I recently met hundreds of COVID-19 vaccines at the door of Vermont’s large public vaccination drive, shepherding each one to meet the nurses who would perform the vaccination.
I screened each for symptoms of active disease, commented on the lovely spring weather, and asked if they had any concerns.
One nattily dressed Black woman in her mid-forties admitted she was nervous as we walked toward her chair.
“I hate needles,” she said, visibly shaking. “Are these vaccines safe?”
We paused. I listened. I said I was glad she had come. I reassured her that I believe, as a physician, that COVID-19 vaccination will make her much safer than she was before.
Safety Concerns and Vaccine Hesitancy
In Europe, recent reports of extremely rare clotting complications of the AstraZeneca vaccine made European vaccine recipients markedly more nervous about vaccine safety. Many public health authorities worried public safety fears could hurt efforts to vaccinate past a fourth wave of COVID-19 deaths.
The announcement today by the FDA and CDC recommending a pause in states’ use of the Janssen (Johnson & Johnson) vaccine due to similar reports of extremely rare clotting complications made clinicians like me, public health authorities, and various pundits fearful that mentioning these safety concerns could lead people to defer their vaccine appointments and thus remain unprotected from the far greater risks of COVID-19.
As the world nears three million deaths from COVID-19, it’s tempting to keep the vaccine side effect genie in the bottle, particularly regarding extremely rare complications whose causal linkage to vaccination is only just coming into the light. If the European Medicines Agency never voiced clotting concerns related to the AstraZeneca vaccine, might fewer people have died of COVID-19? Will the same thing happen here in the U.S.?
The Long Game in Vaccine Trust
We should view scientific transparency – about vaccine-related clotting concerns and beyond – as having massive long-term benefits and tiny short-term side effects, much like COVID-19 vaccines themselves.
COVID-19 vaccines confer massive protection from hospitalization and death from COVID-19, not to mention protection from persistent symptoms that have dogged upwards of a third of people afflicted with COVID-19. These benefits come at the cost of common side effects like sore arm, low-grade fevers, achy muscles and fatigue, as well as extremely rare toxicities like blood clots arising from the auto-immune generation of antibodies that activate platelets.
Scientific transparency is similar. Most people are reassured that scientists and regulatory officials are being exceedingly careful with COVID-19 vaccines, including pausing distribution to investigate safety signals. Surely this can drive short-term vaccine hesitancy, but since vaccine hesitancy derives from mistrust of science, trying to hide vaccine side effects will only exacerbate the problem over the long term.
We should tolerate the short-term side effect of temporarily increased vaccine hesitancy in order to derive the long-term benefit of public trust in global efforts to scale up COVID-19 vaccines to protect our loved ones and restore our beloved normal ways of life.
The Virtue of Being Boring
Between ushering new vaccine recipients to their places, I checked in on the woman who earlier said she was afraid to get a COVID-19 vaccine.
She confessed her lips tingled from nervousness just before and after she got her shot, but just minutes later she was feeling better and looking forward to going home.
Her nurse and I confirmed more than once during the prescribed waiting period that she was well and improving, and reiterated we were happy she had come. As she walked out, the woman turned back to us and said, “it wasn’t that bad.” She promised her next step was to work on her husband’s vaccine hesitancy.
Short-term wins in conversations and on Twitter are fleeting. True trust is golden and earned over time. Whenever the latest Twitter furor kicks up about vaccines and other measures to put COVID-19 into the history books, I remember the quiet, reasonable majority of people who are worried, and watching and listening for advice from respected leaders.
The more nurses and physicians and public health professionals can be the careful, trustworthy, details-focused geeks our patients know and trust, the more we will have the honor of giving out good advice and saving lives.
Tim Lahey, MD, MMSc, is an infectious diseases physician and ethicist at the University of Vermont Medical Center and professor of medicine at the university’s Larner College of Medicine.
Last Updated April 13, 2021