President Joe Biden last week gave Americans the promise they had been waiting for throughout the COVID-19 pandemic: The nation will have enough vaccines by the end of May “to be able to vaccinate every single adult in America.”
Then came the catch.
“It will not be done by then,” said Biden, “but that supply will be there.”
Securing hundreds of millions of vaccines for a virus just discovered a year ago is an unprecedented accomplishment in medicine. But an unanswered question remains: Will enough Americans want them?
Surveys have shown many in the U.S. are still leery of the shots. A report by the Kaiser Family Foundation even recently found that three in 10 U.S. health care workers say they are hesitant about getting the vaccines – and they are arguably both most at risk for catching the disease and the most knowledgeable about the role vaccines play in preventing infections.
Now, several experts are concerned that as the months pass, infection rates go down and the weather warms, the next big challenge might be persuading Americans wary of the newly created shots to actually get them.
“It’s possible that as mortality declines in the U.S., people may think the epidemic is over, and that there’s no need to get vaccinated,” Zoë Hyde, an epidemiologist and biostatistician at the University of Western Australia, told TheStreet in an email.
Other experts agree.
“Complacency can lead to dire consequences for those who decide to take a chance and not get vaccinated as the pandemic starts to abate,” noted Archana Chatterjee, a pediatric infectious disease specialist and dean of the Chicago Medical School.
A sizable minority of U.S. adults either don’t want to get the injections or is unsure of them, according to recent polls. The numbers fluctuate, but several surveys show only up to around 55% of Americans say they will get the shot as soon as possible if they haven’t already. Then the respondents become much less committal, with around a quarter of American adults saying they either won’t likely get the jab or definitely won’t. Some states like Idaho are even starting to report a slack in demand for shots among current priority groups.
For comparison, only a little more than half of Americans of all ages got the flu shot during the 2019–2020 season, according to the Centers for Disease Control and Prevention. Because no COVID vaccine is currently available for children and younger teens, who make up around 22% of the population, if only around 50% or 60% of adults get the shot, the vaccination rate could prove too low the stave off the pandemic.
A World of Hurt
Hesitancy around vaccines isn’t just a U.S. phenomena. In Japan, for example, surveys have shown half or more of the population is uneasy about getting the jab, which just rolled out there last month. Similar rates have been seen in Hong Kong, where hesitancy is high, too. In Australia, the rates of vaccine unease are lower, but still significant, with a recent survey showing around one in five adults are unlikely to get it.
With more than 116 million vaccines distributed throughout the nation and just about 18% of Americans getting at least one shot to date, lines for getting vaccinated are still long in much of the country. (Vaccines by Pfizer (PFE) and Moderna (MRNA) require two shots and those by Johnson & Johnson (JNJ) require one.)
But at some point soon, supply will likely surpass demand.
“I think it’s a valid concern that the success of vaccines could ironically contribute to some degree of vaccine hesitancy,” said Hyde.
Still, the disease is a new monster and it's debatable what rate of vaccination and natural infection will be enough to create herd immunity. Imperfect coverage may suffice, say some experts.
Despite the hesitancy rates in the U.S. and Canada, "there are sufficient numbers of people very eager to get the vaccine that achievable coverage will make a very big difference to dynamics of infection," says Dr. David N. Fisman, a professor of epidemiology at the University of Toronto. Fisman says that the disease is "very vulnerable to collapse" with even imperfect immunization coverage.
But Hyde feels that inadequate coverage could open the opportunity for the virus to spread and increase the likelihood of variants emerging that could threaten the efficacy of the vaccines. "This could potentially endanger everyone," she said.
Still, another demon could be divisiveness over beliefs about vaccination, suggested Fisman.
Dose of Fear
Two forces could work against the effort to vaccinate people against the disease that has killed more than a half-million Americans: Hesitancy of the newly created shots and the so-called anti-vaccine movement. While various groups and influential leaders have spread fears – often unfounded – about the vaccines, a larger campaign could be at play by governments like Russia’s to spread fears about the vaccines, according to a recent report in the Wall Street Journal.
But there’s also the truth that the vaccines were approved for emergency use and were developed in a time frame previously thought of as impossible. Typically it takes years, even decades, for new vaccines to be created and get needed federal approvals.
“The language surrounding it was a little scary, right? ‘Warp speed. The race for a vaccine. Who’s going to be the first,’” acknowledged Dr. Paul Offit, director of the Vaccine Education Center and a physician at Children's Hospital of Philadelphia, in a recent video posted online to the "This Week in Virology" series.
But in the video, Offit explains that the size of the trials for the new vaccines was typical and so was the short-term safety follow-up – noting that serious safety concerns “invariably” come up within six weeks of vaccination, and none had. The only major unknown, he said, is how long the shots will be effective.
“But, you know, 450,000 people died last year, so you weren’t going to do a … three or four year trial to see how long it’s effective,” Offit said in the video.
Still the technology of the messenger RNA shots by Moderna and Pfizer are newly in use, and some experts have told TheStreet they are concerned about long-term side effects.
“Nobody knows the actual facts about long-term safety, because not enough time has elapsed since we started giving these vaccines to people,” said Dr. Meryl Nass, a physician in Maine who has spoken and written about the anthrax vaccine used by the military. “And not enough good information is available.”
Nass also said in an email she has concerns related to deaths that have been reported shortly after vaccinations.
A Japanese virologist also recently told TheStreet that he also has lingering unease about possible long-term effects of the vaccines, after Pfizer’s shots were rolled out in Japan last month.
"I recommend people take the vaccine, because I think it's better in general for people and I will take it for myself, because I recommend it. However, to tell the truth, I feel a little uneasy ... no one knows for now the effect that may occur far later," said Hidekazu Nishimura, who heads the Virus Research Center at Sendai Medical Center, in an interview last month.
Transparency and Trust
To inform their citizens about the shots, some nations have been printing regular reports in clear language about actual and possible reactions to the vaccines. The U.K., for example has its “Yellow Card” system and Norway puts out a regular assessment of the shots.
Those who read the startling story earlier this year, for example, of deaths reported in Norway could see that the nation’s medical authorities still believe the shots are largely safe.
The U.S., meanwhile, has its Vaccine Adverse Event Reporting System, or VAERS. That can be confusing and cumbersome. It acts as a wide net to catch any possible side effects of vaccines, say experts, and the data can be used to flag potential patterns by health officials. Hundreds of deaths, injuries and other the problems have been reported to the system, but many of those occurred days or weeks after the injections and links to the shots are often believed to be unrelated.
“VAERS is not really intended for public information,” noted Chatterjee, who says she’s concerned that the erosion of trust in governmental agencies may make it difficult “for the public to be reassured by anything that the CDC or other agencies put forth.”
“I think the loss of trust in science and government has been building over the years, but has been accelerated by several factors including the fear engendered by the pandemic (and) social media,” said Chatterjee in an email.
One of several supposed threats circulating the internet of the new vaccines is that they could contribute to what’s called “antibody-dependent enhancement,” or ADE. When ADE occurs, antibodies created through vaccines or prior infections fail to prevent viruses from entering cells, and actually contribute to worse disease, according to information from the Children’s Hospital of Philadelphia. Some videos and posts have claimed the new shots could contribute to ADE, but infectious disease experts say that is highly unlikely.
"While someone can hand-wave concerns about ADE, the ultimate test is what happens to people when vaccinated, which completely trumps theoretical concerns or even in-vitro data. The proof is in the pudding, so to speak, and this pudding is spectacularly good," said Dr. Otto O. Yang, a veteran infectious disease expert and medical doctor at the David Geffen School of Medicine at UCLA.
Another expert told TheStreet there was never really "any major concern” about ADE for vaccines using technology employed in the vaccines by Pfizer, Moderna or Johnson & Johnson.
“Most of the initial concern was around some of the inactivated vaccines, where significant amounts of non-neutralizing antibodies … would be made and were a potential source of ADE,” said Adam K. Wheatley, a senior research fellow in microbiology and immunology at the University of Melbourne in Australia. Wheatley, who co-authored a paper on COVID shots and ADE, said the ones now in use elicit an impressive neutralizing antibody response and should continue to prove highly protective.
Wheatley said that most of the ADE concern had sprung from a very limited number of non-human primate studies using vaccines against the original SARS virus.
But rare reports of deaths following the shots will likely continue to make headlines. And so could uncommon reports of allergic reactions. As the risk of getting COVID decreases, will these types or headlines lead more Americans to hold off getting a shot?
Throughout the pandemic, after all, many Americans have proven more than willing to ditch their face masks at the first sign of a drop in cases -- and there's no side-effects of wearing the masks.
Failing to get enough people vaccinated, however, could cause the pandemic linger on.
“The immediate result will be that the virus continues to spread in the unvaccinated population, and outbreaks will continue indefinitely. Over time, I hope that would encourage people to get vaccinated,” said Hyde.
This story has been updated, including with new quotes by Dr. Fisman.