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COVID Vaccine Could End Pandemic but Millions Will Skip It

Although the numbers appear to have improved since drugmakers Pfizer and Moderna reported their impressive trial results last month, about 40 percent of Americans tell poll takers they don't plan to get a COVID vaccine.

by Todd Ackerman, Houston Chronicle / December 14, 2020
TNS
(TNS) - Derrick Broze, a self-described non-vaxxer, harbors no desire to get the COVID-19 vaccine when it becomes widely available.
 
The Pfizer vaccine, expected to arrive in some Houston-area hospitals Monday, may constitute the world's best hope for ending the coronavirus pandemic that has killed nearly 300,000 Americans, but Broze sees it differently: He doesn't want to be "a science experiment for a vaccine against a virus that has a very high survival rate."
 
"I have more concerns about the safety of the vaccine than the dangers of the virus," said Broze, a 2019 Houston mayoral candidate and ringleader of a rally Saturday against mandatory lockdowns and vaccine and mask mandates. "I don't want to put others at risk, but I'd rather keep taking precautions than the risk that comes with a vaccine pushed out as quick as possible."
 
Broze represents no small minority, both in Texas and nationally. In poll after poll, alarming numbers say they don't plan to be inoculated with the vaccine, whose 95 percent efficacy rate in trials exceeded everyone's expectations. It's scientists' nightmare: create one of medicine's landmark achievements only to have large numbers of people not bother to get it.
 
But that appears to be the reality. Although the numbers appear to have improved since drugmakers Pfizer and Moderna reported their impressive trial results last month, about 40 percent of Americans tell poll takers they don't plan to get a COVID-19 vaccine. In Texas, only 42 percent say they will.
 
Public health officials fear such numbers will hinder the campaign to shut down the greatest scourge since the 1918 Spanish influenza.
 
A lack of trust
 
At stake is a possible squandering of the chance to get COVID-19 under control by late summer, to save countless lives that will be lost the longer it takes to stop the spread of the virus. Also at stake is an increased potential for a more lethal or contagious strain of the virus to emerge, always a threat as long as an infection continues to circulate.
 
"The hesitancy is bad for getting the population vaccinated to obtain herd or community immunity, which would allow for activities to become normal again," said Kirstin Matthews, a fellow in science and technology policy at Rice University's Baker Institute. "The Biden administration will need to find ways to gain public trust in the Centers for Disease Control and Prevention and FDA to ensure communities take the vaccine."
 
A national task force led by Johns Hopkins Center for Health Security and Texas State University's anthropology department added that "if poorly designed and executed, a COVID-19 vaccine campaign in the U.S. could undermine the increasingly tenuous belief in vaccines and public health authorities who recommend them, especially among people most at risk of COVID-19 impacts."
 
The Food and Drug Administration granted the Pfizer vaccine emergency use approval Friday night and began shipping it to some 636 sites around the country this weekend, 27 of them in Houston. Hospitals will use the initial doses to vaccinate front-line employees. Doses for the general public will follow in 2021.
 
Concerns about vaccine safety, such as those expressed by Broze, appear the most common reason behind the vaccine resistance. Other reasons include ideological views that vaccines aren't necessary because the pandemic is exaggerated; an increasingly influential anti-vaccine movement; conspiracy theories such as the claim the vaccine will contain a tracking microchip; and the African-American community's distrust of health care authorities because of historic racism.
 
Vaccine mistrust has been building for years, fueled by a small but growing movement that works to exempt children for "reasons of conscience" from school-required inoculations. But the COVID-19 vaccine has brought a new audience to such groups, like Texans for Vaccine Choice. Its leader told publications this summer that its phones were ringing off the hook with calls from people who said they'd gotten other vaccines but don't want this one.
 
Neil Johnson, a physicist at George Washington University who studies anti-vaccine groups on social media, has estimated that in recent months, 10 percent of people on Facebook asking questions about vaccines have switched to anti-vaccine views.
 
"It's going to be a bumpy road," said Peter Hotez, a vaccine scientist at Baylor College of Medicine. "Given media scrutiny and an aggressive anti-vaxxer movement, particularly in Texas, any adverse vaccine events are going to be amplified."
 
Hotez has an answer to those who worry about safety concerns because the vaccine was developed in seemingly record time, concerns fed by the initiative name, Operation Warp Speed, and the perception that President Donald Trump's desire for an October surprise might have caused corners to be cut.
 
The vaccine was really developed over decades, not a few months, Hotez notes.
 
Scientists have studied coronaviruses since the early 2000s when SARS (Severe Acute Respiratory Syndrome), an older cousin of COVID-19, emerged in China and spread to a number of countries, including Canada. Four years ago, a Hotez team developed a SARS vaccine he thinks likely would have provided some protection against COVID-19, the strains are so similar. Research underpinning the new genetic technology Pfizer and Moderna employed on the two vaccines goes back 30 years.
 
Still, fears about the new vaccine run deep. Phillip Chatham, a Houston tax service manager, said he plans to wait a year or to see what side effects surface, given his time in the military in Afghanistan and Iraq, the reaction he saw to vaccines there, his "experience with the lowest bidder."
 
And Anthony Catania, a 65-year-old North Texas man now battling the coronavirus asks, "Why would I risk the vaccine mutating what my old body has taught itself?"

Messaging will be key
 
Such caution isn't just found among everyday Americans. A CDC survey, made public in November, found just 63 percent of health care workers said they would get a COVID-19 vaccine, barely different from the number found in general polls.
 
The percentages are lowest among African-Americans, who have been hospitalized or killed by COVID-19 at far higher rates than whites. A recent Associated Press poll found only 24 percent of Black Americans said they will get vaccinated.
 
The distrust is typically attributed to the Tuskegee experiments, a U.S. government study between 1932 and 1972 in which Black men were told they were receiving free health care but were instead given placebos so the progression of syphilis without treatment could be observed.
 
"A lot is going to depend on messaging," said Catherine Troisi, an epidemiologist at the UTHealth School of Public in Houston. "It has to address fears, show benefits."
 
The upbill battle to persuade African Americans to get the COVID-19 vaccine also is evident in University of Texas/Texas Tribune polling from October. Fifty-four percent of Black respondents said they were unwilling to be vaccinated, and another 17 percent said they were unsure, the poll's most identifiable resistance. Those in rural areas, independents, Republicans and women also were most likely to reject vaccination.
 
The poll's finding that only 42 percent of Texans would get the COVID-19 vaccine is below the amount even for the flu vaccine, which usually provides protection against the seasonal virus about 50 percent of the time. The rate, one of the nation's lowest, jumped from 38 percent in 2017-2018 to 48 percent in 2018-2019, according to the CDC.
 
If only 42 percent of Texans get vaccinated against COVID-19, it would make it unlikely the state would achieve herd immunity, the protection from an infectious disease that occurs when a sufficient percentage of a population has become immune to a circulating virus. That percentage is still to be determined, but public health experts expect the figure to be between 65 and 70.
 
Hoping polls are wrong
 
Of course, herd immunity comes from not just vaccination but also past infections. At the rate COVID-19 is spreading, some 30 percent of the state's population may be infected with the virus by late spring, based on early results from ongoing antibody surveys that suggest a current figure of nearly 20 percent.
 
That might get the state in the desired ballpark, but experts note that there would likely be some overlap of people previously infected and those getting vaccinated and that by mid-2021, immunity may wane in some people infected early in the pandemic. Also, children represent 20 percent of the population, and they won't be vaccinated until last because the shot's safety has yet to be studied on them.
 
Plus, there will be pockets where there is less herd immunity because of vaccine resistance, such as rural areas or minority neighborhoods.
 
"That's why it's so important that we vaccinate more people than the polls indicate," said Troisi. "We're going to need a higher percentage of people getting the vaccine to achieve herd immunity."
 
But public health officials are hopeful that the percentage of people getting vaccinated will be higher than the polls predict. For one, the polls are moving in a positive percentage nationally. A few months ago, before trials showed the Pfizer and Moderna vaccines provided protection 95 percent of the time, the percentage of people saying they'd take the vaccine was about 50 percent.
 
Officials are also hopeful because they think getting the vaccine will become a societal norm as it becomes clear it's effective, causes no serious side effects and allows those who got it to be confident enough to circulate freely again.
 
In any event, there'll be more people wanting to get the vaccine than available vaccines through the spring, said Dr. Paul Klotman, president of Baylor College of Medicine.
 
"If people choose not to get the vaccine, they're putting their life at risk," said Klotman. "I'm really not sure what they're thinking — we're now losing more people a day than we lost in Pearl Harbor or 9/11 and there's more risk in driving your car than taking a vaccine."
 
todd.ackerman@chron.com
 
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