While companies race to produce a safe, effective vaccine for the novel coronavirus, a crucial question remains: Will enough people take it to make a difference?
Early statistics are grim.
Only about one-third of Americans say they'd be very likely to get a vaccine to prevent COVID-19, according to a poll released last month – virtually unchanged since the spring.
More people said they would get it if the vaccine were free, and others said they would sign on if there was a second wave of infections – a sign that while many Americans are hesitant about a vaccine, their opinions aren't set in stone.
But convincing them that getting a vaccine is a good idea will take effort and money. And so far, no federal dollars have been set aside for vaccine education.
Peter Pitts oversaw the Food and Drug Administration's public outreach programs during the George W. Bush administration. Back then, as now, there was no budget.
"It was all bully pulpit stuff, and that only goes so far," said Pitts, now president and co-founder of the Center for Medicine in the Public Interest, a New York-based nonpartisan think tank.
Now we're in a global crisis, and funding and attention is urgent, he said. "As far as I can tell, there's no strategy on the federal or state or local levels to educate the public relative the value of a COVID vaccine specifically, or to vaccines just in general."
Two decades ago, the Human Genome Project – a $3 billion effort to map every gene – set aside 3% to 5% of its budget for public communication, said Emily Brunson, a medical anthropologist at Texas State University. She'd like to see the same thing done with COVID-19 vaccine development.
She and other advocates fear that if the work doesn't start soon, it'll be too late. A vaccine is likely to receive federal approval as soon as later this year.
Causes for hesitancy vary widely
Not everyone is hesitant for the same reasons.
People of color often have been treated poorly by the medical establishment, so they have good reason to be distrustful, said Dr. Bisola Ojikutu, an infectious disease specialist at Brigham and Women's and Massachusetts General hospitals in Boston.
Ojikutu said she's confident in the vaccine development process because of her own knowledge of the system and some of the people involved. But others will need to be convinced. "I'm concerned whether or not communities of color are going to take it," she said.
Latinos, for instance, may be afraid of authority because of the administration's aggressive immigration policies. They also often hold essential jobs with inflexible hours, which may make it challenging for them to get a vaccine even if they want one.
Different strategies will be needed to address different causes of vaccine hesitancy, said Monica Schoch-Spana, who with Brunson co-chaired a Working Group on Readying Populations for COVID-19 Vaccines that recently produced a white paper.
People concerned about safety will need reassurance; people of color will need to be engaged in a process that builds trust; and people worried about government overreach will need to be heard, said Schoch-Spana, a senior scholar with the Johns Hopkins Center for Health Security.
More research will also be needed to fully appreciate this hesitation, said Lois Privor-Dumm, a senior research associate with the Johns Hopkins Bloomberg School of Public Health and an expert in vaccine introduction.
"Understanding and respecting what people believe and what is important to them is really crucial," she said.
Then there are those who won't like any vaccine, regardless of how it was developed or what officials say.
Pitts, the former FDA official, said such anti-vaxxers shouldn't be allowed to control the public discussion around vaccines. "They are a threat to themselves, their families, their neighbors and their communities," he said.
Early signals from feds may have hurt
The administration made a mistake emphasizing speed when it announced federal funding for vaccine development, vaccine advocates said. Calling the project "Operation Warp Speed" suggested to many people that it would prioritize speed over safety.
"This issue of speed is not sitting well within Black communities," Ojikutu said, suggesting the title "Operation Safe Recovery" instead.
"Everyone wants a resolution to this devastating pandemic," Ojikutu said. "But in communities that have heightened mistrust towards systems, you have to focus in on how you will protect them, not on how you will develop something quickly. The piece of this that is so critical is safety."
In recent weeks, the National Institutes of Health's Dr. Anthony Fauci and other leaders of the government's vaccine development effort have repeatedly said safety is their top priority.
But first impressions linger.
"My concern is that there's be a great deal of pressure on whoever developed and tested the vaccine to get it out as quickly as possible," said Jeffrey Freed, a 59-year-old information technology consultant from Charlotte, North Carolina. "If it takes four years to do it right, then that's what we have to do."
Freed said he's not opposed to vaccines, he just wants to be convinced the science behind one is solid. Once he is and his doctor gives him the all-clear, Freed said he'll be more than willing to get a shot.
Living alone and working from home for months has left him as ready as everyone else for the coronavirus outbreak to end. "I want out," he said.
President Donald Trump and Operation Warp Speed may also have created unrealistic expectations, said Sandra Crouse Quinn, a professor and chair of the department of family science at the University of Maryland.
Unless trials go perfectly, Quinn doesn't believe a vaccine will be ready before the end of the year, as the president has promised, and even if there is one, it won't reach the average citizen for months. But by creating this expectation, Trump may be setting people up for disappointment – and potentially disillusionment in the process.
"Operation Warp Speed is raising doubts about safety and cutting corners," she said.
Concrete steps to take
Who delivers a pro-vaccine message will be important, Ojikutu said. If African Americans don't see people who look like them talking about getting vaccinated, they'll be far less likely to take that step themselves, she said.
She suggests enlisting Black community leaders, faith leaders and health care providers – "people who have a vested interest in caring for people" – in efforts to inform the public about COVID-19 vaccines.
It's not a matter of rebuilding Black confidence in vaccines, she said, because there's so little to begin with. But done right, a COVID-19 vaccination campaign could help build public faith in other vaccines.
It would be great to have Black doctors recommending vaccines, but only 2% of all doctors in the U.S. are African-American, said Dr. LaTasha Perkins, a family physician and assistant professor at Georgetown University School of Medicine.
Still, role models are essential, as is Black participation in clinical trials that will determine whether a vaccine is safe and effective.
"If you can show that the vaccine works for us, works in us and that we were part of the process, that will build trust," Perkins said.
One way to remove people's hesitancy about vaccines is to make it easy to get them, said Privor-Dumm, at Johns Hopkins. Vaccines should be low-cost or free, and given out at convenient times and locations, she said.
Someone who has to miss work to get a shot – or even two, as most of the vaccines under development will require – will be much more hesitant about a vaccine than someone who can get one for free, close to home at a time that works, she said.
It's also crucial to counter misinformation with accurate data about an eventual COVID-19 vaccine. There are so many myths right now "it's mind-boggling," said Theresa Horner, chair of the public health department at St. Francis University in Loretto, Pennsylvania.
"Information that can help alleviate that and provide honest answers and truths, it will certainly serve the United States well in trying to eradicate this (virus)," she said.
The bottom line is that the pandemic can't end without a vaccine that the majority of Americans are willing to take, said Dr. Lindsey Baden, director of infectious disease clinical research at the Brigham and Women's Hospital in Boston.
"If we have a successful vaccine and (only)half the people take it, we've failed."
Contact Weintraub at kweintraub@usatoday.
Health and patient safety coverage at USA TODAY is made possible in part by a grant from the Masimo Foundation for Ethics, Innovation and Competition in Healthcare. The Masimo Foundation does not provide editorial input.
This article originally appeared on USA TODAY: COVID vaccine: Why a vaccination is key to ending coronavirus pandemic