Reviewed and updated by Myrna Buiser Schnur, MSN, RN: February 26, 2024
 
Vaccines have played a critical role as a cost-effective intervention to eradicate disease and improve health all over the world, yet vaccination remains a controversial and polarizing topic. Prior to the COVID-19 pandemic, the World Health Organization (WHO) named vaccine hesitancy one of ten major threats to global health in 2019. It’s been four years since the first case of COVID-19 was identified and the U.S. emergency response to the pandemic is over. However, confidence in vaccines continues to divide our nation. A study conducted by the Pew Research Center in March of 2023 found approximately 34% of those surveyed have embraced the COVID-19 vaccine, have been fully vaccinated and are up to date with the most recent booster (Funk, Tyson, Kennedy & Pasquini, 2023). The survey also found about 33% are fully vaccinated but have not received a recent booster and are concerned about the safety and efficacy of COVID-19 vaccines. The last 21% refused vaccination completely and had concerns about the vaccines.
 
Vaccine hesitancy is defined by the WHO Strategic Advisory Group of Experts (SAGE) as a “delay in acceptance or refusal of vaccines despite availability of vaccination services.” This sentiment is shaped by three main factors (Anderson & Bryson, 2020):

• Complacency: belief that the risks of the disease are low
• Convenience: availability, affordability, and accessibility of vaccines
• Confidence: lacking in the safety and effectiveness of vaccines, health care system, pharmaceutical companies and the leaders who recommend them

 
An earlier study conducted by the Pew Research Center in February 2021 cited several factors that positively influenced individuals to get vaccinated (Funk & Tyson, 2021):

• Trust in the vaccine research and development process
• Advocates of community health
• Habits and practices with the seasonal influenza vaccine

 
However, the survey also found that 30% of Americans were vaccine hesitant for the following reasons:

• Concerns about side effects
• Feel the vaccines were developed and tested too quickly
• Need to know more about vaccine efficacy
• Previously experienced too many mistakes from the medical care system
• Don’t think they need it
• Don’t get vaccines in general

Building Vaccine Confidence

Vaccine confidence is the trust that patients, their families, and providers have in the recommended vaccines, the people that administer vaccines, and the processes and policies that lead to vaccine development, licensure or authorization, manufacturing, and recommendations for use (CDC, 2023). How do we build vaccine confidence in individuals with vaccine hesitancy? As health care providers, we need to listen to their concerns, answer their questions, and help them feel good about their decision to be vaccinated.
 
The CDC outlines four ways to help build COVID-19 vaccine confidence:

1. If you are vaccinated, become an advocate for immunization. Be a role model, lead by example, and promote your decision to get vaccinated. Let others know that you trust the scientific process and believe in the safety and efficacy of the COVID-19 vaccines. Share your reasons for getting vaccinated and encourage others to get vaccinate. Encourage leaders in your community or organizations to be vaccine champions.
2. Talk with family and friends about getting vaccinated. Provide opportunities where people can openly discuss their views and ask questions about the COVID-19 vaccines and listen to their concerns with empathy.
3. Tackle COVID-19 vaccine misinformation. Help educate people about COVID-19 vaccines, how they are developed and monitored for safety, and how individuals can talk to others about the vaccines. When you find COVID-19 information, verify it with credible sources and learn how to respond to misinformation with facts (see below).
4. Share your decision to get vaccinated on social media platforms. 

Dispelling the Myths

There’s a lot of misinformation on the internet, in the media and in the news. When you’re asked questions about COVID-19 vaccines – be prepared and arm yourself with the facts. Here are five common myths regarding COVID-19 vaccines.
 
Myth: The COVID-19 vaccines were developed too quickly to be safe.
A significant amount of research had been conducted on coronavirus vaccines and messenger RNA (mRNA) technology long before the pandemic occurred (Saunders, 2022). The vaccines have met the Food and Drug Administration’s (FDA) rigorous scientific standards and review processes for safety, effectiveness, and manufacturing quality required for approval. During the pandemic, hundreds of millions of people in the U.S. received COVID-19 vaccines under strict safety monitoring (Centers for Disease Control and Prevention [CDC], 2023).
 
Myth: I can get COVID-19 from the vaccine.
None of the available COVID-19 vaccines available in the U.S. contain the live SARS-CoV-2 virus, therefore you can’t get infected with the virus or sick with COVID-19 after receiving the vaccine. The vaccines teach the immune system how to recognize and fight the virus. This process can cause symptoms but doesn’t cause infection.
 
Myth: The side effects of the COVID-19 vaccines are dangerous.
The COVID-19 vaccines may have side effects however most side effects are minor and short term such as pain at the injection site, body aches, headache, fever, chills, or fatigue. These are normal signs that your body is building protection. There have been reports of myocarditis and pericarditis following COVID-19 mRNA vaccination and the CDC is closely monitoring these adverse effects. The CDC continues to recommend that all individuals over the age of 6 months get an updated COVID-19 vaccine.
 
Myth: I’ve already had COVID-19, I don’t need to get the vaccine.
Vaccination is still recommended to individuals who have had COVID-19 since duration of natural immunity and protection is unknown. Individuals who have contracted the virus should wait until they have fully recovered from COVID-19 prior to vaccination and those treated with monoclonal antibodies or convalescent plasma should wait 90 days before getting the vaccine.
 
Myth: The COVID-19 vaccine can change my DNA and contains harmful substances.
The ingredients in COVID-19 vaccines include an mRNA strand, lipids, salts, sugars, and buffers. The mRNA vaccines work with the body’s natural defense system to safely develop immunity to the disease. The mRNA doesn’t enter the nucleus of the body’s cells where DNA is located and can’t change the DNA. It remains in the cytoplasm of the cell and is broken down within a few hours (Saunders, 2022). The vaccines also do not contain implants, microchips, or tracking devices.
 
Danielson et al. (2019) describes the most effective approach to addressing vaccine hesitancy is through engagement in conversation in a nonconfrontational manner, by providing factual, evidence-based information, recognizing your patients’ beliefs about vaccination, building trust, addressing health literacy, and getting involved in public health initiatives.
 
What has your experience been with vaccine hesitancy? Do you have effective strategies to share? Please comment below.
 

References
 
Anderson, P. & Bryson, J. (2020). Confronting vaccine hesitancy: What nurses need to know. Nursing2020, 50(8), 43-46. https://doi.org/10.1097/01.NURSE.0000668436.83267.29
 
Centers for Disease Control and Prevention (2023, December 20). Vaccinate with confidence: Strategy to reinforce confidence in Covid-19 vaccines – Building confidence in COVID-19 vaccines. https://www.cdc.gov/vaccines/covid-19/vaccinate-with-confidence.html
 
Centers for Disease Control and Prevention (2023, November 3). Safety of COVID-19 Vaccines. https://www.cdc.gov/coronavirus/2019-ncov/vaccines/safety/safety-of-vaccines.html

Danielson, L., Blima, M. & Boyle, L. (2019). Special feature: Countering vaccine misinformation. AJN, American Journal of Nursing, 119(10), 50-55. https://doi.org/10.1097/01.naj.0000586176.77841.86

Funk, C. & Tyson, A. (2021, March 5). Growing share of Americans say they plan to get a COVID-19 vaccine – or already have. Pew Research Center.  https://www.pewresearch.org/science/2021/03/05/growing-share-of-americans-say-they-plan-to-get-a-covid-19-vaccine--or-already-have/
 
Funk, C., Tyson, A., Kennedy, B. and Pasquini, G. (2023, May 16). Americans’ Largely Positive Views of Childhood Vaccines Hold Steady. Pew Research Center. https://www.pewresearch.org/science/2023/05/16/americans-largely-positive-views-of-childhood-vaccines-hold-steady/
 
Saunders, M. A., & LMSW (2022). Dispelling COVID-19 Myths: Implications of Vaccination Acceptance by African Americans and Others in Marginalized Communities. Delaware journal of public health, 8(1), 80–83. https://doi.org/10.32481/djph.2022.03.013
 
World Health Organization. (2019). Ten threats to global health in 2019.
https://www.who.int/news-room/spotlight/ten-threats-to-global-health-in-2019

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