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Coronavirus vaccines speed ahead, but experts fear not everyone will take them.

As few as half of Americans say they will get vaccinated, according to recent polling, well short of the 70% to 90% needed to achieve the ‘herd immunity’ that can prevent the spread of the SARS-CoV-2 virus. While convincing vaccine opponents might not be possible, public health officials, governments and drugmakers need to be thinking about reaching those who may hesitate to get a vaccine or doubt its effectiveness. 

"I couldn’t worry about this more," Julie Gerberding, a former director of the U.S. Centers for Disease Control and Prevention, and now an executive at Merck & Co., told a House of Representatives subcommittee on Tuesday.

The question of trust looms large as the public health system gears up to mount what could be the biggest vaccination program of this century. The groups in charge of organizing will need to make addressing doubts a priority, said Arthur Caplan, professor of medical ethics at New York University school of medicine. 

"If you have a vaccine that 30% of the public doesn’t want to take, you’ve already lost," he said in an interview.

With nearly 200 experimental vaccine projects underway, the chances are good that one or several will eventually prove safe and effective, and be made available. At least five drugmakers are advancing candidates into large late-stage trials within the next few months. Under the best-case scenario, at least some people could receive the first injections of an authorized vaccine later this year or early next.

Public health officials from the federal level down to county and city public health departments are now preparing for the vaccination campaign to come. They’re doing so amid a pandemic that, particularly in the U.S., has become politically charged, adding to the challenge. 

Winning the public’s trust 

When polled, the share of Americans who say they will get a coronavirus vaccine ranges from 49% to 72%. The higher figure came from a Pew Research Center poll that asked a binary question, while the lower number is from an AP-NORC poll that included "not sure" as an option, to which 31% responded. 

The share of respondents who said they would not get vaccinated appears similar in both polls, 27% in Pew and 20% in AP-NORC.

Gaining the trust of the uncertain or resistant will be a critical task, as the government’s ability to mandate vaccination primarily applies to children, through mechanisms like school health requirements.

But there’s some debate over the best way to do that. 

Communication about coronavirus vaccines will need to be open and transparent about the risks and benefits of inoculation, experts agree. Beyond that, however, the keys to persuading people may involve appeals to community benefits, to fear or the desire to more quickly end other public health-related restrictions. 

"Giving the impression that you’re telling people what they should do is never well received," James Blumenstock, chief of health security at the Association of State and Territorial Health Officials, in an interview. "That immediately puts up the defense shield that really is a barrier to effective communication."

Instead, people should be shown how vaccination protects their families and communities from further spread of disease, Blumenstock said.

That’s an idea that Mark Navin, a bioethics professor at Oakland University in Michigan, rejects.

"I don't think you're going to get very far with solidarity and fairness arguments. There's no evidence that that kind of messaging works for people," Navin said. "What motivated more than a million Americans to let their kids participate in the polio trials at schools was fear," he said.

Another approach, Caplan argued, is to link vaccines to uniquely American values like liberty, allowing those who receive them a return to pre-pandemic lifestyles.

"If you don’t like masks and you don’t want to socially distance … the road runs through vaccines," he said. 

Author: Jon Gardner


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