What If They Gave a COVID-19 Vaccine and Nobody Came?

Public acceptance of a COVID-19 vaccine is far from a lock. A nurse who participated in a trial for one of the vaccines up for FDA approval worries that side-effects will diminish uptake.

A nurse who participated in the trial for Pfizer/BioNTech’s vaccine for coronavirus disease 2019 (COVID-19) sounds a cautionary note about whether the public will be lining up or running away. Kristen R. Choi, PhD, RN, writes about her experience in a perspective in JAMA Network. She happened to come across an ad asking for people to participate in the trial. “As a nurse and researcher who has encountered social media recruitment in my own work—and has closely followed the COVID-19 vaccine trials—I was curious to see how Pfizer planned to convince 30,000 people in the US to volunteer,” Choi writes.When Choi looked at the material soliciting participants for the trial, she decided to sign up. “Volunteering for the trial felt like an honorable thing to do—and the 50% chance to be randomized to the vaccine early seemed equally compelling to me as a practicing nurse,” Choi writes.

Like many people, Choi places a lot of hope in a COVID vaccine, but after her experience in the trial—and again like many people—she also has some misgivings. As the Pfizer/BioNTech version moves ever closer to becoming a reality in the United States, healthcare experts warn that it or any other vaccine (such as the one being developed by Moderna) won’t necessarily be the cure-all that will get us back our pre-COVID lives. The low-tech methods of infection prevention that the public has been encouraged to use since the beginning of the pandemic—hand hygiene, social distancing, masking—will still be needed, at least for the initial months, and possibly longer. And there’s the question of vaccine uptake. A Gallup poll in November said that 42% of Americans would not take the vaccine.

Kevin Kavanagh, MD, a member of Infection Control Today®’s Editorial Advisory Board said in a recent Q&A that he worries that the side effects of a vaccine will discourage people from getting it. “I’m worried that they are going to cause a significant immune response, not one that’s dangerous, but one which may discourage people from getting the vaccine,” Kavanagh said. “We see this with the shingles vaccine. People take the first dose. They don’t want to take the second dose, because they had a fever and were sick. That may be very problematic.”

Turns out that Choi worries about the same thing. She got the first shot of the COVID vaccine and felt fine. As for the second shot? “My arm quickly became painful at the injection site, much more than the first time,” Choi writes in her JAMA Network article. “By the end of the day, I felt light-headed, chilled, nauseous, and had a splitting headache. I went to bed early and fell asleep immediately. Around midnight, I woke up feeling worse—feverish and chilled, nauseated, dizzy, and hardly able to lift my arm from muscle pain at the injection site. My temperature was 99.4 °F (37.4 °C). I tossed and turned, sleeping little during the rest of the night.”

The next morning her temperature was 104.9 °F (40.5 °C). She took acetaminophen and the fever subsided. A research nurse told her that “a lot of people have reactions after the second injection.” Choi rebounded by the next day.

As is the case with double-blind trials, Choi doesn’t know if she in fact got the experimental vaccine, but her physical reaction suggests to her that she did. She believes that most people will have at least one of the adverse reactions to the vaccine that she experienced.

“The adverse effects of the vaccine—even if, at worst, they all happen at once—are transient and a normal sign of reactogenicity signaling an effective immune response,” Choi writes. “But I worry that they could be a major barrier to vaccine uptake. Clinicians will need to be prepared to discuss with patients why they should trust the vaccine and that its adverse effects could look a lot like COVID-19. They will need to explain that fatigue, headache, chills, muscle pain, and fever are normal, reactogenic immune responses and a sign that the vaccine is working, despite the unfortunate similarities with the disease’s symptoms.”