How to Prepare for Public Dissent from a COVID-19 Vaccine

It will be critical to lay the groundwork for a novel coronavirus (COVID-19) vaccination program even prior to its successful development, according to a Viewpoint recently published in JAMA.

A team of investigators from Washington, DC, said at the time of publication that 8 vaccines were currently in phase 1 trials, with the goal of becoming a globally-implemented and safe solution for the pandemic.

But, they wrote, “as launches of prior mass vaccination programs have demonstrated, careful planning to ensure readiness of both the general public and the health community for a COVID-19 vaccine should begin now.”

A vaccine refusal rate greater than 10% would impede a targeted vaccination rate of between 55% and 82%, which is the early estimate for achieving herd immunity against this virus. Beyond those who are ineligible for the vaccine due to biological, environmental, and socio-behavioral factors, vaccine hesitancy could be a real barrier to herd immunity, the authors noted.

As such, their commentary addressed possible objections to a COVID-19 vaccine.

One common belief, they wrote, is that the benefits of vaccinations do not outweigh the risks. However, that may be combated in the case of COVID-19 due to overwhelming morbidity and mortality rates associated with the virus. A 1996 paper demonstrated that enthusiasm for vaccines is “highest during a pandemic, prior to, and immediately following the release of a novel vaccine,” investigators wrote.

Because of this, the global health care community should capitalize on anticipated welcoming of a vaccine with a well-organized distribution plan.

Vaccine safety also is typically an issue, investigators noted, and these should be addressed before and during vaccine distribution. Another tool global agencies should employ is educational programs that inform the masses about herd immunity.

Another barrier this vaccine may face is the argument of “freedom of choice,” which can stem from mistrust of the medical community, investigators wrote. The COVID-19 burden is borne by African Americans, most often, so their perspective on vaccination will be critical in this instance. Enlisting the help of cultural leaders to develop and spread relevant messaging through various venues and formats would be helpful in reaching those most vulnerable to COVID-19.

Investigators stressed that a proactive, educational vaccine campaign should be leveraged on both traditional and social media to cast the widest net and reach the biggest audience possible. Healthcare agencies should monitor real-time social media updates, as the platform can be a source of both factual and false information.

Others that may be able to play a central role in encouraging COVID-19 vaccination are healthcare workers, investigators added. Strong recommendations by physicians can bolster support for vaccinations in the community, as can the influence of nurses and allied health professionals.

“Ensuring that all individuals who interface with patients in the clinical setting are confident about the safety and effectiveness of a future COVID-19 vaccine is critical for presenting a unified message of strong vaccination support from the medical community,” they wrote.

The eventual vaccine should be delivered to the public in an equitable and just fashion as soon as rigorous testing is completed, and it should target those at the highest risk for complications and disease transmission. A vaccination program should also be prepared to address potential obstacles to wide acceptance through both educational campaigns and the endorsement of health care professionals, the team concluded.

“Frontline health care workers should be taught how to make strong recommendations for COVID-19 vaccination, including, if relevant, sharing their personal experiences with COVID-19 and the vaccine,” they wrote.