Distrust and Vaccines

What is the major reason for people declining the COVID vaccine? My answer: distrust. There are other apparent reasons: People are also misinformed, complacent, suspicious, fearful, stubborn, in denial, and there are those who regard declining the vaccine as a sign of loyalty to a political party. As a nurse for so long, I find that last reason very odd.

We need to reach herd immunity in order to counter the COVID pandemic and natural immunity is not the way to get there. Vaccine-acquired immunity is more effective than natural immunity and obviously eliminates having to suffer through the illness and face the many associated risks.  “To go back to a pre-pandemic lifestyle, we would need at least 70% of the population to be immune to keep the rate of infection down “ (https://www.jhsph.edu/covid-19/articles/achieving-herd-immunity-with-covid19.html). But we don’t know if we will reach that goal because we have vaccine hesitancy and much of the reason is distrust, not resistance to medical science. The same people who are declining COVID vaccines are not declining medical care for their cardiac conditions, cancer, broken bones or other health issues.
     
It is best to be transparent about the vaccine: There are some risks with the vaccine, but the numbers are low. Many types of medications carry higher risks of side effects than the COVID vaccine, and yet people still take chances with these medications. Are there long-term effects of the vaccine that we don’t know about? The answer: It is unlikely, but we do not know for sure. We do know that the COVID-19 illness can be fatal and may very well have long-term effects. So what we do know is more important than what we don’t know (https://www.nejm.org/doi/full/10.1056/NEJMms2101220). There are also legitimate reasons for some people to be suspicious about research. There is a long legacy of Black people experiencing poor medical treatment and questionable practices in drug development. The Tuskegee Study took place from 1932-1970, and the Black male subjects of the research project suffered unnecessarily. The story of Henrietta Lacks is astounding. Her body cells were utilized for science without her consent starting in the1950s. It wasn’t until 2013 that her family began to have limited control; her cells are still being utilized world-wide for extensive genetic advancements (https://www.cdc.gov/tuskegee/timeline.htm.).
     
When the COVID pandemic first started, I thought it would finally bring this nation together – much like 9/11. Instead, the pandemic has deepened our divide and has sharpened the polarization over science (https://www.nejm.org/doi/full/10.1056/NEJMms2101220). But why?
     
Many people do not understand that this is a public health crisis, and they certainly do not understand the science of pandemics. In the case of misinformation causing vaccine hesitancy, providing insights about the value of vaccinations is helpful, and making it personal might encourage compliance:

• The vaccine can protect you from getting sick
• People of color are more vulnerable to severe illness and the vaccine provides protection
• Getting the vaccine helps your community and will help lead society to recovery
• Vaccine development has been considered fast, but the researchers did not skip steps. The processes utilized by researchers have been tested over many years.
• Side effects of the COVID vaccine, if any, are mostly temporary
• If you had the illness, the vaccine will provide added protection (https://www.hopkinsmedicine.org/health/conditions-and-diseases/coronavirus/covid19-vaccine-hesitancy-12-things-you-need-to-know)

  
In contrast to misinformation being the issue, vaccine hesitancy for many is a passionate one. People’s emotions and behaviors are the obstacles, and bombarding these people with science is not the answer to vaccine acceptance. We must explore people’s perspectives and concerns. Here is a sample list of responses (perspectives) in regard to why there is vaccination hesitancy: it was rushed, it will make me sick, it will make me infertile, we are being experimented on, it has a microchip, in the long-run it will cause health problems, fear of the unknown, and some people simply never get flu shots, so they feel no need to get a COVID vaccine. But the underlying theme is distrust (https://www.npr.org/2021/03/17/978288331/how-to-get-trump-voters-vaccinated-when-half-say-they-dont-plan-to).
  
Where do we begin with allaying people’s fears and distrust? We need to turn to those people who are trusted in the community. This typically includes personal physicians, healthcare workers, social workers, personnel in the mental health field, priests, ministers, and trusted public health officials. People will also respond to trusted friends and co-workers. What is the first step?… Building a trusting relationship. What is the message?... People with emotional concerns do not want to start the conversation listening to vaccine information. They want to address their concerns, beliefs or historical issues (as addressed above).
  
After building the trusting relationships a domino effect might occur. For example, one’s private physician or minister may be influential: “I got this vaccine, and I want you to have it, too.” Other examples from trusted cohorts: “You’ll be able to travel and see your family.” Friends may say: “We can get together for various social events.” A co-worker or customer might add: “We can get back to normal business practices and work habits.” Others might simply watch their neighbors and friends return to normal activities and want to join in.
      
Although there is a cohort that think the denial of science is the reason for vaccine hesitancy, I don’t think that’s the issue. Many people, who are not getting vaccinated, are still going to doctors and hospitals, and accepting other aspects of science in their everyday life. The reasoning begins with truth and it is better to be mindful as to how to tackle that challenge. There is a  Catch-22 with vaccine hesitancy: “By challenging untruths, we may inadvertently feed the perception that the “real” truth is being suppressed.” Just as COVID has spread, so has distrust in this nation (https://calmatters.org/politics/2021/04/california-covid-vaccine-resistance/). In my opinion, the answer to getting enough people vaccinated in order to reach herd immunity in our country is going to take the building of trusting relationships, listening and responding to people’s concerns, and utilizing the power of example and emulation  – a much different path than we are witnessing out there.

Charlotte Michos is a clinical nurse specialist who values personal-centered care and serves as a Healthcare Consultant in helping others make informed decisions. For more information, email her or call (845) 548-5980.