COVID-19 vaccines: An opportunity for unparalleled, rewarding, and transformational global health efforts
Monumental steps have been taken this week in the direction of gaining better control of the SARS-Cov-2 virus, the virus that has brought the world to its knees. No doubt, however, more monumental steps must be taken in the months ahead for vaccines to reach their full potential.
Reports are emerging of vaccines that are effective in preventing COVID-19 that are near market readiness. Last week, Pfizer announced a vaccine designed by the husband/wife team of Sahin and Tureci that is 90% effective in preventing COVID-19. Today, Moderna announced results from a vaccine study that demonstrate 94.5% effectiveness in preventing COVID-19. Though detailed reports of the primary data are not widely available, respected sources have lent credence to claims that the data is scientifically sound and very promising. These high levels of vaccine efficacy are remarkable and more than most expected. These accomplishments are game-changers.
Even so, those familiar with the barriers that exist in vaccine administration and the persistent immunological uncertainties know of the long road ahead. Aside from the issues of mass production and distribution of vaccines, some of which may have stringent temperature and storage requirements, we must overcome the behavioral resistance to vaccines and gain a better understanding of the amount of time for which vaccines can confer resistance.
There have been pockets of resistance to vaccines in the US and elsewhere for decades. Those very same forces that allowed a British scientist’s fabricated data to take hold and ignite an anti-vaccination movement decades ago have now been unleashed and generalized to many efforts of the CDC, NIH, and WHO. This has been complicated by the fact that the resources, scientists, and policies of messaging and data presentation of these organizations have been altered in the last several years, creating reasonable distrust at all levels. We have not seen this level of medical mistrust and this level of decimation of our trusted health resources in the US in our lifetimes. These sentiments and realities will prove a major challenge to achieving optimal and timely population health outcomes for the COVID-19 vaccine.
Additionally, most vaccine protocols that are emerging seem to involve the administration of two doses of vaccine to reach full efficacy. It will be no small feat to achieve high levels of timely adherence to the second dose to assure efficacy. We know that adherence to prescribed health regimens in even some of the most critical conditions can be as low as 30 to 50%. We will need to leverage all that we have learned in behavioral health about medical regimen adherence over the last four decades. Financial barriers must be removed. Education and communication must be optimized, and reminders and incentives must be provided. All media resources will need to be employed to dispel misinformation and promote validated and useful information. Social media is part of the fabric of a large portion of the world now, but unfortunately, it can be an almost unbridled source of misinformation when used inappropriately. COVID-19 will not change this usage pattern within the next three months. The medical community will be required to step up and ally itself with marketing intelligence in new and creative ways, better than it has ever done before.
Finally, we must be prepared that the immunity conferred by vaccines may be limited and may vary based on the vaccine administered. It will be important to define the ranges of conferred immunity duration to ensure workplace safety and optimum productivity. Eventually, re-vaccination or repeat vaccination may be necessary to not only fight the dominant existent SARS-COV-2 virus but to fight the variants that have and will continue to emerge from mutations. We should plan for this type of strategic thought to be part of our culture.
We are up to this task. We have to be. But we are going to need to have stamina and be patient, determined, prepared and accepting of repeated failures. We need to be willing to do the work. We need to get back to the point where we can use the range of health resources that the US and the world can offer and apply these resources in strategic and coordinated fashions. This requires multidisciplinary, creative input in a way that we have not used before in health.
Though daunting, this could also prove to be one of the most rewarding and transformational challenges we have seen in health and international policy. This virus has the potential to unite the entire world behind a common cause. We saw the beginnings of this with climate change and the Black Lives Matter movement this summer, predominantly generated at the level of global citizenry. We are now going to need to see this level of cooperation at the levels of government.
With the changes that have happened in the American political landscape in the last few weeks, there is an opportunity for the US to again become a better partner in the world’s scientific and population health efforts. This has been a vital but missing element in the COVID-19 battle over the last months. With the potential for better partnerships insight, the foundation for scientific aequanimitas has been restored and productivity will be increased.
Kimberly Gandy, M.D., Ph.D., is a Northwestern/Stanford/Duke trained physician-scientist with over 25 years of experience at the intersection of science, medicine, and technology.