COVID-19 vaccine hesitancy: The problem ahead


COVID-19 vaccine hesitancy: The problem ahead

Photo Credit: Luis Alvarez/Getty Images

Vaccines are here! The end of the pandemic is in sight! There is light at the end of the tunnel! Wait a minute. Is that really a light or the next more challenging phase of the pandemic speeding toward us? After more than a year of lockdown and restrictions, all of us have grown weary of the struggle and should be racing to get vaccinated. But we are not.

Polls in the United States suggest a vaccine acceptance rate of barely 51 percent. Polls from many low- and middle-income countries report only slightly better acceptance rates in the 55 percent to 60 percent range. More troubling, all the polls show an increase in vaccine hesitancy over time. With these already low and declining acceptance rates, how are we ever going to reach the magic 65-85 percent vaccination rate needed to achieve herd immunity?

Worse still is the challenge stated by Dr. Heidi Larson of the Vaccine Confidence Project. “The pandemic will soon enter a new phase when the pandemic wanes, cases drop, vaccine supply expands, restrictions ease and vaccine hesitancy rates spike. People and policymakers need to be ready with a roadmap to deal with falling vaccine acceptance and demand as the perceived risk or immediate threat of COVID-19 diminishes.” Currently, there are no comprehensive roadmaps for this phase of the pandemic and how we will combat vaccine hesitancy effectively.

What can be done to head off this looming problem that is just weeks away? There is no easy answer, but there are actions we can take:

  • Think about what is to come. Most policymakers and public health officials are consumed with vaccine production rates, rollout and logistical issues. They may soon realize that, although these are immediate problems, simply providing high-quality COVID-19 immunization services will likely not achieve the necessary vaccination rate. Every mass vaccination effort, from smallpox to polio to measles, learned the same lesson: Vaccine acceptance, social and community support for vaccination and combating vaccine hesitancy are an essential core strategy. Respected immunization champions, such as Dr. D.A. Henderson (smallpox), Drs. Stephen Cochi and Bruce Alyward (polio) and others, consistently list community mobilization and behavior change as game-changing strategies to fight vaccine hesitancy. The global community needs to quickly relearn these lessons and design strategies to address the growing vaccine hesitancy threat.
  • Prepare strategies and plans using social and behavior change tools, such as FHI 360’s Demand Creation and Advocacy for COVID-19 Vaccine Acceptance and Uptake: An Interim Quick Start Guide. It offers ways to target various audiences ranging from the easy-to-convince to the poorly reached, unconcerned and hesitant. This will allow policymakers and public health workers to tailor communication and community engagement to motivate people to seek immunizations.
  • Become conversant in strategies and approaches that address vaccine hesitancy, including the promotion of the benefits of vaccination. The benefits that will resonate include decreased mortality and morbidity to COVID-19, returning to school and traveling freely, and returning to normalcy. Provide information about the consequences of nonvaccination, such as the danger to personal and economic health if a community remains unvaccinated. Present real-life stories of people who have experienced COVID-19 and those who experienced the benefits of vaccination. Have a locally credible person speak in favor of vaccination, identify and compare pros and cons of vaccination, and offer incentives (when appropriate) to promote vaccination.

Sound public health interventions, like social distancing, mask wearing and quarantining, helped bring down the astronomically high number of daily new infections during the surge that took place in the winter of 2020-2021 in the northern hemisphere. We now need a comprehensive social and behavior change communication strategy to bring down the exceptionally high vaccine hesitancy rate. Or that proverbial light at the end of the tunnel may be farther away than we expect.

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