Reasons for Covid-19 vaccine hesitancy are many; here’s what medical and public-health experts say about some concerns

Illustration from MedPage Today

By Melissa Patrick
Kentucky Health News

In a society that gives out trophies for participation, it’s only natural that the U.S. is celebrating that about a third of its population is fully vaccinated against the coronavirus and 43% have received at least one dose of a vaccine.

But hold those trophies, public health officials might say, because we have a ways to go before we reach herd immunity that will offer a level of protection for those who can’t or won’t get a vaccine — and to keep the virus from spreading and mutating, perhaps into more contagious variants.
Vince Venditto, assistant professor in the University of Kentucky College of Pharmacy, told Kentucky Health News he likes to call herd immunity “community immunity” because that better describes what that term actually means and doesn’t invoke an image of cattle.
Herd immunity occurs when a certain percentage of a population is protected against a disease, either through vaccination or infection, providing significant protection for people who are either unwilling or unable to get vaccinated. Health experts aren’t sure, but say a vaccination rate of 75% to 80% is needed to reach herd immunity for the coronavirus.
So, right now the U.S. is  not even halfway to herd immunity, and Kentucky’s even farther from it, with with only 29% of the state’s population fully vaccinated and 39% having received at least one dose of a vaccine.
Venditto stressed that getting vaccinated is not only about protecting yourself from the virus, but also about protecting the community.
“We need to have a high enough level in our community because there are people in our community that cannot be vaccinated,” he said. “There are medical reasons why they cannot be vaccinated, and so we need to make sure that we’re getting vaccinated to protect the rest of our community.”
Whether the nation or Kentucky are able to meet that goal remains uncertain, since vaccination rates are dropping, the percentage of people not returning for a second shot has gone up, and a persistent 13% of people say in polls that they won’t get vaccinated, no matter what.
Even so, the goal remains the same: to get at least 75% of the population vaccinated to slow the spread of the virus, to slow the spread of the more contagious variants, to decrease hospitalizations and deaths and to get on with life as we used to know it.
The Kaiser Family Foundation Covid-19 Vaccine Monitor found in March that Republicans, white evangelicals and people in rural areas were most likely to say they would “definitely not” get the vaccine, but the poll report cautioned that “no group is monolithic in their vaccine attitudes.”
What that boils down to is that there can’t be a one-size-fits all approach to get the 17% of people who said in the Kaiser foundation’s poll that they would “wait and see” before getting vaccinated. Venditto and the foundation say it’s important that this group hears messages from trusted sources.

“If somebody doesn’t trust the information that is available on what I believe are very trusted sources, I don’t know that you can convince them without sitting down and connecting with them on a personal level,” Venditto said. “I think the challenge that we face as a society is getting enough of those people, leaders in the community, to actually sit down and serve in that capacity.”

That point came to life in an April 30 New York Times article, titled “Faith, Freedom, Fear: Rural America’s Covid Vaccine Skeptics.” It tells a story about the challenges vaccine proponents in East Tennessee have in convincing their largely white, Republican, Christian neighbors to get vaccinated.
Reporter Jan Hoffman sums it up: “A week here in Greene County reveals a more nuanced, layered hesitancy than surveys suggest. People say that politics isn’t the leading driver of their vaccine attitudes. The most common reason for their apprehension is fear — that the vaccine was developed in haste, that long-term side effects are unknown. Their decisions are also entangled in a web of views about bodily autonomy, science and authority, plus a powerful regional, somewhat romanticized self-image: We don’t like outsiders messing in our business.”
She describes the “near-joyous fatalism” among the religious who believe getting the virus, or not, is in God’s hands, and if they get it and die, they are bound for Heaven. She goes on to write about many who have gotten the vaccine, but don’t tell anyone — let alone encourage others to get one too.
But Hoffman also reports that “resistance is not firm” and there is a hunger for information from trusted people, a need for paid time off to recover from any side effects, and a desire to get the shot from their own doctor.
The Biden administration it offering tax credits to employers for paid time off, and Kentucky and some other states are slowly moving away from mass vaccination and scattering vaccine supplies among local providers.
KFF’s polling found, much like Hoffman’s reporting, that the No. 1 reason people gave for their hesitancy were concerns about potential side effects, including missing work because of them. Other concerns reflected a lack of easy access to the vaccine, often related to transportation or the desire to get it from a trusted provider. Others said they had a lack of accurate information.
Here are some common reasons given for not getting vaccinated, along with what medical and public-health experts say.
“The vaccines were created too quickly.” They were created and approved in less than a year, by far a record, but it wasn’t as rushed as it seems. Drug companies used research that had been in place for several decades along with “technical expertise, urgency and financial resources” from the federal government, Kaiser Health News and PolitiFact report in detail.
Added to that was the willingness of tens of thousands of Americans to take part in clinical trials that showed the vaccines work. They numbered many more than studies done for many licensed vaccines, which have had as few as 3,000 participants in their clinical trials, said Dr. Ruth Karron, director of the Center for Immunization Research at Johns Hopkins University.
The U.S. Food and Drug Administration has firm guidelines that it has to follow before it can  approve a vaccine for emergency use, the current authorization for all three vaccines used in the U.S.
“I’m going to wait and see before I get a vaccine.” Through April, Americans had taken more than 240 million doses of vaccine. Only two serious health issues have reported after vaccination, and both are rare, says the CDC.
“A small number of people have had a severe allergic reaction,” anaphylaxis, after vaccination, the CDC says. Because of this, anyone getting a shot is asked to stay at least 15 minutes afterward for observation, and vaccinators have medications available to immediately treat this reaction.
And after receiving the Johnson & Johnson vaccine, 15 women out of 7 million people who took the one-dose vaccine had an unusual type of blood clots with low platelets. Use of the vaccine was paused for a little over a week, but federal officials declared it safe for use, with a caution for women of child-bearing age. The CDC notes that the problem occurred at a rate of about seven per 1 million vaccinated women between 18 and 49, and “for women 50 years and older and men of all ages, this adverse even is even more rare.”
What about long-term side effects? They are unlikely from the vaccines, the CDC says, because side effects generally happen within six weeks of receiving a dose, and the FDA required each of the vaccine recipients to be monitored for at least eight weeks after the final dose. “Millions of people have received Covid-19 vaccines, and no long-term effects have been detected,” says the CDC.

That should settle the matter, Venditto said: “I don’t think that we’re going to be able to get more data to suggest that they are any more safer than what we already have collected. And so, for people who are waiting to see, we have enough data.  I don’t know that waiting any more is going to generate anything more convincing than what we already have.”

“I’m concerned about the effectiveness of a vaccine.” Yale Medicine compares effectiveness of the vaccines:
  • The Pfizer-BioNTech vaccine is 95% effective in preventing Covid-19 in those without prior infection and 100% effective at preventing severe disease.
  • The Moderna vaccine is 94.1% effective at preventing symptomatic infection in people in those without prior infection. The efficacy rate dropped to 86.4% in people 65 and older.
  • The Johnson & Johnson vaccine has a 72% overall efficacy rate and an 86% efficacy rate against severe disease in the U.S.
All of these vaccines protect against the highly contagious B.1.1.7 variant, which was first detected in Great Britain and is now the most dominant strain in the U.S.

The variants are “all the more reason to get vaccinated,” Dr. Anthony S. Fauci, the nation’s top infectious-disease specialist, told The New York Times. “The vaccines we are using very well protect against the most dominant variant we have right now, and to varying degrees protect against serious disease among several of the other variants.”

A recent CDC study found that the Pfizer and Moderna vaccines can reduce coronavirus-related hospitalizations in fully vaccinated adults 65 years and older by 94%, compared to the unvaccinated.
The CDC has a website on vaccine effectiveness, with links to research.
“I’m worried about the side effects.” Common side effects from the vaccines include pain, redness and swelling at the injection site, and tiredness, headache, muscle pain, chills, fever and nausea throughout the rest of your body. Many if not most people have no side effects at all.
Generally, side effects only last a few days and are more intense after a second shot. The CDC recommends calling your doctor if you think you may be having a severe allergic reaction, or if the redness and tenderness at the injection site gets worse after 24 hours and your side effects don’t go away after a few days.
Side effects are actually a good sign, because they it means the vaccine is training your immune system how to recognize and fight the virus. Vox created a YouTube video to explain why side effects are good.
“I’m worried about catching Covid-19 from the vaccine.” You can’t. And if you can’t catch the virus from a vaccine, you won’t infect your family, which is also a concern for some.
The vaccines used in the U.S. do not contain the virus that causes Covid-19, which means that a Covid-19 vaccine cannot make you sick with the virus, the CDC says.
Some people catch the virus after being vaccinated, because it takes several weeks for the body to build immunity.
“I already had Covid-19 so I don’t need a vaccine.” While people who have been infected have some level of immunity, they can’t know how strong their immune response is without further testing, which is not done routinely and can be expensive, Venditto explained.
“The data indicate that people who are infected have very variable responses,” he said. “People who are immunized have very strong and consistent responses that are persistent for a long period of time.”
“I’m young and healthy, so I don’t need the vaccine.” Fauci pushed back on recent comments by podcaster Joe Rogan advising young, healthy people to not get vaccinated, which Rogan has since clarified.

Young, healthy people should “absolutely” get vaccinated, Fauci said, noting that unvaccinated, asymptomatic people “are propagating the outbreak” because they can infect others who may be at high risk from the disease, and may do so without having any symptoms.

“I’m afraid of needles.” This fear, known as trypanophobia, affects about 25% of adults, according to the CDC. The Johnson & Johnson vaccine would be the best for such people since it only requires one shot.
“I heard that . . . “ Some hesitancy about vaccines is caused by completely false reports circulating on on the internet, such as the notions that they contain aborted fetal tissue (they don’t) or a microchip that allows recipients to be tracked, or worse. Hoffman describes a discussion about this false rumor among a Tennessee couple and their doctor:

Dr. Lewis patiently addressed the Fletchers’ questions, delineating between what researchers do and don’t yet know.
“How can we be sure there are no chips in the vaccine, like the things you put in your dog?” Mr. Fletcher asked.
“We can’t make microchips that small,” Dr. Lewis countered.
“Well, it’s like a grain of rice,” said Mr. Fletcher.
“I couldn’t inject a grain of rice with a needle,” Dr. Lewis said.
Dr. Lewis held up his smartphone. If you’re worried about being tracked, he said, all the technology is right here, in the very thing you pick up every day. Every hour.
The Fletchers [he is a retired telecommunications engineer] looked abashed.
“It’s your decision,” Dr. Lewis said gently. “I just want you to be able to make an informed decision and I want to do the best I can to help you.”
Mr. Fletcher replied, “Well, we have to spend some time in discussion.”
Later, Dr. Lewis was optimistic: “I think I can eventually persuade them.”
To date, the Fletchers say they will not take the vaccine.

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