With two COVID-19 vaccines pending eminent FDA review, the biggest hurdle to widespread vaccinations is simply convincing people to be vaccinated.
With two COVID-19 vaccines pending eminent FDA review, the biggest hurdle to widespread vaccinations is simply convincing people to be vaccinated.
That’s harder than it should be. These vaccines face a double challenge. The first is the growing global mistrust of government and health authorities around vaccination. The second is the vaccines themselves. The mRNA vaccines that will become available first are a completely new type of vaccine that uses a different mechanism of action to confer immunity. Many of the details – including duration of immunity – are unknown, so people are naturally concerned.
After Italy’s devastating experience, researchers there report that trust in research and vaccines decreased during Phases 1 and 2 of the Italian pandemic.
“The proportion of citizens that seem to be intentioned to get the COVID-19 vaccine is probably too small to effectively stop the spreading of the disease,” Lorenzo Palamenghi, Università Cattolica del Sacro Cuore, in Milan, and colleagues reported in the European Journal of Epidemiology.
The hesitation to be vaccinated is global. A report from Israel shows healthcare professionals who are not caring for COVID-19 patients are more hesitant to be vaccinated than those actively involved in the pandemic. In Malta, 56% were willing to be vaccinated for COVID-19. In France that figure is 77%, while in the U.S. it is 69%, and 64% in the UK.
Overcoming this hesitancy requires “open and honest messaging about exactly what is and isn’t known…well before the planned rollout,” David Phizackerley, deputy editor of the UK’s Drug and Therapeutics Bulletin, said in an editorial December 1. The immediate goal is to achieve herd immunity, but doing so depends upon the reproduction rate of the virus and the effectiveness of the vaccine. (Moderna claims 94% efficacy, and 100% against severe cases. Pfizer says its vaccine is 95% effective.)
People don’t understand how the vaccines could be developed so quickly and still be safe.
“It took just 248 days to get from the day we announced our plans to collaborate with BioNTech to our FDA submission date,”Pfizer CEO and Chairman Albert Bourla said while discussing the FDA submission. mRNA vaccines can be developed years faster than traditional vaccines, and modern production methods add even more speed, but most people don’t know that.
Communicating the outcomes of clinical trials that included tens of thousands of people from multiple ethnicities, backgrounds and ages, therefore, can help. Phizackerley advised describing adverse events, their frequency, and “what happened to those who experienced side effects. Information on effectiveness will need to describe how successful the vaccines have been in clinical trials and what outcomes were assessed. This should include what is known about the impact of the vaccines on symptomless transmission, the period of infectiousness, and duration of disease,” he wrote in the Drug and Therapeutics Bulletin.
Healthcare professionals also need to be able to discuss what is and isn’t known about the vaccines. That includes such details as whether a specific vaccine prevents mild disease, reduces admission to hospital intensive care units, or reduces the risk of dying from COVID-19.
Multiple research studies show the importance of anecdotes in addition to statistics in presenting scientific messages to the general public and even healthcare personnel. Although statistics reinforce the message to the already-converted, more human persuasion is needed for the rest. A 1996 study of alcohol education messages, for instance, shows that skeptics rely more on evidence than statistics.
There’s another reason, too. Many people, including those from industrialized nations, are scientifically illiterate. According to a 2016 study by Jon Miller, director of the International Center for the Advancement of Scientific Literacy of the University of Michigan, only 36% considered themselves either attentive or well-informed about current science policy. Only 28% were considered scientifically literate. Other industrialized nations have similar scientific literacy challenges.
Therefore, England’s deputy chief medical officer, Professor Jonathan van-Tam, called on “the Mum test” during a Downing Street media briefing in which he said he had phoned his mother and strongly advised her to take the vaccine when it became available. That’s a common strategy, but it’s not sufficient to convince enough people to be vaccinated against COVID-19 to build herd immunity.
The social impact of vaccination also should be discussed, Phizackerley said. He recommended tailoring information based upon individuals’ ages and risk of complications (from the disease as well as from the vaccine). How vaccination will affect the need for social distancing, mask-wearing, or traveling may be an important determinant in people’s vaccination decisions.
The International Air Transport Association (IATA), for instance, is near completion of a digital health certification (the IATA Travel Pass) to enable international travel without quarantine measures. “We are bringing this to market in the coming months to also meet the needs of the various travel bubbles and public health corridors that are starting operation,” Alexandre de Juniac, IATA’s Director General and CEO, said in a statement. If vaccination lets people travel more freely, vaccination rates likely will increase.
The information, ideally, will come not just from vaccine manufacturers, but from outside sources. “Policymakers, vaccine experts, statisticians, and healthcare professionals who are independent of the vaccine manufacturers need to respond quickly to provide high-quality, accessible information and decision aids—in a wide range of formats and languages—before the vaccines are made available,” Phizackerley stressed. “This is essential to “help counter rumors, fake news, unsubstantiated scare stories, and overinflated claims of success.”
Vaccination can bring COVID-19 under control, but it isn’t a personal panacea. Until herd immunity is reached, social distancing policies are likely to continue. “You can’t just say, ‘I’ve had the vaccine so I don’t need to worry anymore.’ That’s a very key message that needs to go alongside this,” Phizackerley said.
