Public Health

Why some patients may vacillate on COVID-19 vaccination

Len Strazewski , Contributing News Writer

It's a happy occasion for the medical community, but even as COVID-19 vaccines are rolled out to medical professionals on the front lines of care, the public continues to ask questions about safety, timing and administration of COVID-19 vaccines as they wait for their own doses.

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AMA President Susan R. Bailey, MD, participating in a webinar for journalists about reporting on the COVID-19 pandemic, noted that a Pew Research Center survey reveals that about 60% of Americans said they would definitely or probably get vaccinated against SARS-CoV-2 if they could.

But about 21% said they do not plan to get vaccinated and that even more information of safety or efficacy would not change their mind. She noted that there is a particularly high lack of vaccine confidence among Black and Hispanic patients.

This lack of confidence poses a problem for successful implementation of vaccine, she said.

Learn more with the AMA about COVID-19 and vaccine development.

"Experts estimate that about 80% of people will need to be vaccinated to slow the pandemic's spread. It is so important that we educate the public about coronavirus vaccines in a positive way without unintentionally fueling vaccine hesitancy," Dr. Bailey added.

Leon McDougle, MD, MPH, agreed. He is president of the National Medical Association (NMA)—the oldest and largest national organization representing Black doctors—and said there is a cloud of mistrust in the Black community about vaccines and therapeutics.

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Dr. McDougle said the NMA has teamed with other professional groups to meet with Pfizer, AstraZeneca and other vaccine developers to ask safety questions and take the answers back to the African American community in order to encourage vaccination.

The mistrust, he said, is complicated by a legacy of medical discrimination going back to the U.S. Public Health Service Study at Tuskegee and other horrific, racist research projects.

Dr. McDougle said that while the community continues to have concerns, particularly about vaccine use among sickle cell anemia patients and patients prone to allergic reactions, he was pleased that the phase 3 trials were larger than usual and had significant participation from patients of color.

The Food and Drug Administration plans to follow patients for extended periods after vaccination to identify any unexpected side effects, a move Dr. McDougle said is necessary.

Hosted by AMA physician leaders, each installment of "COVID-19: What Physicians Need to Know" webinar series offers fact-based insights from the nation's highest-ranking subject matter experts working to protect the health of the public, particularly during the COVID-19 pandemic.

The webinar was a joint project of the AMA and the Poynter Institute for Media Studies in St. Petersburg, Florida, a nonprofit journalism school and research organization. The webinar also addressed a wide range of public questions and concerns that journalists may need to research, ranging from the security of the review process to the individual fear of needles.

Panelists also included Paul Offit, MD, director of the Vaccine Education Center of Children's Hospital of Philadelphia and Patricia A. Stinchfield, RN, MS, president-elect of the National Foundation for Infectious Diseases.

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Dr. Offit, also a member of the FDA Vaccines and Related Biological Products Advisory Committee

that reviewed the Pfizer BioNTech vaccine and Moderna vaccines for emergency use authorization, said even the nomenclature used by medical researchers has the potential to frighten away participants. COVID-19 vaccines were not submitted for licensing that way most drugs are but rather for "emergency use authorization," or permission to explore use during a crisis.

"That scares people. When people hear emergency use authorization, they are thinking hydroxychloroquine—which was pushed out there without any data. When people hear emergency use authorization, they are thinking an untested product. But that's not true here," he said.

Peter Marks, MD, PhD recently joined the AMA's president for a deep dive on how emergency use authorization fits into the coronavirus vaccine-approval process.

The size of the trials with tens of thousands of participants mean they have been well tested, he explained, but not for the same length of time as a licensing approval. Dr. Offit said researchers will "remain humble" and continue to monitor patients and be prepared for any issues if they develop.

Even though data indicates the two vaccines have strong efficacy results, Dr. Bailey advised against journalists proclaiming the end of the pandemic, even if vaccinated individuals are not getting sick.

"The verdict is still out as to whether or not you can still transmit the virus to someone else after you have had the vaccine," she said.