In December 2020, a Kaiser Family Foundation survey found that 27% of Americans are vaccine hesitant, indicating they probably or definitely would not get a COVID-19 vaccine, even if it were free and scientists said it was safe.
The top five concerns reported by those saying they would not get a vaccine were:
- Fears about potential side effects (59%).
- Distrust in the government’s ability to ensure the vaccine is safe and effective. (55%)
- Preferring to wait and see how the vaccine works for others. (53%)
- The role of politics in the vaccine development process. (51%)
- Belief that COVID-19 risks are exaggerated. (43%)
A nationwide survey published in December 2020 reported that most Americans eager for a COVID-19 vaccine were interested in news coverage that provides expert testimony on the safety and efficacy of vaccination. The same survey also found that the biggest motivator for getting vaccinated is the desire to get back to normal. And an endorsement from a personal physician or nurse was the most important consideration for whether or not those surveyed would get the COVID-19 vaccine as soon as it is available to them.
The Centers for Disease Control and Prevention (CDC) recommends a national strategy to reinforce confidence in the COVID-19 vaccines and recognizes the key role healthcare professionals play in improving vaccine acceptance because they are in contact with patients regularly. By fostering a culture of immunization in the practice, both providers and patients can participate in vaccination programs with confidence.
Board-certified allergists are uniquely qualified to serve as community health care leaders in improving vaccine acceptance. Our understanding of immunology makes us natural experts and educators in how vaccines work, their importance, and the risks and benefits associated with administration.
Fostering confidence in COVID-19 vaccines starts with educating those around us – our fellow providers, nurses, medical assistants, front office workers, insurance workers, and administrative personnel. When everyone is educated and understands the importance of COVID-19 vaccination, the message to patients becomes positive and consistent.
Messages for your allergy clinic staff:
- Get a COVID-19 vaccine when it is available to you.
- Share your experience and personal reasons for getting vaccinated with patients, friends, and family.
- Share your vaccine advocacy on social media.
Messages for your allergy clinic patients:
- Engage with every patient at every visit about the COVID-19 vaccine.
- Ask your patient if they have been vaccinated or are planning to get vaccinated. If not, ask them about their concerns and questions.
- Address specific concerns with the facts and relevant talking points.
- Reassure them that you had the vaccine (or that you plan to be vaccinated once a vaccine is available). Explain why you got the vaccine and what it was like (or why you plan to get it when available).
- Stress the importance of receiving the second dose.
Effective communication that encourages vaccination and instills confidence includes:
- Starting from a place of empathy and understanding.
- Assuming patients will want to be vaccinated and being prepared for questions.
- Giving a strong recommendation in favor of vaccination.
- Addressing misinformation by sharing facts.
- Listening and responding to questions.
- Proactively explaining side effects.
Counteract misinformation with correct information:
- COVID-19 vaccines cannot give you COVID-19.
- People who have already gotten sick from COVID-19 will still benefit from vaccination.
- Getting vaccinated helps prevent getting sick with COVID-19.
- COVID-19 vaccines will not cause you to test positive on COVID-19 antigen or DNA viral tests.
Know the answers to these specific patient questions:
- What is an mRNA vaccine? How do we know they are safe when they are so new?
- mRNA is like the instruction manual that comes with your Do-It-Yourself furniture kit or a recipe card that tells you what to do to prepare food. Simply stated, mRNA tells a cell what proteins to make.
- the mRNA vaccine tells your cells to make a protein like the one that decorates the surface of the coronavirus.
- Your body then makes antibodies against this specific protein.
- These antibodies circulate in your bloodstream and are immediately ready to attack the actual virus if you are ever exposed.
- mRNA has a short life span before it is destroyed naturally. It delivers a message and once the work is done, it disappears.The antibodies, however, can circulate for quite a long time.
- There is no virus involved in this process, so you cannot get COVID-19 from the vaccine.
- mRNA is also much easier and faster to manufacture than older types of vaccines, which means protecting large populations can happen much, much faster than in the past.
- mRNA technology is not actually that new: it has been used in cancer therapeutics previously.
- More than 10 million people in the US and more than 40 million people worldwide have been vaccinated with great results. Approximately 70000+ people who were part of the mRNA vaccine clinical studies are still being followed to assess continued safety.
- What is “Operation Warp Speed?” How were COVID-19 vaccines developed so quickly?
- Operation Warp Speed (OWS) is a federal government initiative which began working on an accelerated timeline for the development of a COVID-19 vaccine at the start of the pandemic.
- To accelerate vaccine development while maintaining standards for safety and efficacy, OWS has selected the most promising vaccine candidates and is providing coordinated government support. None of the steps in traditional vaccine development timelines were eliminated; instead, steps have proceeded simultaneously.
- This increases the financial risk, but not the risk of the vaccines. Researchers used existing clinical trial networks to begin conducting COVID-19 vaccine trials.
- Manufacturing was started while the clinical trials were still underway. Normally, manufacturing doesn’t begin until after completion of the trials.
- mRNA vaccines are faster to produce than traditional vaccines.
- FDA and CDC are prioritizing review, authorization, and recommendation of COVID-19 vaccines.
- Have these vaccines been tested in people like me?
- The first two mRNA vaccines in line for Food and Drug Administration (FDA) authorization were tested in a diverse group of people. About 30% of U.S. participants were Hispanic, African American, Asian or Native American. About half were older adults. There were no significant safety concerns identified in these or any other groups. Trials in pediatric patients are underway.
- Is it better to get natural immunity rather than immunity from vaccines?
- You may have some short-term antibody protection after recovering from COVID-19, but we don’t yet know how long this protection lasts.
- Vaccination is the best protection, and it is safe. Currently, we know the vaccines protect 95% of people from getting a severe case of COVID-19. However, we don’t yet know how long this protection lasts or if it prevents transmission.
- COVID-19 can cause serious illnesses and death. It can also cause debilitating symptoms that persist for months.
- If you get COVID-19, you also risk giving it to loved ones who may get very sick.
- Remember that the vaccines are not a perfect fix. We will still need to practice other precautions like wearing a mask, social distancing, handwashing until public health officials say otherwise.
- Will the shot hurt? Will it make me sick? What about the side effects?
- The shot will be a lot like any other shot. Your body will respond to the vaccine like it responds to other vaccines. For example, expect local swelling, redness after the vaccination. A lot of people report feeling achy or tired (sleepy) more than usual for the first day or so.
- The CDC also has a program in place to monitor the side effects of the vaccine in real time with the V-safe app to collect additional information on what people experience.
Other reassurances to talk with patients about:
- The CDC is taking safety seriously. COVID-19 vaccines are being tested in large clinical trials to assess their safety. The CDC has an independent group of experts that reviews all the safety data as it comes in and provides regular safety updates. If a safety issue is detected, immediate action will take place to determine if the issue is related to the COVID-19 vaccine and determine the best course of action.
- The CDC and FDA encourage the public to report possible side effects (called adverse events) to the Vaccine Adverse Event Reporting System (VAERS). This national system collects these data to look for adverse events that are unexpected, appear to happen more often than expected, or have unusual patterns of occurrence. Reports to VAERS help the CDC monitor the safety of vaccines. Health care professionals are required to report certain adverse events following vaccination to VAERS.
- The CDC has also implemented a new smartphone-based tool called V-safe to check-in on your health after you receive a COVID-19 vaccine. After receiving the vaccine, you will receive a V-safe information sheet telling you how to enroll in V-safe. If you enroll, you will receive regular text messages directing you to surveys where you can report any problems or adverse reactions you have after receiving a COVID-19 vaccine. This allows the CDC to collect real-time safety data on COVID-19 vaccinations.
Proactively explain side effects
- The new mRNA COVID-19 vaccines stimulate your immune system and therefore are reactogenic. They are likely to cause side effects, especially after the second dose. The most common side effects include sore arm, fatigue, headache, or muscle pain.
- The side effects are not a sign that the vaccine gave you COVID-19.
- Side effects indicate a good immune response.
- Side effects are generally short-lived.
- It is important to get the second dose even if the first had unpleasant side effects.
Allergy/Immunology patients, as well as many of our non-allergist colleagues, are likely to have specific concerns about allergic reactions to COVID-19 vaccines based on media reports of systemic reactions in a small number of patients after receiving one of the vaccines. Know the answers to these specific patient questions.
- How common are allergic reactions to the COVID-19 vaccines?
- Severe allergic reactions to COVID-19 mRNA vaccines are exceedingly rare. As of Jan. 29, 2021, there are reported to be 5 reactions in 1 million people immunized with the Pfizer vaccine and 2.8 reactions per 1 million people immunized with the Moderna vaccine.
- Of note, no one has died from an allergic reaction to the COVID-19 vaccine.
- In perspective – your risk of getting COVID and getting seriously ill or dying from COVID is far more common. You are 100 times more likely to die from COVID than to have a serious allergic reaction to the vaccine. To date, with more than 10 million people immunized in the US, no one has died from an allergic reaction to a COVID vaccine.
- What safeguards are in place for patients who may have an allergic reaction to the vaccine?
- Everyone who gets a vaccine is monitored for 15 minutes after getting the vaccine or 30 minutes if you have had a severe allergic reaction or any type of immediate allergic reaction to a vaccine or injectable therapy in the past.
- How will I know if I am having a severe allergic reaction to the COVID-19 vaccine?
- Symptoms of a severe allergic reaction to the vaccine may include hives, swelling, and wheezing for up to four hours after vaccination. Instruct patients with these symptoms to seek emergency care immediately.
- How do I know if I am at risk for an allergic reaction from a COVID-19 vaccine?
- If you have allergies not related to vaccines – such as food, pet, venom, environmental, or latex allergy, you are NOT at increased risk for an allergic reaction to the COVID-19 vaccine.
- Talk with your allergist if you have had an allergic reaction to other types of vaccines. Your allergist will help you decide if it is safe for you to get vaccinated.
- If you have an allergic reaction to your first COVID-19 vaccine, you should NOT GET THE SECOND VACCINE.
- If you have had an allergic reaction to polyethylene glycol (PEG) or polysorbate, do not get the COVID-19 vaccination until you have had a consultation with your allergist.
Wrapping up the conversation:
Remain open to patients’ concerns and comments.
Remind patients that deciding when to get a vaccine is their choice, but everyone who is eligible should get a vaccine. “The COVID 19 vaccine is a way to protect you, your family, your community and your way of life.”