COVID-19: How RNs can help overcome public vaccine hesitancy

Vaccines have been on the minds of many Americans. SARs-CoV-2 cases are increasing across the U.S. Its pathogenicity has touched the lives of the most secure and elite populations of our society. As we yearn for past conveniences and as we experience mask and social distance fatigue, as well as continued disruptions in work-life balance, all of us want to know: When will a safe coronavirus vaccine become available? Who will have access to the vaccine when one becomes available? How will its distribution be prioritized?  

On Oct. 2, a distinguished group of scientists and researchers from the National Academies of Science, Engineering and Medicine issued the Framework for Equitable Allocation of COVID-19 Vaccine to address a multitude of questions about distribution and priority groups. It describes fair and transparent decision-making about provision of the vaccine to frontline and essential workers, the young and the old, the compromised and the healthy. However, near the end of the document, in Chapter 7, “Achieving Acceptance of COVID-19 Vaccine,” the authors acknowledge that “distrust in the government, in the medical research community, and in pharmaceutical companies” is a key factor in “COVID-19 vaccine hesitancy.” They note that “anti-vaccine sentiment is as old as vaccination itself” and that current anti-vaccine groups are well-organized and well-funded.  

Underlying all of this exhaustive planning is the ethics of collective trust — trust in the information the public receives and the sources of that information and whether the public can trust messaging and information about the effectiveness and safety of any vaccine put forward. A national tracking poll has indicated that 62 percent of individuals are worried that political pressure will lead the FDA to rush its approval of a vaccine before adequate trials are completed. The poll also showed that the share of adults who trust the Centers for Disease Control (CDC) decreased by 16 percent from April to September, to 31 percent of polled individuals. 

As we have learned from past disasters, epidemics and pandemics, trust is easily disrupted and eroded at all levels: trust between individuals, trust within communities and health care systems and trust in leaders and government officials. And social media has intensified these divisions.  

Who can help the public understand complicated information and weigh the risks and benefits of a COVID-19 vaccine, when the mismanagement and politicization of messages has invaded every computer and television screen and every living room across the country? Is it time to look to other groups to provide these messages, beyond those who are typically showcased in the popular media?  

Polls show that Registered Nurses (RNs) are the most trusted health care professional group in the United States, and they have been ranked “the most honest profession” for 18 years in a row. They are knowledgeable about complex phenomena; skilled in communicating with other professionals and with patients and families; compassionate caregivers; educated at the undergraduate, graduate, and doctoral levels; and committed to a code of ethics that upholds the ethical value, worth and dignity of every person.

Professional civic engagement by RNs is no longer a matter for debate. They cannot remain silent after what they have seen, heard and experienced during the pandemic. As the largest professional group in the country, with more than 3 million RNs licensed to practice, they have placed their own lives in jeopardy and have personally experienced the internal and external damages of a virus that showed no mercy to themselves, their patients, their families or their communities. They, too, have suffered loss. When a vaccine has been readied for distribution, RNs can serve as dependable allies. The public trusts nurses, and RNs will play critical roles in public health communication efforts and in vaccine distribution.   

The COVID-19 pandemic has revealed the weakness and fragility of our systems. It has shown us the critical need for carefully constructed messaging that will not only inform and educate individuals and communities about basic facts, scientific data and the evidence-based decisions that follow but will also promote trust in the messages’ contents and sources. We have also seen how race, ethnicity and gender can influence both the message and its impact, and when a vaccine is available, we must craft inclusive messages that take into account historical reasons for mistrust of health care and other authorities. 

Trust is the bedrock of democratic societies, the hallmark of professional relationships between patients and clinicians. Trust is an understated ethical value that extends across time and place.  

Isn’t it time we listen to the voices of RNs? By listening to them, we can better understand what went wrong and find new ways to educate and inform the public. RNs can help repair the damage caused by the pandemic. Then perhaps we can move beyond distrust and vaccine hesitancy to the implementation of a safe, beneficial vaccine.   

Connie M. Ulrich, PhD, RN, is a professor of Bioethics and Nursing and the Lillian S. Brunner Endowed chair in Medical and Surgical Nursing at the University of Pennsylvania School of Nursing. 

Julie Fairman, PhD, RN, is a professor, the Nightingale Professor in Honor of Nursing Veterans, and chair of the Department of Biobehavioral Health Sciences at the University of Pennsylvania School of Nursing.