**1. Introduction**

Before the Covid-19 pandemic, vaccine hesitancy was a term reserved for individuals, primarily in developed countries, in which there is a significant refusal or delay in uptake despite vaccine availability/access. In this instance, the term minute might be misleading since vaccine hesitancy is in no way a monolith. Indeed, vaccine hesitancy can take many forms and stems from multiple etiologies. However, never in the past decade had individuals' choices and personal convictions regarding a vaccine had such a profound effect on the perceived ability of entire nations to effectively control a pandemic at large [1].

This "rise to fame" and increased recognition in the public health community was borne out of the realization that multiple vaccine candidates were nearing the later stages of clinical trials in the fall of 2020. After nearly nine months of social protective measures and economic turmoil, a clear disparity had been recognized between the rapid vaccine production process and public knowledge/acceptance toward eventual vaccine uptake. For instance, the first vaccine (Pfizer) against

#### *Fighting the COVID-19 Pandemic*

Covid-19 was given emergency use authorization on December 11, 2020, in the U.S. A week later, a second vaccine (by Moderna) was also approved. However, unlike traditional vaccine rollouts, the U.S. government had pre-purchased hundreds of millions of doses from multiple manufacturers via Operation Warp Speed, hoping to speed up the initial delivery to essential frontline workers and high-risk individuals [2]. The program was considered an overnight success as over 6 million doses of each vaccine was shipped within a week of authorization, enough to vaccinate the entire U.S. healthcare worker population. Within a few weeks, reports began emerging that only 68% of healthcare workers, the supposed most informed subset of the population, had chosen to receive the vaccine when offered to them [3]. To put this in perspective, annual influenza vaccine uptake in the U.S. stands at around 81% [4]. One might ask, what separates the two numbers? The answer is, of course, much deeper than surface level; however, one question has been proposed and proven highly appropriate in post-roll out public opinion polling: where was the vaccine marketing campaign? After all, the U.S. spent over \$12 billion on vaccine candidates undergoing clinical trials before a single jab was given [2]. The first official Covid-19 vaccination information campaign was not announced until January

#### **Figure 1.**

*"COVID-19 vaccine acceptance rates worldwide. For countries with more than one survey study, the vaccine acceptance rate of the latest survey was used in this graph. The estimates were also based on studies from the general population, except in the following cases where no studies from the general public were found (Australia: parents/guardians; DRC: healthcare workers; Hong Kong: healthcare workers; Malta: healthcare workers)." Source: Reproduced from "Figure 2: COVID-19 vaccine hesitancy worldwide: A concise systematic review of vaccine acceptance rates" by Malik Sallam. Licensee MDPI, Basel, Switzerland. Made available under the CC by 4.0 license.*

*Myths Surrounding Covid-19 Vaccine Candidates: A Guide to Fight Back DOI: http://dx.doi.org/10.5772/intechopen.98714*

#### **Figure 2.**

*Traditional vs. (accelerated) Covid-19 vaccine development timeline. Source: GAO analysis of Food and Drug Administration (FDA), pharmaceutical research and manufacturers of America, and Operation Warp speed information. | GAO-21-319.*

27, 2021, over a month after the first vaccine approval. Multiple analyses of the U.S. vaccine timeline have dubbed this period, between the late summer of 2020 and early spring of 2021, the "lost time" in the fight against the Covid-19 pandemic [5].

Thus, a question emerges. What could have been done to quell the impending rise of vaccine-hesitant individuals (**Figure 1**)? Here we find a great model in annual influenza immunization campaigns. The initiatives are backed by decades of research showing that a multi-disciplinary collaboration consisting of providers, public agencies, and private sector companies is needed to adequately address questions and instill confidence in individuals regarding upcoming vaccines. The word upcoming is critical in this context, as the marketing campaign is kicked off months BEFORE the first jab is expected to be given. Consequently, a logical time to begin educating individuals on the developing Covid-19 vaccines likely would have been months before the first approval. Unfortunately, the movement did not catch enough support, and we may never know the difference this may have made on vaccine hesitancy levels during the rollout.

During this "lost time," as mentioned, very little data exists surrounding vaccine hesitancy levels via traditional cross-sectional studies/surveys. Most statistics cited are taken from public opinion polling, which asked individuals their opinion on various aspects of the pandemic and, specifically, whether they intended to receive a Covid-19 vaccine if and when it is approved. To continue with the U.S. example, a poll taken in July 2020 showed that only 42% of Americans were considering getting vaccinated, with lower rates among minority groups, who are disproportionately affected by Covid-19 in both hospitalization and mortality rates [6]. Fast forward to November, and that number had not changed. However, the percentage of anticipated uptake among Black Americans had gone down [7]. Hence, we have our disparity: billions of dollars and public resources were given to vaccine

development, while virtually no attention was given to promoting the vaccine among its intended populations.

But what could have caused this? How did millions of individuals in one of the most developed nations in the world with access to social media, news outlets, and governmental information not warm to the greatest vaccine development feat in modern history? Well, aside from the missing vaccine marketing campaign, other factors must have been at play to erode public confidence and stall optimism in the wake of the surging pandemic. Of these factors, one was very preventable and remains a global barrier to vaccine administration: myths. That is, myths surrounding virtually every aspect of vaccine production, trials, administration, and longlasting effects. Such myths, circulated at large with the rise of unverified outlets (e.g., social media), have the ability to reach a mass audience with little recourse. A potent example lies in the fact that one false statement from a well-known celebrity can potentially reach hundreds of millions of viewers before any official rebuttal or correction is offered. Therein lies the challenge in combatting myths, reliant on the public's level of trust in public health officials compared to those spouting such research-lacking claims [8]. To accomplish this on an individual level, like all delicate encounters, requires both first-hand knowledge and effective communication techniques. While the latter two are character traits that may or may not be improved (see Section 2), the first is an area that deserves a review.

#### **2. Addressing vaccine myths**

Before diving in, it is worth reiterating that countering vaccine hesitancy, similar to the definition itself, is not a one-size-fits-all approach. The knowledge laid out below will provide a foundation for providers and the general public alike to interact with and have fruitful conversations regarding common misconceptions. However, there are extraneous principles that are important and necessary to follow to maximize such opportunities. A 2018 study out of the Thomas J. Long School of Pharmacy and Health Sciences identified several successful strategies that can be used to improve confidence and decrease hesitancy levels in recipients. Even more impressive is that the study involved pharmacy students rather than licensed medical providers, decreasing the likely power differential and knowledge gap seen in clinical practice [9].

The first viable strategy found was that of rapport. For example, a commonplace argument for vaccine aversion is that "vaccine side effects are worse than the disease itself." Instead of trying to ramble off a dozen facts and figures, a better solution was found in asking patients to boil the fear down to a specific side effect (e.g., headaches, diarrhea, etc.). Once this was done, the student could dig even deeper to determine if the patient had personally suffered or had a family history of suffering from such symptoms. From here, rapport could be established, and a risk–benefit analysis consisting of actual data would be much more appropriate than trying to combat the entire notion that vaccines should be "side-effect free." Now, this may seem like a "no brainer." However, one may not know as much as they think about their friend's/family member's health if they only interact once a year. Thus, it may be wise to take a deeper dive, regardless of relationship, before countering their pre-existing vaccine perceptions.

Once rapport has been established, a winning strategy is to start with the positives rather than harping on rare side effects and complications. A popular starting point would be explaining vaccine-driven herd immunity and how community protection is the basis for eradication/control of nearly all major outbreaks. Next, a solid turning point would be to suggest that they resist looking to unqualified

#### *Myths Surrounding Covid-19 Vaccine Candidates: A Guide to Fight Back DOI: http://dx.doi.org/10.5772/intechopen.98714*

personnel (on social media, television, etc.) and talk to an actual expert on the topic, such as their physician or pharmacist. Another important goal is to evaluate an individual's level of knowledge about the vaccine. Studies have shown that greater education simply about the vaccine itself and how it works can lower levels of hesitancy [10]. Thus, they do not need to walk away agreeing with you; simply informing them about how the vaccine works (mRNA technology, viral vector, etc.) is a step forward in our book. Then, it is important to assess their current risk–benefit stage. Two popular dimensions used are an individuals' perceived likelihood of harm and perceived consequence severity if that harm were to occur [11]. Narrowing this down, similar to establishing rapport, is key to addressing underlying fears/aversions. Consequently, it is also important to establish their "best-case scenario." They likely want the same endpoint for society (eradication/ negligible transmission). Using this as common ground and talking about realistic paths toward getting there is an excellent segway into discussing current research projections.

Two factors that cannot be ignored are that of socio-cultural pressure and religious convictions. Unfortunately, these are very hard to change in the longterm, much less in the course of a single conversation. Leveraging the idea of social responsibility, where an individual has a sort of role to play in achieving herd immunity for the betterment of those around them, has proven effective. However, a fine line should not be crossed so as to force down a specific belief on individual behavior [12].

These research-driven strategies may or may not be enough to build your communication arsenal the next time a patient, friend, or loved one mentions hesitancy toward vaccination. However, striving for rapport, providing judgment-free educational information, and being knowledgeable about all components of vaccine development and administration is a recipe for success in this fight toward ending the Covid-19 pandemic and future pandemics to follow. Speaking of knowledge, perhaps you are wondering what myths exactly are circulating about Covid-19 vaccines. If so, let us address your eagerness (not hesitancy).
