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University of Nevada, Las Vegas (UNLV)

UNLV Vaccination Expert Explores How Vaccine Refusal Might Change in Light of COVID-19

As governors across America begin to unveil and deploy plans to reopen their respective states, at the center of the debate a question has emerged: how soon is too soon?

Some states, including Nevada and neighboring California, are taking a phased approach in response to the COVID-19 pandemic, and have joined together in a pact with other western states to forge a path forward. Other states have already lifted some restrictions, and still others never issued formal stay-at-home orders.

While the myriad approaches might lead to some confusion, it’s becoming clearer that a full reopening of the nation’s economy could be months away. Much of the attention is focused on a vaccine - it’s progress and, once we have it, how soon until it’s widely available.

Will a vaccine be a requirement for the nation’s schoolchildren? Will people jump at the chance to be the first in line for a vaccine?

Will vaccine-refusing parents rethink their strongly held beliefs?

Here, Johan Bester, director of bioethics for UNLV’s School of Medicine, explores some of these questions, as well as whether receiving a COVID-19 vaccine should be considered an act for the greater good.

Do you think the coronavirus pandemic will cause people who haven't vaccinated their children in the past to reconsider that choice moving forward?

Based on what we know about vaccine hesitancy and vaccine refusal, some parents will change their minds and reconsider vaccines and others will not. Vaccine-refusing or vaccine-hesitant parents are a diverse group. It is too simplistic to lump everyone under the same heading.

There are some parents who are uncertain about vaccines because they fear potential adverse effects from vaccinations and don't see much danger from vaccine-preventable diseases. We don't routinely see cases of polio, measles, diphtheria, and so on in our daily lives. There is so much misinformation about vaccines online that the genuinely curious parent may become very worried by doing an online search to find answers. Combine with this the fact that seeing your child being injected is quite traumatic for any parent — something we'd like to avoid if we can. It’s easy to see how parents can become hesitant or formulate serious questions about vaccination.

If such parents suddenly see a frightening disease outbreak, they may change their minds and become less vaccine hesitant. The threat from the illness will make fears of vaccine-adverse effects, which are very rare, less compelling, and the primary question for such parents will be: how do I protect my child against this outbreak? We see that happen when there are measles outbreaks, and we also have some reports of people changing their minds about vaccines because of the COVID-19 pandemic.

Is there a chance that those vehemently opposed to vaccinations will strengthen their resolve?

I would expect that there are some parents who would double down on their vaccine refusal, and become more entrenched in their opposition to childhood vaccines during the pandemic. The world, unfortunately, has become more polarized in recent years. As the psychologist Jonathan Haidt pointed out, people often make up their minds about controversial issues based on the tribe they belong to, and come up with justifications for their choices afterwards. The same principle is at work for many who refuse vaccines: their identity is tied up with the refusal of vaccines; being opposed to vaccines is part of who they are.

They simply don't trust information from experts, people who provide evidence in favor of vaccines. There is research that shows that some people who have very strong anti-vaccine views become even more opposed to vaccines when you provide them with evidence and facts about vaccine safety. When you present information related to vaccine science to people who have their identity wrapped up in opposition to vaccines, they experience it as a personal attack rather than a discussion on what should be done for a child.

Overall, the key is building trusting relationships. People will hear what you say if they trust you. Relationship and goodwill comes before education and communication of the scientific facts; you can’t have one without the other.

This is one reason I have such an antipathy to the moniker "anti-vaxxer.” It is not helpful to lump all vaccine-hesitant people together under a term that has taken on derogatory overtones. It polarizes the issue further, rather than seeking to build the trust and goodwill needed for people to hear what you have to say.

If and when a vaccine becomes available, should all people consider it a civic duty to receive it? Should all vaccinations in general be viewed in this way? Why or why not?

Society is the working together of individuals as a collective to reach goals that cannot otherwise be reached. When people in society work together, we are all better off, happier, and freer than if we go it alone. Ultimately, society is there to safeguard the well-being of its members. This includes protecting the lives, freedom, and opportunities to thrive afforded to individuals. As a member of society, I have obligations to society and society has obligations to me. Society has to take steps to protect my well-being, and I have to work with society to protect the well-being of others. At bare minimum, I should refrain from actions that would harm others, or put the well-being of others at risk.

Severe infectious disease seriously threatens the well-being of individuals and society as a whole. If I socially distance, act in ways to minimize spread, wear a mask, take a vaccine — all of this decreases the harm to others. This means that we all need to do our part; all it takes is a few of us to do otherwise for the disease to wreak havoc.

Based on these considerations, then yes, there is a civic duty to take vaccination. But it would depend on a number of things: the vaccine should be very successful, the adverse effects should not outweigh benefit, it should be widely available, and people should be able to afford it. If the vaccine is not very successful, has a host of side effects, and is too expensive to afford, nobody should take it. If it is very effective, has low side effects, and is affordable, the case for a duty to accept vaccination is clear.

When people choose not to vaccinate their children, does that usually include all vaccinations? Could you see a scenario where people will want to get the coronavirus vaccine, but still avoid vaccinating for other diseases?

There is substantial variation in how people who are hesitant to vaccines deal with vaccine schedules. Some parents delay vaccines, some refuse only certain vaccines (say, the MMR/measles vaccine and the influenza vaccine). In particular, some people who generally accept vaccines may be very hesitant about the influenza vaccine because of the impression that it is less effective than other vaccines. This is a mistake when it comes to children, especially as influenza vaccines have an important role to play in keeping young children healthy.

I could therefore see that some people who generally accept vaccines may be hesitant towards a coronavirus vaccine. I could also see that some people who are hesitant to other vaccines may gladly accept a coronavirus vaccine. We still don't know how effective such a vaccine would be, and that would be key.

Do you think a coronavirus vaccine will become required for school attendance, like other diseases, including measles and hepatitis?

This will entirely depend on how effective the vaccine is, how long coronavirus stays with us, and how the rest of the pandemic plays out. If coronavirus becomes seasonal or stays with us for the long haul, and an effective and safe vaccine is developed, it may be that the coronavirus vaccine becomes mandatory. This is essentially what happened with measles. Measles killed many, many people each year and there was nothing that really could be done about it. Then a successful vaccine was developed, and measles was eliminated from the U.S. An effective and safe vaccine is really the most powerful tool we have to protect people against serious infectious diseases.

Adults are not mandated to get the flu vaccine, but could you see more people getting the flu vaccine in the future because of attention on coronavirus?

I would sincerely hope that there is more influenza vaccine uptake in the future. This won't change anything about the coronavirus or the current pandemic, but it is a moderately effective vaccine that will decrease illness from influenza virus outbreaks.

Personally, I'd like not to confuse the two issues. I was dismayed when I saw a number of well-meaning scholars write op-eds about how we should worry about influenza and not COVID-19 in January and February. Back then, news from China and other places in the world gave us good reason to be worried about a possible COVID-19 pandemic. Trying to raise alarm about influenza is a good thing generally, but it was so timed that in the minds of many this was just "another influenza" that was going to come around, and we needn't worry about it more than we worry about influenza.

COVID-19 is not influenza. It’s good to accept influenza vaccines as influenza represents a serious public health problem. But the COVID-19 pandemic is a once-in-a-generation kind of disaster with implications far beyond any influenza outbreak and requires extraordinary steps to combat it. While there is not much chance that the influenza vaccine will be mandated for adults, let us hope there is a widespread acceptance and uptake of a COVID-19 vaccine when it becomes available.

Are there any other concerns about vaccinations that we should know about?

There are unfortunate and disturbing reports that childhood vaccine administration is being disrupted by the COVID-19 pandemic all over the world. This is worrisome because it would mean that not only would we worry about coronavirus resurgence after social distancing is relaxed, but also about resurgence of a host of other awful infectious diseases like polio and measles. During the pandemic we should continue to vaccinate, and continue to provide for children those things needed to protect their well-being. This is challenging, but important.

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