As of August 2021, more than 350 million doses of COVID-19 have been administered in the United States and 52% of the population is fully vaccinated. While the overall rate of vaccination in the US slowed in the early summer, July and August have seen increased rates of vaccination due to the surge of illness caused by the highly contagious delta variant.
Increases in availability and easier access to vaccines has made it possible for people who want a vaccination to get vaccinated. Our previous talking points are working for them. However, around 20-25% of the population remain vaccine hesitant. Vaccine hesitancy is defined as a delay in acceptance, or refusal of vaccines despite the availability of vaccine services.
In December 2020, a Kaiser Family Foundation survey found that 27% of Americans were 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.
Six months later, in June 2021, the Kaiser Family Foundation recontacted these individuals to find out whether they chose to receive a COVID-19 vaccine. They found that the vast majority of people who said they would only “get vaccinated if required” or said they would “definitely not” get a COVID vaccine remain unvaccinated.
The most commonly offered reasons for not getting a vaccine included:
- Concerns about side effects (27%)
- Concerns that the vaccine was too new, too unknown, or not tested enough (16%).
- They don’t think they need the vaccine because they do not think they are at risk of getting sick from the virus, or that they already had COVID (12%)
- They don’t trust the vaccine and don’t normally get vaccines (7%)
- They have a medical condition which prevents them from receiving a COVID-19 vaccine (7%)
- COVID is not that bad, and the vaccine is worse (7%).
Among people who were still unvaccinated but not resistant to getting a COVID-19 vaccine, about 4 in 10 said they planned on waiting more than a year before getting a COVID-19 vaccine. Concern over possible side effects was the most frequent reason offered for why they have not gotten vaccinated.
As healthcare providers and vaccine advocates, talking with someone who is vaccine hesitant, or vaccine resistant, is not as straightforward as simply providing factual information and answering questions. In fact, using this approach for the vaccine resistant has not really moved the needle toward vaccination. Vaccine hesitancy is complex and multifactorial. Numerous messaging techniques and communications are being studied and it appears that vaccine acceptance among vaccine resistant people will require multiple, brief interactions from multiple people. The goal is listening more than talking. The key is patience, and always leaving the door open for further communication and answering questions. Being prepared to listen and utilize talking points based on the most current issues may help focus conversations on the information necessary to help the vaccine hesitant to begin a journey which ends in vaccination.
TALKING POINTS to help CURRENT CONCERNS OF THE VACCINE HESITANT
CDC regularly creates reports (COVID-19 State of Vaccine Confidence Insights Report) about the status of COVID-19 vaccine confidence in the United States, emphasizing major themes that influence vaccine confidence and uptake. The reports include analyses of multiple quantitative and qualitative data sources, ranging from social listening and web metrics to immunization survey data and CDC-INFO inquiries. The reports seek to identify emerging issues of misinformation, disinformation, and places where intervention efforts can positively increase vaccine confidence across the United States.
The report identified some of the following themes:
1. Consumer concerns about the safety of COVID-19 vaccines were fueled by overlapping misinformation narratives.
These narratives entered the digital landscape when concerns over myocarditis and pericarditis after vaccination were at the top of consumer’s minds. Consumers’ fears about vaccine safety were fueled by the FDA warning on July 12,2021, about cases of Guillain Barre syndrome following vaccination with J&J/Janssen COVID-19 vaccination. Consumers sought information online about these safety concerns and found large volumes of misinformation leading them to question the transparency of the government in reporting adverse events related to COVID-19 vaccination.
Specific talking points:
- Start from a place of empathy. “I get it. It seems like we just learned about possible heart problems from the vaccine and now there are warnings about Guillain Barre. It’s good to ask questions. I am happy to answer your specific concerns and questions about COVID -19 and the vaccine. Is now a good time?”
- Use supporting facts to combat misinformation if your patient is interested – More than 350 million vaccinations have been given in the United States as of August 8, 2021. Between December 2020 and August 2, 2021, VAERS (Vaccine Adverse Event Reporting System) received 6490 reports of death following COVID vaccination (0.0019%). This does not mean that the vaccine caused the death. Each case is reviewed and to date, there are 3 deaths that appear to be linked to blood clots that occurred in people following the J&J/Janssen vaccine related to thrombosis with thrombocytopenia, TTS, a rare serious adverse of event of blood clots with low platelets.
Guillain-Barre Syndrome is a rare disorder which can cause muscle weakness and transient paralysis. Most people fully recover but some people do have permanent nerve damage. 143 preliminary reports in VAERS of GBS following J&J/Janssen vaccination as of July 30. The cases are 2 weeks after vaccination and occur mostly in men 50 years and older.
2. Vaccinated consumers are concerned about vaccine effectiveness against the Delta variant while unvaccinated consumers remain unconcerned about the variant’s spread.
News about the infectivity and transmissibility of the Delta variant in July led to conflicting reports about whether additional doses would be needed as a result because many vaccinated consumers are concerned about what it means for the ability of the U.S to return to “normal.” Some consumers (often vaccinated consumers) called for mask mandates to return even for the vaccinated to help slow the spread of the Delta variant. However, vaccine deniers amplified narratives that the Delta variant is less serious and spread misinformation that those who are vaccinated are at increased risk for severe illness from the Delta variant.
Specific Talking points:
- Start from a place of empathy and ask permission to address concerns and answer specific questions. “We thought we had this virus licked and now all of a sudden we have to wear masks again.”
- The Delta variant is currently the predominant strain of the virus in the United States. It causes more infections and spreads faster than early forms of SARS-CoV-2.
- Some data suggest the Delta variant might cause more severe illness than previous strains in unvaccinated people.
- Unvaccinated people are currently the greatest concern because of their ability to transmit the Delta variant whether they have symptoms or not. Fully vaccinated people with Delta variant breakthrough infections can also spread the virus to others. However, vaccinated appear to be infectious for a shorter period.
- Vaccines in the U.S. are highly effective, including the Delta variant.
- Given what we know about the Delta variant, vaccine effectiveness, and current vaccine coverage, layered prevention strategies, such as wearing masks, are needed to reduce the transmission of this variant.
3. Some consumers claim a COVID 19 treatment is being suppressed to unnecessarily promote vaccination.
In July, consumers on social media increasingly claimed that a COVID-19 “cure,” ivermectin, is being “suppressed” by government agencies to promote vaccination.
Specific Talking Points:
- Start from a point of empathy. Ask questions about what they know about ivermectin, or do they know someone who took it, etc. Ask permission to speak to their concerns.
- Vaccination is one of many tools that are being used to help end the pandemic, so government agencies are promoting vaccination in the interest of public health. As far as Ivermectin and hydroxychloroquine, both of these medications, as well as many others, are being extensively researched and the media has been extensively involved in presenting the data from scientists studying these potential treatments. Extensive research efforts are ongoing into additional, effective treatments.
4. Some consumers are angered by the announcement of new “door to door” vaccination outreach efforts.
President’s Biden’s announcement in early July 2021 of a tactical shift to increase vaccination by bringing vaccines to the people in a “door to door” fashion, was met with some consumers feeling that such direct government action impinges on their liberty. False claims exist that the government would send “strike teams” across the country to coerce or even forcibly vaccinate adults and teens. Despite the White House clarification of the message as like a census taking or voter registration drive, some consumers expressed dismay that communities were being identified so that the federal government could secretly track individual vaccination status.
- Start from a place of empathy. A statement such as: “Personal liberty is important to everyone.”
- COVID-19 is affecting people worldwide – not just in the U.S.
TALKING POINTS related to VACCINATION OF ADOLESCENTS
- In May 2021, the FDA expanded its emergency use authorization (EAU) for the Pfizer-BioNTech COVID-19 vaccine for the prevention of COVID-19 caused by SARS-CoV-2 to include adolescents from age 12 and up. In August 2021, the FDA gave full approval for the Pfizer-BioNTech COVID-19 vaccine for ages 16 years and up.
- Remember to ask parents and adolescent patients if they have gotten their COVID -19 vaccination or if not, what are their plans?
- Address specific concerns with the facts:
- More than 7 million adolescents have been vaccinated and mostly mild to moderate side effects were reported, including: fever, fatigue, headaches, chills, diarrhea, muscle, and joint pain. Worse side effects were reported with the second dose compared to the first.
- Myocarditis is a rare side effect which has been reported among 397 adolescents. Most cases were mild and resolved within days.
- The vaccine was 100% effective in clinical trials.
- The vaccine helps avoid long COVID 19 and improve symptoms of those already with long COVID.
- Stress that there is a real need for vaccination of adolescents.
- Over 400 pediatric deaths have been reported since the beginning of the pandemic. Although the number seems low compared to adults, COVID 19 is now a top 10 cause of death for adolescents in the U.S.
- As of July 2021, over 4.1 million COVID 19 pediatric cases have been reported. The CDC estimates that the true burden is almost 27 million pediatric cases in the U.S.
- Long Covid-19 has been reported among adolescents.
- Address concerns over any long-term side effects.
- Based on knowledge of mRNA and the human body, long term side effects from vaccination are not expected.
- There are anecdotal reports that menstrual cycles changed after vaccination. This suggests that the body was mounting an immune response and is likely a side effect, like a fever.
- In the history of vaccines, serious adverse effects have only popped up in the first 2 months of receiving the vaccine.
- Stress the need for vaccination even when the adolescent has already had COVID-19.
- The vaccine offers greater protection than the virus, especially to the variants.
TALKING POINTS for people who have had COVID and as a result, feel they do not need a vaccination.
- People who have already gotten sick from COVID-19 will still benefit from vaccination. In August 2021, the CDC released a media statement that vaccination offers higher protection than previous COVID-19 infection based on a study of COVID-19 infections in Kentucky through June 2021, among people who were previously infected with SARS-CoV-2. The study showed unvaccinated people are more than twice as likely to be reinfected with COVID-10 than those who were fully vaccinated after initially contracting the virus.
- Receiving a COVID-19 vaccine or having natural immunity to COVID 19 from a previous infection will not cause you to test positive to a COVID-19 antigen or DNA viral test.
TALKING POINTS (previously published in March 2021) – These talking points will likely work best for people who are not vaccine hesitant.
Messages for your allergy clinic staff:
- Get a COVID-19 vaccine
- Share your experience and personal reasons for getting vaccinated with patients, friends, and family.
- Share your vaccine advocacy on social media.
- Consider mandating vaccination for your staff.
Messages for your allergy clinic patients:
- Engage with every patient at every visit about the COVID-19 vaccine.
- Ask all of your patients (12 years or older) 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. Explain why you got the vaccine and what it was like.
- 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.
- As of August 2021, more than 198 million people in the U.S. have received at least one dose of a Covid-19 vaccine, including about 169 million people who have been fully vaccinated by Johnson & Johnson’s single-dose vaccine or the two-dose series made by Pfizer-BioNTech and Moderna. More than 4.46 billion vaccine doses have been administered worldwide 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?
- According to the CDC, COVID-19 vaccines offer better protection than natural immunity alone and vaccines, even after prior infection, help prevent reinfections.
- Vaccination is the best protection, and it is safe They prevent severe illness, hospitalization, and death. Additionally, even among the uncommon cases of COVID-19 among the fully or partially vaccinated vaccines make people more likely to have a milder and shorter illness compared to those who are unvaccinated.
- 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 and 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. The V-safe app collects additional information on what people experience.
Other reassurances to talk with patients about:
- The CDC is taking safety seriously. 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 takes 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 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. Anaphylaxis to the mRNA COVID-19 vaccines is currently estimated to occur in 2.5 to 5.0 cases per million doses.
- 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 198 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. There is current evidence, however, to suggest that patients with severe allergic reaction, including anaphylaxis to COVID-19 vaccine, may tolerate a second dose.
- 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:
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.”
CDC COVID-19 State of Vaccine Confidence Insights Report, July 26, 2021