December 15, 2020
By Yvette C Terrie, BS Pharm, RPh, Consultant Pharmacist
This year all eyes have been focused on the development and pending approval of a COVID-19 vaccine. In a press release from December 11, 2020, the manufacturers, Pfizer and BioNTech SE announced that the FDA authorized the emergency use of the mRNA vaccine, BNT162b2, against COVID-19 in individuals 16 years of age or older and that the vaccine is now authorized under an Emergency Use Authorization (EUA) while Pfizer and BioNTech gather additional data and prepare to file a planned Biologics License Application (BLA) with the FDA for a possible full regulatory approval in 2021.1 In conversations with other health care providers and patients, there is still great debate about the approval of a vaccine for COVID-19. Every year, despite its availability, many individuals still decline the influenza vaccine for various reasons, so once the COVID-19 vaccine becomes available to the general public, it will be interesting to see how many individuals obtain the vaccine.
In some ways, vaccines for other diseases have appeared to have taken a back seat during the ongoing pandemic due to the disruptions and challenges in the delivery of health care. Vaccines are considered to be one of the most cost effective protective measures against some vaccine preventable diseases (VPDs). While they are not 100% effective, vaccinations offer critical protection against certain illnesses and potentially serious disease related complications. Despite the availability of vaccines for many diseases, various myths, misconceptions and the fear of adverse effects are often barriers to obtaining vaccines and has created vaccine hesitancy among many individuals.2 Research indicates that vaccine hesitancy can be attributed to 3 major categories which can include lack of confidence (in effectiveness, safety, the system, or policy makers), complacency (perceived low risk of acquiring VPDs), and lack of convenience (in the availability, accessibility, and appeal of immunization services, including time, place, language, and cultural contexts).3 According to the Immunization Action Coalition (IAC), only 25% of adults are up-to-date on routinely recommended adult vaccines, leaving many adults at risk for illnesses, hospitalizations, disability and deaths from vaccine-preventable diseases.4 They also indicate that low rates of vaccinations among adults may be due to several reasons such as lack of patient awareness of vaccines recommended for them, and in some cases, absence of a provider recommendation or offer for vaccination. 4
Numerous sources have indicated that vaccination rates for other vaccines decreased during the pandemic. For example, McNally et al indicated that as COVID-19 cases soared and states implemented stay-at-home orders, outpatient visits decreased substantially and as a result, childhood immunization rates also dropped.5 Moreover, according to results from a Winter Wellness Survey, many in the U.S. indicate that they still have concerns as the influenza season is underway and the COVID-19 pandemic continues.6 The objective of the survey was to gain a better understanding of participant’s views on influenza vaccination, willingness to receive a COVID-19 vaccine when available and concerns about both viruses and social distancing during the holidays.6 The survey included those over 65 years of age, Gen X (those age 40-55), Millennials (age 24-39) and Gen Z (age 18-23). The results from their survey including 1,550 online interviews conducted from November 25 to November 30th revealed the following:
- The majority of individuals under 65 are worried about getting influenza and COVID-19 at the same time and 56% of Gen Z, 57% of Millennials, 60% of Gen X had concerns.
- Across all generations, most respondents plan to continue safety protocols after a COVID-19 vaccine becomes available.
- An estimated 70% of Medicare beneficiaries (65+) have already had their influenza vaccine this year, compared to 41% of Gen Z, 43% of Millennials, and 39% of Gen X.
- Older adults are taking more precautions this year, while concerns and even confusion about the influenza vaccine are evident among younger generations.
- Individuals in the Gen Z, Millennials, and Gen X were equally likely to believe that influenza vaccine would prevent COVID-19 (35% of Gen Z, 35% of Millennials, 38% of Gen X). At the same time, only 8% of Medicare beneficiaries (65+) agreed.
- Among Gen Z, Millennials, and Gen X, more than 25% indicate that they do not plan to get an influenza vaccine this year. Of which, 68% of Gen Z, 80% of Millennials, 78% of Gen X say they normally don’t get the annual vaccine and more than 50% also report concerns that it would only boost their risk of illness (55% of Gen Z, 56% of Millennials, 61% of Gen X).
- Among those over 65, 40% say they plan to get the COVID-19 vaccine as soon as it is available and 34% Gen Z, 35 % Millennials, and 39 % Gen X plan to get the vaccine. 5
The results from this survey clearly indicate that a focus on patient education and increasing awareness about the efficacy and safety about vaccines is warranted. The full survey report can be found at https://www.gohealth.com/report-flu-shots-covid-19-vaccine-and-holiday-gatherings/
Unfortunately, some individuals shy away from vaccines due to myths and misconceptions and health care providers should encourage open dialogues with patients to identify and address any concerns. As one of the most accessible health care providers, pharmacists are in a pivotal position to educate patients about the efficacy and safety of vaccines as well as dispel many of the myths and misconceptions about vaccines. Providing patients with the facts and easing any concerns they may have will enable them to make informed decisions about vaccinations based on clinical data from reputable health care organizations. Pharmacists are well positioned to improve vaccination rates and can act as advocates, educators, identifiers, and immunizers. The CDC encourages all health care providers to educate patients about vaccine-preventable diseases and strongly recommend vaccines, as data have revealed that provider recommendation is one of the most convincing drivers of vaccination.7 Additionally, the IAC states that patients are more likely to obtain vaccinations if recommended by their primary health care providers and if their questions and concerns are addressed. 4 While vaccination is an individual choice, pharmacists can stress the importance of obtaining the recommended CDC vaccinations and serve as a patient resource by providing patients with the facts and addressing their fears and concerns. Patient education about the efficacy and safety of vaccinations is more important than ever as the availability of a COVID-19 vaccine is on the horizon.
- Pfizer and BioNTech Celebrate Historic First Authorization in the U.S. of Vaccine to Prevent COVID-19. Published December 11, 2020. Accessed December 12, 2020. https://www.pfizer.com/news/press-release/press-release-detail/pfizer-and-biontech-celebrate-historic-first-authorization
- Ventola CL. Immunization in the United States: Recommendations, Barriers, and Measures to Improve Compliance: Part 1: Childhood Vaccinations. P T. 2016;41(7):426-436.
- Shen SC, Dubey V. Addressing vaccine hesitancy: Clinical guidance for primary care physicians working with parents. Can Fam Physician. 2019;65(3):175-181.
- Strategies to Improve Adult Vaccination Coverage. Immunization Action Coalition website. https://www.immunize.org/catg.d/p2050.pdf Updated October 2020. Accessed December 10, 2020.
- McNally VV, Bernstein HH. The Effect of the COVID-19 Pandemic on Childhood Immunizations: Ways to Strengthen Routine Vaccination. Pediatr Ann. 2020 Dec 1;49(12):e516-e522. doi: 10.3928/19382359-20201115-01. PMID: 33290569.
- Report: Flu Shots, COVID-19 Vaccine and Holiday Gatherings. Go Health website. Published December 8, 2020. Accessed December 10, 2020.
- Tanzi MG. Adult vaccination rates show modest, but far from optimal gains. Pharm Today. 2017;23(8):43. https://www.pharmacytoday.org/article/S1042-0991(17)31108-8/fulltext