Once a winning COVID-19 vaccine emerges from the dozens in development, the only way it will truly be successful is if enough people get the vaccine to create herd immunity.

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Ensuring that success starts now, authors write in a JAMA Viewpoint essay, “Planning for a COVID-19 Vaccination Program.”

The health care system must deliver the vaccine to the public as soon as rigorous testing is completed and the efficacy and safety are established. Patients at the highest risk for complications and disease transmission to others must get the vaccine first if the initial supply doesn’t meet demand, the authors wrote.

However, first, it is imperative today to start combating vaccine hesitancy—concerns about vaccine safety, choice and the very need for vaccination. The authors cautioned that vaccine hesitancy may be a major barrier to people getting the vaccine and creating herd immunity.

“The mere availability of a vaccine is insufficient to guarantee broad immunological protection; the vaccine must also be acceptable to both the health community and general public,” they wrote. “Depending on varying biological, environmental and sociobehavioral factors, the threshold for COVID-19 herd immunity may be between 55% and 82% of the population.”

With a number of patients unable to get the vaccine because of their age, because they are immunocompromised or have another preexisting medical condition, a vaccine refusal rate greater than 10% could mean the nation doesn’t reach herd immunity, the authors cautioned. They noted that recent surveys suggest only three in four people would get vaccinated if a COVID-19 vaccine were available and that only 30% would want to receive the vaccine soon after it is available.

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Most recently, a Pew Research Center survey found that 27% of American adults said they would not opt for a COVID-19 vaccine if it were available today.

The authors—pediatricians Sarah Schaffer DeRoo, MD, MA, and Linda Y. Fu, MD, MS at Children’s National Hospital, and Natalie J. Pudalov, at the George Washington University School of Medicine and Health Sciences—offered three steps physicians and others can take now to ensure more people get the vaccine when it’s available.

Because a vaccine is being developed so quickly and some people mistrust the government’s pandemic response, vaccine safety will be a significant concern for patients.

To combat that, transparency will be key. The public needs to hear about the rigorous testing and ongoing monitoring that the vaccine approval process requires, and educational campaigns should include information on the important role that individual vaccination plays in herd immunity, Viewpoint authors say.

The authors noted that hesitancy based on freedom of choice may really reflect a mistrust of the medical community, particularly among some African Americans whose fear stems from historical and contemporary mistreatment and disparities in care. The authors recommended that public health campaigns enlist cultural leaders outside of medicine and public health “to develop and spread culturally relevant messaging and ensure educational content is shared via readily accessible venues and formats.”

Misinformation campaigns are already circulating the idea that a COVID-19 vaccine is “tyrannical” and conspiracy theorists are telling people that a forced vaccine will inject a microchip to track individuals and cull the global population.

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Robust public educational campaigns need to use traditional and social media platforms to monitor and combat that information immediately “before dangerous myths take root in the public psyche,” the essay explains.

Those on the front lines of health care—especially physicians whom patients trust—will play a key role in encouraging patients to receive a COVID-19 vaccine. Studies show that physicians who talk about their personal immunization decisions play a big role in encouraging hesitant families to receive vaccinations.

Nurses and allied health professionals’ attitudes also will be important and Viewpoint authors say “ensuring that all individuals who interface with patients in the clinical setting are confident about the safety and effectiveness of a future COVID-19 vaccine is critical for presenting a unified message of strong vaccination support from the medical community.”

You can stay up to speed on the fast-moving pandemic with the AMA's COVID-19 resource center, which offers a library of the most up-to-date resources from JAMA Network™, the Centers for Disease Control and Prevention, and the World Health Organization. 

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