The development of COVID-19 vaccines brought hope to at least a portion of the restriction-fatigued public, yet many significant challenges lie ahead. Alongside existent and potential problems in the production, purchase, distribution, and storage of the vaccines, there is the human element that must not be overlooked: anti-vaccine sentiment.
Even though experts initially believed the development of a safe and effective COVID-19 vaccine would take at least a few years, by December 2020 there were at least six vaccines approved and/or in use in various countries. While the public optimism on the possibility of going back to at least partial normalcy this year has increased as a result of the latest news, one should keep in mind that there are many issues to be addressed in the process of vaccination before updating one’s beliefs. To mention a few, supply-side problems include limited production speed and difficulties in delivery due to storage temperature requirements, whereas demand-side problems include the distribution and storage of the vaccines in different parts of a country and the discrepancies in income and hence in access to vaccines across countries. On the final consumer side, vaccine hesitancy seems to be the greatest challenge.
Placed by the WHO among the ten greatest threats to global health in 2019, vaccine hesitancy can be described as the unwillingness or refusal to be given a vaccine or to have one’s children vaccinated. The leading cause of this hesitancy is believed to be safety concerns. According to a survey conducted by Fredrickson et al (2004), 52% of the parents who refused certain vaccines did so out of fear of side effects, communicated to them through media and/or other people. Claims that vaccines can cause autism, allergies, multiple sclerosis, etc. have fueled anti-vaccine movements across the globe.
A common cause apart from health concerns is religious beliefs: some religious people may reject all kinds of vaccines due to their views against immunization, while some may reject certain vaccines as they contain components that should not be taken into the body according to their religion. Another common cause is personal and philosophical beliefs, such as the belief
s that natural immunity is better, that diseases to be vaccinated against are not very prevalent and therefore the risk of contraction is low, that such diseases are not life-threatening and/or easily treatable, and the like. Additionally, lacking access to more information about a vaccine may render people more skeptical and hesitant. Gust et al (2005) conclude that the perceived lack of access to information of parents can be attributed to negative opinions about immunization and toward healthcare providers. They suggest that information passed on by a trusted provider can be very helpful in keeping them or making them feel reassured about the immunization process.
In the case of the COVID-19 vaccines, there is an additional element intensifying the safety concerns of the hesitaters: the speed at which the vaccines were developed. Traditionally, vaccines take years or sometimes even decades to be developed. For instance, Dr. Jonas Salk started to work on a polio vaccine in the 1930s and the vaccine was shown to be safe and effective in 1955. A more recent example is the vaccine for human papillomavirus (HPV), which is a sexually transmitted virus associated with most types of cervical cancer. Professors Ian Frazer and Jian Zhou from the University of Queensland in Australia began to synthesize “virus-like particles” (VLPs) that mimicked HPV and hence induced a high level of antibody production in the body against this virus in 1990. The design, testing, and human trials of the vaccine were completed in seven years, and it was approved in the USA and Australia in 2006, following extensive clinical trials that verified its effectiveness. In fact, before the pandemic, the shortest time frame in which an entirely new vaccine was developed was four years.
The development of COVID-19 vaccines in record time can be attributed to circumstances. Given the gravity of the health situation and the economic and social disruption created by the novel coronavirus around the world, and given that whichever vaccine that would come first in the vaccine race would potentially generate an immense amount of profit for the contributors, it is likely that governments, companies, and organizations transferred an unprecedented amount of financial resources and facilities to COVID-19 vaccine researchers. Moreover, two of the ready-for-use COVID-19 vaccines, the Pfizer-BioNTech and the Moderna vaccines, use the messenger RNA (mRNA) technology, which makes the development process relatively short. Before these two, no mRNA vaccine had been approved for use, as only recently stability and efficiency issues of such vaccines were largely overcome. mRNA vaccines against certain infectious diseases and certain types of cancer have been yielding promising results, yet the fact that mRNA technology in vaccines is quite new may be bringing added worries to health-concerned hesitators.
In a survey conducted by Euronews in October, 63% of the British, 57% of the Germans, 55% of the Italians, and only 37% of the French said that they were willing to be vaccinated if “a coronavirus vaccine becomes available at little or no cost within the next year”.
Lazarus et al (2020) conducted a survey in 19 countries to identify potential acceptance rates and reasons for the nonacceptance of COVID-19 vaccines. 71.5% of the 13,426 people surveyed stated that they would be “very or somewhat likely to take a COVID-19 vaccine”, yet, there is high heterogeneity in the vaccine acceptance rates across countries. When they were asked if they would take a “proven, safe, and effective vaccine”, respondents from China gave the highest proportion of positive responses (88.6%) and the lowest proportion of negative responses (0.7%). The highest proportion of negative responses came from respondents from Poland (27.3%), and the lowest proportion of positive responses came from Russia (54.9%).
In this survey, people over 25 were found to be more likely to accept a COVID-19 vaccine compared to those aged 18-24, and the difference in acceptance rates was strongest between those aged 18-24 and those aged above 65. Gender differences were not very large, male respondents being slightly less likely to give positive responses compared to female respondents. Income and education levels were both positively correlated with acceptance rates. Rather interestingly, people who have contracted COVID-19 themselves or whose family members have were not more likely to give positive responses. A significant factor affecting acceptance rates was trust in government: respondents who stated that they trusted their government were more likely to be accepting of a COVID-19 vaccine.
A relevant question here is whether governments can go in the direction of making COVID-19 vaccines mandatory. Although technically possible, this is considered a violation of human rights. There is case-law of the European Court of Human Rights from the Solomakhin v. Ukraine case, which holds that “[c]ompulsory vaccination – as an involuntary medical treatment – amounts to an interference with the right to respect for one’s private life, which includes a person’s physical and psychological integrity, as guaranteed by Article 8(1)” (para 33).
All in all, given that vaccine hesitancy can hinder a timely return to normalcy, yet compulsory vaccination goes against human rights, the best governments can do is to ensure transparency and make guidance and reliable information regarding COVID-19 vaccines available to their people, thus building public confidence.