Winning over the ‘vaccine hesitant’: Kansas and Missouri prepare for questions, fears
The coming COVID-19 vaccines have been called the path back to normalcy. The two leading vaccines have both passed through three phases of clinical trials, including one to establish their safety. At this point, they have been tested by tens of thousands of people.
Anderson Lowe is still cautious. The EMS director for Halstead, a city of 2,000 in south central Kansas, said he supports vaccines and is ultimately willing to get one himself. He worries, however, about rushing to inoculate his entire staff, even though they transport several virus patients each week.
He’s considering having one or two take it at first and expanding the number from there, assuming no one has problems. “If something by chance got missed or something goes south with it, I wouldn’t want to take my entire department down at once,” Lowe said.
Kansas and Missouri may begin receiving doses in as soon as two weeks if the Food and Drug Administration grants emergency approval to one or both of the leading vaccines from Pfizer and Moderna.
The first shots go to doctors, nurses and other healthcare workers caring for COVID-19 patients. Nursing home residents and other frontline workers will soon follow — kicking off a massive months-long vaccination campaign welcomed by much of the population.
But health leaders must find ways to win over the “vaccine hesitant” — not opponents who try to block mandatory inoculations for schoolchildren or indulge in conspiracy theories — but those who have concerns about the shot yet are open to persuasion. They may have a specific fear, such as long-term side effects, or simply want more information before they commit.
Six-in-ten Americans are willing to receive a COVID-19 vaccine, according to a Gallup poll conducted in late October. Of the 40% who are not, three-quarters cited reasons that could potentially be addressed, including concerns with a rushed process and wanting to wait to see how safe it is. Only 12% said they don’t trust vaccines generally.
The ranks of the hesitant even include some in the healthcare community, who will play a key role in shaping public attitudes toward the vaccine.
While an October survey by the American Nurses Foundation of nearly 13,000 nurses found 63% somewhat or very confident that a vaccine will be safe and effective, only 34% said they would take it voluntarily.
“There is still a lot of vaccine hesitancy among our nurses,” said Heidi Lucas, director of the Missouri Nurses Association.
Health officials face an endless flow of contradictory, misleading and false information from social media and other corners of the web that will only add to the challenge of winning over people who are already reluctant.
“From well documented studies with flu and childhood immunizations on vaccine hesitant patients, we know that this is a complex, dynamic, constantly changing environment,” Chad Johanning, a Lawrence doctor and president of the Kansas Academy of Family Physicians, wrote in a letter to members earlier this fall.
At stake is how quickly the vaccine can bring the pandemic under control and, hopefully, halt the virus’s spread. As vaccination rates rise, infections will fall, easing the burden on the healthcare system and eventually allowing people to put their masks away and go back to living normally.
Health officials in both states, who emphasize that an unsafe or ineffective vaccine won’t be administered, plan multiple efforts to build confidence. They point to data from vaccine trials, which have found no serious safety problems. At least one health leader, University of Kansas Health System chief medical officer Steve Stites, has promised to broadcast his vaccination.
“We have confidence in our FDA and the (National Institutes of Health), that they are not going to make approval … unless it does show, number one, safety, but also efficacy,” said Dana Hawkinson, medical director of infection prevention and control at The University of Kansas Health System.
Missouri has launched a vaccine website that debunks falsehoods and provides safety information. And Kansas is promising regular updates about the rollout and public messaging to encourage vaccination.
Randall Williams, director of the Missouri Department of Health and Senior Services, estimated about 30% of the public is undecided about the vaccine.
“We are very much focused on what we need to do to educate them, to answer their concerns or questions,” Williams said.
Promising data
Vaccine development often takes years, but the race for a COVID-19 shot has shattered previous records. The two leading vaccines, from Pfizer and Moderna, were both been created using mRNA — a new technique that uses a “spike protein” found on the surface of the COVID-19 virus to help the body build immunity.
The mRNA technique accelerated development, but the Centers for Disease Control and Prevention says mRNA vaccines are held to the same standards as others.
Vaccine hesitancy isn’t a new concept to doctors and Johanning said they’ve encountered it for years with the annual flu vaccine. Fewer than half of American adults typically get a flu shot.
“This is kind of like that, but with a little bit of a twist in the fact that we’re dealing with a brand new disease that we’re trying to immunize against. We’re also dealing with a brand new vaccine technology, which just leads to more hesitancy,” Johanning said, referring to the use of mRNA.
Data released so far by Pfizer and Moderna has been extremely promising and the United Kingdom has already authorized emergency use of the Pfizer shot.
Pfizer, which produces the vaccine Kansas and Missouri are likely to receive first, reported 95 percent effectiveness last month. A drug monitoring committee has reported “no serious safety concerns,” the company said.
Brett Bricker, a University of Kansas researcher who studies vaccination messaging, said the main challenge government and medical providers will encounter is convincing people to trust institutions over what they might read from non-experts. Any effort to build confidence will have to use messages tailored to diverse constituencies, he said.
That’s especially true in communities of color, where the pandemic has had a disproportionate impact. Black Americans have died from the virus at a far higher rate than white Americans.
But episodes such as the reprehensible Tuskegee study, in which U.S. government researchers withheld syphilis treatment from Black men, have left a legacy of mistrust.
“In Kansas City, if you have Black pastors standing up and being willing to say, ‘I’m taking the vaccine, I hope you do too,’ that’s going to have so much more purchase for a lot of people in that community than seeing their KU Med white doctor say that,” Bricker said.
“To engage communities of color effectively, health systems will need to overcome a range of barriers, many of which are rooted in historic abuse and mistreatment by the medical system and ongoing implicit bias in healthcare,” said Qiana Thomason, president and CEO of Health Forward Foundation, a Kansas City-based organization that works to reduce racial, geographic and socioeconomic disparities in healthcare, during an October panel discussion.
“It’s equally important to understand,” Thomason added, “that communities of color are experts in our own lived experience and know the solutions that are effective in building trust in our communities.”
Williams said he and Lee Norman, secretary of the Kansas Department of Health and Environment, have been on a call with Health Forward Foundation listening to what the organization says is important in encouraging minorities to get vaccinated.
“We’re very sensitive of that, especially based on what we’ve learned that those communities can be more vulnerable,” Williams said, adding that messaging will need to revolve around trusted community leaders and grassroots efforts.
‘I want you to see it’
The vaccines have been developed in a climate that has raised fears the process would be politicized. During his campaign for re-election, President Donald Trump made false statements about when the vaccine would be ready.
Bricker said central to any effort to build vaccine confidence will be showing that the development process, while accelerated, was legitimate.
“I think it needs to be shown that corners were not cut, that the studies were large enough and despite the fact that it’s an emergency authorization, that does not mean that it carries significantly more danger,” Bricker said.
Trump’s signature initiative, Operation Warp Speed, has allowed the manufacturing of vaccines to be ramped up even before one has been approved. But health experts frequently note that doesn’t mean testing was reduced.
“The warp speed is the production of the vaccine. The warp speed (doesn’t mean) that the phase one, phase two, phase three trials have not been given sufficient length of time,” said Lee Norman, secretary of the Kansas Department of Health and Environment.
The Missouri Nurses Association is mounting an effort to combat hesitancy that includes working with state officials, Lucas said. MNA and other nurses groups plan to hold presentations and webinars with Pfizer to answer questions.
Stites, the chief medical officer of the University of Kansas Health System, said most people in the system are looking forward to getting the vaccine. He added that people want to see the full data surrounding the vaccines, which he said will be available before doses are shipped.
“That will be important because healthcare workers tend to be people who want to look at the science side of this,” Stites said.
Stites said his guess is that the vaccine data is “as good as we think it is,” in part because of the signals being sent by the FDA, the CDC and the vaccine companies. He said if that’s the case, healthcare workers will be overwhelmingly positive about getting the vaccine.
“When it’s my turn to get the shot … I’ll do it right here,” Stites said on a daily video call with reporters. “I want you to see it, I want everybody to see it because I believe in what we’re trying to do around that.”
This story was originally published December 6, 2020 at 5:00 AM.
