Op-Ed: The Coronavirus Vaccine Race Is On — Someone will win, but then what?

April 29, 2020 | SPH in the News

In an op-ed for Medpage Today, CUNY SPH Distinguished Lecturer Scott Ratzan, London School of Hygiene & Tropical Medicine Professor Heidi Larson, and Journal of Health Communication Special Projects Editor Ken Rabin, PhD, discuss how vaccine hesitancy could deter efforts to end the COVID-19 pandemic, unless we start now to educate and engage the public and policymakers about the value of a new coronavirus vaccine.

The Coronavirus Vaccine Race Is On

— Someone will win, but then what?

No fewer than 70 coronavirus vaccine candidates are in the pipeline, and some are already in phase I safety testing. The U.S. government joined with Johnson & Johnson to invest $1 billion towards expediting testing and manufacturing for a lead vaccine candidate. The goal is to manufacture a billion doses if the vaccine proves successful in human trials, clears lowered regulatory hurdles, and wins expedited marketing approval. Other vaccines are already in human trials in different parts of the globe.

The urgency is palpable. At the White House coronavirus task force briefing on April 6, Anthony Fauci, MD, director of the National Institute of Allergy and Infectious Diseases, told reporters: “Ultimately, the showstopper will obviously be a vaccine.”

But what if a successful vaccine is developed in a record time, only to find that the public is less eager for it than policymakers and public health officials are?

Recall that just a scant year before our political leaders were purportedly “shocked” by the advent of SARS-CoV-2, the virus that causes COVID-19, the World Health Organization had issued two related warnings. The first was to anticipate the rise of serious new infectious threats like the coronavirus, or the resurgence of existing ones like Ebola. The second was that “vaccine hesitancy” was one of the top 10 global health threats that had already contributed to triggering the resurgence of a number of infectious diseases like measles and polio.

Even if the world is fortunate enough to have a SARS-CoV-2 vaccine available in record time, the evidence we have seen suggests that without extensive communication and engagement, public health departments may not be able to obtain the coverage needed to achieve “herd immunity” or “community immunity” within a given population. Coined in 1923, the term “herd immunity” refers to the percentage of vaccinated individuals required to protect an entire community from a disease. For COVID-19, herd immunity will require a significant immunization rate (some estimate it at 70%) to achieve meaningful protection.

Our data suggest that with the current reported levels of willingness we are seeing right now in New York, the United States will not easily reach this minimum coverage goal, irrespective of the cost of the vaccine or the number of shots that may be required.

The vaccine hesitancy that helped bring measles outbreaks back to some New York communities just months before COVID-19 struck could play a role in deterring uptake of a new COVID vaccine, if communication around a new vaccine doesn’t start early. The numbers speak for themselves in a recent tracking survey of New Yorkers’ response to coronavirus.

Our surveys in New York, the epicenter of America’s COVID-19 outbreak, are not reassuring with respect to acceptance of a new coronavirus vaccine. For 2 previous weeks, only 60% of New Yorkers told us they would take a new vaccine. Earlier this month, at the peak of tragic deaths and heroic medical efforts, only 56% said they would take a new vaccine themselves and barely a third (34%) would vaccinate their children.

These findings are even more problematic when compared with the results of similar public attitude surveys in Europe, as reported by our colleagues at the Vaccine Confidence Project at the London School of Hygiene and Tropical Medicine and ORB International. They found, for example, that 80% of people in the U.K. and Austria, 86% in Australia, and 70% in France said they are willing to accept a new coronavirus vaccine.

As trillions are lost in the economic debacle surrounding COVID-19, the evidence suggests that America must invest as aggressively in factual and persuasive coronavirus vaccine communication to support the costly process of medical research required to develop the vaccine itself. We will need to use all our social science and communication skills to do this.

Fauci is right to say that a new vaccine could be a showstopper, but we contend that this terrible show could still get a curtain call unless we start now to educate and engage the public and policymakers to value a new coronavirus vaccine.

Scott C. Ratzan, MD, MPA, is editor-in-chief of the Journal of Health Communication: International Perspectivesa distinguished lecturer at CUNY Graduate School of Public Health and Health Policy in New York City, and a member of the National Academies of Science Engineering and Medicine Board on Global Health. He has also served on the CDC Board of Scientific Counselors for the Office of Infectious Disease. Heidi Larson, PhD, is professor and director of the Vaccine Confidence Project at the London School of Hygiene & Tropical Medicine. Ken Rabin, PhD, is special projects editor for the Journal of Health Communication.