BU Today: Are you alarmed at the rate of COVID-19 vaccine aversion? Is it potentially going to prolong the pandemic?

Cozier: Certainly, higher compliance is better. But even people who under normal circumstances would engage in vaccination may have pause, because this is the first time this one is being rolled out. And this was fast-tracked. [Vaccine refusers] may have legitimate safety concerns. I don’t want to add to undermining vaccination, but this has to be reckoned with—legitimate fears. The other part that is underestimated is the national infrastructure to roll this out. We don’t really have a fully functional, fully accessible healthcare system. I don’t know what the plan is to roll this out, so that’s going to hinder the number of people that can actually be reached.

I think we’ll get there eventually; it’s not going to be at the snap of a finger in January. We will probably get to acceptance the same way we have with the influenza vaccine, over time—and we’re talking over many years, decades, that the uptake of that vaccine regimen has increased. Having a vaccine is not the same as vaccination. If people cannot get vaccinated because of systemic things, that’s going to slow it down.

Other than safety concerns, what reasons account for vaccine refusal, particularly among two groups: pro-Trump folks and marginalized communities such as African Americans?

With anti-vaxxers, we’re often talking about some very affluent individuals. They may be a little more libertarian. I’m not as clear why some pro-Trump individuals, especially those of lower socioeconomic status, would jump on that bandwagon, other than general mistrust—not trusting anything the government has said about anything.

The other side—marginalized people of color—has not been well-served by the existing public health system. They’re last in everything, they get the least quality, health-wise, in medicine. They are excluded from the mainstream of healthcare. Now we’re saying to this group—who we also have deemed essential workers—We’re going to give you the vaccine first. Does that mean that it’s coming from an altruistic place? Is there something we’re not telling people? These are legitimate concerns. And we haven’t even talked about costs—are these vaccines free, are they going to have a co-pay?

These are very different concerns, from libertarian Republicans to safety issues to marginalized folks screwed by the healthcare system. Can you suggest messages to get these disparate groups to accept a vaccine?

It’s predicated upon whether we get a functional vaccine. That remains to be seen and will take a lot more time than we’re considering. Russia says they have produced a safe vaccine. OK, show us your data. They haven’t done that. There’s almost no  possible way they could know that this is safe.

Assuming we get to a proven, safe vaccine, a public health message has to be clear in the benefits and potential risks. It has to create the true narrative, how valuable health and life are, how transmissible this virus is, and how the vaccine protects not just one person, but many people around them. This message will have to be crafted in the way we’ve done with the influenza vaccine. Every year, someone says, I don’t take the influenza vaccine; I don’t think I need it. Or, I took it and I got sick. Well, believe me, you did not have influenza, or you got a mild case of influenza that did not require you to be hospitalized.

It’s not going to be a short, pithy message. It’s got to be a targeted, detailed campaign. We have to look at this not as a January 2021 issue. We have to look also at a January 2025 thing, something we have to continue to work on. The world has never created a successful [approved] coronavirus vaccine. [Other coronaviruses cause diseases, such as Middle East respiratory syndrome (MERS) and severe acute respiratory syndrome (SARS).] One of the reasons COVID-19 vaccine production has been able to be fast-tracked is because other efforts going to other coronavirus vaccines—everything that was learned and those failures—are now being harnessed towards this COVID-19 vaccine. There’s a lot of trial-and-error data that is being put to use, a lot of collaboration. That has to be conveyed to people. This isn’t just something that began in June. There might need to be a narrative of what was the process.