| Governments and drugmakers have long faced skepticism, and even hostility, from a small but vocal group of anti-vaccination campaigners. But fading trust in institutions and the dash to create a shot in record time may sow doubts in a broader swath of the population — those who have trusted vaccines in the past and would normally be on board. Assuming immunizations can be successfully developed, mass produced and deployed, vaccine advocates will need to convince some people the shots are key to ending the crisis. In a survey of 20,000 people conducted over the summer by the World Economic Forum and Ipsos, more than a quarter of respondents said they wouldn't get a Covid shot The effort to overcome that sentiment will start with health workers who are at increased risk of catching the virus, will likely be among the first to get immunized, and may be a bellwether for acceptance in the wider population. Their acceptance shouldn't be taken for granted. "If health-care workers are going to be expected to advocate for the vaccine, then their natural concerns will have to be addressed in advance," said Sara Gorton, head of health at Unison, a union in the U.K. representing nurses, paramedics and others in the field. "It's not going to help with take-up if you go to have your jab and the person who gives it to you isn't able to say reassuring things." A study in Hong Kong earlier this year found that only 63% of nurses expressed a willingness to get a potential Covid shot. If less than two-thirds of nurses during an outbreak intend to get immunized, "we anticipate that promoting the vaccine to the general public in the post-pandemic period will be much more challenging," according to researchers including Kin On Kwok, an epidemiologist at the Chinese University of Hong Kong. Increased engagement with the public may be needed to explain how vaccines are being created and how they will be deployed, said Heidi Larson, who leads the Vaccine Confidence Project, a research group. Many promising Covid shots are relying on novel approaches, such as messenger RNA. "There hasn't been much discussion about why these vaccines are able to be made faster, the new technologies being used, how some may have one dose and others two," she said. "We need to talk about that more."—James Paton and Sybilla Gross | 
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