CANNES, FRANCE – JANUARY 13: People are vaccinated against COVID-19 at the Cannes Palace of … [+]
Whether it’s a pandemic, an epidemic or an endemic disease threat, vaccines without vaccination will not save lives.
The healthcare community leveraged existing vaccine platforms to rapidly create and deliver safe and effective vaccine candidates for Covid-19 within a year of the pandemic’s onset. But despite an obvious cause for celebration, U.S. vaccination rates were modest at best and the impact of this scientific achievement was diminished. The aggressive rollout of the Covid-19 vaccine in the US coupled with disappointing public acceptance is a call to action for our medical and public health communities to understand why and quickly develop and implement informed interventions.
The timing for this introspection and course correction couldn’t be more urgent following the unanimous vote of the U.S. Food and Drug Administration Vaccine Advisory Committee for future Covid-19 vaccines containing a single XBB component and new vaccines to be available this fall.
The first Covid-19 vaccines became available in the US under a regulatory pathway for emergency use, about a year after the first cluster of pneumonia cases were reported in China. At the time, it was not fully understood how Covid-19 spread within populations, the virus’ tendency to mutate, and the duration of vaccine-induced protection, leaving open the possibility that high-level population immunity could be achieved and the pandemic would be short-lived. .
Covid-19 vaccination rates rose rapidly, but eventually slowed and stuttered. Today, approximately one-third of the US population has not received a full primary vaccination course (first two doses) and more than 80% have not updated (bivalent) booster vaccination. Still, between 250 and 500 Americans die each week from Covid-19, according to June 10 data from the CDC.
Disinformation and misinformation about vaccine ingredients and far-fetched conspiracy theories contributed to reduced acceptance. However, important and reasonable questions about acute and long-term side effects of vaccines also made people wary. Questions about the safety of the Covid-19 vaccine eventually permeated discussions about other vaccines. As a result – and erratic reductions in vaccine accessibility – vaccination rates for numerous diseases are being increased turned down during the pandemic and outbreaks of vaccine-preventable diseases such as measles. Since most people have never experienced the fear associated with outbreaks of morbid and deadly diseases such as polio or Ebola, it was no longer a compelling case to advocate vaccination against Covid-19 based solely on avoidance of hypothetical risks.
People were also concerned that the effectiveness of vaccines was rapidly declining. The term “breakthrough infection” became all too familiar. As more people became infected, observations of the protective capabilities of naturally acquired immunity also challenged the rationale for vaccination.
The emergence of new and evasive SARS-CoV-2 variants has been met with attempts to “boost” immunity by administering additional vaccine doses. Booster doses were first implemented using original formulation vaccines, but then variant specific vaccines were tested and finally a bivalent formulation targeting the original and more recently circulating strains (BA.4/.5) were recommended.
Older individuals were most likely to be vaccinated, probably driven by their self-perception of an increased risk of serious illness and death from Covid-19. Vaccine uptake decreased as the age of potential recipients decreased. Just as the perception of increased risk drove older adults to get vaccinated, the perception of reduced risk caused many young people to abstain from vaccination and most parents passed on the vaccination of their children. It is not that these perceptions were incorrect, but the risks of Covid-19 in young people (e.g. inflammatory syndromes, long-term Covid-19 and very rarely death) were understated. The risk-benefit analysis of vaccination in this population was further complicated by the significant effects of an “endless” pandemic (e.g., virtual learning and social isolation) and the evolving story of very rare vaccine side effects (e.g., cardiac inflammation) in young men. .
Despite the clear clinical benefit of Covid-19 vaccination, the benefit is not the same for everyone. Those at low risk of a poor outcome from Covid-19 benefit less from vaccination. Covid-19 vaccines reduce the risk of serious illness, hospitalization and death, but are less effective at preventing infection or mild illness. Vaccination has been associated with a reduced risk of long-term covid-19 in some studies and is safe and beneficial in multiple special populations (e.g., pregnant women, people with suppressed immune systems). The benefits of immunity against natural infection may be similar to those of vaccination with original vaccine formulations, while hybrid immunity (infection plus vaccination) may provide more protection than either alone.
The impact of disinformation and misinformation on individual beliefs and behaviors during the pandemic hinted that medical and scientific literacy among the general population was likely overrated. The same can also be said about enclaves of medical and scientific professionals. Most people don’t know how vaccines are made, tested, or how closely each step of the process is scrutinized before regulatory approval or authorization for use is granted. As a result, it was impossible to meet public standards for vaccine safety and effectiveness.
Validating the credibility of information sources during the pandemic has also been a challenge for the public write big. The result was a significant amount of “noise” introduced into important and consistent discussions about Covid-19 treatment and prevention. Clinicians were threatened with lawsuits or violence for refusing to prescribe several ineffective drugs promoted on social media. Previous “well-known acquaintances” in science and medicine were now faded and questioned.
Scientists and clinicians tried to educate and inform the public in a variety of ways. But communicating medical and scientific information at the population level is a very different skill than communicating with individual patients or families. Dealing with the press and media was also a challenge for many doctors and scientists. Ineffective, poorly worded messages confused people and forced them to access information from less credible sources.
Shakespeare may have coined the phrase, “Expectation is the root of all heartache,” but the mismanagement of public expectations when it came to the safety and benefits of the Covid-19 vaccine was a stunning example. Unrealistic expectations of 100% vaccine safety and 100% effectiveness had to be managed and placed in the context of the ongoing threat to health. Unfortunately, we fell short of this task and eroded public confidence in the process.
As efforts are made to improve the next generation of Covid-19 vaccines, the healthcare community must also improve the way we communicate and discuss vaccines with intended recipients. Doctors need to embrace the new normal of an increasingly hesitant population and have clear messages about the risks and benefits of vaccination.
Doctors, scientists and public health professionals need to recognize that there are highly motivated and organized individuals who want a vaccine-free world. Credible sources of information must be easily accessible and sources of blatant disinformation must be held accountable.
Scientists and clinicians need communication and media training, and local and regional public health agencies need more control over communication with their communities and less reactivity to centralized messaging.
Finally, public expectations regarding vaccine safety and effectiveness need to be managed so that they understand that the individual’s vaccination experience is as individual as their choice of whether or not to be vaccinated.