Understanding and addressing vaccine hesitancy

By: Sree Chaguturu, MD Senior Vice President, CVS Health and Chief Medical Officer, CVS Caremark Troy Brennan, MD Executive Vice President and Chief Medical Officer, CVS Health Garth Graham, MD Vice President, Chief Community Health Officer, Aetna

We are now entering a new phase of our collective response to the pandemic. If and when any of the several leading COVID-19 vaccine candidates are approved, manufacturers are expected to ramp up wide-scale production. Many of the public health levers we have used to date to control the pandemic — social distancing, wearing masks, hand hygiene, broad testing and contact tracing — will continue to be important. However, vaccines offer us a new and powerful tool in combating the pandemic. For the country to achieve significant control of COVID-19, widespread adoption of safe and efficacious vaccines across all communities and populations will be critical.

While initial results show the vaccines pending authorization to be both safe and highly efficacious, several reports have emerged suggesting widespread adoption will be difficult due to vaccine hesitancy. Better understanding the reasons behind vaccine hesitancy enables us to implement a targeted campaign to address these concerns and help ensure widespread adoption across communities. We wanted to obtain a clear view of which populations are more or less willing to receive a COVID-19 vaccine, and why they have those particular sentiments.

To do so, we initiated a broad, nationwide survey that is representative of the U.S. population as described by the U.S. Census Bureau. The survey was initiated the day after Pfizer and BioNTech released their first interim efficacy analysis from their Phase-3 study indicating their vaccine candidate was more than 90 percent effective in preventing COVID-19 and had 5,153 participants. The survey was conducted November 10-15, 2020. Its findings allow us to better understand vaccine hesitancy at this point in the pandemic and hence, address it.

While the results showed significant hesitancy across multiple populations — only 28 percent of this general population sample were interested in receiving the COVID-19 vaccine as soon as it is available — they also gave us the information needed to effectively overcome these barriers. These findings are a snapshot in time and are likely to evolve.

Among survey respondents:

Responses from different demographic groups highlight cultural and ethnic differences in their attitude toward vaccination. Our survey revealed that Black participants were least likely to seek the COVID-19 vaccine, with only 16 percent interested in receiving a vaccine when one is first available, and 29 percent planning to wait before getting vaccinated. Asian responders were most likely to get the vaccine, but were likely to wait and see (51 percent) rather than get one immediately (21 percent).

Based on the findings, it is clear that education and awareness efforts should focus on helping those very interested in getting a vaccine as soon as it is first available understand that certain populations will be prioritized. Individuals who do not meet the priority criteria may not be able to access a vaccine early on. CVS Health plans to address vaccine hesitancy and access through the following:

• Data and reporting We will continue to periodically survey the nation to update our findings. We will create focus groups — with an emphasis on minority populations — to better understand community-specific concerns. Additionally, we are developing reporting for Aetna and CVS Caremark clients to determine uptake of the vaccine.

• Targeted messaging Using these and future survey findings, we will develop targeted messaging to be delivered through traditional and digital media outlets and our in-store channels. We will also train nearly 90,000 clinicians — pharmacists, pharmacy technicians, nurse practitioners, and other professionals — to deliver these messages. We will provide vaccine educational materials to Aetna and CVS Caremark plan sponsors to assist them in empowering their own beneficiaries, employees, and dependents.

• Providers and other influencers as educators We will partner with influencers — including health care providers — and other stakeholders across the country to amplify information about the safety, efficacy, and benefits of COVID-19 vaccines. We will also educate Aetna and CVS Caremark members through a variety of channels including as a health and pharmacy benefit provider, and through Aetna’s contracted network of providers.

• Convenient access to vaccination services We believe convenient access matters. We are present in communities across the country, with more than 70 percent of Americans living within three miles of a CVS Pharmacy. In addition, nearly 60 percent of CVS Pharmacy locations are in communities more vulnerable to the impacts of COVID-19.As determined by the CDC’s Social Vulnerability Index We will provide vaccination services to nearly 30,000 long-term care and skilled nursing facilities in collaboration with the CDC. All of our nearly 10,000 pharmacies will provide vaccination services. Vaccines will be available by appointment only while supply is limited. Patients will be able to sign up online and schedule their follow-up booster shot at the time of initial scheduling.

Read the full white paper, "Understanding and addressing vaccine hesitancy"