To beat COVID-19, focus on vaccine distribution and building trust

By: kennylin

Posted on: December 6, 2020

To beat COVID-19, focus on vaccine distribution and building trust

Even as the numbers of persons hospitalized for and dying daily from COVID-19 are surpassing all-time highs, America is suffering from pandemic fatigue. Although millions have curtailed social gatherings or changed holiday travel plans, exhortations by public officials, school closings, and renewed stay-at-home orders don't seem to be slowing the spread of the virus in most states. In September, I warned that a vaccine against SARS-CoV-2 was unlikely to be a "magic bullet" for the pandemic unless it had very high efficacy and population uptake well beyond the historical standard set by annual influenza vaccines. As it turns out, though, the first two messenger RNA vaccines developed by Pfizer/BioNTech and Moderna/National Institutes of Health appear to be highly efficacious (despite these important caveats) in preventing mild to severe COVID-19 infections, and both could receive an emergency use authorization from the U.S. Food and Drug Administration to begin administering the first doses within the next two weeks. Historians of medicine will likely chronicle the "warp speed" development of these vaccines as an amazing achievement given the intense political and humanitarian pressures involved. But in terms of ending the pandemic, that may turn out to be the easy part.

Physicians like me have some sayings about other strongly recommended medical interventions. "The best screening test for colorectal cancer is the one that gets done." "The best blood pressure medication is the one the patient can afford to buy and is able to take every day." Conversely, I agree with the title of a recent Washington Post article by the director of the Yale Institute of Global Health: "Rapid development of a [coronavirus] vaccine won’t help much if people refuse to take it." On one hand, I don't place a great deal of stock in (and feel that there's been entirely too much journalistic hand-wringing about) surveys that found that sizeable percentages of Americans were reluctant or unwilling to receive a coronavirus vaccine; nearly all were polled when no viable vaccine candidate existed, and it's unsurprising and, frankly rational, that people would have reservations about being injected with a completely theoretical foreign substance.

Since it will be at least several months before enough vaccine doses are available for the entire population, the first wave will be administered to health care workers and residents of long-term care facilities, followed by essential workers and adults at high risk due to age or other medical conditions. I suspect that the vast majority of persons in these categories will choose to receive a vaccine. Personally, it will be a great relief to have protection against becoming severely ill due to an occupational exposure to COVID-19, and potentially (if the vaccine prevents asymptomatic viral transmission, which is uncertain but probable) protecting my spouse and children until they are eligible to receive the vaccine themselves.

The big question is: will other Americans who don't consider themselves to be at "high risk" for severe COVID-19, who have suspicions about the motivations of the federal government and/or pharmaceutical companies, or are concerned about the safety of the vaccine (whose long-term side effects are obviously not known, though it's hard to imagine that they could be worse than what thousands of COVID-19 "long-haulers" are already suffering) accept vaccination in high enough numbers to provide herd immunity to the population and halt the pandemic? And will our inefficient, fragmented public health and health care systems be up to the task of delivering a vaccine to everyone who wants it?

A Commonwealth Fund report found that states with higher COVID-19 case counts and larger percentages of Black, Latino, and American Indian populations (who have a disproportionately higher risk for hospitalization and death than Asian Americans and non-Hispanic Whites) have been less successful than other states in administering annual influenza and H1N1 vaccines, and nearly all states report historically lower vaccine uptake in the same racial and ethnic groups that are at highest risk. A modeling study in Health Affairs suggested that problems with implementation of a national vaccination program - how quickly vaccine doses can be manufactured and deployed, for example - could easily blunt the population benefits of a vaccine that is highly effective in individuals:

The benefits of a vaccine will decline substantially in the event of manufacturing or deployment delays, significant vaccine hesitancy, or greater epidemic severity. Our findings demonstrate the urgent need for health officials to invest greater financial resources and attention to vaccine production and distribution programs, to redouble efforts to promote public confidence in COVID-19 vaccines, and to encourage continued adherence to other mitigation approaches, even after a vaccine becomes available.

The stakes could not be higher, and there is no more time to waste. The vaccine scientists have done their job, and we owe them an enormous debt of gratitude. Now it's time for medical professionals and their allies (you, who are reading this blog post) to spread the word that being vaccinated against COVID-19 when your turn comes is not only good for your own health and personal safety, but benefits our communities, our states, and our country. There is no Democratic vaccine or Republican vaccine, and who you happened to vote for President no longer matters. We are all in the fight against this virus together, as we have always been. As Benjamin Franklin is thought to have said at the signing of America's Declaration of Independence, "We must all hang together, or, most assuredly, we shall all hang separately."

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