Insights (Essays)

Insights (Essays) July 2020

Let’s Talk COVID-19 Vaccine Hesitancy

Mobeen Ahmad, Judy Truong and Umair Majid

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Introduction

Vaccination is an integral public health policy that has been implemented by healthcare systems globally for protection against vaccine-preventable diseases. The COVID-19 virus continues to threaten the health and safety of individuals worldwide and researchers are working diligently to deliver on a vaccine that can combat this pathogen. A wealth of knowledge has surfaced over the past few months as scientists continue to amass more information pertaining to the development of a COVID-19 vaccine (Liu et al. 2020). While these research studies show promising results, some individuals continue to refuse routine vaccination despite there being plenty of health resources to account for them (MacDonald 2015). Furthermore, there is no shortage of false information raising fears and misconceptions about COVID-19 and the efficacy of a potential vaccine (Frenkel et al. 2020).

To ensure widespread uptake of a potential COVID-19 vaccine, healthcare professionals must understand factors that encourage or discourage vaccine hesitancy to better address individual concerns. The following paragraphs will delve into our work on vaccine hesitancy both in relation to healthcare providers and during pandemics, epidemics and outbreaks. We hope that our reflections can aid decision-makers to develop strategies around adapting to individuals’ beliefs towards vaccines, which may guide their vaccine administration programs and improve vaccination uptake.

Factors that Might Encourage COVID-19 Vaccine Hesitancy

In a recently published article (Majid and Ahmad 2020), we identified a number of factors that can influence the vaccine decision-making process, such as: 

  1. previous experiences with vaccines and information preferences;
  2. "natural" and "organic" living;
  3. distrust in health system players (pharma, physicians, government and academic research);
  4. and mandatory vaccine policies (Majid and Ahmad 2020). 

We depicted the relationships between these factors as a gear train to emphasize their overlaps and interconnectedness. We explained how changes made to each factor is the equivalent of turning a gear on the train, affecting the remaining factors and ultimately individual perceptions of vaccines. While our review (Majid and Ahmad 2020) is focused more on parents’ expectations of childhood vaccines, we believe our findings and implications can be applied to other populations.

First, individuals expressed fear surrounding vaccine safety, particularly the side-effects that may have long-lasting health implications (Blaisdell et al. 2016). They expressed a belief that healthcare providers were unaware of the long-term effects of vaccines, and therefore, could not provide them with a clear answer on vaccine risks and benefits (Alstyne et al. 2018). To increase acceptance for a potential COVID-19 vaccine, general practitioners or healthcare providers, who interact with patients on a regular basis, need to be more proactive. They must seek out new information, so they continue to be updated with the growing body of evidence surrounding the COVID-19 vaccine. More importantly, healthcare providers will need to prepare themselves to answer challenging questions about vaccine safety and side-effects. We also believe that if healthcare providers explain the uncertainties prevalent in vaccine literature – particularly pertaining to long-term side effects for which evidence may be unavailable – individuals may be more willing to accept vaccination, or at least continue to engage in a conversation with their healthcare providers that may ultimately lead to vaccine acceptance.

In addition to personal experiences, vaccine-hesitant individuals demonstrated an aversion towards allopathic medicine and vaccines, in general, due to their “organic” way of living (Attwell et al. 2018a). Individuals who adopted an organic lifestyle believed that vaccines contained numerous artificial chemicals that were detrimental to their health (Helps et al. 2018). Many individuals may even go so far as to deliberately encourage exposure to COVID-19 for the purposes of “naturally” strengthening their immunity. One strategy to incorporate vaccines into the lifestyles of such individuals is to provide them with information on vaccine constituents. Explaining the vaccine’s mechanism to such individuals may help them align vaccines with their organic lifestyle.

In order to increase trust in a possible COVID-19 vaccine, allopathic healthcare providers, governmental bodies and pharmaceutical companies must establish themselves as trustworthy sources of information in the eyes of vaccine-hesitant individuals. The key to facilitating that trust – and increasing the chances that information will be well received by the general public – may lie in providing balanced information including the risks and benefits (Alstyne et al. 2018). Although this may seem counterintuitive initially to some healthcare professionals, providing information regarding potential side-effects and uncertainties of vaccines may provide individuals the autonomy to make an informed decision. In addition, providing balanced information may also enable individuals to be active participants in the vaccine decision-making process.

Although mandatory vaccination policies can be a useful approach towards increasing vaccine uptake, it is also the reason that leads to entrenchment in vaccine hesitancy (Attwell et al. 2018b). During a pandemic, the idea of enforcing mandatory vaccine policies for a potential vaccine may seem sensible and worthwhile, but the findings of our review (Majid and Ahmad 2020) also demonstrate that such policies can intensify vaccine hesitancy by increasing fear, anxiety and mistrust in health system players. Even if individuals are obligated to accept the COVID-19 vaccine, their vaccine hesitancy may be bolstered, which might have long-lasting implications for the uptake of future vaccines and general health policy recommendations (Dada 2019).

Conclusion

The prospect of a COVID-19 vaccine is a hopeful one. As researchers work around the clock to develop a potential vaccine, we must ensure that it is efficacious and received positively by the public. We must ensure that the information being provided to the public is evidence-based and explores the risks and benefits of vaccines in order to offer a non-biased opinion. Doing so will facilitate a non-judgemental environment that encourages discussion and possibly higher acceptance of vaccination in general. During this dynamic time, it is more important than ever that healthcare providers continue to educate and build trust with their patients to ensure that the COVID-19 vaccine becomes widely accepted. 

About the Author(s)

Mobeen Ahmad, MBBS, completed his medical degree at Allama Iqbal Medical College, Lahore, Pakistan. Follow him on Twitter at @AhmadMo1512.

Judy Truong, BSc, MSc, is a Research Scientist at Acorn Biolabs and MaRS Centre for Impacting Investing, Toronto, ON. https://www.linkedin.com/in/judy-truong-70baab197/

Umair Majid, BSc, MSc, Med, PhD(c), is an Instructor at McMaster University, Toronto, ON, and a Global Health Systems Consultant. Follow him on Twitter @majiduma. https://www.linkedin.com/in/umair-majid/

References

Alstyne, J. A. M-V., G. J., Nowak and A. L. Aikin. 2018. What Is ‘Confidence’ and What Could Affect It?: A Qualitative Study of Mothers Who Are Hesitant about Vaccines. Vaccine 36(44), 6464–72. doi:10.1016/j.vaccine.2017.09.007.

Attwell, K., S. B. Meyer and P. R. Ward. 2018a. The Social Basis of Vaccine Questioning and Refusal: A Qualitative Study Employing Bourdieu’s Concepts of ‘Capitals’ and ‘Habitus’. International Journal of Environmental Research and Public Health 15(5): 1–17. doi:10.3390/ijerph15051044.

Attwell, K., D. T. Smith and P. R. Ward. 2018b. ‘The Unhealthy Other’: How Vaccine Rejecting Parents Construct the Vaccinating Mainstream. Vaccine 36(12): 1621–26. doi:10.1016/j.vaccine.2018.01.076.

Blaisdell, L.L., S. Gutheil, N. A. M. Hootsmans and P. K. J. Han. 2016. Unknown Risks: Parental Hesitation about Vaccination. Medical Decision Making 36(4): 479–89. doi:10.1177/0272989X15607855.

Dada, S., G. McKay, A. Mateus and S. Lees. 2019. Lessons Learned from Engaging Communities for Ebola Vaccine Trials in Sierra Leone: Reciprocity, Relatability, Relationships and Respect (the Four R’s). BMC Public Health 19(1): 1665. doi:10.1186/s12889-019-7978-4.

Frenkel S., B. Decker and D. Alba. 2020. How the ‘Plandemic’ Movie and its Falsehoods Spread Widely Online. The New York Times. Retrieved July 9, 2020. <https://www.nytimes.com/2020/05/20/technology/plandemic-movie-youtube-facebook-coronavirus.html>.

Helps, C., J. Leask and L. Barclay. 2018. "It Just Forces Hardship": Impacts of Government Financial Penalties on Non-Vaccinating Parents. Journal of Public Health Policy 39(2): 156–69. doi:10.1057/s41271-017-0116-6.

Liu, C., Q. Zhao, Li. Yingzhu, L. V. Garner, S. P. Watkins, L. J. Carter, et al. 2020. Research and Development on Therapeutic Agents and Vaccines for COVID-19 and Related Human Coronavirus Diseases. ACS Central Science 6: 315–31.  doi:10.1021/acscentsci.0c00272.

MacDonald, Noni. 2015. Vaccine Hesitancy: Definition, Scope and Determinants. Vaccine 33(34): 4161–64. doi:10.1016/j.vaccine.2015.04.036

Majid, U., and M. Ahmad. 2020. The Factors That Promote Vaccine Hesitancy, Rejection, or Delay in Parents. Qualitative Health Research 1–15. doi:10.1177/1049732320933863.

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