When COVID-19 vaccinations began in late December, it was gratifying to see that those on the front lines who have endured so much were prioritized to receive them. I was surprised, however, to hear a Houston physician report that 50% of the nurses in the ICU where he works say they will not get the vaccine because they are "skeptical it will work and are worried about unfounded side effects."
In October 2020, before any vaccines were available, the American Nurses Foundation surveyed approximately 13,000 nurses on what they knew and believed about the development of a COVID-19 vaccine. When nurses were asked if they would get the vaccine, approximately one-third said yes (34%), one-third said no (36%), and one-third (31%) were unsure. Much of the hesitancy involved nurses' lack of knowledge about testing, adverse effects, the conduct of clinical trials and the approval process, and whether the process was moving too quickly. About 50% mistrusted the information about the process.
Then, in December, the Food and Drug Administration (FDA) issued an emergency use authorization (EUA) for the Pfizer-BioNTech COVID-19 vaccine in persons 16 years and older because this "vaccine met FDA's rigorous, scientific standards for safety, effectiveness, and manufacturing quality needed to support emergency use authorization."
The vaccine, which requires two doses, was tested in a randomized, double-blind study (neither the participants nor those who administered the vaccine knew who received the vaccine or the saline placebo) in which half of the 37,586 participants received the placebo and half received the vaccine, and all were followed for two months after receiving the required second dose. Adverse effects were minimal. The EUA was granted when it was determined that the potential benefits outweighed the potential risks. Since then, an EUA has been issued for a second COVID-19 vaccine from Moderna for use in those 18 years and older.
So two vaccines are now available that have the potential to save millions of lives. Perhaps now that the vaccines are not hypothetical but real and available and tested, most of the nurses who responded negatively to the American Nurses Foundation survey will change their minds. One hopes that nurses, as clinicians committed to professional practice grounded in science, who have witnessed the devastating physical and psychological effects of COVID-19, will roll up their sleeves and be vaccinated, and then help spread accurate information to their communities. This will not be an easy task.
In a webinar held December 18 by the National Academies of Sciences, Engineering, and Medicine, Building Public Vaccine Confidence to Prevent COVID-19, researchers from a variety of fields presented findings on the reasons underlying vaccine hesitancy and how health professionals can respond. Current research and experiences with prior vaccine campaigns show that lack of trust, often because of past experiences; misunderstanding of how vaccines work; and fears about adverse effects are why many people reject vaccines. All presenters seemed to agree that the way to counter misgivings is to rebuild trust in the health system at the national, state, and local levels. And fact-based, consistent, and transparent information from respected leaders at all levels-and especially within local communities-is vital.
Nurses are essential to administering the vaccines, and we need to be prepared with accurate information about the science behind them: how they work, what we know and don't know about them, and what might change as more data emerge. We need to engage with local and influential community leaders-ministers, politicians, and youth leaders-and ensure they have accurate information. Success will be determined at the local level.
We know from prior vaccine campaigns that there is much deliberate misinformation disseminated on social media. We need to "drown out" the misinformation with facts and not amplify a few severe reactions as the norm (for example, while some people may have severe reactions to penicillin, it is still safe for most people). As nurses, we can weed out and nullify these voices with fact-based information-not engage in false debates but listen to the concerns of our communities and answer with science.