2020 has been a year that will be hard to forget (even though most of us will want to). The spread of Covid-19 across the globe has been devastating to say the least. We never imagined that we would still be fighting the virus 8 months later, and even more so, that the numbers would continue to be rising. The idea of a vaccine being distributed seemed far out of reach—until now.

While the latest news of a Covid vaccine brings hope that this nightmare can come to an end, it also brings up a new challenge: getting a large percentage of the population vaccinated. Our recent study shows that many are not convinced in getting the vaccine for reasons such as its side effects and doubts about its effectiveness. Other studies also make a case about people’s distrust of the vaccine being released with an Emergency Use Distribution by the FDA. Regardless, a vaccine will not prevent the spread of Covid if people are not actually getting vaccinated.

To learn more about this issue, we sat down with Eileen Fry-Bowers, PhD, JD, RN, CPNP, FAAN. Dr. Fry-Bowers is an associate professor at the University of San Diego and has a wealth of experience in health care. In this interview, she shares with us the importance of the messaging around vaccines, reasons why some are against them, and what she expects will happen once the vaccine is distributed.

Rasto Ivanic, GroupSolver: We often take a look at present issues in society and ever since Covid-19, we have been running pulse checks to see what people are thinking. The biggest news right now revolves around the vaccines. I remember someone once said that vaccines don’t prevent the spread of the virus—it’s the vaccination. So, what I would like is to have a conversation with you about this topic given your experience and knowledge. I’d like to begin with one thing that shocked me when analyzing this study. We saw that there was a split among those who would, would not, or are unsure of getting the vaccine when it is available. How can we change those numbers to something like 80-20%?

Eileen Fry-Bowers, University of San Diego: I think the first thing to note is that we are just looking at it [messaging around vaccines] through a Covid lens. This conversation about vaccines in general is part of a much larger conversation that has been happening for quite some time, and that is questioning vaccines in general. With my background as a pediatric nurse practitioner, having those conversations with parents over getting childhood vaccinations was common. The challenges arising from those conversations have continued to grow for several decades around concerns about the safety of childhood vaccines and we see hesitancy and refusal by some parents. This, vaccination against disease, has been one of the great wonders of the 20^th century. Much of the reduction of morbidity and mortality over the 20^th century is related to the introduction of vaccines, for diseases such as measles, polio, and other illnesses. I think this Covid conversation is happening as a sub-conversation about vaccines in general. 

Another thing to note is that we haven’t been all that successful with communicating about the annual flu vaccine either. There are certain populations who are older or have underlying health risks who often get the flu vaccine. But for other folks the public health message of getting the flu vaccine to protect yourselves but also others around you at higher risk hasn’t always worked. We haven’t managed to break through that dual importance of protecting yourself and those around you. The same messaging is being used for the Covid vaccine. But it is a hard sell for people. Especially with such polarization around the issue of Covid, as seen in your findings. Maybe instead of one global message, we should create certain messages for different audiences based on their beliefs and concerns.

I will say that those who are stating that they will not be getting the vaccine will be the hardest to convince. The ‘no’ is sometimes based on personal or religious beliefs, while some are based on political beliefs. Within that ‘no’ group, you have so many different types of ‘no’. You will need many different targeted messages.

RI: I imagine that there will be those who will never be convinced, especially if it is based on religious reasons. But what do you think is a reasonable number in terms of percentage of the population getting the vaccine that will be helpful for us to try to combat this issue?

EFB: I don’t know that we have those exact numbers yet for Covid, some say 70% – 80% of people need to become immune either through vaccine or infection but for some communicable diseases, like measles, we need higher than 85-90%. If we can’t get near those numbers by relying on vaccination and achieve some level of herd immunity, then these efforts are for naught. The point of the vaccine is to help reduce infections and try to get life back to normal.

RI: I agree with you that messaging may be the main factor that can convince people to get vaccines. That being said, in this day in age, are we in trouble since messaging can be so polarizing?

EFB: I am definitely concerned about it. But this is the world we are living in. I am mostly worried about those who don’t have access to resources or information. And if they get conflicting messages from officials or even some of their friends and family, it can create a difficult situation. Social media feeds into that too. 

I also wanted to bring up that we cannot ignore the plans for distribution. For instance, if somebody is in the ‘unsure’ group about the Covid vaccine, but they take their kids or themselves to their health care provider and are educated about and then offered the vaccine, if it is convenient they may get it right then and there. This is how we do it with Flu shots. We see every encounter as an opportunity to educate and offer the vaccine. But if we don’t have the Covid vaccine available and ready to distribute in ways like this, we are going to miss a lot of people. We have to make the right thing an easy thing. I worry that we aren’t hearing a lot about the plans for distribution. This is causing a lot of concern and leads to a lack of public confidence in our systems.

RI: I completely agree with you with the distribution being critical. That should improve the success. I want to ask you one thing. I think there is a tremendous amount of trust and admiration for doctors and nurses. When we take our kids to the doctor, we are trusting them with their recommendations on things such as vaccines. What do you think doctors and nurses should be telling the public to trust vaccines?

EFB: I think the first thing is that people need to understand how bad a coronavirus infection can be and what the risks are for them or their loved ones. And also, for them to remember that we don’t know what the long-term risks or effects are yet. We need to listen to our front-line providers who are treating these patients every day. In addition, Covid patients are filling our hospitals. So, if you are having a medical issue or an emergency, health care providers may not be able to give you a bed because it is taken up by someone else with Coronavirus. Or you may have to be transported elsewhere which takes time and may affect your treatment or outcome. There is not enough conversation about the stress and strain on the system overall. There is no unlimited supply of resources. 

I think the providers can also share information about the process used in the creation of the vaccine to increase that trust too. We should have faith in our processes. Yes, we acknowledge that there is a lot of conversation about political influences. But there are a lot of really smart professionals working really, really hard on this. From pharmaceutical companies to the people in the federal agencies who are not political appointees. This is their job! I think we should have faith in the folks who are true public servants who are working on this. They know what they are doing and are not persuaded by political influences.

RI: A lot of that hinges still on the faith in institutions where faith has been eroded significantly. Do you think that because of where we are today, our families and communities play a bigger role in convincing those who are unsure of getting the vaccine? Or do we need some sort of widespread propaganda that persuades people to get it?

EFB: I think unfortunately we’ve had the propaganda but for opposite reasons. It’s really hard to put that horse back in the barn. When we think about public pressure and people doing things because it’s the norm, that has been eroded. 

RI: I want to ask you one last question. When this is all said and done, and vaccines are available and distributed, what do you think will end up happening in terms of getting number of vaccinations to a certain level where we can start removing our masks and getting back to a somewhat normal?

EFB: I am not someone who goes on a limb, but I am going to do that now! I think we are going to see some patchwork response. Some communities are going to be more successful than others [because of vaccines]. My hope is that when people see that things are working and communities are able to start having life as we knew it, that others will come along. Just like a lot of parts of the country that wouldn’t initially put into place certain restrictions are doing so now. I hope that reluctant communities will take an earlier lesson though from the places that have embraced public health guidance and interventions. I think it will be a slow and spotty progress, but I do hope we have early successes.