Special Articles21 December 2020

COVID-19 Vaccine: Promoting Vaccine Acceptance

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    While many questions remain about COVID-19 vaccine, there has been great progress since mid-October 2020, when Annals of Internal Medicine and the American College of Physicians (ACP) hosted our first forum about COVID-19 vaccine (1). As we hosted our second forum on 16 December 2020, Americans and others around the globe were beginning to be vaccinated to protect them from COVID-19. Now comes the hard work of making sure sufficient numbers of people are vaccinated to end this pandemic. The vaccine does no good if it remains in freezers and vials—we need to get the vaccine into people.

    Internists and other clinicians must be prepared to participate in this effort. To help prepare them, Annals and ACP gathered 4 experts for a discussion of strategies to promote acceptance of vaccine—Dr. Ada Adimora from the University of North Carolina, Dr. Helene D. Gayle from the Chicago Community Trust, Dr. Peter J. Hotez from Baylor University, and Dr. Heidi J. Larson from the London School of Tropical Medicine. Dr. Ryan D. Mire, ACP Regent, and Dr. William Schaffner from Vanderbilt University moderated the discussion. Readers can view the program in the video that accompanies this article. Attendees submitted hundreds of questions ahead of time. While it was infeasible to answer all of these questions during this program, the panelists addressed many issues that appear to be on clinicians' minds.

    The panelists warned against dichotomizing people into those who are pro-vaccine and those who are anti-vaccine. Most people are somewhere in the middle. For sufficient numbers of people, particularly those in this middle group, to actually receive COVID-19 vaccine, immunization must be available, convenient, and affordable. Among the roughly half of Americans who are unwilling or hesitant to be vaccinated (2), we will need to not only meet these conditions but also work hard to increase their trust in the vaccine, trust in those recommending vaccine, and understanding of the true benefits and risks of COVID-19 vaccination. Unfortunately, the enormous amount of misinformation circulating on social media and other venues about vaccines in general and about COVID-19 vaccine in particular in addition to the politicization of the pandemic make this task a monumental public health challenge (3). To address this challenge, the panelists provided excellent suggestions, including the advice that follows.

    First, we need to battle misinformation with aggressive dissemination of accurate information about the realities of COVID-19 and the risks and benefits of vaccination. This needs to be done both in conversations with individuals and in well-crafted media campaigns delivered by trusted messengers who reflect people of color and other populations who tend to be vaccine hesitant.

    Second, we must acknowledge rather than dismiss people's concerns about COVID-19 vaccine. For example, we need to recognize that we currently do lack data on long-term safety and that the first vaccines to become available are based on a novel mRNA technology. To allay these concerns, it may help to reiterate what we do know about the adverse consequences of COVID-19. People need to understand what the vaccine is protecting them from so that they are able to balance the risks and benefit of vaccination. People also need to know that, although the first vaccines out of the gate are the first mRNA vaccines, this technology has been under study for nearly 2 decades. This may provide assurance that the science has not been rushed, as some vocal vaccine opponents suggest. These many years of research are what make scientists confident that mRNA vaccines will not damage recipients' genes.

    Third, we need to manage the public's expectations. Some people will wonder why they should be vaccinated if vaccination will not enable them to immediately discard their masks and return to life as it was in 2019. We need to emphasize that the initial goal of vaccination is to keep people well and out of hospitals and to reduce mortality. A secondary goal is to prevent transmission to a sufficient percentage of the population so that the pandemic ends. When we achieve this secondary goal, we can begin to shed our masks and gather with others.

    Fourth, when people are skeptical of the vaccine's effectiveness and safety, we need to let them know that the trials leading to emergency use authorization included participants with a range of ages, racial and ethnic backgrounds, and comorbidity. Further, public health messengers need to be trusted by, and to reflect, the populations they seek to reach.

    In summary, clinicians and public health professionals need to anticipate, validate, and be prepared to address people's questions and concerns. We must amplify sound information to combat rampant misinformation. Finally, we must demonstrate our own confidence that the benefits of vaccination outweigh the risks by being vaccinated ourselves as soon as the opportunity becomes available. Each person who accepts COVID-19 vaccine becomes an advocate for vaccination in the most unambiguous way possible.


    • 1. Laine C, Cotton D, Moyer DV. COVID-19 vaccine: what physicians need to know. Ann Intern Med. 2020;173:830. doi:10.7326/M20-6841 LinkGoogle Scholar
    • 2. Fisher KA, Bloomstone SJ, Walder J, et al. Attitudes toward a potential SARS-CoV-2 vaccine: a survey of U.S. adults. Ann Intern Med. 2020;173:964-73. doi:10.7326/M20-3569 LinkGoogle Scholar
    • 3. Hotez PJ. Antiscience extremism in America: escalating and globalizing [Editorial]. Microbes Infect. 2020;22:505-7. [PMID: 32961275] doi:10.1016/j.micinf.2020.09.005 CrossrefMedlineGoogle Scholar


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    John Robbins21 December 2020
    Why bother now?

    With many people wishing to take the vaccine now, why spend time and money trying to convince skeptics to take it.  After many months, when 50 to 70% of the population have been vaccinated, with minimal side effects it will but much easier, and cheaper,  to convince the skeptics.

    Dr. Thomas M. Wnorowski21 December 2020
    Drug Approval

    Withdrawn from the market in 2018 were more than two dozen "approved" drugs, some with a twenty-year longevity.  How, then, can a one-year-old drug be trusted to be safe?  All explanations are welcome.

    Jairo Vergara23 December 2020

    People who have had covid-19, could they get the vaccine?

    Gaurav Chhaya2 February 2021
    Safer vaccination drive

    It is after 1st month of drive in various areas of world ... and many people inoculated vaccines .. found to be safe vaccination against COVID-19.  Also acceptance is increasing all over. 
    Question about efficacy can be answered only after 4 months.

    Cherylyn Y Pipkin16 September 2021

    Very informative and insightful on topics they predicted would be problematic have today proven to be true. 

    Heather Schroeder29 September 2021

    Helpful information

    Stephanie,Lyles29 June 2022

    Helpful information

    Von Brown14 January 2023
    Vaccine advocate

    Hearing about the mRNA vaccines/technology interested me from the beginning. I don't mind being a messenger for those who are unsure about the misinformation.