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  • Writer's pictureAlan Frischer, MD, MPH

COVID-19 Vaccine Hesitancy

Updated: Sep 25, 2021

Vaccines for COVID-19 have been in distribution for some eight months now. The goal was to reach “herd immunity” as quickly as possible, in order to restore some kind of normalcy to our lives. That has not happened; numbers of cases are soaring; and we are now facing new variants and risk closing down to some degree again.

Recalling the enormous success of the polio vaccine, our U.S. government coordinated widespread domestic vaccine distribution and avoided financial disparity issues by making the vaccine free of charge. However, to date, only slightly over 50% of the population is fully vaccinated.

Just what are the ramifications of not achieving a vaccinated society? It leaves us vulnerable to risks including:

  • additional outbreaks and deaths,

  • new variants that can only occur if the virus spreads; variants which may well be resistant to our current vaccines, and which put those who are vaccinated as well as our younger population at greater risk,

  • and the enormous economic fallout from a continuing pandemic.

Many among my own patient population have not been vaccinated, and feel strongly about their decision. Here are some of the issues I’ve encountered:

Vaccine access. Months ago, we were sharing stories about searching fruitlessly online to find an appointment. Today, vaccines are easily available, in major pharmacies and elsewhere, with no appointment necessary. Of course, there are still hurdles: some may lack transportation, or may have difficulty taking time from work. Others live in remote areas. Some still worry (unnecessarily) that it will cost them money, or pose a risk to their immigration status.

Is COVID-19 indeed a threat? Polls show that one of the major predictors for not becoming vaccinated is that this group does not see COVID as posing a major risk. Of course, it is common knowledge that there have been almost 640,000 COVID deaths so far, in this country alone. Others believe that if they have had the virus, they have “natural” immunity. Note that current research shows that immunity from the vaccine is far more effective than the immunity one gets from having had the disease itself.

What about the side effects from the vaccine? Potential side effects include a day or two of fever, body aches, and fatigue. With well over 300 million doses already administered, and ample opportunity to observe fertility issues, there is absolutely no evidence that the vaccine affects fertility. Also, it is literally impossible to get COVID-19 from the vaccine, because the vaccine doesn’t contain the live virus strain. And, blood clots have been found in 28 out of 8.7 million people who received the Johnson & Johnson shot. This bears repeating: Blood clots have been found in 28 out of 8.7 million people who received the Johnson & Johnson shot, and these blood clots led to three deaths. Blood clots have not been found among those who received the Moderna or Pfizer vaccines. Some 5,000 deaths have occurred following vaccination, but were not attributed to the vaccine. By comparison, almost 640,000 people have died from COVID-19 in this country alone…so far. There are a few extremely rare side effects from the vaccine. Anaphylaxis is seen in one out of 100,000 vaccines, and is completely treatable. Heart inflammation is seen in one out of 100,000 vaccines. On the other hand, the odds of getting severe COVID are one of every six cases.

Information about side effects varies widely, depending on the source. Studies show that at least half of those refusing vaccination believe in at least one theory unproven by science and the medical establishment. We are all only too aware that anyone can publish anything at all on the Internet, regardless of whether it has any basis in fact. It is critical that opinion leaders disseminate only the most honest, straightforward, and vetted information.

Some have the realistic concern that one or two days of vaccine side effects could keep them out of work. Of course, the disease itself, with the potential of putting us on a ventilator in the ICU, would keep us out of work far longer.

Why is there a lack of trust, among some, in the vaccines? Some feel that vaccine development was rushed, and it is certainly true that they were created in record time. Further, at this time, the FDA has given only emergency approval. Do note that these vaccines went through the normal clinical trials, and met criteria for safety and efficacy. Getting full FDA approval is not a matter of better results, but rather a factor of time. It is anticipated that full approval is coming by or shortly after Labor Day, and polls show that one-third of those who are unvaccinated due to trust issues will be willing to become vaccinated once full approval is achieved.

For others, the trust issues are not about COVID or the vaccine, but rather about the institutions involved. Some don’t believe that the government agencies or the companies that helped to develop the vaccines are looking out for their best interests. Or, perhaps the lack of trust is with the health care system itself. Certainly the history of Black Americans, including such atrocities as the U.S. Public Health Service syphilis study at the Tuskegee Institute, has had an impact on trust in these vaccines. It is my hope that education, opinion leaders, and even incentives will help to break down some of these barriers.

Some feel that vaccinations are contrary to their religious beliefs. I have great respect for the importance of religious freedom. I also feel that there are times when the social good may outweigh certain individual rights. If one declines a tetanus shot, they are potentially harming only themselves. If one declines a COVID vaccination, they are putting everyone around them at risk. We’ve cured so many diseases through thought and reason; by using vaccines, medications and public health measures. Vaccines have rid us of smallpox and have prevented paralysis from polio. Vaccines protect us as well as everyone in our community.

I care about all of my patients, both vaccinated and unvaccinated. When my unvaccinated patients explain to me why they refuse to get the vaccine, I am concerned for their well being. Unvaccinated patients make up between 90 and 99% of those hospitalized with COVID-19, depending on location. The risk of this disease is far, far greater than any risk from the vaccine.

Unfortunately, the consequence of having a partially vaccinated populace is that the virus will continue to spread, mutate, and kill. The pandemic is not over…not by a long shot. Please stay safe, wear masks, and become vaccinated.

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