VACCINE HESITANCY: WHY PEOPLE REFUSE COVID-19 VACCINE

I’m old enough to remember what life was like before vaccines. As a child I had measles, mumps, and chicken pox and remember being really sick and missing school for long periods of time during those illnesses. I remember how panicked my parents were when Bobby Grabhorn developed polio after being on a Boy Scout campout I also attended. Polio was devastating, often fatal, and every parent feared their child would get it. Bobby spent months in an iron lung, the ventilator of that time, and was left with severe hoarseness from the  tracheotomy he needed to breathe. But he survived.

When Dr. Jonas Salk invented polio vaccine, it was considered a miracle and a major milestone  that would save the lives of millions of children. Polio was so feared that no one even considered not being vaccinated. The vaccine was universally accepted; no protests, no resistance, no conspiracy theories. Parents eagerly had their children vaccinated, and it was even given in schools. The media championed the discovery, promoted vaccination, and deified Dr. Salk. 

Vaccines are unquestionably some the most impactful developments of the 20th century. Smallpox was eradicated to the point where vaccination is no longer recommended. Polio vaccine has prolonged efficacy, and the disease is now only a memory. Hepatitis A and B can now be prevented successfully. Human papilloma virus (HPV) vaccine has transformed cancer of the uterine cervix into a preventable disease. Common childhood illnesses (measles, mumps, rubella and chicken pox) had been prevented until recently when rates of vaccination declined, immunity diminished, and the diseases resurged. 

The 21st century, 2020 in particular, has been plagued by the COVID-19 pandemic that has taken the lives of millions of adults. In record time, three vaccines for SARS-CoV-2 were developed and administered to people who voluntarily accepted them and saw taking them as important for the survival of themselves and other citizens. 

Unfortunately, a large number of people have not seen the wisdom of being vaccinated. Mistrust, uncertainty, and philosophical bias have kept huge sections of the populace from getting vaccinated. Vaccine hesitancy is not just an American dilemma but a worldwide problem. From my childhood experiences, I’ve always been a strong vaccine advocate and was perplexed when patients refused to vaccinate their children. That’s the case again with the COVID-19 pandemic—why on earth do people refuse vaccination when they see what COVID-19 has done to people all over the world? So I did some research to learn the reasons and try to understand why so many folks are putting themselves, their friends, and their families at risk.

Surprisingly, I didn’t find many articles presenting data from the U.S., but France, Turkey, Saudi Arabia, and other Arab countries were well-represented. I was especially interested in vaccination rates among healthcare workers because they are in a prominent position to influence vaccine acceptance in the general population. 

All of the studies cited here have searched the medical literature for hesitancy statistics and factors that either encourage or prevent people from receiving COVID-19 vaccine. The statistics vary depending on the population studied and the reasons for refusal or acceptance are numerous. 

“A survey of 19 countries that included 13,426 people found that 71.5% of participants would be very or somewhat likely to take the vaccine.” A Turkish study found that 66.1% of participants would refuse a foreign-made COVID vaccine while 37.4% would refuse a domestic  vaccine. In Australia, 85.8% of adults would accept the vaccine while in the U.S. only 67% of adults would accept it. Health care workers are an important demographic for vaccine adherence so the results of a French study were notable. Older male physicians comprised the majority of the 74% of respondents who would accept a COVID-19 vaccine. Nurses and nursing assistants were much less likely to be vaccinated. 

The reasons people reject vaccinations are numerous and have been studied again and again. The identification of these factors, unfortunately, has not improved acceptance rates. Factors determining vaccine acceptance fall into three broad categories. They are:

 Demographic Factors

Scientific Factors

Psychological Factors

DEMOGRAPHIC FACTORS:

   Males are more likely to be vaccinated than females

   Older age persons are more likely

   Income level—higher income-level people are more discriminating and accepting

   Higher education level people are 4 times more likely to worry about vaccine safety

   Lower education level people have a higher rate of vaccine refusal

   People with over 10 years of professional practice experience have greater acceptance

   Size of household—larger number means greater acceptance

   Employment—type of job and fellow workers influence choice

   Rural dwellers less likely to accept

   Republicans less likely to accept

   Lack of education about COVID-19–less likely to accept

SCIENTIFIC CRITERIA:

   The following all cause vaccine hesitancy:

     Safety of the vaccine**

     Not knowing the Efficacy of the vaccine**

     Side Effects of the vaccine**

     How much you fear risk from COVID-19

     Distrust of foreign-made vaccines**

     Uncertainty of duration of immunity 

     Concern about overloading the immune system with too many vaccines

     Exposure to myths and misinformation 

     Lack of recommendation by healthcare workers

     Doctors are diagnosing COVID for financial gain

     5G technology transmits the virus and weakens human immunity

     Fear that additives (aluminum, mercury, formaldehyde, DNA fragments) weaken the immune 

       system and cause chronic illnesses

PSYCHOLOGICAL FACTORS:

   Distrust of the medical system and pharmaceutical industry

   History of racial discrimination among African-Americans and Hispanics

   Nurses are less like to accept COVID-19 vaccine than are physicians

   People are less likely to accept a foreign-made vaccine than a domestic vaccine

   People with high anxiety levels reject vaccines

   Fear of disease has been replaced by fear of vaccination—as fear of disease decreases, 

      vaccination acceptance increases

   Wariness of motives behind vaccine administration are a deterrent

   Different social, cultural, and political views affect vaccine acceptance

   False religious beliefs

   Fear of needles, pain

   Lack of belief that COVID-19 exists

   COVID-19 is punishment from God

   It’s a weapon of biological warfare

   COVID-19 is a Pharmaceutical industry conspiracy to sell products 

   The unfounded fear that vaccines cause autism, infertility, diabetes, developmental delays

      and autoimmune disease

**  The most frequent reasons for VACCINE HESITANCY

Dr. G’s Opinion: Essentially, the message delivered by vaccine advocates is that those who reject vaccines are ignoring scientific advancements and aren’t very smart. Skeptics are more fearful of the effects of vaccination than they are the potential harms of the diseases, which is faulty logic. I empathize with people who are concerned that COVID-19 vaccines were rushed to market and haven’t been evaluated as thoroughly as previous vaccines. That’s true. But for a lot of reasons, vaccines had to be available ASAP because the government’s response to the pandemic was costing people their jobs and homes and destroying the economy. A vaccine(s) was the only thing that would reassure the public and put an end to the societal skid that was occurring. 

Vaccines have been administered now since December, 2020. As of “early May, 152 million Americans have received at least one dose of COVID vaccine.” If that isn’t a massive clinical study, I don’t know what is. We haven’t seen a spate of deaths or people maimed from the vaccine! The vaccines are safe—that’s no longer an issue. What we don’t know is how long disease protection will last and will they be effective against virus mutations; will we need a booster shot this Fall? I suspect we will.

So, knowing this, there’s little or no reason to reject getting vaccinated now. The suggestion that these vaccines alter your DNA, are used to track your movements, or are some device to control your mind and thoughts is sheer paranoid lunacy. People who think that are severely misinformed, and changing their minds is a difficult task. Regardless of the facts, some people still think “We never walked on the moon and Elvis ain’t dead!”

A bothersome development is that vaccinated people are getting sick and testing positive for COVID-19. How do we explain that? I don’t think we can other than to call them “breakthrough infections.” COVID-19 deaths after vaccination are extremely rare, too, occurring in less than .001% of those vaccinated. Thus, the 95% effective statistic is true and concerns over efficacy are unfounded. 

During my years in practice, I can recall only one mother who opted to not vaccinate her children. In the 1970’s, she was virtually alone in her steadfast position. Unfortunately, in 1998, a British medical journal, The Lancet, chose to publish an article that alleged certain vaccines caused autism. Even though that article was retracted and the autism correlation discredited, anti-vaccine sentiment continued to grow. The attitude was ripe for seasoning when COVID-19 appeared and a vaccine was rapidly brought before the public. Controversy, uncertainty, and conspiracy theories were commonplace.  

So much cynicism and skepticism are present in our society that we never know who’s being truthful and who is not. The media has lost all credibility with the public, too. Even the CDC has its skeptics. From my viewpoint, as one who administered vaccinations to kids from 1967 to 2014 (47 years), vaccines are one of the most significant public health developments in modern times, and any mis-use or abuse of that altruistic concept is inconceivable. COVID-19 vaccine is another of those miraculous creations that was designed to save lives and not change our make-up. Thinking otherwise is way off base and shows how far distrust in our institutions has advanced.   

References: Hildreth JEK, Alcendor DJ. Targeting COVID-19 Vaccine Hesitancy in Minority Populations in the U.S.: Implication for Herd Immunity Vaccines (Basel) 2021 May;9(5):489.

Kreps S, et al. Factors Associated with U.S.Adults’ Likelihood of Accepting COVID-19 Vaccination JAMA Network Open 2020 Oct;3(10):e2025594

Geoghegan S, O’Callaghan KP, Offit PA. Vaccine Safety: Myths and Misinformation Front Microbiol 2020;11:372.

HTTPS://www.tandfonline.com/doi/abs/10.1080

Ullah I, Khan KS, et al. Myths and conspiracy theories on vaccines and COVID-19: Potential effect on global vaccine refusals. Vacunas 2021 May-August; 22(3):93-97.

Song lyrics: “It’s All in Your Head,” by Diamond Rio.