COVID-19 vaccines are now arriving slowly but surely in communities around the world, where healthcare experts are working to combat hesitancy from some to roll up their sleeves.

Vaccines from Pfizer Inc.-BioNTech SE and Moderna Inc. have received emergency use authorization in the U.S. and many other countries to fight the coronavirus pandemic, while other vaccines are still being studied in clinical trials. The vaccine from Pfizer and BioNTech was 95% effective in a late-stage study, and Moderna's was 94.1% effective — neither demonstrated significant safety concerns during clinical trials.

In an ongoing survey from London research group YouGov released Jan. 15 that looked at attitudes towards vaccinations from July 2020 onward, only 47% of people in the U.S. said they would get vaccinated against COVID-19 when the inoculation became available. In the survey, 27% of Americans said they would not accept the vaccine and the remaining 26% said they did not know.

"Vaccinations can help us get back to normal," Pfizer Senior Director of Media Relations Sharon Castillo told S&P Global Market Intelligence. "But the vaccine is only as good as the willingness of the public to take it."

Pfizer has teamed up with healthcare organizations representing underserved communities to promote vaccination in general such as the American Nurses Association, the National Black Nurses Association, the American Pharmacists Association, the American College of Emergency Physicians and the American College of Preventive Medicine.

Three of the biggest challenges to widespread vaccination are access, language and trust, Castillo said.

"We've always understood that the Herculean effort we put into research and development for the vaccine would have to be matched with a comprehensive educational campaign on vaccine confidence," Castillo said. Pfizer partnered with groups that are trusted in the Black and Hispanic communities as those groups have exhibited more hesitancy and in some cases have been at higher risk of infection, Castillo said.

The distrust can stem from a sense of safety risk from receiving a vaccine, a product of disinformation on one side and lack of clear science communication on the other, Robert Wood Johnson Foundation CEO Richard Besser said on a Jan. 7 panel organized by the USC-Brookings Schaeffer Initiative for Health Policy. Besser also noted discriminatory access to care among minority groups.

"These vaccines were developed faster than we've ever developed a vaccine in our history, and with that some people are concerned about safety, given that safety data for approval was only two months' worth," Besser said. "I want to get vaccinated as soon as possible, but my sense of risk is not everyone's sense of risk."

As of Jan. 14, Israel and the United Arab Emirates led in the number of COVID-19 vaccinations administered per 100 people, according to a study from the University of Oxford, which ranked the U.S. fifth. Israel in particular has a long history of infrastructure and communication technology to provide swift inoculation, according to Israeli non-profit Start-Up Nation Central.

'Trusted voices'

Besser said that the U.S. healthcare system needs to depend on trusted voices in affected communities to carry the message that the vaccines are safe and effective against the dangerous virus.

"People would feel much more comfortable with the risk of getting COVID and dying from COVID than they would a small risk of a bad reaction to a vaccine," Besser said. "It's challenging, [but] how you present it to people is really important."

People tend to trust their primary care physician most when it comes to health decisions like vaccines, said Wändi Bruine de Bruin, a USC provost professor of public policy, psychology and behavioral science, on the same panel.

"Distributing a vaccine where people are is very important and people will see their peers getting vaccinated, which is an effective way of overcoming trust issues," de Bruine said. "If they see people like them and their friends and families are getting vaccinated, they trust friends and families more than some politician."

The language used by providers can change an individual's attitude about vaccination, researchers from Boston Medical Center found in a study released Jan. 12. The study showed that simple statements indicating that a vaccine is due results in nine times higher compliance rates than language that suggests the shot is elective.

Rebuilding the system

Part of the erosion of trust in the vaccine comes from a breakdown of the healthcare system in an attempt to distribute the shots in the U.S. Healthline Medical Affairs Manager Lindsay Slowiczek said in an interview that a lack of trust in science, the healthcare system and the political machinery behind the research contribute to hesitancy.

"It looks like we're really struggling with logistics behind rollout of these vaccines, which I think was not expected, and is working to further erode the public's trust in the government and the healthcare system as a whole," Slowiczek said.

The Trump administration's goal of administering 20 million doses by the end of 2020 fell short by about two thirds, Slowiczek said.

"Vaccine hesitancy has gained momentum based on the unique situation of the past year. There are people who are not anti-vaccination in general but who are hesitant about the COVID-19 vaccines or are against receiving them," Slowiczek said.

Aetion Inc., a healthcare analytics company specializing in "real-world data," has looked to large swaths of patient populations to analyze the effects of the pandemic. Of particular interest to the company is how patients interact with the healthcare system.

Aetion Chief Scientific Officer Jeremy Rassen said in an interview that the speed of the pandemic and vaccine development has made real-time analysis necessary for transparency and clear communication.

"It's gone so fast that people are thinking very personally about whether they want this vaccine," Rassen said. "So much about the confidence we can create in these vaccines is being very quick on our feet about responding to questions that emerge."