To help in the prevention of the coronavirus disease 2019 (COVID-19), the Food and Drug Administration (FDA) issued an emergency use authorization (EUA) for the Pfizer-BioNTech vaccine on December 11, 2020. One week later, the same action was issued for the Moderna vaccine (Table 1). (1,2) The availability of vaccines against COVID-19 has provided a sense of optimism, as many have endured prolonged isolation and quarantine, the mental health effects of the pandemic, and the morbidity and mortality of the disease. However, for vaccines to achieve the desired affect there must be a minimum number of individuals who accept it. Vaccine hesitancy is not a new issue; it has been widely studied. In fact, the World Health Organization identified it as 1 of the top 10 global health threats in 2019. (3)
A large survey by the Pew Research Center found the intent to get the COVID-19 vaccine dropped from 72% in May 2020 to 51% by September 2020. (4) Of those respondents, 77% reported a concern that vaccine swould be prematurely approved without long-term safety data. Among the individuals who did not want the vaccine, 76% expressed concern about its potential adverse effects, whereas 72% wanted to know more about its efficacy before administration. Of the individuals who intended to get the vaccination, 19% expressed a great deal of confidence about safety and efficacy, 45% reported a fair amount of confidence, and 35% reported not much or no confidence at all (Figure 1). (4) The intent to get vaccinated increased in December 2020, as 60% of Americans said that they would "definitely" and "probably" get COVID-19 vaccination once it is possible. (5)
More recently, the Kaiser Family Foundation (KFF) surveyed 1676 adults in the United States from November 30 to December 8, 2020. They found that 71% of respondents reported they would "definitely" or "probably" get the COVID-19 vaccine, whereas 27% expressed concern and were hesitant to receive it. (6) The sample was randomized to represent the population, including Hispanic and non-Hispanic Black adults. Vaccine hesitancy was high in individuals identifying as Republicans (42%), rural residents (35%), and Black adults (35%) (Figure 2). (6) For comparison, during the 2009 influenza A H1N1 pandemic, the early estimates of vaccine acceptability were between 50% and 64%. (7) To address lagging hesitancy and resistance, vaccine myths and disinformation need to be addressed, and clear and consistent messages should be delivered to the community about the importance of receiving the vaccine. Psychiatrists can and should take time to address these issues with their patients.
Types of Vaccines
Messenger RNA (mRNA) vaccines. In the 2 COVID-19 vaccines currently available, the mRNA carries instructions to make the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) attach, or spike, protein to the host cells. After the vaccine is injected, the mRNA is taken up by the macrophages near the injection site and instructs these cells to make the spike protein. This spike protein then appears on the surface of the macrophages inducing an immune response. (8,9)