Speaker: Allergists, immunologists can lead the fight against COVID-19 vaccine hesitancy

Allergists and immunologists can play a vital role in educating the public about COVID-19 vaccines, dispelling misinformation and creating greater trust in their use, according to one of the speakers at the Eastern Allergy Conference.

Vaccine hesitancy has impeded efforts to achieve herd immunity, extinguish the virus and stop new strain development, Joseph A. Bellanti, MD, director of the International Center for Interdisciplinary Studies of Immunology at Georgetown University Medical Center, said during his lecture, which was published in Allergy and Asthma Proceedings.

Joseph A. Bellanti

Bellanti told Healio vaccine hesitancy is “moderately common” among patients in his own practice.

Misinformation, myths and fallacies about the vaccine drive this hesitancy, Bellanti said, but so does a diminished level of confidence in the government, medical and business communities felt by some segments of the public.

Drivers of hesitancy

Bellanti cited a study in his lecture that summarized the historic and sociocultural factors that contribute to vaccine hesitancy, including knowledge and information, past experiences, perceived importance of vaccination, associated risk perception and trust, subjective norms and religious and moral convictions.

When asked, people who were vaccine hesitant and participated in a poll-based study said they were concerned about side effects, the vaccines’ rapid development and approval process, and getting infected with the virus through the vaccine.

Also, people said they were not concerned about getting seriously ill from the coronavirus or that the outbreak was not as serious as some people said it was. Doubts about vaccines’ effectiveness, dislike of needles and lack of time also were referenced.

Addressing allergic reactions, side effects

But Bellanti said that the most common question patients have is whether they should get the vaccine if they have allergies. Allergists and immunologists, then, need the most up-to-date information pertaining to these issues, he continued.

The first step in allaying these concerns, Bellanti said, would be to reassure patients that the vaccines are safe and effective and that serious allergic reactions are rare. Anaphylaxis is extremely rare, he added.

The COVID-19 vaccines contain mRNA, Ad26.COV2.S and lipids. They also include polyethylene glycol (PEG) and polysorbates, or excipients, which may cause the allergic reactions that have been reported.

When discussing potential allergic reactions to the vaccines with patients, Bellanti said, allergists and immunologists should make four points.

First, he said, it is unlikely that all the reactions specifically to the mRNA vaccines that have been reported have been mediated by IgE. Second, there has been no clear proof that PEG has been a causative allergen. Third, even if PEG is the allergen, there has been historical difficulty in consistently and accurately assessing the results of anti-PEG IgE skin testing.

Finally, Bellanti said that pre-vaccination risk-stratification questionnaires can add medical complexity that could create confusion and dilute vaccination messaging because there is no clear evidence that a personal or family history of anaphylaxis, medication or food allergy, asthma or allergic rhinitis could produce a risk for an adverse reaction.

Bellanti additionally addressed the 28 cases of thrombosis with thrombocytopenia syndrome reported among people receiving the Johnson & Johnson vaccine, calling it a rare adverse event that’s even rarer among men and women aged 50 years and older. Other vaccine options do not present this risk.

Patients also may be concerned about the 393 reports of myocarditis or pericarditis following vaccination, which the CDC and FDA are investigating, Bellanti said, adding that patients who received care responded well to treatment and rest. Also, the CDC continues to recommend vaccination due to the greater risks presented by COVID-19 than vaccination.

An active dialogue

The public now has immediate access to information, which can be both good and bad, Bellanti said, adding that public interest in medical news is soaring.

So instead of speaking at the public, Bellanti said, professionals should foster an active dialogue with the public that empowers people to be actively involved in science and medicine as key stakeholders, instead of passive recipients of information. And, in doing so, he continued, professionals should consider the factors that drive vaccine hesitancy.

Bellanti told Healio that patients who have expressed concerns about allergic reactions have been “most receptive” to lengthy conversations, and they all have since received the vaccine. Similarly, patients concerned about thrombosis also have been receptive to these discussions, and most have gotten one of the mRNA vaccines instead of the Johnson & Johnson vaccine.

Additionally, Bellanti has engaged patients with other concerns about the vaccine in “an active dialogue of shared decision-making,” he said, and he encourages providers to conduct similar conversations.

For example, when patients say they are concerned about side effects or the rapid development and approval process, providers should respond “by pointing out the thorough review process in clinical trials,” Bellanti told Healio.

When patients say they are concerned about getting infected with the coronavirus from the vaccine, providers should note that there is no live virus in the vaccine, so there is no chance of becoming infected with it.

As for patients who aren’t concerned about getting seriously ill with COVID-19 or who don’t think the outbreak is as serious as people say it is, providers can point out the morbidity and mortality statistics associated with the disease.

Bellanti further said that he is encouraged by recent increases in vaccination rates, but all providers need to do more, with “continued discussions in an active dialogue of shared decision-making,” he said.

For more information:

Joseph A. Bellanti, MD, can be reached at bellantj@georgetown.edu.