COVID-19 has changed the world, and we have all experienced those changes in a variety of ways. For some of us that meant working, or learning, from home, for others, it meant being distant from loved ones, while others lost jobs and businesses, and many more have lost their lives. After facing all of these hardships we are all looking forward to things returning to some semblance of normal, or open. One thing that seems to be a prerequisite for most countries around the world to re-open fully is an effective vaccine (Guidry et al., 2020). Yet, now that there are 2 vaccines, with Emergency Use Authorization (EUA), in the US, there are growing concerns that many people will refuse, or choose not, to get vaccinated. “Vaccine hesitancy overall has risen so substantially that the World Health Organization (WHO) now considers it a major threat to global health” (Guidry et al., 2020, p. 2).

There are several different factors that may make someone hesitant to take the COVID-19 vaccine. Hallsworth and Buttenheim (2020) break those factors down to three categories: rationalization, habituation, and rejection. Rationalization decreases vaccine compliance because people may think that they don’t need the vaccine as they are going to work, and doing many of the same things they did pre-COVID (Hallsworth & Buttenheim, 2020). Asymptomatic cases of COVID-19 also make rationalization more likely, because some people will assume that they had COVID-19 already and therefore don’t need to be immunized, or they will think that any illness they had during the pandemic was COVID-19 (Hallsworth & Buttenheim, 2020). Similarly, Hallsworth and Buttenheim (2020) describe habituation as people just accepting that it is inevitable that they will contract COVID-19, and therefore they have less motivation to get the vaccine or take other precautions. Rejection, however, is where people are resistant to getting a vaccine because after months of lockdowns, quarantine, economic hardship, etc., people may believe that they have already put in the effort to manage the pandemic and don’t see why they should now have to get a vaccine on top of everything else (Hallsworth & Buttenheim, 2020). Another factor that decreases the likelihood of vaccination is concern about the vaccine itself. 

For some, it is a concern that the whole process of developing the COVID-19 vaccine has been rushed, at the expense of safety, due to political pressure and the desire for a quick fix to the pandemic (Hallsworth & Butteheim, 2020; Schoch-Spana et.al., 2020) Others, who may have been onboard for taking the COVID-19 vaccine as long as it went through the usual process of approval, are now uncertain about taking a vaccine that has received emergency use authorization (EUA) (Cohen, 2020). Even with the EUAs, individuals who reported being more likely to get the vaccine are those who are younger, white, and with fewer barriers to getting the vaccine (Guidry et al., 2020). Overall, individuals of color report being less willing, or likely, to get the COVID-19 vaccine, due to concerns about the vaccine’s effectiveness, and distrust of the government and other agencies that are developing and distributing the vaccine (Cohen, 2020; Guidry et al., 2020; Schoch-Spana, 2020). Concerns about the vaccine’s effectiveness may decrease the number of parents vaccinating their children due to the fact that there have been lower risks associated with COVID-19 for that age group (Hallsworth & Buttenheim, 2020). Similarly, the fact that people in different ethnic groups and geographic locations have been impacted in vastly different ways by COVID-19, could result in a belief in some places or groups that a vaccine is not needed to manage the virus in that location or population (Hallsworth & Buttenheim, 2020).

In response to all of those concerns, the Working Group on Readying Populations for COVID-19 with the Johns Hopkins Center for Health Security has several recommendations for the US government and other agencies and policy makers (Schoch-Spana et al., 2020). The first recommendation is to figure out what different communities’ understandings and expectations are by having Congress fund and partner with state and local health agencies, and then make sure that there is a nationwide rollout of promotional information about the COVID-19 vaccine’s benefits, risks, and availability (Schoch-Spana et al., 2020).  Secondly, Schoch-Spana et al. (2020) recommend making the COVID-19 vaccine available for free, and having the federal government and other agencies work with the public and state, and local, health officials to reassess the vaccine allocation plan to ensure that vaccine distribution is seen as fair and equitable to people from different racial, ethnic, and socio-economic backgrounds (p.6). By making the vaccine free and reassessing the distribution plan the government and other agencies could help remove some barriers to getting the vaccine and begin rebuilding Americans’ trust in the government (Schoch-Spana et al., 2020).  

Aside from making the vaccinations available to all Americans who want to get vaccinated, for no cost, Schoch-Spana et al. (2020) also recommend making the vaccine available in non-medical locations like churches, schools, etc., pairing the distribution of vaccines with other services, and then clearly communicating where, when, and how people can get vaccinated, including any information on how much it will cost, if there is a cost (p. 7). Another way to increase COVID-19 vaccinations is to communicate with local health departments and communities directly, while also making sure to get trusted members of the community to speak positively about the vaccine to effectively address and dispel misinformation that has been released on the vaccine (Schoch-Spana et al., 2020). Additionally, at the federal level, there should be an apolitical panel of experts that, “review, synthesize, and report on best practices for engaging communities in vaccine allocation, deployment, and communication systems to achieve equity, solidarity, and good health outcomes” (Schoch-Spana et al., 2020, p. 8). Similarly, each state should have an oversight committee that takes data on access, allocation, distribution, and understanding and acceptance of the COVID-19 vaccines, to make sure that all groups have equal access to the vaccines (Schoch-Spana et al., 2020).  All of these recommendations could address some of the barriers that make people hesitant to take the COVID-19 vaccines. 

However, even if the US government implements all of the above recommendations it may not be enough to convince some people to take the COVID-19 vaccines. Large-scale vaccination of the population, along with other preventative measures like social distancing and wearing masks are essential to managing the pandemic and protecting yourself and others in your community from COVID-19 (CDC, 2020). While we have all experienced significant changes to our lives, and in many cases overwhelming losses, due to COVID-19 we now have 2 vaccines that could enable us to return to some semblance of our pre-COVID world. 

References:

CDC. (2020, December 21). Benefits of Getting a COVID-19 Vaccine. Retrieved fromhttps://www.cdc.gov/coronavirus/2019-ncov/vaccines/vaccine-benefits.html

Cohen, J. (2020). Here’s how the U.S. could release a COVID-19 vaccine before the election—and why that scares some. Science, online. Retrieved from https://www.sciencemag.org/news/2020/08/here-s-how-us-could-release-covid-19-vaccine-election-and-why-scares-some#

Guidry, J. P. D., Laestadius, L. I., Vraga, E. K., Miller, C. A., Perrin, P. B., Burton, C. W., … Carlyle, K. E. (2020). Willingness to get the COVID-19 vaccine with and without emergency use authorization. American Journal of Infection Control, 1–6. https://doi.org/10.1016/j.ajic.2020.11.018

Hallsworth, M., & Buttenheim, A. (2020). Challenges Facing a COVID-19 Vaccine: A Behavioral Science Perspective. Behavioral Scientist, online. Retrieved from https://behavioralscientist.org/challenges-facing-a-covid-19-vaccine-a-behavioral-science-perspective/

Schoch-Spana, M., Brunson, E., Long, R., Ravi, S., Ruth, A., Trotochaud,M. (2020). on behalf of the Working Group on Readying Populations for COVID-19 Vaccine. The Public’s Role in COVID-19 Vaccination: Planning Recommendations Informed by Design Thinking and the Social, Behavioral, and Communication Sciences. Baltimore, MD: Johns Hopkins Center for Health Security. https://www.centerforhealthsecurity.org/our-work/pubs_archive/pubs-pdfs/2020/200709-The-Publics-Role-in-COVID-19-Vaccination.pdf