Rupali Limaye got her first dose of Covid-19 vaccine a couple of weeks ago. “I bawled,” she admitted without the slightest hint of embarrassment.
It so happens that Limaye is a staunch proponent of vaccination; she works at the International Vaccine Access Center at Johns Hopkins University. But her reaction is not uncommon. Talk to anyone working in or volunteering at Covid vaccination clinics, and you’ll hear tales about the joy, the relief, the shedding of the cloak of dread that has weighed people down during our difficult period of pandemic isolation.
“I don’t think many people felt grateful for vaccines before Covid,” Ruth Karron, director of the Johns Hopkins Center for Immunization Research, told STAT. “I think it is a reset.”
It seems vaccination — long viewed as a chore or an I’d-rather-not or, for many adults, a completely forgotten part of preventive health care — is having a moment.
Not since the rollout of polio vaccine in the mid-1950s, when frantic parents queued with their children to get Jonas Salk’s preventative inoculations, have vaccines been seen in such a favorable light. More than six decades later, relatively few people today have first-hand memories of that time, Karron noted.
The question is whether the newfound embrace of vaccines will translate into anything more. Adult vaccination against other diseases has long trailed the success of childhood efforts, for example. Will some people reconsider the importance of inoculations in general?
“I was always surprised how much parents could compartmentalize childhood vaccination and adult vaccination,” said Alison Buttenheim, an associate professor of nursing and health policy at the University of Pennsylvania who works on vaccine acceptance. “Parents who are super diligent — like their kid would never miss a dose of anything, fully vaccinated, gung-ho — would still say, ‘I never get the flu shot.’”
Still, others are hopeful that there will be a greater appreciation for vaccines across the board now that Covid-19 vaccinations are helping to lower death rates and ease social distancing restrictions. For many people, vaccination will result in fundamental changes in their daily lives.
Patsy Stinchfield, a pediatric nurse practitioner at Children’s Minnesota in Minneapolis-St. Paul, recalled seeing a highly anxious man in a long line at a vaccination clinic recently. Concerned for him, she pulled him out of line and into the clinic. He told Stinchfield he hadn’t been around so many people in months, and was feeling agoraphobic. He also had a strong fear of needles.
And yet you are here, she said, trying to calm him. The man explained he was there because he is a teacher and desperate to get back into the classroom.
“How we’ll get out of this is one arm at a time,” Stinchfield said, recalling the encounter.
While it’s not clear how long people will associate vaccination with a return to something approximating normal life, they certainly will in the short term. Just last week the Centers for Disease Control and Prevention released guidance that, among other things, said people who have been fully vaccinated can now spend time together indoors and unmasked. Vaccinated grandparents were given a green light to visit unvaccinated children and grandkids as long as they were not at risk of severe Covid.
“Legitimately somebody could say ‘I owe being able to hug my family to this and I’m not going to forget that,’” said Brian Southwell, senior director of science in the public sphere at RTI International, a think tank located in Research Triangle Park, N.C.
Southwell isn’t sure appreciation for Covid vaccines — a response to a health crisis — will translate into renewed interest in flu shots or a more fastidious approach to keeping tetanus coverage up to date.
“I think there is potential for the act of vaccination to take on a different symbolic level of meaning for people that perhaps wasn’t there,” he said. But “it’s an open question as to whether this spills over into the broader domain of vaccination for all kinds of diseases … because, again, we’re still talking about some sense of collective remedy to something we’ve been through as opposed to, in many cases, where vaccination is a prevention of an abstract threat.”
Nearly 70 million Americans have received at least one dose of Covid vaccine, and 11% of the population is fully vaccinated at this point. (For the vaccines made by Moderna and Pfizer-BioNTech, fully vaccinated means two doses per person. For the most recently approved vaccine, made by Johnson & Johnson, only one dose is needed.)
Demand still outstrips supply, and will, for some weeks to come in the United States. Times of shortage actually increase demand for a product, noted Limaye, who is director of behavioral and implementation science at the International Vaccine Access Center. The balance is expected to tip later in the spring, at which point the focus of the vaccination effort will shift to hesitant folks who have hidden behind the eager throngs.
Heidi Larson, director of the Vaccine Confidence Project and a professor at the London School of Hygiene and Tropical Medicine, said time spent now on reaching out to those who are still worried about Covid vaccines will pay off, and not just in terms of acceptance of these vaccines.
“I think what’s really important here is the trust building,” Larson said. “I think that’s where it’s really important to use strategies that are not necessarily vaccine specific, they’re more about overall relationship building…. That’s going to have a positive knock-on effect for sure, whatever the vaccine.”
Acceptance can beget acceptance. Larson said she was recently involved in a roundtable meeting with officials from a number of African countries who noted the news of Americans jockeying for access to Covid vaccines is creating demand for the products in their own countries.
Public opinion polling in this country shows that reluctance to take Covid vaccines — which were developed with unprecedented speed — has declined as clinical trials have shown the vaccines to be highly efficacious, Limaye said. And with the numbers of doses administered worldwide topping 350 million, the safety profile of these vaccines is looking exceptionally good.
“Having this roll out over time has allowed those people to gain comfort with the process and with the vaccines,” Karron said of the people who initially indicated they wanted to wait for a while before being vaccinated, the “after Dr. Fauci, after the first million … after my pastor” folks.
The fact that these vaccines make up so much of the public discourse these days may also be play to the favor of vaccine acceptance going forward, experts said. Many people are so familiar with the attributes of various vaccines that they have opinions about which they want to receive.
Virtually no one who gets a flu shot or a tetanus shot knows who made it.
People have seen, in real time, how vaccines are developed, tested, and approved for use. Thousands of people watched the streamed meeting of the meeting of the Food and Drug Administration’s Vaccines and Related Biological Products Advisory Committee as it assessed the data on the first vaccine to get an emergency use authorization, the one made by Pfizer and BioNTech. When the Advisory Committee on Immunization Practices, an expert panel that makes policy recommendations to the CDC, met on Dec. 1 to vote on who should be at the front of the line for Covid vaccines, 32,000 computers were streaming the meeting at a point.
“People have had a window into the process,” said Karron. “And what I’ve been saying is if we get it right, that can increase people’s faith in the process in general. And if we get it wrong, then that decreases people’s faith in vaccines.”
Buttenheim said pediatricians going forward are likely going to need to brush up their talking points on why parents should vaccinate their children, because parents may come armed with questions about things like the vaccine platforms — the mechanisms, like messenger RNA or viral vectors, that vaccines use to induce an immune response — used in the various vaccines in the childhood vaccination schedule.
“It may be that [with] people’s literacy … or their interest, that we’ve got new opportunities to sell the safety and efficacy of our childhood schedule in ways we didn’t use to have,” she said.
In terms of adult vaccination, Covid vaccine may help to get people into the habit of being vaccinated — especially if it turns out booster shots are needed to deal with variants of the coronavirus that emerge.
“Yes, there will be some people whose appreciation for vaccines is so enhanced that it actually tips them over the line to getting vaccinated [for other things] in countries where that’s easy to do,” said Julie Leask, a professor at the University of Sydney’s School of Nursing and Midwifery who works in the field of vaccine acceptance. Leask wasn’t certain, though, if that would carry over into improved childhood vaccination rates.
Karron thinks favorable public discussion about vaccines could help to overcome the negative messaging of the anti-vaccination community. Anti-vaxxers have had fierce and vocal champions, but outside of public health officials, there have been fewer passionately pro-vaccine voices.
“The people who are crying [for vaccine] now, who were generally pro-vaccine in kind of a lukewarm … way, those could be champions,” she said. “And that could make a difference.”