases, from whooping cough to shingles. Being in the middle of a global pandemic and its vaccination efforts, we no doubt are more focused on the new COVID-19 vaccines.
People elect not to receive vaccinations for a variety of reasons. Vaccine hesitancy isn’t new to the COVID-19 pandemic. For some diseases with very effective vaccines and high vaccination rates, it may be the success of those vaccination programs that lead to indifference, and hence disease outbreaks. Overcoming vaccine hesitancy is a difficult challenge, and when the challenge is not met the results can be devastating. In 2012 over 48,000 pertussis cases were reported to the Centers for Disease Control and Prevention. Considering that pre-vaccine cases topped 200,000 per year, 48,000 is a remarkable decrease. But considering that in 2002 there were less than 10,000 reported cases and in 1982 there were less than 2,000 cases, those 48,000 cases represented an almost 500% increase over 30 years. It would appear the trend line is heading in the wrong direction.
For polio, after having two of the three known infectious strains declared eradicated in 2015, case counts are climbing. As of last October, there were 441 cases of polio in the world. This was up from 378 cases reported the year before and only 15 in 2016, nearly a 3000% increase in less than five years.
People choose to not be vaccinated for a variety of other reasons. The two most cited reasons for avoiding vaccines are fear of contracting the disease and apprehension over possible side effects. More recently cited reasons include the misunderstanding of how vaccines work, people’s willingness to rely on herd immunity, a concept not widely discussed before the current COVID-19 vaccination efforts, and societal pressure to not give in to perceived government mandate or loss of personal freedom. By the close of April 2021 only 30% of the United States was fully vaccinated against COVID. Of more concern is the findings from a poll conducted in March 2021 by the Kaiser Family Foundation COVID-19 Vaccine Monitor. The poll found that of those not yet vaccinated, 13% answered they have no intention of getting the vaccine and an additional 7% would agree to be vaccinated only if required.
Presently we have an opportunity to make a significant difference in the control of the coronavirus with the rapid development of several COVID-19 vaccines. This difference cannot be made by the WHO, the CDC, or local departments of health. It will take health professionals willing to educate the public on the benefits of the vaccines and a willing public to be vaccinated. To be effective, that education must be specific to the target patient group. Patients who are uncertain about receiving the vaccine because they are concerned about getting the disease or exaggerated side effects need education on the immune response and to not confuse normal post vaccination effects with actual infection. Others who refuse to be vaccinated because they feel it is an infringement on their personal rights might better respond to logical discussions that with greater vaccine utilization, pre-pandemic activity can return to normal including greater freedom of movement for everybody. The patients “waiting out” being vaccinated in the hopes of relying on herd immunity may be educated on current vaccine rates and a sincere request that they join those already vaccinated so they can contribute to the “herd” cohort.
The Kaiser Family Foundation survey also found that 18% of health care workers polled said they would not be getting the COVID vaccine and an additional 12% had yet to decide if they would. Again, hesitancy is high. Among those identified as not getting or not yet decided to get the vaccine, 81% cited the newness of the vaccines as a reason for their hesitancy. Vaccines normally take several years to develop, yet the COVID 19 vaccines were created in less than a year. It is understandable that mistrust and misconceptions about safety and efficacy may arise from this process. Keep in mind that we are not operating under normal circumstances but are in the midst of a pandemic and time is of the essence. We have had unprecedented global collaboration and cooperation from scientists and researchers contributing to the efforts to end the pandemic. Extensive clinical trials demonstrated safety and efficacy. Surveillance and monitoring are continuing post vaccination to ensure long term safety. Confidence will replace hesitancy when healthcare professionals at the forefront of this pandemic embrace the available means to lower their risk of infection. Those administering the vaccines who are vaccinated add to the confidence of the yet unvaccinated public.
The COVID vaccines have been administered to millions of people yet hesitancy remains. Evidence indicates that the vaccines are safe and effective. Caregivers can serve as role models by getting the vaccine, sharing their experiences, and encouraging others to do the same. It is important that healthcare professionals evaluate the risk and benefits of COVID vaccine and determine if safety has been compromised. This is one infectious disease that we can prevent and it takes each one of us to make that possible.
If the COVID vaccines were not yet available and took another year to develop, would we respond differently to getting vaccinated? We could still be discussing how long the isolation practices will continue instead of how soon we will be able to socialize again. It took us a while but now we don our masks as part of our routine. We could keep social distancing into the unforeseeable future. We could continue to live in fear while waiting.
Vaccines have the potential to bring us together. As healthcare professionals, we can offer accurate information, provide guidance, and encourage vaccination. Vaccines only work if people are willing to be vaccinated. Will we let vaccines do their work and bring us together or will we let the disease tear us apart?