1/ Thread: Mass Vaccination Redux: Why 4 in 10 Americans may refuse COVID-19 vaccines. Here are five ways to address vaccine refusal to speed our return to normal https://jesse-pines.medium.com/mass-vaccination-redux-why-4-in-10-americans-may-refuse-covid-19-vaccines-632beaabce9d

2/ In the coming days, there will be 2 emergency use authorizations for COVID-19 vaccines by FDA: Pfizer & Moderna. Early reports suggest these vaccines are effective in reducing COVID-19 infections and safe from major adverse events.

3/ A recent discussion topic with my doctor friends has been America's coming mass vaccination: how vaccines may return us to normal and when. One memorable comment was from an ER physician from Ohio. In a straw poll of his ER nurses, remarkably none planned to get vaccinated.

4/ Vaccines were a 20th century triumph. Undoubtedly the development of multiple effective COVID-19 vaccines in 9 months is one of the 21st century’s greatest scientific achievements to date. Yet American vaccine hesitancy will be a major impediment to ending this pandemic.

5/ Estimated COVID-19 vaccine refusal rates fluctuate: a Gallup poll from Oct 19-Nov 1 estimated 58% of Americans would take the vaccine, up from 50% from September but down from 66% in July.

6/ Put another way, 42% — more than 1 in 4 Americans — don’t plan on taking a safe and effective COVID-19 vaccine. This is amidst a pandemic that is killing nearly 3k people daily, slightly shy of the numbers who died on September 11, 2001 and in Pearl Harbor.

6/ Vaccine hesitancy and refusal comes from concerns that risks don’t outweigh benefits. Myriad reasons are declared but are mostly flawed: religious reasons or specific concerns that vaccines cause health problems.

7/ Yes, some sects do not favor vaccination but major religions have no objection including Judaism, Islam, Hinduism, and most branches of Christianity. Health concerns are similarly unfounded — for example, that the MMR vaccine is linked to autism– a thoroughly debunked claim.

8/ Vaccine resistance also comes from mistrusting science. Some think pharmaceutical companies are just out to make money. For others, the sentiment extends to distrust of government, that FDA will make scientific decisions for political gain.

9/ The past four years has seen an expanding firehose of information from social, mainstream and fringe media. Misinformation abounds from the highest levels. It is harder for the average American to differentiate truth, opinion, and lies.

10/ The two streams of divergent messaging from the left and right have unfortunately bled into public health messaging and questions of science. This sows confusion and feeds doubt.

11/ Yet, according to research, the fundamental source of hesitancy centers in small social groups strongly questioning vaccines.

12/ Here’s what happens: vocal group members feel strongly vaccines are not to be trusted. Shared hesitancy spreads, becomes socially acceptable, and later becomes identity. This is similar to gun ownership & abortion where beliefs become strong & ingrained, then part of identity

13/ This may explain why a small, highly educated, yet informed group –nurses in a single Ohio ER– all seeing COVID-19 deaths daily, might collectively believe the risks of vaccination outweigh its benefits, despite clear evidence to the contrary.

14/ This raises two questions: 1) will vaccine hesitancy slow America’s safe re-opening? and 2) if yes, how to overcome it?

15/ To address the first question, consider the statistics that nearly 6 in 10 say they’ll take the vaccine. There are > 14 million documented COVID survivors, and perhaps 3 to 5 times more who went untested and may have some degree of immunity.

16/ The herd immunity target — where infections will fall precipitously — is 7 in 10 Americans. Therefore, assuming the willing get vaccinated immediately, there could theoretically be rapid herd immunity and back to normal without the 42% who refuse.

17/ The problem: the mass vaccination of America will be a long, arduous process. It will take months or even years. There are issues with storage, logistics, and attrition given that fever is a common side effect, which may lead many to not get their second dose.

18/ It’s safe to conclude that vaccine hesitancy if not directly addressed will throttle America’s safe re-opening. Its effect will vary locally given its “social” nature, with deaths tragically amplified in the same communities that resisted mask wearing. Below are 5 solutions.

19/ 1st: Leadership is needed. Former presidents Obama, Clinton, and Bush volunteered to take vaccine on camera. We need similar messages from leaders in communities of color ( @KingJames) & potential refusers. Perhaps @JessicaBiel may say she’ll get a COVID-19 vaccine?

20/ 2nd: Social media can propagate positive vaccine movements. Remember the “ice bucket challenge”, which raised $220 million for ALS research? We need an entertaining action / fun sticker for COVID-19 vaccination. People can post pictures / videos to social media.

21/ 3rd: When vaccinating millions, some will inevitably suffer strokes / heart attacks after a vaccine. As N of 1 stories sow fear, public health messages should confirm events were unrelated to vaccination. Statistics should be reported publicly to deflate these anecdotes.

22/ 4th: Pay people to get the COVID-19 vaccine. Don’t need pay the first wave. Announced this later when there’s plenty of vaccine around and uptake has fallen. $ could come from govt, insurance co's who profited in 2020 from lower healthcare use, or directly from employers.

23/ 5th: Mandate a COVID-19 vaccine. This will be the most effective intervention yet also the most controversial. Two groups who can mandate are employers and schools. We are likely to see some COVID-19 vaccine mandates, but they will likely be a local and variable decision.