The core U.S. strategy for returning to pre-pandemic societal functioning is to vaccinate all eligible individuals. The two Covid-19 vaccines currently approved for emergency use and being distributed to the states have been shown to be highly effective in preventing infection and serious disease. It is hoped, but not yet proven, that the vaccines will also prevent transmission from a vaccinated person who has been exposed to an unimmunized individual, an important step to achieving herd immunity. The key to securing these benefits is getting people to accept vaccination. The CDC has recommended that health-care personnel and residents of long-term care facilities be offered the first doses of Covid-19 vaccines, as they are high-risk populations.
Recent reports have noted, however, that some health-care personnel, including long-term-care staff, are reluctant to be vaccinated. For some, this is shocking news. People in the health-care field are educated about medical science behind the vaccines’ development and testing, have significant professional experience with serious infections and deaths, and often have an intrinsic desire to protect others. Nonetheless, there is some reluctance—albeit limited—to being vaccinated among this crucial population. What is behind this hesitancy?
Last December, investigators conducted an anonymous survey of 3,523 employees of Yale Medicine and Yale Health System to determine their willingness to receive an FDA-approved vaccine. The survey’s response rate was low (just 11 percent), but 85 percent of respondents said that they were extremely likely or somewhat likely to get the vaccine; 14.7 percent were reluctant. Crucially, the top two reasons cited for reluctance were related to a desire for more follow-up data on safety. Less than 2 percent of the sample expressed an anti-vaccine perspective, saying that nothing would make them comfortable getting the vaccine. By contrast, a survey of approximately 250,000 U.S. households by the Census Bureau conducted in January 2021 found that about 9 percent said that they would definitely not get the vaccine. These data suggest that health-care workers’ reluctance may be less motivated by anti-vaccine sentiment than is reluctance among the general public.
Their doubts may simply reflect the newness of the vaccines. The two approved vaccines have received emergency-use authorization from the FDA. The criterion for that emergency approval was evidence that the vaccines prevented more infection in the vaccine group than in a placebo group and were free of serious side effects. The determination of the efficacy of the vaccine came from an interim analysis—a reliance on data collected from participants before they had completed the full two-year follow-up period. The data reviewed by the FDA from the trials showed a high level of short- and medium-term protection and very limited side effects—but the FDA could not conclude with a high degree of certainty that there is long-term protection or the absence of serious side effects. This may be the root cause of health-care workers’ reluctance.
While the health-care workers’ reservations may be understandable, the FDA’s emergency-use authorization was justified, and the drive to vaccinate is meritorious, given the pandemic’s severe impact on society. Since researchers expected most of the complications to develop within the first month of receiving the vaccine, there is little reason for individuals to hesitate accepting vaccination.