COVID-19: Will Vaccine Hesitancy Make It Harder to Reach Herd Immunity?

Vaccine distribution in North Texas just took a hit.
Vaccine distribution in North Texas just took a hit. Photo by CDC / Courtesy of Unsplash
All Texans became eligible for the coronavirus vaccine Monday, but not everyone is eager to sign up. Although some fear widespread vaccine hesitancy could inhibit the state’s ability to beat COVID-19, experts say herd immunity is still attainable.

In Texas, 28% of residents said they’d flat-out refuse to get a vaccine once it was made available, according to a February University of Texas/Texas Tribune poll.

But if the remaining 72% were to get vaccinated, the state would be “on the cusp” of reaching herd immunity, said Dr. Erin Carlson, an associate clinical professor in the College of Nursing and Health Innovation at the University of Texas at Arlington. Between 70% and 80% of Texans would need to become immune to the coronavirus by infection or inoculation to hit that mark, she said.

There are many unknowns at play as to whether that type of herd immunity can be attained, Carlson said. Still, she’s cautiously optimistic that vaccine-hesitant Texans will eventually come around.

“I am legitimately hopeful that more and more people will get the vaccine as they see others getting the vaccine, and we’ll edge closer to herd immunity than we initially thought possible,” she said.

Misinformation has run rampant since the pandemic’s outset, with some political leaders seeking to downplay the disease. Anti-COVID grandstanding became fodder for a 24-hour news cycle, but some experts feared it has also had long-lasting effects on the state’s ability to shake the virus.

Hesitancy varies according to party. In Texas, 59% of Republicans said they were reluctant to get the COVID-19 vaccine or would reject it altogether, according to the same UT/Texas Tribune poll. Meanwhile, a quarter of Democrats said the same.

At the pandemic’s outset, public health experts warned that Black Texans would be particularly wary of the vaccine given the health industry’s history of racist medical practices. But over the past few months, that number has steadily improved, going from 53% in October to 29% in February, according to The Texas Tribune.

Although there will always be a certain number of decided anti-vaxxers, Carlson said public health experts should continue to focus on Texans who remain unconvinced.

“‘Not sure’ we can work with; refusal is a different thing,” she said.

“The fact we’ve had this many people sign up is really quite promising." – Dr. Erin Carlson, Associate Clinical Professor at the University of Texas at Arlington

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Dallas County’s health department has been working on spreading awareness, partnering with a media company to help with vaccine messaging, said director Dr. Philip Huang. On top of that, they’ve been urging political, church, community and medical leaders to “roll up their sleeves” in encouraging North Texans to enroll.

Much of the early distrust in the vaccine could be related to last year’s election, Huang said; many had the sense that the rollout was being rushed for political purposes. Now, people are witnessing their loved ones have a good outcome from getting vaccinated.

“I think that that just builds more trust as time goes on,” Huang said.

On top of vaccine uncertainty, Carlson said there are many lingering questions about the feasibility of herd immunity. New variants of the coronavirus that causes COVID-19 continue to crop up, and experts still don’t know how long the recently recovered will enjoy natural immunity.

Even though many Texans still have their doubts, Carlson said the COVID-19 vaccine acceptance rate is much higher than the flu, which averages around 40%.

“The fact we’ve had this many people sign up is really quite promising,” she said. “These are very good numbers, so we’re very hopeful.”

There are two ways to look at herd immunity, said Dr. Diana Cervantes, an infectious disease epidemiologist and assistant professor at the University of North Texas Health Science Center. The first is by breaking the chain of transmission to the point where the virus fizzles out. The second is when the population reaches a baseline where it always has the disease, but its effects are less severe.

Cervantes doubts COVID-19’s chain of transmission will ever be completely broken, as was the case with smallpox. However, Cervantes said by late summer or fall the population will likely reach a high level of protection, whereby sharp spikes in cases subside to small blips.

COVID-19 will eventually become more of a seasonal illness like other coronaviruses or the flu, Cervantes said. Similarly, not everyone will get vaccinated for COVID-19 each year and the shot won't be 100% effective, but it'll still provide plenty of coverage, she said.

Someday, enough people will have been vaccinated that protection will stay high while morbidity and mortality remain low, Cervantes said. In that way, herd immunity is attainable.

“This is now a vaccine-preventable disease,” she said, “and we can definitely get there.”
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Simone Carter, a staff news reporter at the Dallas Observer, graduated from the University of North Texas' Mayborn School of Journalism. Her favorite color is red, but she digs Miles Davis' Kind of Blue.
Contact: Simone Carter