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Pediatric & Maternal Pulse with Dr. Donna HallasPediatric & Maternal Pulse with Dr. Donna Hallas
Vaccine Refusal

How Vaccine Refusal Can Impact the Next Normal

Author(s): Donna Hallas PhD, PPCNP-BC, CPNP, PMHS, FAANP, FAAN

“Are we there yet?” Parents know all too well this question is asked by their children every time the family goes for a long drive or a road-trip vacation. The same question is being asked by the majority of adults who so desire to return to the Next Normal in a Covid-19 post-pandemic world. The answer to the children’s question is easy to answer as parents can merely look at the distance they need to travel, estimate the time it will take to travel and provide an age-based answer. The answer to the adults’ question is far more difficult. We do not have a road map, a distance to calculate, or a miles/per/hour to inform them of the expected date of the start of the Next Normal. The driving force behind the unknown answer is all about the Covid-19 vaccination acceptance rate and the concurrent behaviors of both the adult and child/adolescent populations.

At this time, Covid-19 vaccines are available in every state for adolescents 16-years of age and older and all adults. Registration to schedule vaccine appointments is open and appointments fill up quickly. Indeed, there are so many people 16-years old and over who want the vaccine. Over the last 14-months of the Covid-19 pandemic, they have experienced one or more of the devasting pandemic effects: 1) the personal pain of seeing a relative ill from Covid-19; 2) family deaths with families saying good-bye to their loved ones via a tablet rather than in-person; 3) quarantine from contracting Covid-19 themselves with or without long-term adverse effects; 4) loss of income; and 5) a total disruption and destruction of pre-pandemic lifestyles.

Vaccine hesitant and vaccine refusers

The question then becomes, “what about those who are vaccine hesitant and vaccine refusers?” Are they registering for the Covid-19 vaccine? Surveys show that individuals and groups who are vaccine hesitant or refusers will continue with their pre-pandemic practices and refuse the available vaccines. It is estimated that on average 30% to 35% of the population may be either vaccine hesitant or refusers.1 If these behaviors persist, it will be unlikely that the United States will achieve the high degree of herd immunity necessary to eradicate Covid-19. Rather Covid-19 will remain a threat in the vaccine resistant parts of the country in endemic with high potential to become epidemic in some areas. Continued vaccine refusal will also affect those who are vaccinated and the Next Normal may include mask wearing, and some limitations on recreational activities, such as indoor dining at full capacity, large sports gatherings, etc.

School health policy

For our children, the “Are we there yet?” question may have a better outcome with the latest announcement from Pfizer that their randomized controlled clinical trial (RCT) for children 12- to 15-years old showed 100% efficacy with a robust antibody production greater than that experienced in their 16- to 25-years old clinical trial.2 At this time, Pfizer, Moderna and Johnson & Johnson are conducting studies in children 6-months old and over. Thus, the pediatric population will be able to be vaccinated after the Food and Drug administration (FDA) reviews the study outcomes and provides Emergency Use Authorization (EAU) for their vaccines. The hope for the Next Normal for children will be that they will be protected from the devastating adverse effects from Covid-19 that some children have experienced, such as Multiple Inflammatory Syndrome-Children (MIS-C). For children, many vaccinations are required to enter school. For the health and well-being of all the children, as well as all school personnel, states should consider mandating the COVID-19 vaccines as a requirement for return to school.

Donna HallasDonna Hallas PhD, PPCNP-BC, CPNP, PMHS, FAANP, FAAN is a certified as a pediatric nurse practitioner and pediatric primary care mental health specialist. She is a Clinical Professor and Director of the PNP program at New York University Rory Meyers College of Nursing. She has presented nationally and internationally on numerous research and clinical topics with the overall goal of improving health care outcomes for infants, children, adolescents and young adults. 


1Hamel, L. Kirzinger, A. Munana, C. & Brodie, M. KFF COVID-19 Vaccine Monitor: December 2020. Accessed April 13, 2021. Retrieved from https://www.kff.org/coronavirus-covid-19/report/kff-covid-19-vaccine-monitor-december-2020/

Pfizer-Biontech. Pfizer Biontech announces positive topline results of pivotal COVID-19 vaccine study in adolescents. Pfizer-Biontech Press Release. Accessed March 31, 2021. Retrieved April 13, 2021 from https://www.pfizer.com/news/press-release/press-release-detail/pfizer-biontech-announce-positive-topline-results-pivotal#:~:text=(NYSE%3A%20PFE)%20and%20BioNTech,exceeding%20those%20recorded%20earlier%20in


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