A Behavioral Approach to COVID-19 Vaccine Hesitancy
As of early December 2020, three promising COVID-19 vaccine candidates have been announced. Moderna, Pfizer, and AstraZeneca each report a vaccine efficacy rate of 94.5%, at least 90%, and 90%, respectively (although there is some controversy surrounding the clinical data provided by AstraZeneca).1,2,3 This is all just seven months after the U.S. government founded Operation Warp Speed, an initiative to accelerate the testing, supply, development, and distribution of safe and effective COVID-19 vaccines, therapeutics, and diagnostics.4 But despite these breakthroughs, there may still be significant behavioral barriers to ending the pandemic: vaccine hesitancy and the anti-vax movement have many people uneasy about the prospect of a COVID-19 vaccine.
A successful vaccine can be a long-term solution to a pandemic that has already killed hundreds of thousands. However, Operation Warp Speed came with a major blindspot: just because a successful vaccine is available does not mean people will take one. Hence, creating the vaccine is only half the battle. The other half is ensuring that enough of the American public actually gets vaccinated. Understanding how people may react to the vaccine will be essential in guiding policies and campaigns working to increase vaccine uptake.
The anti-vax movement in the U.S.
Recent polls have already shown that Americans are hesitant to accept a COVID-19 vaccine: about one in three Americans do not plan to get vaccinated once an FDA-approved vaccine is available.5,6 These poll results are alarming because insufficient vaccine uptake could result in a failure to reach herd immunity and reduce the overall effectiveness of the vaccine on our nation’s public health. In turn, the pandemic will persist and the country will continue to face great social, economic, and health costs.
The United States already has a history of difficulty with vaccine uptake. For example, let’s take a look at the statistics for the flu shot. In the 2018–2019 flu season, only 45.3% of the US adult population received a flu shot, a vaccination that has been around for several decades. (For perspective, current models suggest that 60–70% of the population would need to be vaccinated in order to contain the spread of COVID-19.)17 This is due in part to lack of awareness and accessibility, but also behavioral challenges. Given the novelty of SARS-CoV-2, we can only anticipate new behavioral factors specific to the current pandemic that will contribute to vaccine hesitancy
References
1. Promising Interim Results from Clinical Trial of NIH-Moderna COVID-19 Vaccine. 15 Nov 2020 [cited 29 Nov 2020]. Available: https://www.nih.gov/news-events/news-releases/promising-interim-results-clinical-trial-nih-moderna-covid-19-vaccine
2. Callaway E. What Pfizer’s landmark COVID vaccine results mean for the pandemic. Nature. 2020 [cited 29 Nov 2020]. doi:10.1038/d41586-020-03166-8
3. AZD1222 vaccine met primary efficacy endpoint in preventing COVID-19. 23 Nov 2020 [cited 29 Nov 2020]. Available: https://www.astrazeneca.com/media-centre/press-releases/2020/azd1222hlr.html
4. Coronavirus: Operation Warp Speed. [cited 29 Nov 2020]. Available: https://www.defense.gov/Explore/Spotlight/Coronavirus/Operation-Warp-Speed/
5. Malik AA, McFadden SM, Elharake J, Omer SB. Determinants of COVID-19 vaccine acceptance in the US. EClinicalMedicine. 2020;26: 100495.
6. O’Keefe SM. One in Three Americans Would Not Get COVID-19 Vaccine. In: Gallup [Internet]. 7 Aug 2020 [cited 29 Nov 2020]. Available: https://news.gallup.com/poll/317018/one-three-americans-not-covid-vaccine.aspx
7. Brunson EK, Schoch-Spana M. A Social and Behavioral Research Agenda to Facilitate COVID-19 Vaccine Uptake in the United States. Health Secur. 2020;18: 338–344.
8. Schoch-Spana M, Brunson E, Chandler H, Gronvall GK, Ravi S, Sell TK, et al. Recommendations on How to Manage Anticipated Communication Dilemmas Involving Medical Countermeasures in an Emergency. Public Health Reports. 2018. pp. 366–378. doi:10.1177/0033354918773069
9. DeRoo SS, Pudalov NJ, Fu LY. Planning for a COVID-19 Vaccination Program. JAMA. 2020;323: 2458–2459.
10. Andhavarapu S. Game Theory Can Explain Why You Should Wear A Mask – The Decision Lab. 18 Aug 2020 [cited 1 Dec 2020]. Available: https://thedecisionlab.com/insights/health/game-theory-can-explain-why-you-should-wear-a-mask/
11. Hallsworth M, Buttenheim A, Violante A, Fennell LA, Saldanha N, Ghai S. Challenges Facing a COVID-19 Vaccine: A Behavioral Science Perspective. 11 Aug 2020 [cited 1 Dec 2020]. Available: https://behavioralscientist.org/challenges-facing-a-covid-19-vaccine-a-behavioral-science-perspective/
12. “Just beautiful”: Another COVID-19 vaccine, from newcomer Moderna, succeeds in large-scale trial. 16 Nov 2020 [cited 1 Dec 2020]. Available: https://www.sciencemag.org/news/2020/11/just-beautiful-another-covid-19-vaccine-newcomer-moderna-succeeds-large-scale-trial
13. Perchick M, Green M. The COVID-19 vaccine will require multiple doses. How officials plan to ensure compliance. In: WTVD-TV [Internet]. 26 Nov 2020 [cited 1 Dec 2020]. Available: https://abc11.com/8280593/
14. Wadman M. Public needs to prep for vaccine side effects. Science. 2020;370: 1022–1022.
15. Andhavarapu S. How To Remain Vigilant In The Era Of COVID-19 Information Overload – The Decision Lab. 13 Jul 2020 [cited 2 Dec 2020]. Available: https://thedecisionlab.com/insights/health/remaining-vigilant-in-the-era-of-information-overload
16. Hersh ED, Goldenberg MN. Democratic and Republican physicians provide different care on politicized health issues. Proceedings of the National Academy of Sciences. 2016. pp. 11811–11816. doi:10.1073/pnas.1606609113
17. Aschwanden, C. (2020, October 21). The false promise of herd immunity for COVID-19. Nature. https://www.nature.com/articles/d41586-020-02948-4
About the Author
Sanketh Andhavarapu
Sanketh is an undergraduate student at the University of Maryland: College Park studying Health Decision Sciences (individual studies degree) and Biology. He is the co-Founder and co-CEO of Vitalize, a digital wellness platform for healthcare workers, and has published research on topics related to clinical decision-making, neurology, and emergency medicine and critical care. He is also currently leading business development for a new AI innovation at PediaMetrix, a pediatric health startup, and previously founded STEPS, an education nonprofit. Sanketh is interested in the applications of behavioral and decision sciences to improve medical decision-making, and how digital health and health policy serve as a scalable channel to do so.
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