We Must Overcome COVID-19 Vaccine Hesitancy

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Original story posted on: February 1, 2021

Approximately 25 percent of the population is vaccine-hesitant.

I’m going to get real with you: COVID-19 may very well be with us forever. We may be wearing masks or seeing our elders die from new strains of COVID-19 forever – unless enough of us get vaccinated.

Herd immunity varies by disease – measles requires 95 percent immunity to protect the unvaccinated 5 percent. The original percentage postulated to achieve herd immunity from COVID-19 has been quietly ratcheting up, and Dr. Anthony Fauci, Chief Medical Adviser to President Biden, has a concern that it may take close to 90 percent immunity to stop COVID-19 in its tracks.

Vaccine hesitancy and resistance are not new. It has always shocked me that my husband and I have several friends who are opposed to vaccination. I just found out that prior to going on safari in Africa, however, they got all the necessary vaccines. If they recognized that the potential diseases were dangerous enough to overcome their anti-vaccine sensibilities for that, I hope we can educate the general public into overcoming their vaccine hesitancy for COVID-19 vaccines. After all, we want our lives back.

Approximately 25 percent of the population is vaccine-hesitant, with variability according to certain characteristics. Hesitancy is highest among Republicans (42 percent), people between the ages of 30 and 49 (36 percent), rural residents (35 percent), and Blacks (35-40 percent). Reportedly, one-third of essential workers – and, shockingly, one-third of healthcare deliverers – are also reluctant to get vaccinated (https://www.medscape.com/viewarticle/944213).

I am going to go over a few common issues or concerns, highlighted below in bold. If you want to see this advice in official publications, see AMA (American Medical Association) COVID-19 Vaccines: Patient FAQs or go to the Centers for Disease Control and Prevention (CDC) website, CDC COVID-19 Vaccination Resources:

  • I am nervous taking any vaccine that comes out of a project called “Operation Warp Speed.”
    • Personally, I liked this name; it reflected that we needed a rapid response to COVID-19, because the magnitude of the problem was being recognized. Unfortunately, it can give the misperception that the vaccines were hastily developed. The vaccines being utilized under the Emergency Use Authorization were not rushed, and are being closely monitored for safety. Operation Warp Speed removed barriers, but not the Food and Drug Administration’s (FDA’s) usual rigorous vaccine approval process.
  • I don’t trust the previous administration, under whose watch Operation Warp Speed was created.
    • The Warp Speed name really refers to the planned rapid manufacture and distribution. The politicization of the process was unfortunate, because there is always some suspicion aimed at the federal government and the pharmaceutical industry, regardless of who is in power. This is not about the government; it is about all of us joining together to fight the virus, united.
  • What about this new mRNA technology? How do we know it is safe?
    • Everyone knows that our chromosomes have our DNA instructions, which make us, us. The way they make us is by encoding RNA, which in turn makes the proteins that are the building blocks and the functioning units of the body. Your eyes are brown because of proteins, you metabolize sugar with the protein insulin, and your red blood cells can carry oxygen because of the hemoglobin protein.

The mRNA vaccines by Pfizer and Moderna take a snippet of messenger (m)RNA, which encodes for the spike protein of the coronavirus, and our body manufactures copies of the spike protein (the “antigen”). Our immune system reacts to it in the usual fashion by creating antibodies against the spike protein. The mRNA is short-lived and dissipates quickly, leaving only the antibodies and primed immune system in its wake.

Remember your first cell phone? Would you prefer to use that over the iPhone or Android you have in your pocketbook today?! This technology is new, but not brand new. It has been used in cancer therapy for years, with amazing results. The reason they used it for this vaccine is that they expected the development time to be rapid – and they were right.

  • Can I get COVID-19 from the vaccine?

    • Older (and other) vaccines used to use live virus, attenuated (or weakened), as the main ingredient. As a result, people sometimes got a mild version of the illness, especially immunocompromised patients. In fact, if a patient is known to have a weakened immune system, they are not eligible to receive live, attenuated vaccines. This is not the case with any of the current COVID-19 vaccines. There is absolutely no virus at all in these vaccines.

You cannot get COVID-19 from any of the current vaccines. However, when your immune system responds to the antigen, you may experience symptoms.

  • I heard people have a lot of side effects from getting vaccinated.

    • I welcome side effects from vaccines! It makes me aware that my body is doing what it is supposed to be doing. I liken it to morning sickness with pregnancy; you know there are hormones, and the pregnancy is probably doing well.

Side effects from the currently available Moderna and Pfizer vaccines are pretty common, especially pain in the deltoid muscle injection site, fatigue, headache, muscle aches, and chills. Symptoms are even more prominent after the second shot. I recommend that institutions stagger the second shots, because some people don’t feel well enough to work for a day or two after. (See: https://www.goodrx.com/blog/side-effects-covid-19-vaccine/ for good graphics)

Just think, if you don’t like those symptoms, you would probably REALLY not like getting COVID-19! I had COVID-19 last March, and I felt like I had been run over by a truck for five days straight.

  • How long does it take to be fully protected?
    • People are getting whichever vaccine is available. Pfizer’s is a two-dose course separated by 21 days. Moderna is two doses 28 days apart. You need to have two doses of the same vaccine; it is not mix-and-match. There is another vaccine coming down the pike from Johnson & Johnson, which requires a single dose, one and done. That will be welcomed, because the logistics of the two-dose course are problematic for the vaccinators. Although two weeks after the first dose, there is limited efficacy, approximately two weeks after the second dose, an individual is considered to have full protection (~95 percent efficacy). It has yet to be determined how long immunity will last.
  • Why should I bother getting vaccinated if the virus is just going to mutate, and the vaccine may not cover that variant anymore?

    • It works the other way around. If everyone were to get vaccinated and we were to achieve herd immunity, there would be way less opportunity for the virus to spread and mutate. The reason the virus can mutate is because there is such rampant spread. It travels into a person, and when it replicates, errors that are favorable to the virus may get propagated. At this time, experts believe that the variants are still covered by the available vaccines.
  • If the vaccines are 95 percent effective, why will I still have to wear a mask?

    • Once a person is fully vaccinated, they have a low chance of getting COVID-19, and the chances of having a serious case is extremely unlikely. However, it is not clear whether folks are getting asymptomatic infections, through which they can transmit the virus to others. Once there is herd immunity, we may be able to unmask, because if I transmit COVID-19 to someone else who has been vaccinated, neither of us should have a bad case.
  • I am a person of color. How can I trust that this isn’t another Tuskegee Experiment?

    • Unfortunately, people of color are on the front lines, making them prime targets for the novel coronavirus. They disproportionately are essential workers – they work in healthcare and long-term care facilities; they work in meat packing and in grocery stores; they serve as cashiers and work in and/or utilize public transit. Black, brown, and indigenous people, often with comorbidities, have a disproportionately higher rate of dying from COVID-19.

The Tuskegee syphilis experiment was an egregious example of unethical medical research, wherein the Public Health Service and CDC followed a group of Black sharecroppers, some of whom had contracted syphilis, to determine the natural course of the disease – without revealing to the men that they had contracted syphilis, or providing them with efficacious antibiotics that had been discovered during the same period in which the study was being conducted. To me, if people of color shun vaccination, it will be an example of “reverse” Tuskegee. White privilege will afford vaccination to the white population, and vaccine hesitancy will reinforce the disparity of Black and brown people disproportionately getting sick and dying. It makes me crazy thinking there is staff in my father’s assisted living facility who refused vaccination. I care about them, and want them alive and well.

Don’t be the control group. And don’t let your friends and family be the control group, either.

  • I just hate shots. Do I really need to get this one? Can’t I be in the 5-10 percent of people who don’t get the shot, and get herd immunity from the rest?

    • This is a very benign shot at the time of vaccination. The needle is very thin, and most people don’t complain about the actual inoculation.

However, if everyone relied on everyone else to get vaccinated, no one would get vaccinated, and we would never reach herd immunity. Yes, you need to get this one.

Don’t you want life to go back to normal? Don’t you want to go to the movies and to restaurants and on vacation again? Don’t you want to stop eyeing your neighbors with suspicion, wondering which one of them might be harboring the virus? Don’t you want to see people’s smiles again?

I know many of you who know me, trust me. Please trust me on this. Please, please, please get your vaccine when your turn comes! If you are reluctant and do it, post pictures or share it on social media and encourage others to do it, too. We all have to overcome our vaccine hesitancy. Vaccines don’t save lives; vaccinations do.

Programming Note: Join Dr. Erica Remer today as Talk Ten Tuesdays begins a four-part series, “Vaccination Nation,” 10 a.m. Eastern.

Erica E. Remer, MD, CCDS

Erica Remer, MD, CCDS has a unique perspective as a practicing emergency physician for 25 years, with extensive coding, CDI, and ICD-10 expertise. She was a physician advisor of a large multi-hospital system for four years before transitioning to independent consulting in July 2016. Her passion is educating CDI specialists, coders, and healthcare providers with engaging, case-based presentations on documentation, CDI, and denials management topics. She has written numerous articles and serves as the co-host of Talk Ten Tuesdays, a weekly national podcast. Dr. Remer is a member of the ICD10monitor editorial board, a former member of the ACDIS Advisory Board, and the board of directors of the American College of Physician Advisors.

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