Past and ongoing studies provide important insights for COVID-19 vaccination in the U.S. and around the world

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COVID-19 vaccines are currently in high demand, with many Americans competing for scarce appointments in a process that’s been likened to the Hunger Games. But as vaccine supply increases in the U.S. and around the world, public health officials are concerned that hesitancy to get the vaccine will put a damper on this demand and keep us from reaching herd immunity.

Vaccine hesitancy, according to the World Health Organization, refers to the reluctance or refusal to receive vaccines, despite their availability. The choice of whether to get a vaccine or not is influenced by a variety of factors, including trust in government and science, socioeconomics, media consumption, misinformation, and ideology. Vaccine hesitancy is not a new phenomenon, but it has been fueled in recent years by social media.

As the U.S. and the world undertake the largest vaccination campaign in human history, past and current NYU research on vaccine acceptance and hesitancy can inform our understanding of these issues.

Vaccination in nursing homes
Nursing homes and other long-term care settings have been particularly hard-hit by COVID-19. As a result, they were prioritized during the initial distribution of COVID-19 vaccines.

Jasmine Travers, assistant professor at NYU Rory Meyers College of Nursing and an aging, long-term care, and health disparities researcher, has studied vaccination trends in nursing homes. She led two studies in 2018 about racial and ethnic disparities in vaccinations among nursing home residents, which found that racial/ethnic minorities were less likely to receive flu and pneumococcal vaccines than were their white counterparts. This same population was also less likely to have vaccines offered to them and their vaccination status tracked—illustrating the need for policies to ensure that vaccinations are equitably offered and documented. Facilities with high shares of Black residents accounted for a large proportion of the disparities seen in vaccination.

Travers also led a 2016 study on nursing homes and flu vaccination, and found that government and nonprofit nursing homes were more likely to have higher vaccination rates than were for-profit and "chain" nursing homes. Smaller facilities, those located in the Northeast (vs. Midwest), and those caring for more patients with dementia were also more likely to have higher vaccination rates. In addition, Travers found that only a third of nursing homes required their staff to get a flu shot, despite the vulnerability of their residents and research showing that higher staff vaccination rates are linked to higher resident vaccination rates.

Vaccine hesitancy and informed decision making among new parents
How do parents decide whether to vaccinate their children or themselves? Researchers at NYU Rory Meyers College of Nursing—Donna M. Hallas, Susan Altman, and Jason Fletcher—led a study that used an online intervention to increase informed decision making and reduce vaccine hesitancy in pregnant women and new mothers. Some mothers, often influenced by social media, were on the fence about taking vaccines or having their kids vaccinated.

The web-based intervention gave participants scientific information and resources—including photos of children with vaccine-preventable diseases like whooping cough—and helped them to understand how to find reliable, trustworthy information. The researchers found that giving people the skills to find trustworthy resources and make informed decisions ultimately encouraged many vaccine-hesitant women to choose to vaccinate, especially pregnant women.

Understanding COVID-19 vaccine hesitancy among patients with kidney disease
People with end-stage kidney disease undergoing dialysis are at a higher risk for severe illness and death from COVID-19, making vaccinating this population critically important. An ongoing study by Maya Clark-Cutaia at NYU Rory Meyers College of Nursing and Lama Nazzal and David Charytan at NYU Langone Health seeks to better understand why some dialysis patients are hesitant to receive a COVID-19 vaccine. Notably, people of color—particularly African Americans—are at increased risk for end-stage kidney disease.

The study will use surveys and interviews with dialysis patients in New York City to explore perceptions of discrimination, mistrust, and stigma surrounding health care, as well as cultural beliefs, attitudes, and preferences that influence their ability and willingness to get vaccinated. The knowledge gained from the study—funded by KidneyX, a partnership between the U.S. Department of Health and Human Services and the American Society of Nephrology—will inform interventions to increase vaccine acceptance in end-stage kidney disease patients.

How belief systems shape COVID-19 vaccine hesitancy
NYU School of Global Public Health researchers David Abramson, Diana Silver, and Rachael Piltch-Loeb are kicking off a new study to examine the role of belief systems in shaping COVID-19 vaccine hesitancy. The project—which will be funded by the National Science Foundation—focuses on the beliefs held by individuals, such as the legitimacy of science, the trustworthiness of political and public health leaders, and what constitutes a fact, and the extent to which these beliefs influence their willingness to take the COVID-19 vaccine.

The study will also explore the degree to which these beliefs are promoted by national advocacy groups, political organizations, and religious leaders. The researchers will analyze the narratives and stories disseminated by these national leaders through social and broadcast media, and will conduct a longitudinal survey of U.S. participants to understand the impact of these narratives and beliefs on vaccine uptake.

Understanding hesitancy and countering misinformation among frontline workers
Healthcare workers, first responders, and other essential workers have been prioritized for COVID-19 vaccines, given their increased risk of contracting the virus. Rachael Piltch-Loeb, an associate research scientist at NYU School of Global Public Health and a preparedness fellow at Harvard T.H. Chan School of Public Health, is working with colleagues at Harvard and the Massachusetts Association of Health Boards to study vaccine hesitancy among these frontline workers.

The researchers started by surveying essential workers and found that past experience of racial discrimination was a predictor of vaccine hesitancy. Piltch-Loeb and her colleagues also found that people who are less likely to get a COVID-19 vaccine are using social media as their sole source or as at least one source of information, suggesting that social media channels can play a role in educating people who are hesitant about vaccines.

Using this knowledge, the researchers are designing YouTube videos to counter vaccine misinformation and will evaluate whether the videos shift vaccine attitudes and awareness. Rather than trying to counter specific beliefs about vaccines, their approach will prime viewers to be aware of misinformation. The research is funded by Google’s Jigsaw and is a partnership with the PERIL Center at American University.

The legacy of the Tuskegee Syphilis Study
The Tuskegee Syphilis Study—an infamous government-led study in which syphilis treatment was deliberately withheld from Black men in Alabama—is often used as the case study for unethical biomedical research. More recently, it’s been cited as a reason why African Americans are hesitant to get a COVID-19 vaccine. But more than a decade’s worth of research by Ralph Katz and Stefanie Russell at NYU College of Dentistry challenges that idea.

Katz and Russell were part of the NIH-funded Tuskegee Legacy Project, which sought to determine whether the Tuskegee Syphilis Study made African Americans more reluctant to participate in clinical research. The research—which generated more than a dozen published papers and a book edited by Katz—found that African Americans were much more likely to be aware of the Tuskegee study and were more fearful of participating in research than were white people–but there was no difference between African Americans and whites in their willingness to participate in biomedical research.

The researchers posit that lower enrollment of minorities in clinical trials is more likely to be connected to present-day circumstances, including a lack of effort to recruit diverse participants and Black individuals’ ongoing experiences of discrimination and mistreatment in healthcare.

How college students and government officials are working together to fight vaccine hesitancy in the Middle East
The global rollout of COVID-19 vaccines faces unprecedented challenges, including constrained supply and lack of equitable access by poorer countries. Moreover, low trust in science and the spread of misinformation and conspiracy theories are undermining public health responses.

This spring, NYU students are working alongside professionals from health ministries, the World Health Organization (WHO), UNICEF, and other NGOs to address vaccine hesitancy in the Middle East and North Africa. They are enrolled in a course called Behavioral Communication Strategies for Global Epidemics: Social Behavioral Change for Vaccines, led by Chris Dickey and Erma Manoncourt of NYU School of Global Public Health.

The timely course focuses on vaccine acceptance and hesitancy, misinformation and disinformation, ethics, public trust, and community engagement best practices, including social listening and digital engagement. The participants—who come from 21 different countries—are split into teams of students and health professionals tasked with developing a strategy to improve vaccine uptake in a specific region. At the end of the course, the teams will present their strategies to a panel of public health experts, and a subset of groups will receive funding from WHO and the Global Institute for Disease Elimination (GLIDE) to implement their strategies in the field.

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