After conducting two rounds of clinical trials to determine that their COVID-19 vaccines are safe, pharmaceutical giant Pfizer and biotech startup Moderna launched phase 3 trials in late July to determine whether the vaccines could reduce infection risk on a mass scale. They have contracted with dozens of clinical research sites across the country to recruit a total of 60,000 volunteers for the two-year study. Participants will receive one shot of either the vaccine or a placebo, followed by a booster shot about a month later. There is cautious optimism that a vaccine might be available by the end of the year. But what happens if a significant number of people refuse to be immunized? One-third of Americans in a CNN poll said they would not get vaccinated against the coronavirus, even if a vaccine is widely available and affordable. That number remains steady across other surveys as well. In an August 14 poll by NPR, PBS NewsHour, and Marist, 71 percent of Americans said the coronavirus is a real threat but 35 percent said they wouldn’t get vaccinated. Resistance to a COVID-19 vaccine is especially strong in Black communities. A Pew Research Center study published in June 2020 found that 44 percent of Black adults said they would not get a coronavirus vaccine if one were available. To be truly effective, vaccines must create herd immunity, where enough of the population is immune to stem the spread of infection. Anthony Fauci, MD, director of the National Institute of Allergy and Infectious Diseases, has said that if only two-thirds of the population is vaccinated, herd immunity is less likely. In a sign that the vaccine, like the pandemic itself, has been politicized, there are huge divisions along education and political lines. People with college degrees are 19 points more likely to get vaccinated than those without (72 percent to 53 percent), and Democrats are 23 points more likely than Republicans (71 percent to 48 percent). RELATED: Mask Wars: Which Side Are You On?
Growing Distrust About Vaccines
Concerns about immunizations predate the coronavirus pandemic. Over the past decade, early-childhood immunization rates have been slipping, leading to the worst measles outbreaks since the disease was declared eradicated 20 years ago. The World Health Organization lists vaccine hesitancy as one of its top 10 global health threats. Some of the skepticism reflects a mistrust of the pharmaceutical industry or the government. Many Americans have never seen diseases like measles, mumps, diphtheria, or polio and think these immunizations are unnecessary. The current crisis reflects the general mistrust of vaccines and is made more alarming because, rather than a thousand cases of measles in one year, COVID-19 has already killed more than 184,000 Americans. Carol McSwain, 63, was vaccinated as a child during the government’s mass immunization programs of the 1960s. Twenty years later, she vaccinated her own two children, a decision she now regrets. “I wasn’t as informed as I am now,” she says. “I just don’t trust them, and I’m definitely not getting this coronavirus vaccine.” Although neither McSwain nor her children ever suffered ill effects from the vaccines, the retired educator in DeKalb, Georgia, believes there must be something to the many claims about the nefarious intentions of vaccine proponents. She’s active on social media, sharing anti-vaccine viewpoints, including Plandemic, the much-watched video filled with conspiracy theories about the virus and the pandemic.
The Power of Social Media
In a CNN report, National Institutes of Health (NIH) director Francis Collins, MD, PhD, said he underestimated the level of public resistance to the vaccine, given the visible toll the virus has taken on the country. But the internet and social media are formidable opponents. Among other things, skeptics have claimed the vaccine is a CIA plot to take over the world or a way for Bill Gates to implant tracking devices and monitor people around the globe. A July report from the Center for Countering Digital Hate found that falsehoods about a COVID-19 vaccine have been prevalent on social media sites for months and grown more dire over time. Most prominent were “anti-vaccination entrepreneurs,” people who sell or profit off of vaccine misinformation. A new study published by the University of Pennsylvania Annenberg Public Policy Center based on Twitter activity related to the 2018–2019 flu season found that tweets that express concerns about vaccines were already connected to negative attitudes about immunization.
Is Warp Speed Too Fast?
When health authorities repeatedly tout Operation Warp Speed, the $10 billion public-private partnership initiated by the U.S. federal government that is driving much of the current vaccine research, they inadvertently elevate one of the public’s biggest concerns about the coronavirus vaccine — the rush to create it. Developing the mumps vaccine, the fastest ever produced, took four years. Many believe the rigorous, sometimes decades-long process previously used to develop a safe, effective vaccine is being short-circuited. William Rivers, a Charlotte, North Carolina, construction manager, is not opposed to vaccines, but when asked if he will get the coronavirus vaccine, his answer is emphatic: “Hell, no! Not the way they’re rushing this thing out. Who knows what might happen to you down the road. You might grow a third leg or something!” An intense global effort is underway to develop this vaccine, and certain steps that usually take years, like securing funding and getting approvals for the trials, have been eliminated for expediency. in a June 2020 New York Times op-ed, Paul Offit, MD, and Ezekiel Emanuel, MD, PhD, from the University of Pennsylvania expressed fear that, under pressure from a president who is determined to improve his reelection prospects, the government “could release a coronavirus vaccine before it had been thoroughly tested and shown to be safe and effective.”
The Effect of Racial Bias
For Black Americans, who have been hit disproportionately hard by COVID-19, concerns about the coronavirus vaccine may also stem from historic distrust of the medical establishment. In describing his reluctance to get a potential COVID-19 vaccine, for instance, William Rivers mentions the notorious Tuskegee experiment. In 1932, the U.S. Public Health System recruited 600 Black men in Macon County, Alabama, to participate in the “Tuskegee Study of Untreated Syphilis in the Negro Male,” with the promise of free medical care. At the time, there was no known treatment for syphilis, but even after penicillin emerged as an effective cure 15 years later, the researchers withheld the drug and continued to monitor the progression of the disease. They simply watched as the men died, went blind or insane, or experienced other severe health problems. The legacy of Tuskegee may help explain why many Black Americans are reluctant to participate in clinical trials. That distrust, combined with ongoing systemic racism in the medical establishment that tends to put Black patients at the end of the line for critical care, has implications for the COVID-19 vaccine. Both Moderna and Pfizer say diversity is a priority for the phase 3 trials, given COVID-19’s outsize impact on Black and Latino communities. But of the 45 subjects in the first phase 1 Moderna trial, there were only two Black participants compared with 40 white participants. This lines up with the historical data showing that Black and Hispanic Americans are less likely to be included in clinical trials for disease treatment. Black Americans make up about 13 percent of the population but on average 5 percent of clinical trial participants. For Hispanic Americans, trial participation is about 1 percent on average, though they account for about 18 percent of the population. One thing is clear: When a vaccine does become available, there won’t be enough to go around. So who goes first? If accessibility is perceived to be unfair, it could only heighten mistrust among certain groups. Questions about whether race should be a factor have sparked a contentious debate within the Advisory Committee on Immunization Practices (ACIP). Dayna Bowen Matthew, PhD, dean of George Washington University Law School and an ACIP consultant on vaccine distribution, told The New York Times that racism should be directly addressed in the distribution plans. “It’s racial inequality — inequality in housing, inequality in employment, inequality in access to healthcare — that produced the underlying diseases,” she said. “And it’s that inequality that requires us to prioritize by race and ethnicity.” RELATED: Black Americans Have Been Hit Hardest by COVID-19 — Here’s Why
Building Trust
Lavanya Vasudevan, PhD, assistant professor of family medicine and community health at the Global Health Institute at Duke University in Durham, North Carolina, said at a media briefing on July 22 that vaccine opposition is the logical progression of the divide over coronavirus safety measures in general: “We are having trouble convincing people to adopt very simple behaviors like wearing masks and physical distancing. Convincing them to accept a vaccine will be even harder.” National health officials are engaged in a high-stakes game of whack-a-mole to combat the conspiracy theories, correct misinformation, and build trust. “We are behind here,” Dr. Collins of the NIH told CNN. “We haven’t done a good job of getting [coronavirus vaccine] information out there.” “The best strategy is to invest in communication. Communicating early, communicating often, communicating through trusted entities,” said Dr. Vasudevan. “If it’s on the national level, it feels more distant. And relaying the importance of vaccines is critical. Vaccines are our best shot to ending this pandemic.”
