Poland, director of the Mayo Clinic vaccine research group, says opposition greeted the first smallpox vaccine in the 19th century, subsided as the public witnessed the 20th century taming of measles mumps, polio pertussis and rubella, and then re-emerged as the memory of those diseases fell away.

Today, health officials are wrestling with a slowing of interest in COVID-19 vaccines. Health systems that recently filled 1,200 appointments in hours have transitioned to "hardly being able to fill 100 appointments," according to Perry Sweeten, southwest Minnesota director of pharmacy for Mayo Clinic Health System.

"Something's happening in the last two weeks," Sweeten said. "We can attribute it to a lot of different things. In our community, planting has begun. College students are starting to disperse back to their hometowns. Some people are seeking out a vacation."

Health experts add that it's not fully clear the term "vaccine hesitancy," is even accurate, saying the current plateau isn't so much of a resistance as a deceleration due to problems of access or unanswered questions.

"If you didn’t get your flu shot last year, are you 'vaccine hesitant'?" a Brown University professor of public health argued recently. "Are people who aren’t ready today to get the COVID-19 vaccine skeptics? Or do they just have important questions about the vaccine?"

"Having been through this many many times," Poland says, "demand (for vaccine) waxes and wanes. It's fickle and will depend upon what's in the news, politics ... a change in the virus could change demand dramatically. So we need to keep that longer-term perspective."

In a wide-ranging interview, Poland, who has consulting arrangements with all the major vaccine manufacturers, addressed many of the major objections to the COVID-19 vaccine now slowing uptake. Questions and answers have been condensed for clarity.

Q: Why should I trust the vaccine is effective if some vaccinated people get COVID-19 anyway?

"The 95% efficacy of the vaccines relate to death, hospitalization and severe disease. Those numbers drop as we go to milder disease. In other words, the disease-blocking ability of the vaccine exceeds the infection-blocking ability. The second reason is that you have to ask if somebody was really fully vaccinated, when they got COVID-19 — were they 14 days or more after their second dose."

Q: Why should I trust the vaccine if it was made so fast?

"Let's take the mRNA vaccines. Those were developed 31 years ago. They might be new to the public and the media, but they certainly aren't new to us as physicians and scientists ... I think what people see is that normally these clinical trials take years. That's absolutely true. What's different here (is that) we were able to streamline administrative decisions ... to coordinate and very rapidly enroll trial participants."

Q: What about the risk of side effects?

"There are risks and benefits either way you go. The observed risk of mRNA vaccine is anaphylaxis, about 2-4 cases per million. The observed risk of COVID-19, if you decide not to get a vaccine, has been the disruption of every aspect of our lives, the development of new variants, a virus that now causes a viral load four-fold higher than the previous version and one in 560 risk of dying. So which risks do you want to take? Making a decision to not get a vaccine is infinitely riskier. "

Q: Why take the vaccine when you have no long-term data on side effects?

"All vaccine side effects manifest themselves within minutes to a few weeks at most. There is no such thing as a vaccine side effect that takes years to develop. That's just never been observed. The observed risk of that is in fact zero. You can see Guillain-Barre syndrome, a type of paralysis associated with — with we can't even say caused by — influenza vaccine for as long as six weeks afterward.

"When we used to use oral polio vaccine, you could see oral polio vaccine-associated paralysis past that six-week time frame. Short of that, we really don't see any kind of side effect that's ever been associated in any science-based way with vaccine ... the observed risk of that in U.S. registered vaccines is zero."

Q: With pharmaceutical executives already talking about the need for annual booster shots, isn't this just an entry point for a pharma campaign seeking profits and control?

"This is our third coronavirus. Imagine the criticism the government would face for not being prepared if a variant came around that the current vaccine didn't offer as high a level of protection against? I don't think it's a great idea that pharma CEOs announced that almost certainly we're going to need boosters. They don't have access to any more information than scientists do, and we do not yet see that need."

Q: If other countries can't afford the vaccines but they can provide an unvaccinated home for new variants to emerge and then travel here, shouldn't we lift the patents and proprietary protections on how to manufacture them?

"I'm not qualified to talk about the legal aspects of that ... But I am sympathetic with the expression that none of us are safe, until all of us are safe. That is really true with a highly transmissible respiratory virus that is in fact global. As long as there continues to be transmission, because this is an RNA virus, there will be continuing mutations. Until we control this worldwide, we all remain at risk."

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