Americans made no secret of their skepticism about COVID-19 vaccines this year. They fear political interference and a “warp-speed” timeline that tarnishes confidence in the shots. As recently as September, almost half of adults in the United States said they did not want to be vaccinated.
With two promising vaccines expected to be launched within a few weeks, ethics and immunization behavior experts expect attitudes to rapidly change from widespread hesitation to urgent, even heated, demand.
“People talk about the anti-vaccine folks being able to suppress the intake. I don’t see that, “said Dr. Paul Offit, a vaccine doctor at Philadelphia Children’s Hospital, was watching a recent JAMA network webinar. “For me, this is more like the beanie baby phenomenon. The attractiveness of a limited edition. “
Reports that the vaccines made by drug makers Pfizer, BioNTech and Moderna appear safe and effective, as well as the deliberate emphasis on science-based guidance from the future Biden administration, should largely reverse the uncertainty, said Arthur Caplan, director of the department in Medical Ethics from New York University School of Medicine.
“I think this will reverse the trust problem,” he said.
The shift can already be seen. A new poll by the Pew Research Center found that by the end of November, 60% of Americans said they were receiving a vaccine for the coronavirus. Even when a federal advisory group met to develop guidelines for vaccine distribution, a long list of stakeholders – from representatives of home health workers and community health centers to patients with kidney disease – for state and federal officials hoped their ingredients are prioritized for the first tight doses.
“When we get closer to the vaccine reality, there is obviously a lot of jockeying,” said Katie Smith Sloan, executive director of LeadingAge, a non-profit advocating the involvement of staff and patients in long-term care centers in the top priority category.
Certainly some consumers remain cautious, said Rupali Limaye, a social and behavioral health researcher at the Johns Hopkins Bloomberg School of Public Health. Concerns that drug manufacturers and regulators may cut back to speed up a vaccine on-residence even if details of the studies are made public and the review process becomes more transparent. Some health care workers who are at the forefront of the shoot are reluctant to go first.
“There will be people who say, ‘I’ll wait a little longer for security data,” Limaye said.
But those doubts are likely to subside once the vaccines are approved for use and become widely adopted, said Offit, who sits on the FDA advisory panel to review the emergency approval applications that Pfizer and Moderna have filed.
He predicted that demand for COVID vaccines could keep up with the noise of 2004, when production problems early in the influenza season led to severe flu vaccine shortages. This led to long lines, rationed cans, and ethical debates about distribution.
“That was a very popular vaccine,” Offit said. “I think in many ways this could happen here.”
The vaccine supply will initially be scarce. Federal officials plan to ship 6.4 million doses within 24 hours of FDA approval and up to 40 million doses by the end of the year. The CDC panel recommended that initial admissions go to the 21 million US healthcare workers and 3 million nursing home workers and residents before expanding to other groups based on a hierarchy of risk factors.
Even before a vaccine becomes available, some people are trying to increase their chances of getting there, said Dr. Allison Kempe, professor of pediatrics at the University of Colorado Medical School and expert on vaccine dissemination. “People called me and said, ‘How can I get the vaccine? “She said.” I think not everyone will be happy to wait, that’s for sure. I don’t think there will be any riot in the streets, but pressure could be put on. “
This is likely to involve emotional debates about how, when, and to whom the next doses should be given, Caplan said. According to the CDC recommendations, vulnerable groups include 87 million workers whose jobs are classified as “essential” – a broad and ill-defined category – and 53 million adults aged 65 and over.
“We’ll fight over high-risk groups,” said NYU’s Caplan.
Conversations get complicated. Should prisoners who have little control over their COVID exposure be given vaccination priority? How about professional sports teams whose performance could boost society’s overall morale? And what about residents of facilities that care for people with intellectual and developmental disabilities, who are three times more likely to die from COVID-19 than the general population?
Control over vaccination allocation rests with states, so that’s where the biggest conflicts will arise, Caplan said. “It’s a short fight I hope in the sense that it will be done in a couple of months, but I think it will be quite vocal.”
Once vaccine supplies become more plentiful, perhaps by May or June, another consideration is sure to fuel demand: proof of COVID vaccination requirements for work and travel.
“It is inevitable that you will see immunity passports or that you will have to show a certificate on the train, plane, bus or subway,” Caplan predicted. “Probably also to enter certain hospitals, probably to enter certain restaurants and government facilities.”
But with a grueling winter flood and new predictions that COVID-19 will fall to 450,000 Americans by February, the tragic reality of the disease will undoubtedly fuel demand for vaccinations.
“People now know someone who got COVID, who was hospitalized or who sadly died,” Limaye said.
“We can all see that now,” said Kempe. “Even deniers are starting to see what this disease can do.”
Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation that is not affiliated with Kaiser Permanente.
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