The Crucial and Urgent Role of Family Physicians in Increasing COVID-19 Vaccinations

At the time of writing (August 2021), Arkansas, Louisiana, Mississippi, and Florida each recorded >500,000 new coronavirus disease 2019 (COVID-19) cases, making the southern United States the epicenter of the epidemic.¹ At present, 85% of the public trust their family physicians as reliable sources of information on COVID-19.² This editorial serves as an urgent plea to family physicians to educate their patients that widespread vaccination, combined with masking, social distancing, crowd avoidance, and frequent hand washing are the most effective and safe means to mitigate and contain COVID-19 in the southern United States.³

Addressing vaccine misinformation will help overcome vaccine hesitancy. Among patients with vaccine hesitancy, 59% worry about adverse effects and 53% believe that the vaccine is too new.² We hope that family medicine physicians will provide reassurance to the public to increase their acceptance of the COVID-19 vaccines. Full approval of all of the COVID-19 vaccines by the US Food and Drug Administration is expected and this action surely will address vaccine hesitancy for a proportion of those remaining unvaccinated.

In the United States today >99% of deaths from COVID-19 occur among the unvaccinated.¹ Furthermore, low COVID-19 vaccination rates of <33% among Blacks is another example of a lifesaving innovation exacerbating racial inequalities. Previous examples include the increase in racial inequality in mortality following the introduction of lifesaving innovations for the human immunodeficiency virus, acute respiratory distress syndrome, and hepatitis C.⁴

Many patients with vaccine hesitancy believe in their individual right to remain unvaccinated. Family physicians may wish to discuss the issue of balancing individual rights with personal responsibilities when vaccine hesitancy is driven by this concern. For example, cigarette smokers have the right to die from lung cancer and cardiovascular disease, but they also have a responsibility not to increase these risks to others.

Family physicians may wish to address with their patients the many marked differences between influenza and COVID-19 as well as their vaccines. First, the case-fatality rate for influenza is >30 times lower than that for COVID-19. (Centers for Disease Control and Prevention [CDC] 2021–2022 U.S. Flu Season: Preliminary In-Season Burden Estimates, February 12, 2022; CDC COVID-19 Data Tracker February 18, 2022). Second, influenza patients may infect 1 to 2 others, while COVID-19 patients with the delta variant may infect >5 and omicron >10–15. (“Omicron Variant (B.1.1.529): Infectivity, Vaccine Breakthrough, and Antibody Resistance.⁵ Suboptimal vaccination rates in the United States and low rates worldwide have contributed to the rapid emergence and spread of initially the delta variant, and more recently the omicron variant which is now causing >99% of all new US COVID-19 cases (Zee News. Omicron accouns for 99.9% of new weekly Covid-19 cases in United States. CDC, 2/12/22 Accessed 2/20). Third, vaccine efficacy is >40% for influenza but approaches 95% for COVID-19. Fourth, the COVID-19 vaccine offers almost complete protection against hospitalization and death. For every 100 deaths from COVID-19, up to 99 occur among unvaccinated people. Fifth, he overall safety profile patterned a lower risk of serious adverse events following immunizations with mRNA vaccines compared with influenza vaccines.⁶

Fortunately, the unprecedented collaborative and coordinated efforts of academia, industry, government, and the regulatory authorities have fostered the extraordinarily rapid development of multiple highly effective and safe COVID-19 vaccines and their widespread manufacture and distribution to the US population in <1 year. Unfortunately, however, even these enormous successes in 2021 will not be sufficient to mitigate and control COVID-19 in 2022. Successful mitigation and control of the COVID-19 pandemic during 2022 will require the achievement of much higher vaccination rates throughout the United States, along with the production and distribution of sufficient quantities of vaccine throughout the world.

The totality of evidence indicates that the current vaccines are as safe as or safer than nearly all of the other vaccines being administered daily to many millions of children and adults. Moreover, the levels of protection provided by COVID-19 vaccines far exceed those of the influenza or other vaccines, which have been widely accepted by the majority of family physicians and their patients. Because the scope of family medicine includes pediatrics, adult medicine, and geriatrics, family physicians can make a major impact on knowledge and behavior across a wide range of patients and their families.

In conclusion, we hope that family physicians will reassure their patients about the remarkable efficacy and safety of the COVID-19 vaccines. Family physicians must play crucial and major roles to mitigate further increases in COVID-19 in the southern states and throughout the country by counseling all of their patients about the urgent need to increase vaccination rates now. Future hospitalizations and deaths will continue to be determined by the numbers of patients that become fully vaccinated against COVID-19 as additional variants emerge, both in the United States and worldwide. Specifically, the clinical and public health challenges to mitigate and contain COVID-19 in the United States require achieving higher rates of vaccination before the catastrophic emergence and spread of newer variant strains resistant to the current vaccines.

Family physicians have and must continue to strive to do the most good for the most patients. The failure to adequately address vaccine misinformation will continue to fuel vaccine hesitancy and thus continue to fuel the epidemic of COVID-19 among unvaccinated individuals, which is already affecting children younger than 12 and immunocompromised patients. Family physicians represent an important and trusted source of reliable information to increase vaccination rates by overcoming widespread vaccine misinformation and vaccine hesitancy.