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A new expert commentary suggests that healthcare professionals need to tackle vaccine hesitancy in a way that avoids stigmatization. Ian Forsyth/Getty Images
  • According to a new editorial, vaccine hesitancy could seriously threaten efforts to stop the pandemic.
  • The editorial blames vaccine hesitancy on the controversy, misinformation, a lack of confidence surrounding vaccine trial data, anxiety about vaccine safety, and historical mistrust of the medical establishment due to current or past negative treatment.
  • They also state that there are also important differences between people who are vaccine hesitant versus people who are anti-vaccine or “anti-vaxx,” referring to definitions of anti-vaxxers as activists who deliberately spread misinformation.
  • Health experts must communicate vaccine information with more empathy and address all vaccine questions or concerns without prejudice or bias.

Factors that include vaccine supply and distribution continue to complicate this unprecedented COVID-19 vaccination rollout. But, according to a new editorial, it seems that vaccine hesitancy could cripple global efforts to stop the pandemic.

And rates of vaccine hesitancy are high worldwide. In a 2021 systemic review exploring COVID-19 vaccine acceptance rates in 33 countries before December 25, 2021, the average acceptance rate in the United States was only 56.9%.

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In the review, the average U.S. rate of vaccine acceptance was very close to Poland (56.3%), France (58.9%), Russia (54.9%), and Italy (53.7%), which were among the lowest in the world. Acceptance rates were even lower in several Middle Eastern and Arab countries such as Kuwait (23.6%) and Jordan (28.4%).

We now know that vaccine acceptance in the U.S. has increased to around 61.7% as of March 15, 2021.

Researchers are scrambling to find ways to address and improve vaccine acceptance rates. That is why two prominent researchers co-authored a new editorial discussing vaccine hesitancy, the threat it poses to vaccine efforts, and how to tackle it.

The editorial is a collaboration between Heidi J. Larson, director of The Vaccine Confidence Project at the London School of Hygiene & Tropical Medicine in the United Kingdom, and David A. Broniatowski, associate director of the Institute for Data, Democracy, and Politics at The George Washington University in Washington, DC.

The study appears in the journal Science.

The authors of the editorial note that it is important to understand the difference between vaccine hesitancy and being anti-vaccine or “anti-vaxx.”

Vaccine hesitancy refers to “the delay in acceptance or refusal of vaccination despite the availability of vaccination services.”

Vaccine hesitancy is a complex matter that involves various factors, such as confidence, complacency, and convenience, which differ across different places, times, and vaccines.

In other words, someone may be hesitant to take a specific vaccine but willing to take other vaccines. This may occur if they do not feel a vaccine is safe or effective. And these feelings can develop from a combination of factors such as concerns, misinformation or miscommunications, and past or historical medical experiences.

Research shows that individual factors, such as beliefs, values, knowledge, emotions, and perceptions of risk, influence vaccine hesitancy. It also appears to be affected by various historical, political, cultural, and social factors.

On the other hand, people who are anti-vaccine are actively against vaccines.

According to the Anti-Vaxx Playbook published by the Center for Countering Digital Hate, anti-vaccine groups tend to promote three key messages:

  • COVID-19 is not really dangerous
  • vaccine advocates, such as healthcare workers or public health officials, are not trustworthy
  • the vaccine carries negative health risks or is dangerous

These key messages expand upon a legacy of other pervasive anti-vaccine messages, such as those that:

  • claim alternative cures exist
  • claim vaccines infringe upon individual civil rights
  • falsely question the efficacy or safety of a vaccine
  • claim vaccines are somehow immoral
  • claim vaccination efforts are somehow related to conspiracies against the public
  • claim vaccines have links with a wide range of health conditions

The Centre for Countering Digital Hate defines anti-vaxxers as: “individuals who have made a conscious decision to use their online platforms to campaign against vaccines and spread misinformation about them.”

“This makes them distinct from “vaccine-hesitant” people, which includes those who are unsure whether they will get a vaccine, and from those who simply have questions or concerns about new COVID vaccines.”

According to the new editorial, these anti-vaccine messages and themes have become widespread. The authors claim that around 150 anti-vaxx organizations have more than 10 million followers on social media.

The authors note that unlike the vaccine hesitant, anti-vaxx advocates often have associations with organizations with explicit financial, political, and ideological agendas and interests.

The group of people who have vaccine hesitancy and the variety of reasons hesitancy occurs is much more diverse, the writers of the new editorial explain.

“Those who refuse vaccines are not necessarily anti-vaxx, although vaccine-hesitant individuals may consume content from anti-vaxx organizations as they search for evidence to confirm or dispel their concerns,” they write.

“The vaccine hesitant are therefore vulnerable to manipulation by anti-vaccine activists. They also risk being judged or labeled ‘anti-vaxx’ by the very people — healthcare professionals — who are best positioned to encourage healthy behaviors.”

The authors conclude that health experts need to deliver information about vaccines in a more empathetic way to prevent the risk of stigmatizing people who are vaccine hesitant.

This means creating messaging that acknowledges and addresses the variety of reasons someone may be hesitant to take a vaccine without bias or judgment.

“Messages about vaccines must be delivered in a way that is empathetic to avoid stigmatizing people who have questions about the vaccine. Particularly in the context of COVID-19, with all its uncertainties, people need to be reassured and feel that their concerns are heard,” says co-author Larson.

To do so, the authors claim that healthcare professionals need to leverage well-established relationships to address specific vaccine-hesitant concerns. They cite a few examples of relationships that could serve this need.

For example, the Engaging in Medical Education with Sensitivity initiative, established during a 2019 measles outbreak, involved Orthodox Jewish nurses helping parents in their community develop their own ideas about vaccines. The nurses also listened to parents’ concerns and helped give them context for vaccine information and data.

Another example the authors cite is the University of Maryland’s Health Advocates In-Reach and Research Campaign, which helps beauty salons and barbershops in Prince George’s Country become culturally relevant places that deliver medical and public house services and provide health education.

The authors add that trustworthy voices also need to help endorse the safety of vaccines to restore people’s confidence.

Identifying all the nuanced, wide-ranging, individual and cultural factors and concerns that contribute to vaccine hesitancy will not be an easy task.

But without everyone — or nearly everyone — agreeing to be vaccinated, achieving herd immunity could be extremely difficult.

Herd immunity refers to natural protection from the virus that occurs when the rates of infection or transmission are very low due to large levels of immunity in a population acquired from vaccinations.

The precise rate of vaccination necessary for herd immunity from SARS-CoV-2 remains unknown. It also varies, often drastically, between diseases.

But it is likely a substantially high percentage, probably higher than many current vaccine acceptance studies are finding.

Despite discouraging stats and trends, some estimates have the U.S. gaining herd immunity by the summer of 2021 at rates ranging from 60–90%.

But the authors conclude their editorial by stating it will take as many safe vaccines as can be utilized and public confidence and trust to bring this pandemic to an end.

“The world needs all the safe and effective vaccines that exist to end the pandemic,” they write. “But it needs people who believe in them too.”

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