"We get vaccines to the American people and they don't take them," Gen. Gus Perna told CBS "60 Minutes" of his worst nightmare in November. "Shame on us. 'Hey, I was already sick, I don't need it.' Shame on us. 'Hey, I don't believe in vaccines.' Shame on us."
Pfizer and Moderna have submitted requests to the U.S. Food and Drug Administration for emergency use authorization of their COVID-19 vaccines. The FDA is set to review Pfizer's request on Dec. 10 and Moderna's on Dec. 17. Both companies have announced vaccine efficacy rates of more than 90%.
The government's Operation Warp Speed has said there will be "shots in arms" within 24 hours of authorization.
But a Gallup Panel survey, which was conducted in late October before Pfizer and Moderna released results about the likely effectiveness of their vaccines, found that 58% of Americans would be willing to get a COVID-19 vaccine, a decrease from July, when 66% said they would.
Secretary of Health and Human Services Alex Azar pointed to the fact that the United Kingdom's regulatory agency recently approved the Pfizer vaccine.
"While the FDA completes its review, the approval of another independent regulatory body should give Americans additional confidence in the quality of such a vaccine," Azar said Wednesday.
Meanwhile, Facebook announced Wednesday it would take steps to combat misinformation about COVID-19 vaccines in order to keep users safe and informed. "For example, we will remove false claims that COVID-19 vaccines contain microchips, or anything else that isn't on the official vaccine ingredient list," Head of Health Kang-Xing Jin wrote in a statement. "We will also remove conspiracy theories about COVID-19 vaccines that we know today are false: like specific populations are being used without their consent to test the vaccine's safety."
The Centers for Disease Control and Prevention (CDC) also announced a new strategy to "educate and promote vaccination," a CDC spokesperson told ABC News. In the vein of "I Voted" stickers, the agency plans to give health providers a template for buttons and stickers people can wear to declare they have been "vaccinated for COVID-19."
As of Thursday, there were more than 14 million confirmed coronavirus cases and 275,000 deaths from COVID-19 in the United States.
ABC News spoke to three experts about the American public's confidence in getting the vaccine and what they think needs to be done to ensure people get vaccinated once it's available to them.
Why is confidence in getting this vaccine so low?
Dr. Susan Bailey, president of the American Medical Association: We have been in this pandemic for less than a year, and development of COVID-19 vaccines has been on an accelerated timeline. And it's natural for people to be suspicious of things they don't know about.
Jessica Malaty Rivera, M.S., infectious disease researcher and science communication lead at the COVID Tracking Project: The science community has been bracing itself for hesitancy for many months. It's an epidemic of misinformation. From the beginning, we had a lot of bad actors creating misinformation about the vaccine and conspiracy theories.
Dr. Richard Besser, president and CEO of the Robert Wood Johnson Foundation and former acting director of the Centers for Disease Control and Prevention: The biggest hurdle we have to overcome is the concern that the systems we have to make sure that vaccines are appropriately tested for safety and effectiveness have been politicized. Politics has interfered with science and public health too many times during this pandemic. That has led to a deep erosion of trust -- particularly in communities of color that have been hit hardest by this virus.
How important is it that doctors and nurses get on board?
Malaty Rivera: We are seeing people in health care-adjacent roles express their distrust. I don't think they realize the ripple effect that can have. Their biases and misinformation can impact everyone. It's a matter of making sure of making these people in positions of leadership and leadership in science don't discredit the process that we look for. What should make them come around is the data. The only thing that should be informing the process -- its all about the safety and efficacy of the data.
Besser: As a pediatrician, I have long relied on the recommendations of FDA and CDC to ensure my patients are properly vaccinated. The FDA and CDC have established independent advisory commissions -- which include some of the world's leading medical and public health experts -- to ensure that science and public health informs recommendations on which vaccines should be approved and which populations should receive them. I trust those institutions. If they're free to operate with complete transparency and without political pressure, I will have full confidence recommending approved vaccines to my patients and getting vaccinated myself.
What about the name Operation Warp Speed, what impact that does have?
Bailey: It's a catchy title, and my concern about this has been that it has the potential to imply that speed has been more important than safety or efficacy. But that couldn't be further from the truth.
Malaty Rivera: People think the vaccine was rushed -- it wasn't rushed. It was an incredible collaborative process on a global level, fully financed, no red tape, no bureaucracy, and we had a running start. We had been researching coronaviruses since SARS, and we hit the ground running.
The idea of "warp speed" makes people think they are cutting corners. That is the opposite of what has happened. Safety has not been compromised in this process.
Besser: It is true that the follow-up period in these vaccine trials has been short. For some people, that will make them uncomfortable. That is why it is imperative that the FDA's advisory committee -- a vital part of this process -- be given the time and space needed for its medical and public health experts to do a thorough evaluation of the data being submitted. If they approve these vaccines for emergency use, they must ensure that there is continued follow-up of study participants so that any longer-term side effects are detected.
When it comes to public messaging, what has to happen to increase confidence?
Besser: The CDC has some of the world's leading scientists and public health experts. If we let them lead and then follow their guidance and recommendations without political interference, I believe we can clear the way for improved trust in the process and any approved vaccines. The science that informs our pandemic response is not controversial. Vaccines are a stunning and effective advancement in the history of human health.
Bailey: I think it's an all-hands-on-deck project. We need culturally appropriate education for different parts of our population. We need positive messaging that is honest and transparent.
Do you feel confident that people will eventually come around?
Malaty Rivera: I feel confident that we can get close to 70% to get the vaccine. One thing that is encouraging is that we were hoping for 50% efficacy -- we are seeing that its potentially 90% effective. That changes the game. It gives people more confidence it will work for them.
Bailey: There is a desire amongst health care workers in actually seeing the data about the vaccine trials. Up until now, we have seen press releases and news reports that have been encouraging, and we want to see the data ourselves. And that is coming very quickly. The public will have access to the data that the FDA has, and we will be able to review that. I'm confident that once we see the data, that confidence will soar.
How big of a challenge will this be for the Biden administration?
Besser: We are currently experiencing the worst moments of this pandemic: Cases are soaring, Congress is deadlocked over providing much-needed aid and respiratory viruses like COVID-19 tend to thrive during the colder winter months. The expected vaccines will not quickly change the trajectory of this pandemic -- for most Americans, a vaccine is at least several months away. What we do now will determine whether tens of thousands of Americans live long enough to get vaccinated. I am encouraged that the incoming administration is assembling a team of experts that values science and will follow a public health roadmap to getting the virus under control and our economy back on track. But it is incumbent on each of us to wear masks, socially distance and wash hands -- even after a vaccine is approved.
Malaty Rivera: It's not impossible, but it's going to require an enormous investment. We are going to need as big of a communications campaign as well. We can't distribute massive amount of vaccines without also having the proper communication about them that goes along with it. It's going to require a large amount of investment from the federal government to ensure that people are getting the right messaging. There also needs to be investment and involvement from the community level. There is a lot of distrust about the vaccine from communities of color. To rebuild that trust is going to involve community leaders.
Bailey: I think the experts that are working on this -- the current people in the FDA, and individuals that are on the Biden-Harris COVID team are more than up to the challenge. They are accomplished professionals who know how to do this. It's also important to remember that most of the work that is being done is by career scientists, by the FDA and CDC who don't come and go with administrations. They have dedicated themselves to the health of our country. We need to understand that this process has not been politicized at all. We continue to hold our leaders accountable for providing honest information.
These interviews have been edited for clarity and brevity.