Issues & Insights

With A COVID-19 Vaccine Imminent, We Need To Encourage People To Take It

Cpl. Jackeline M. Perez Rivera

The announcement last week by Pfizer that its COVID-19 vaccine has been shown in large-scale clinical trials to be more than 90% effective at preventing symptomatic infection has been much in the news. It is especially welcome news, given the skyrocketing numbers of COVID-19 cases, percentage of positive tests, and hospitalizations in much of the nation.

However, to state the obvious, the vaccine won’t work if people don’t opt to take it, and surveys have revealed significant reluctance. A Kaiser Family Foundation poll published in September found that only about 42% of Americans would opt for a free COVID-19 vaccination before the presidential election. A similar result emerged from a more recent survey by Morning Consult, which found that only 38% would get a coronavirus vaccine if one became available.

Some of the resistance to the COVID-19 vaccine appears to stem from concerns about the federal government’s “Operation Warp Speed” rushing vaccine development, and from the disinformation promulgated by the anti-vaccine crazies, who have shifted into high gear with all sorts of false and even bizarre claims. If the poll numbers hold up, even after vaccines are available, we could see continuing high levels of COVID-19 infections, with sporadic surges above baseline. 

That could perpetuate the need to wear masks, for social distancing, avoidance of crowds indoors, and so on. It has been estimated that we will need immunity in roughly 70% of the population, through either natural infection or vaccine administration, in order to achieve “herd immunity,” which occurs when a large portion of a community (the herd) becomes immune to a disease, making the spread of disease from person to person unlikely. That protects the whole community — not just those who are immune. Clearly, we will never even approach that if a significant fraction of the population rejects the vaccine: Even with a vaccine that is 90% effective, we would need to vaccinate about 75-80% of the population to attain herd immunity.

Therefore, we need an aggressive campaign to educate the public and to reduce the current worrisome levels of “vaccine hesitancy.” The Centers for Disease Control and Prevention (CDC) is supposedly working on a plan to boost “vaccine confidence,” Director Robert Redfield told a Senate committee in June, but we’ve heard nothing more about it since then, and with the Pfizer vaccine perhaps no more than a month or two from beginning distribution, we need an aggressive, multi-faceted plan.

First, the mainstream media and Hollywood establishment must be major collaborators in this effort. The endorsements of celebrities of various stripes – actors, musicians, athletes, thought leaders, social media influencers, columnists, scientists, and prominent politicians from across the spectrum – can alter public opinion. Those who have studied vaccine hesitancy urge a non-judgmental approach that emphasizes story-telling and narrative, rather than simply a litany of scientific findings.

Second, the medical profession – individual practitioners, as well as hospitals and clinics – must play a pivotal role. It should reach out to patients, explain the importance of vaccination, answer their questions, and assuage their concerns. Local social media are also good platforms for informing and interacting with the public. 

Third, there will be a role as well for the managers of the major social media platforms; fear-mongering about vaccines that have been shown to be safe and effective is anti-social, and should not be permitted. Twitter and Facebook have already made that commitment.

Fourth, it may even be appropriate for the federal government to issue reward debit cards of perhaps $25 to those who are vaccinated, in addition to covering the actual cost of the vaccine (which the feds have already committed to). Free flu shots are common already, so this would just be one additional step justified by the devastating impacts of the COVID-19 pandemic.

Finally, there might be a need for more coercive actions, with vaccination required in medical facilities, certain other businesses, and schools. There are also precedents for governments mandating widespread vaccination. In 1905, the U.S. Supreme Court (in Jacobson v. Massachusetts) upheld a Massachusetts state statute that during a smallpox epidemic required the entire population to undergo smallpox vaccination or pay a fine. The Court deemed it a valid exercise of a state’s police powers that did not violate the U.S. Constitution’s 14th Amendment’s due process clause, inasmuch as the vaccinations were deemed to be necessary to protect the health of the community.

Absent such a coordinated, multi-faceted effort, it seems doubtful that enough people will, in the short term, seek out one of the new vaccines to make a dent in the pandemic, let alone to approach herd immunity. How tragic it would be if the prodigious efforts to develop the COVID-19 vaccines were for naught, simply because they were rejected by a misguided public. There is not a moment to lose in mounting a campaign to encourage vaccination.

Henry I. Miller, a physician and molecular biologist, is a senior fellow at the Pacific Research Institute. He was the founding director of the FDA’s Office of Biotechnology. Andrew I. Fillat spent his career in technology venture capital and information technology companies and is the co-inventor of relational databases. They were undergraduates together at the Massachusetts Institute of Technology.

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9 comments

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  • Before taking a vaccine, I would want to know how eccetive it was in trials (as compared to a placebo), what were the side effects, how unpleasant or debilitating were they, how many doses were needed for effectiveness, were there after-effects and what were they, how long did the protection (antibody buildup) last.

  • Some of us simply chose to boost our immune systems in a more healthy manner. If someone wants to take a vaccine that is 90-95% effective for a disease with a 99+% recovery rate, be my guest.

  • I am a scientist and about as pro-vaccine as they come but I also know that vaccines can be dangerous if they are not extensively safety tested. There is a reason why they normally undergo years of testing. It is not possible for a vaccine to have been tested in such a short time for medium and long term side effects.

    Since CoVid is not a particularly dangerous virus (100-times less so than small pox), doesn’t it make better sense to slow down, test them correctly and get it right?

  • Dear Dr. Miller and Mr. Fillat,
    Two points to make:

    1. The fact that you so blithely drop the thought of forced vaccinations makes me seriously question your motives. The case you mention was for a disease with an over 10% to as much as 30% fatality rate that had been ravaging humanity for centuries. I am sorry, but COVID-19 is not mauling mankind to that extent and pulling out the authoritarian bludgeon of forced vaccinations is absolutely unwarranted for this disease.

    2. I am not going to get into a technical discussion about the vaccine itself, since I don’t have the credentials to do that.
    But, (the infamous “but”) I have done detailed risk analysis as part of my job/career for the last 30 years.
    Based on everything that I have read:
    A. It will be early 2022 before we have enough doses to provide a significant portion of the global population with the vaccine.
    B. It also appears that most of the vaccines are being developed with input and collaboration from around the world, which would make access to the vaccines something that should be shared globally from an ethics point of view.
    C. There are extremely sharp, clear and easily identifiable delineations of COVID-19 outcome risks based on age and several risk factors.
    D. Long term side effects of the vaccines are unknown and unknowable, at this point in time, due to the shortened development schedule. (This is not a criticism; it is just a risk analysis data point. I 100% approve of the global effort and decisions to shorten the vaccine pipeline due to the COVID-19 incubation period issues making containment challenging, the high mortality rates among high risk groups, and the high hospitalization rate.)

    Therefore, pushing for “everyone” to get a vaccine in the US does not appear possible or ethical in the near-term for 2021.

    It would seem to make more sense for us to be pushing for those with the highest risk factors to get the vaccine here in the US and globally. As vaccines come available this is the order in which those doses should be distributed for free and acceptance should be voluntary.

    Therefore, as you get more vaccines you work down the list based on the risk analysis data.
    A. Everyone over 70. (This would probably be 60 in developing countries.)
    B. Those under 70 with one of the critical risk factors such as cancer, a lung disease, an autoimmune disease, or other critical risk factors as smarter people than me would decide.
    C. Those over 60 with one risk factor.
    D. Those under 60 with some combination of 2 or more less critical risk factors as determined by those same smart people.
    E. Those over 50 with one risk factor.
    F. Those under 50 with one risk factor.
    G. Voluntary general population.

    Somewhere around the time you have enough doses to be working through the B or C category, I would also make it available (voluntary only) for all nursing home staff, hospital patient side staff, and first responders. Globally, this is a huge number of doses, so how this impacts those B/C people must be evaluated carefully. Since, I have seen no numbers indicating that significant numbers of these staff doctors, nurses, etc. are catching COVID-19, I believe that the higher risk people need to be the priority.

    This distribution model should dramatically reduce the mortality rate as we progress through 2021 although hospitalization rates could still be problematic through some portion of 2021. This model would also reduce the number of otherwise low-risk people being exposed to vaccines with unknown long-term side effects until we have close to a year of data across a much larger sample size.

    Additionally, as we learn more about this disease and crunch the data as we progress through 2021, we hopefully can use that to improve our data driven response.

    (Please note that all the age points above should be delineated by data. My age points are only for point of conversation.)

    Sincerely,
    PH

    • The long term risks of a Covid infection are almost as unknown as the long term risks of a vaccine. I’d be surprised if the latter risks are greater than the former risks. That said, I probably would not vaccinate children until more risk info is known about the vaccines.

  • The concern I have surrounding the vaccines being offered is that they are RNA vaccines, something the FDA has been reluctant to approve to date. RNA’s are synthetic using nanoparticles as a conduit as opposed to traditional vaccines. What are the long term impacts and side effects? I get concerned when government tries to hard to convince the public this is safe. It raises a flag of caution.

  • You missed an obvious action step: get Democratic politicians like Andrew Cuomo to stop trashing the President and his efforts to accelerate a vaccine and thereby sowing distrust.

    PS I won’t take the Pfizer vaccine for political reasons. I guarantee they had the information about efficacy before the election and chose to withhold it. I haven’t made a judgment about Moderna’s motives yet.

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