Vaccine Hesitancy During the COVID-19 Pandemic

Vaccine Hesitancy During the COVID-19 Pandemic

As a nursing student learning in the midst of the COVID-19 pandemic for the past two years, it has been incredibly frustrating to see that vaccine hesitancy is still a major problem even after the myth of autism being linked to the measles, mumps, and rubella (MMR) vaccine has been debunked. I believe that aside from non-compliance with physical distancing and wearing masks, vaccine hesitancy plays a major role in the delay of eradicating the coronavirus. As of lately, the hospitalized patients identified to have been infected with COVID-19 are primarily the ones who are unvaccinated.

I, too, am concurrently working as a Patient Care Assistant, which is an alternative title to what most people know as a Certified Nursing Assistant (CNA), at a hospital and I started when COVID-19 was at its second peak. When the COVID-19 vaccines rolled out for emergency-use authorization for the very first time, healthcare workers like me had the opportunity and privilege to be vaccinated. However, I have heard some of my coworkers express their concern because they claim there wasn't enough evidence in regards to the safety of the vaccine. This had led me to become initially hesitant as well, and made me want to wait until I heard more experiences from other registered nurses (RNs) and CNAs prior to becoming vaccinated myself. The truth is, the coronavirus has long existed before 2019. The virus that has led to our current pandemic is known as SARS-CoV-2, but the first one has been discovered back in 2003 and led to some people becoming diagnosed with severe acute respiratory syndrome (SARS). (World Health Organization [WHO], n.d.) I knew one month later, that getting the vaccine as soon as possible would not only protect me, but also my patients who are already immunocompromised and my family members who have medical conditions that could potentially put them at higher risk of contracting the disease. Here I am, three doses of the Pfizer vaccine later, with only complaints of muscle soreness and fatigue. Of course, side effects are temporary and will vary from person to person.

A study conducted by MacDonald and the SAGE Working Group discussed about the 3 C's model, which laid out the 3 categories that make up vaccine hesitancy overall: complacency, confidence, and convenience. A visual of these categories have been placed in a Venn diagram, as pictured to your right in MacDonald's 2015 research. (p. 4162) MacDonald defines confidence as the public's trust in the vaccine; the ability and skill of staff responsible for vaccine inventory, drawing up and administering vaccines, the pharmaceutical company that created the vaccine; how much drive that policymakers push for in the decision of which immunizations should be in demand. (2015, p. 4162) Complacency is when the public believes that there is no reason to be vaccinated because the risks supposedly aren't great enough, despite the benefits of the vaccine. (MacDonald, 2015, p. 4162) Last, but not least, convenience is variable per individual — it depends on how available, accessible, and affordable the vaccine is to the patient and what level their health literacy is at. All of these factors tie in with their proximity and travel time to the site providing the vaccine, as well as their mode of transportation. (MacDonald, 2015, p. 4163) 

One major setback to vaccine administration is the influence of celebrities and people who hold a lot of power. Back in 2020, former President Donald Trump made false claims that COVID-19 was "fake news" and continued to downplay the severity of the virus despite the number of hospitalizations increasing on a daily occurrence and having been infected with COVID-19 at one point in his life. Instead, he insisted that the rising cases were due to all the COVID testing we did. (Lovelace Jr., 2020) When misinformation like this is spread all over social media and the news, followers are more likely to be influenced and swayed. Hence, this results in vaccine hesitancy and can further delay the eradication of the disease or the pathway of going from a pandemic to endemic. 

If there has been reluctance with getting the MMR vaccine 20 years ago, and then reluctance again with the COVID-19 vaccine, what are the odds that the same cycle will occur when a new disease emerges in the near future? How can we prevent this cycle from occurring again?

Throughout nursing school, I've learned that patient education is key. It is our responsibility to provide accurate information regarding immunizations through handouts in the appropriate reading and health literacy level for patients to understand. Yes, there will be reluctance regardless of where we practice in the nursing field, and patients always have the right to refuse. After all, administering a vaccine against a patient's will is considered malpractice and a violation to the bioethical principles of nursing. However, it is still our right to educate the community with evidence-based practice...that vaccines are not meant to harm us, but to rather, benefit us and protect us from various diseases. When we provide that education, chances of achieving herd immunity, where at least 95% of the population are vaccinated, will increase. It is crucial for us nurses to ensure that patients have been provided the information they need to make INFORMED decisions. That information we provide includes the expected side effects, what to report to the provider, and signs of anaphylaxis if the patient has had a history of anaphylactic reactions to medications or food.  

Why does this matter so much to me? Here's why. With the number of COVID-19 related hospitalizations and deaths in the hospital setting, the number of nurses feeling burnt out and committing suicide is incredibly alarming. To see nurses having gone from being passionate for what they do in healthcare to feeling hopeless and ending their life is really worrisome. It has led me to feel that the unvaccinated population (who are not medically exempt) have neither regard nor respect for healthcare workers. I personally have seen some of my friends from the same nursing program start off as new grad nurses be sent to immediately float to COVID units instead of the units they were hired to work in. One year later, one of those nurses I knew expressed feelings of burnout and left her job and decided to pursue outpatient nursing. They have seen many patients die in isolation and loneliness without family members by their side to hold their hand. Nurses have cried over their patient's deaths, but had to pretend everything was fine after bagging the body and sending it off to the morgue before moving on to take care of their other patients. The pandemic has left nurses and many healthcare workers in turmoil and emotional distress. Seeing how burnt out nurses have felt during the pandemic has left me worried for the start of my nursing career next year. Will I have to go through the same experience next fall when I work as a full-time bedside nurse? Will I no longer want to do nursing anymore, after having been working so hard in nursing school to get to this point in my life? All I can do is just hope for the best.

References

Lovelace Jr., B. (2020, October 26). Trump claims the worsening U.S. coronavirus outbreak is a 'Fake News Media Conspiracy' even as hospitalizations rise. CNBC. https://www.cnbc.com/2020/10/26/coronavirus-trump-claims-the-worsening-us-outbreak-is-a-fake-news-media-conspiracy-even-as-hospitalizations-rise.html

MacDonald, N. E. (2015). Vaccine hesitancy: Definition, scope and determinants. Elsevier, 33(34), 4161-4164. https://doi.org/10.1016/j.vaccine.2015.04.036

World Health Organization. (n.d.). Severe Acute Respiratory Syndrome (SARS). World Health Organization. https://www.who.int/health-topics/severe-acute-respiratory-syndrome#tab=tab_1