An obstacle to vaccinating healthcare staff against COVID-19 is hesitancy cultivated through the consumption of spurious information.

Although public health officials usually promote a science-based approach to infection prevention and vaccination, some government officials, and even a few healthcare providers, support anti-vaccination, anti-mask views. In December, a Senate committee held a hearing about COVID-19 treatments and vaccines. Lawmakers made time to hear from some who oppose vaccine mandates.1

Considering the mixed messages from public figures, it is easy to understand why some, including healthcare workers, are skeptical of vaccinations, particularly when the COVID-19 vaccines are so new. Some may be skeptical only of the COVID-19 vaccine just because of the unusually fast development process.

“Vaccine hesitancy is a complex topic,” says Kate Strully, PhD, MA, associate professor of sociology at the University at Albany (NY). “When we discuss [hesitancy] in the U.S., even though it’s becoming more nuanced now, it gets polarized, and you’re [labeled] pro-vaccine or anti-vaccination. My collaborators did some focus groups with healthcare workers around the state of New York, and that work still is in progress. There were a lot of concerns around the role of racism and concerns about rushing the vaccine.”

The Infectious Diseases Society of America (IDSA) held a virtual COVID-19 vaccine briefing on Dec. 3. During that session, panelists discussed the hesitancy issue. C. Buddy Creech, MD, MPH, FPIDS, principal investigator for the Phase III trials for Moderna’s and Johnson & Johnson’s SARS-CoV-2 vaccines, said the fast development process should not be a concern for the public or healthcare workers.

“We get so excited about seeing how quickly we can leverage resources,” said Creech, director of the Vanderbilt Vaccine Research Program. “We’ve been laser-focused on leveraging our resources to find an end to this pandemic. We’ve had a call to arms to try to focus only on this, and we’ve lived and breathed COVID treatment and vaccine research.”

That focus, combined with abundant resources, has made it possible for vaccine candidates to reach the public so quickly. “We’re not cutting corners anywhere, but just are doing things in a deliberate and speedy way,” Creech said. “We have to roll out these vaccines in a deliberate and staged manner. That’s very important as we go to our healthcare workers.”

Convincing staff a vaccine is important and safe will take a robust educational plan. Administrators can start by meeting with staff and encouraging them to ask questions. Leaders should emphasize the safety and efficacy data, according to Robert Salata, MD, principal investigator for the Pfizer/BioNTech vaccine trial and chair of the department of medicine at University Hospitals Cleveland Medical Center.

For example, the safety profile of the Pfizer/BioNTech vaccine shows that about 10% to 15% of people experience side effects, primarily at the site of the injection. “But in one or two days, it’s gone,” said Salata, who also spoke at the Dec. 3 IDSA briefing. “Some can get a flu-like illness, but it’s over in 48 hours. It’s all been mild reactions.”

The authors of a recent study examined the motivations of vaccine-hesitant people who also were social media influencers. Researchers found this group did not trust mainstream sources of health information, relying instead on alternative sources and search engines.2

“We found the networking that happens in social media between influencers and other social media users is a place where sentiment around vaccination beliefs is shared,” says Amelia Burke-Garcia, PhD, MA, program area director of digital strategy and outreach in the public health department of NORC at the University of Chicago. “Many of our participants in our study were vaccinated themselves as children. In some cases, their older children had most or all of their vaccines.”

Over time, these participants progressed to the belief that they should not vaccinate their younger children, at least with certain vaccines.

“We also heard of their mistrust of traditional sources of information and feeling platforms like Google and other social media platforms are biased in the information they share,” Burke-Garcia explains. “They seek out alternative sources that they feel provide, from their perspective, a more balanced view, such as a search engine called Duck, Duck, Go.”

Many participants relied on anecdotal and personal data. “Some of them said, ‘I had chicken pox as a child, and that was a rite of passage, a normal human part of life,’” adds Amy E. Leader, DrPH, MPH, who worked with Burke-Garcia on the study.

Beyond combatting all the misinformation, there are logistics problems. The Pfizer/BioNTech and Moderna vaccines require patients to receive two shots, administered at separate sessions. It is unknown whether everyone will have to receive a vaccine annually, and it is likely few, if any, people will have a choice about which vaccine they receive.

Even when the vaccine arrives, some healthcare organizations may not mandate staff to receive it.

“It’s my understanding that many surgery centers and healthcare providers and settings are going to require this,” says Frank Chapman, MBA, chair of the standards development committee for the Accreditation Association for Ambulatory Health Care. “It’s the safest possible thing, especially for the next year. I think we’re going to get into some legal areas that balance an individual’s desire to not be forced to take the vaccine against the overall safety concern of providing care, especially to patients at high risk, and that’s going to play out.”

Although mandatory vaccine policies can be controversial in some settings, they can make it easier to keep staff safe during the pandemic. “It would be a best practice to have all the staff vaccinated against COVID-19,” says Sean A. Diehl, PhD, an associate professor of microbiology and molecular genetics at the University of Vermont.

REFERENCES

  1. U.S. Senate Committee on Homeland Security & Governmental Affairs. Early outpatient treatment: An essential part of a COVID-19 solution, part II. Dec. 8, 2020. http://bit.ly/3qVrcBT
  2. Leader AE, Burke-Garcia A, Massey PM, Roark JB. Understanding the messages and motivations of vaccine hesitant or refusing social media influencers. Vaccine 2020; Dec 3;S0264-410X(20)31533-4. doi: 10.1016/j.vaccine.2020.11.058. [Online ahead of print].