As the U.S. continues to accelerate daily COVID-19 vaccinations of a largely eager public, researchers are predicting the time is fast approaching when all those who desire a vaccine will have received one and interest wanes.

Unfortunately, that day might arrive well before the population reaches herd immunity in which a sufficient percentage of the public has acquired resistance to the coronavirus, either by vaccination or infection.

That scenario makes it all the more urgent for public health professionals to reach the “vaccine hesitant,” who are delaying or refusing to obtain vaccines despite their availability.

The social phenomenon has dogged Western civilization for centuries and continues to this day. But current reasons for reluctance during the COVID-19 pandemic vary widely, necessitating the use of multiple strategies to encourage vaccination.

“It’s not a black-and-white thing,” said Dr. Hendrik Schultz, an infectious-disease doctor and chief medical officer for Medical Associates Clinic.

Scientists estimate that 70% to 90% of the population must acquire resistance to the coronavirus to achieve herd immunity.

A vaccine enthusiasm survey released by Surgo Ventures found that 59% of respondents said they have been vaccinated or want to be as soon as they can obtain one.

At the current vaccination rate of 3.35 million shots per day, 70% of the U.S. population could be vaccinated by mid-June, but the Washington, D.C., medical think tank painted a gloomier picture that predicts vaccinations will plateau in April when supply exceeds demand.

Based on its survey results, Surgo Ventures estimates that only 52% of adults will be vaccinated by July. Even when combined with those who have already been infected, resistance would only stand at 65%, well short of the threshold necessary to reach herd immunity.

Not increasing that number poses public risks, even to the vaccinated, who could be susceptible to coronavirus variants that can spread among unvaccinated hosts and mutate. Immunocompromised people who cannot receive vaccinations rely on herd immunity to stay safe.

Although COVID-19 vaccines are nearly 100% effective at preventing hospitalization and death, a significant percentage of Americans express hesitance or refuse to obtain them despite their increasing availability.

The U.S. Census Bureau has been collecting data concerning vaccine hesitancy since January.

About 13% of people in Illinois are vaccine-hesitant and more than 19% of people in Wisconsin.

Among the 18% of Iowans who identify as vaccine-hesitant, about half cited uncertainty about vaccine side effects as the source of their reluctance, despite the vaccines being rigorously examined prior to approval. Almost 31% intend to wait to see if it is safe, while 29% stated they do not trust vaccines in general.

People who are between the ages of 18 through 29, who identify as politically conservative, who are racial and ethnic minorities or who possess a high school education or less are more likely to express reluctance to receiving the COVID-19 vaccination.

The Dubuque County Public Health Incident Management Team is spearheading a “Sleeves Up” vaccination campaign, encouraging residents to obtain a vaccine when it becomes available.

About 32% of Dubuque County residents — about 31,000 people — have been fully vaccinated, and about 14,000 more have received their first dose.

Refusal or wariness are legitimate reactions to a new vaccine, medical professionals said.

“We have to meet people where they are and work on educating and acknowledging their concerns,” said Mary Rose Corrigan, City of Dubuque public health specialist.

Some communities might object to vaccinations on religious grounds. For racial and ethnic minorities, trusting the American medical establishment is a large ask, particularly when that system carries a legacy of racism, medical experimentation and discrimination.

“We have to acknowledge the past and what has not been done in the best way regarding health care and medicine,” Corrigan said.

An equity committee affiliated with the Dubuque County Public Health Incident Management Team is networking with communities of color and targeting public information campaigns that include Spanish and Marshallese marketing materials.

Schultz said it is important to clarify the process under which the three vaccines currently approved for use in the U.S. were created. Although they were fast-tracked for use under an emergency order, safety has not been compromised.

“(But) we have to admit there is a degree of uncertainty,” he said.

For instance, large-scale studies of the effects of the vaccine in pregnant women have not yet been completed.

“I think the admission that there are some uncertainties is an important part of trusting your doctor when it comes to vaccine advice,” Schultz said.

The recent finding that six women experienced a rare type of blood clot after receiving the Johnson & Johnson vaccine, one of three approved for use in the U.S., might raise fears.

Administration of that brand of vaccine has been paused nationwide while the Centers for Disease Control and Prevention and the U.S. Food and Drug Administration review data. More than 6.8 million doses have been administered, making the potential risk extremely low.

Medical professionals also are more likely to persuade their patients when they personalize the benefits of vaccination, Schultz said.

While the term “herd immunity” could mean little, pointing out that vaccination enables people to safely visit elderly relatives carries weight.

People should also understand the prevalence of COVID-19 vaccine side effects.

“It’s well known that there are some,” Corrigan said. “It’s important for people to realize the difference between a side effect and a vaccine reaction.”

Side effects are generally mild and include headaches, fever, chills and fatigue, while a reaction, such as anaphylaxis, is extremely rare.

The risks of coronavirus infection significantly outweigh those of the vaccine, she said.

The mortality rate for the disease in the United States stands at 1.8%.

And “it’s a wild card as to whether or not you’ll have long-term effects,” Corrigan said.

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