“It’s worth a shot… or is it?” Notes from the grassroots on vaccine hesitancy and bridging gaps

Abstract

To the Editor—One morning in March 2021, during my clinical rounds on the coronavirus disease 2019 (COVID-19) unit, I met a young Black woman with COVID-19. As the hospital epidemiologist and infection preventionist focusing on increasing vaccine uptake in our hospital and community, I asked her if she had received the COVID-19 vaccine. Struggling to breathe, she said without any hesitancy, “No! I don’t want to become a guinea pig. My Nana told me all about the Tuskegee study and so I decided not to get the shot.” The Tuskegee study, conducted from 1932 to 1972, aimed to study the natural course of untreated syphilis. However, informed consent was not obtained from the participants, and neither were they offered treatment despite the widespread availability of penicillin. The study terminated prematurely in 1972 following associated press releases about the study. A Presidential Apology by then-President Clinton was issued and led to the establishment of The National Center for Bioethics in Research and Health Care at Tuskegee University. Although this formed the basis of the highest ethical standards practiced in medical research today, the effects of the Tuskegee study have continued to persist, especially in the African American community. Now more than a year into the pandemic, the COVID-19 vaccines mark a promising turning point in the global journey toward containing this contagion, bringing about a global and unparalleled sense of hope and optimism. The rapid yet thorough development of such effective vaccines (as much as 95% in the case of Pfizer/BioNTech1) has been both unprecedented and unexpected. As millions of people are vaccinated every day in the United States, historic healthcare barriers2 such as socioeconomic status, lack of access to transportation, and lack of education, continue to hinder progress. Vaccine misinformation has permeated media and social platforms.3 However, even more prominent amplifiers for vaccine hesitancy lie not in the information itself but the approach4 in which data are presented, stemming from sensationalized media coverage combined with the effects of an information barrier5 as information “trickles down” from the scientific community to the public. The US government’s recent “pause” on Johnson & Johnson’s (J&J’s) COVID-19 vaccine is a prime example.6,7 In response to understandable questions surrounding the efficacy of the J&J vaccine,8 the infection prevention community diligently spearheaded widespread messaging campaigns stipulating its marked advantages.9 However, the pause, though brief, triggered not only a cascade of public concern but also a sentiment of mistrust of information disseminated by the scientific community. The emergence of data linking rare yet severe cases of cerebral venous sinus thrombosis to the J&J vaccine followedweeks of reassurance to the public that people should receive the vaccine with an emphasis on its “safety” and “efficacy.” Understandably, this discrepancy was alarming for many people. Evenmore recently, the campaign to vaccinate children10 aged 12 years and older has been met with legitimate concerns11 from parents, including the possible link tomyocarditis12 being investigated by the CDC. Infection preventionists are left grappling with the question of how to promote vaccine acceptance in aworld of ever-evolving scientific data. Importantly, the public response and the response from the infection prevention community can look very different. As physicians and scientists, we have been trained to critically appraise available information and consider all possible explanations before arriving at a conclusion. In contrast, a layperson tends to be swayed by multiple factors,13 including personal, cultural, or religious beliefs, a more immediate or “knee-jerk” response. This disparity causes barriers in information between the scientific community and the public as new data are uncovered. We have witnessed COVID-19 ravaging our communities and staff members. We have dealt with many outbreaks in unvaccinated communities. Infection preventionists can play an important role in increasing vaccine uptake by debunking myths and improving scientific communication to the public. First, we need to help clinicians alter their approach when recommending vaccination. Clinicians present recommendations as a list of instructions; they are holding themselves accountable by the public for information they disseminate. As demonstrated by the spike in vaccine hesitancy following the pause in administration of the J&J vaccine, this approach can feed vaccine skepticism if and when new data emerge undermining these claims, eroding trust of clinicians and the scientific community. Most grassroots vaccination efforts, however, have not been designed with these inconsistencies in mind. In fact, a study found that the widespread emotional appeal of antivaccination messaging is largely due to its accessibility and consumeroriented, user-friendly content.5,14 We can recommend that our clinicians be mindful of these factors when discussing vaccinations with their patients. As both vaccine ambassadors and facilitators, the infection prevention community, in addition to using generalized terms such as “safe” and “effective,” can help people Author for correspondence: Ammara Mushtaq, E-mail: [email protected] Cite this article: Grewal M, Mushtaq A, and Chopra T. (2021). “It’s worth a shot : : : or is it?” Notes from the grassroots on vaccine hesitancy and bridging gaps. Infection Control & Hospital Epidemiology, https://doi.org/10.1017/ice.2021.356