COVID-19 vaccine hesitancy could lead to more deaths and longer restrictions

While millions of people rush to be vaccinated against COVID-19, questions remain about how many people do not want to be vaccinated and what this could cost us.

Researchers from Imperial College London’s (ICL) COVID-19 Response Team recently tried to model what the future might look like with vaccine hesitancy, and the results do not look good.

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Even highly effective vaccines against SARS-CoV-2, at current levels of hesitancy, may require continued nonpharmaceutical interventions to control the pandemic at least until the end of 2022, including workplace and school closures and mask wearing.

The model also predicts that thousands of people, both vaccinated and unvaccinated, could be hospitalized and die in the coming months because some people will remain wary of vaccines.

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In the United Kingdom, where coronavirus vaccine hesitancy is low, more than 80% of people recently surveyed said they had already been vaccinated or planned to be. In Germany, around 70% said they would probably or definitely get vaccinated. ICL modeled these countries, respectively, as “low”, “medium” and “high” hesitancy scenarios and compared the results with an ideal scenario in which 98% of people aged 15 and older were vaccinated.

The ideal scenario in the model assumes that a few people cannot be vaccinated because of allergies or preexisting health problems, but that everyone wants to be vaccinated.

The COVID-19 model predicts the waves that await us in winter

The model predicts that several future surges in COVID-19 cases, mostly during the winter months, will continue until 2024 as people keep traveling and workplaces, schools, restaurants and entertainment venues remain open.

Even in a scenario like England’s, with highly effective vaccines and low hesitancy, perhaps between 10% and 20%, the model shows that daily deaths would be about 9 times higher at the peak of the first wave because people decide not to be vaccinated. These deaths would be concentrated among those choosing not to be vaccinated, but vaccinated people would also be affected because even the best vaccines are not 100% effective.

Over the next 2 years, until late 2022, the model predicts around 30% more COVID-19 deaths in a low-hesitancy country such as England than in the ideal model. It predicts approximately 350% more deaths from the disease in a moderately hesitant country such as Germany, and around 770% more in a highly hesitant country such as France.

Where does the United States fit into these scenarios? ICL did not specifically model the United States, but recent surveys place America closest to a moderately hesitant country such as Germany. The model predicts that, with moderate hesitancy, there would be 1744 COVID-19 deaths per 1 million people by the end of 2022: about 168 per 1 million vaccinated people and 1576 among unvaccinated people.

The challenge of modeling

At the Johns Hopkins Bloomberg School of Public Health in Baltimore, Maryland, behavioral and implementation science director Rupali Limaye said there are some things to keep in mind about this model. She says modeling will be difficult because hesitancy clusters.

A person’s likelihood of getting vaccinated depends on a range of factors, including what their friends share on social media, their race, age, sex, political affiliations, religion and even education level. Limaye says “People who tend not to get vaccinated may be friends” in describing this.

For the purposes of their model, the ICL team included only age in the hesitancy equation. They assumed people were equal in every other respect.

Limaye said that the ICL model’s numbers look reasonable, but deaths and hospitalizations resulting from hesitancy would not be evenly distributed in real life. Some communities would be affected much more than others by their hesitancy. Knowing the numbers alone does not help target interventions where they are needed most.

ICL modeling did not involve Limaye, who is working with her Johns Hopkins colleague Shaun Truelove to try to make similar projections for the United States.

Truelove, a data modeler, says the ICL report may paint too pessimistic a picture. First, he says vaccine hesitancy is declining in the United States and other countries. “More and more people are getting vaccinated. We need more data on safety and efficacy, and at the same time, variants (new genetic and behavioral forms of the virus) have brought a resurgence of the pandemic. All this also increases willingness to be vaccinated.” Truelove also pointed out that willingness could fall if people lose confidence in certain vaccines, such as AstraZeneca (Oxford).

In conclusion, getting vaccinated is a personal choice, but that choice has social consequences. This study showed that vaccine hesitancy could have a substantial health impact affecting both vaccinated and unvaccinated communities. Building trust in vaccines is an important public health priority for controlling COVID-19.

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