Vaccine Hesitancy in Georgia HIV Clinic Reflects Well-worn Myths, Resistance to Facts

I had my normal HIV clinic last week. Seven (of 9 scheduled patients) showed, of whom only 2 had received a COVID-19 vaccine. None of the other 5 had plans to get vaccinated.

One patient said he had an anxiety disorder, and even thinking about the vaccine increased his anxiety. Another patient said that his fiancée had received the vaccine and developed a persistent rash.

Still another said that he had a “bad reaction” to the influenza vaccine a few years earlier and didn’t want something similar to happen again. The fourth patient didn’t give a reason; he just said that he didn’t want to get vaccinated.

The fifth patient said that he was going to use herbal remedies to protect himself from COVID-19. When I pointed out that herbal remedies do not protect against getting infected with SARS-CoV-2, he replied, “Well, at least I’ll be healthy if I get it.”

Vaccine struggles in Georgia

I practice in a county in Georgia in which the COVID-19 fully vaccinated rate is 30%. The fully vaccinated rate in the State of Georgia is only 40%. Looking at the data and trying to interpret trends, it seems to me that Georgia may or may not get to a 50% fully vaccinated rate by the end of the year. I have asked many individuals, patients, family members, and folks in the community, why they are hesitant to get vaccinated. The most common reasons?

• Fear of side effects
• The belief that they are healthy enough to avoid hospitalization and severe disease due to COVID-19 if they get infected with SARS-CoV-2
• The perception that the introduction of the vaccine was “rushed” and/or that it is not FDA-approved
• The knowledge that they haven’t gotten it yet, and that there is “less of it around”

There have been other reasons as well.

Several individuals, including some taking immunosuppressive medications, have mentioned that their doctors had advised them not to get vaccinated (contrary to CDC guidance).

Some have mentioned that they had heard that the vaccines increase the risk of infertility and bad outcomes during pregnancy.

And, of course, there are many who believe (stated or not), that vaccination should be a matter of personal choice and not mandated by federal, state, or local elected officials, or by the CDC or other health authorities.

Delta's blows

But now, we have to deal with the Delta variant. Over the weekend, I helped to take care of a critically ill 16-year-old, who was intubated and on ECMO (extra corporeal membrane oxygenation). He had not been vaccinated. For that matter, 1/3 of our nurses have not been vaccinated (compared to only about 5% unvaccinated for our physicians).

"Over the weekend, I helped to take care of a critically ill 16-year-old, who was intubated and on ECMO. He had not been vaccinated."

Our medical center mandates that those of us involved in direct patient care receive an annual influenza vaccine. However, currently there are no plans to do the same for the COVID-19 vaccine. Analogously, many states mandate seatbelt usage. Many of those same states mandate against mask usage.

I wish I knew a way to increase COVID-19 vaccination rates. Our medical students are partnering with local churches to present vaccine information as part of our Vaccine Education Initiative. We do not have any way to measure the effectiveness of this approach, but I am skeptical that either the students or I have changed many minds.

I am afraid that we will have to endure at least one more surge, as is currently happening in Orlando and much of the rest of Florida, before enough of the vaccine-hesitant decide to get vaccinated. Maybe full FDA approval will help, as might ongoing educational efforts. But I am frequently told by patients that their relative was “perfectly fine” until they got the vaccine. While serious side effects do occur, many of these episodes likely reflect recency bias in memory.

"I am frequently told by patients that their relative was 'perfectly fine' until they got the vaccine."

By my calculations, even using the CDC drug reporting system at face value for deaths after the vaccine, the odds of dying after vaccination are anywhere from 1 in 100 000 to 1 in 1 000 000. On the other hand, the odds of getting infected with SARS-CoV-2 in Georgia and then dying from COVID-19 complications, are 1 in 10 000. In other words, there is a 100x – 1000x greater risk of dying without getting the vaccine than after getting the vaccine.

I try not to think along the lines of “what if,” as it applies to patients critically ill with COVID-19. But it saddens and disturbs me, as a physician, parent, and human being, to think about the many deaths that could have been prevented if more of us had gotten vaccinated. And I wonder why it is so difficult for so many to refuse to even consider doing something proactive for the public good instead of falling back on “personal choice.” It seems to me that “personal choice” in these circumstances is more than a little bit selfish.

Rodger D. MacArthur, MD, is Professor of Medicine, Division of Infectious Diseases and Office of Academic Affairs, Medical College of Georgia at Augusta University, Augusta, Georgia. 

Dr MacArthur is an NIH-funded researcher and before arriving at the Medical College of Georgia, he headed the Wayne State University AIDS clinical trial program. He is widely recognized as an authority on the development of antiretroviral treatment.