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A survey of adults in the United States reveals that many are confused about the protection offered by the second dose of the COVID-19 vaccines. Gabby Jones/Bloomberg via Getty Images
  • A recently published survey shows that a significant proportion of people in the United States are not informed of the optimal timing of vaccination for protection and recommended preventative measures post-COVID-19 vaccination.
  • Of the respondents, 20% mistakenly believed that COVID-19 vaccines offer strong protection before the second dose, and 36% were unsure, possibly resulting in skipped second doses.
  • Results of the study indicate the need for educational campaigns, to build trust and provide scientifically sound information about vaccine benefits.

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Vaccination, physical distancing, wearing face masks, and proper hand-washing are important safety measures to protect oneself and others from COVID-19.

Over 147 million people in the U.S. received at least one dose of the COVID-19 vaccines, with more than 106 million people fully vaccinated, as of May 4, 2021.

Even though COVID-19 vaccines are safe and effective in preventing severe disease and potentially reduce transmission of SARS-CoV-2, there are significant obstacles impeding vaccination efforts.

In addition to structural barriers that limit access to vaccination, such as cost, convenience, and supply issues, there are also attitudinal barriers.

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Attitudinal barriers or perceptions about vaccination that lower vaccine acceptance may include low perceived disease risk, beliefs that vaccines are harmful, misinformation about vaccines, mistrust, and lack of knowledge about vaccine recommendations.

Other challenges include the need for follow-up vaccination in the case of the two-dose COVID-19 vaccines, such as the Pfizer-BioNTech and Moderna vaccines, and compliance with the Centers for Disease Control and Prevention (CDC) protective measure recommendations post-vaccination.

Understanding the beliefs of the American population about vaccination and post-vaccination behaviors is essential for improving vaccination efforts in the U.S.

This led researchers to conduct a national survey assessing the public beliefs about the timing of protection, the information they recalled provided after the first dose, and patient characteristics correlating with continued post-vaccination mask-wearing.

Researchers recently published the results of this survey in the New England Journal of Medicine.

They administered the National Opinion Research Center’s AmeriSpeak panel online and telephone survey to 1,027 adults between February 11 and February 15, 2021.

Consistent with CDC guidance at the time of the survey, about 44% of adults responded that vaccines provide strong protection 1–2 weeks after the second dose of the COVID-19 vaccine.

However, 20% of the respondents thought vaccination offers strong protection from COVID-19 before the second dose, and 36% were unsure. This confusion could potentially result in people in the U.S. skipping the necessary second dose.

According to the survey data, misperceptions regarding the timing of protection were more prevalent among Black and Latinx respondents, further exacerbating existing racial and ethnic disparities in virus-related outcomes.

Public confusion about the timing of vaccine protection and the need for a second dose may be due to the initial public debate about delaying second dose administration to expedite vaccine rollout to a greater number of individuals.

Additionally, the availability of a single-dose COVID-19 vaccine may have contributed to a misunderstanding of the lack of need for a second dose in the two-dose COVID-19 vaccine products.

Only 24% of Black and Latinx respondents believed that the Pfizer-BioNTech and Moderna vaccines provide strong protection 1–2 weeks after the second dose, compared with 43% of white respondents.

Also, 45% of Black and Latinx individuals said they were unsure of the time period of strong vaccine protection, compared with 33% of white respondents.

Eighteen percent of survey participants who received at least one dose of a COVID-19 vaccine reported receiving information about:

  • the need for a second dose (85%)
  • when the protection from the COVID-19 vaccine was strongest (54%)
  • the unknown risk of transmission from vaccinated people to others (31%)
  • the continued need to wear masks (61%), maintain physical distance (56%), and avoid crowds (53%)

Dr. Douglas Kriner, study co-author and professor in the Department of Government at Cornell University in Ithaca, NY, commented, “The vast majority [of survey respondents] were told they needed to come back for a second dose, but just over half said that it was impressed upon them that the protection was strongest 1–2 weeks after the second dose.”

“There is an opportunity for us to clarify the messaging to really make sure people understand the reasons to come back for the second shot.”

About 81% of the respondents to the survey agreed (21%) or strongly agreed (60%) that wearing face masks after vaccination was important.

Those least likely to wear masks post-vaccination included people who believed that vaccinated individuals could not transmit the virus (7%) and those unsure about risks (39%).

Results of the study indicate that many people in the U.S. are confused about the time period of optimal protection post-vaccination and the CDC recommendations regarding necessary preventative measures after receiving a vaccine.

Dr. Jillian Goldfarb, lead author of the study and assistant professor in the Department of Biological and Environmental Engineering at Cornell University, told Medical News Today: “Current vaccine attrition rates average between 8 and 10% across the country. By revealing that people are not being informed about time to protection and the severe need for the second dose in this study, my hope is to improve these attrition numbers through better public information campaigns.”

Dr. William Schaffner, professor of medicine in the Division of Infectious Diseases at the Vanderbilt University Medical Center in Nashville, TN, also spoke to MNT about the importance of messaging. He said, “We need to get sustained, coherent, science-based communication out about the importance of the second dose.”

Educational efforts that provide clear guidance about vaccine benefits are key to dispelling misinformation and can play a crucial role in putting an end to the pandemic.

Dr. Goldfarb added, “We need to make the science accessible to people to gain their trust.”

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