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Serious challenges lie ahead for the COVID-19 vaccine

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Now that two coronavirus vaccines have proven effective, it is tempting to think that the pandemic will be over as soon as enough of a vaccine is produced and distributed.

But public health experts warn that there are many hurdles to overcome in getting enough people to take the vaccine.

In September, a Gallup poll found that only 50% were willing to be vaccinated for the coronavirus. That number has improved recently, with Gallup finding in November that 58% are now ready to be vaccinated. But that may still not be enough to reach the 60%-70% vaccinated that many epidemiologists believe is needed to achieve herd immunity and stop the spread of the virus.

“There’s a lot of work to do,” said Marissa Levine, a former state health commissioner in Virginia who is now the director at the Center for Leadership in Public Health Practice at the University of South Florida. “We’ve put a lot of effort into vaccine development and not as much into vaccination programs.”

But the current climate makes those programs more difficult, said Dr. Bob England, the former director of the Maricopa County Public Health Department in Arizona.

“You have a perfect storm of a setup for people to be suspicious about this vaccine because everything about COVID has become politicized,” England said.

That is troubling because public trust that the vaccine is safe and effective is crucial to getting a sufficient number of people vaccinated.

The Food and Drug Administration is likely to grant emergency use authorizations to coronavirus vaccine makers, enabling them to begin distributing the vaccine before all of the safety data is available.

Will Humble, executive director for the Arizona Public Health Association and former director at the Arizona Department of Health Services, claimed that could undermine trust.

“If you instead go to full approval, which takes a few more weeks, then there are nuances you can identify and manage,” Humble said. “But if you rush through it with an [emergency use authorization], you’re risking that you’ll lose long-term confidence in not just that vaccine but in all of them because people will be less likely to trust the process at that point.”

The nuances include identifying possible adverse events and determining if different doses of the vaccine work better for specific subgroups.

England said that waiting for full approval is a double-edged sword as it would mean that getting to herd immunity would take longer. He argued that an emergency use authorization would be acceptable since giving the vaccine to healthcare workers and the most vulnerable first could add to trust in the vaccine.

“By the time the vaccine gets around to the general public … there are going to be millions of people who will have been vaccinated, and we’ll have added that experience and the safety profile of that to what has been accomplished so far with only studies,” England said. “So, hopefully, people will be able to see for themselves that the rate of side effects is low … and serious side effects are rare.”

Another hurdle may come when the number of people vaccinated reaches about 50% to 60%. For example, Humble said he thinks that of the roughly 7.2 million people in Arizona, perhaps 5.5 million will need to be vaccinated. He argued that getting the first 3 million to 4 million vaccinated won’t be too difficult but that the last 1 million to 1.5 million will be much more challenging.

“I think it becomes a bigger problem when you move into May and June,” he said. “By that point, you’ll have a much bigger supply of vaccine, and there will appear to be much less of a crisis because most older people and nursing homes have been vaccinated, taking the pressure off hospitals.”

That could lead younger people to feel less urgency to get vaccinated.

“Once the crisis looks like it is subsiding, people’s perception of risk versus benefit changes, especially people in their 20s and 30s,” Humble said. “They may think, ‘Why get vaccinated? The hospitals are OK now.’ Understanding how you can reach younger adults is going to be a challenge.”

Levine agreed that younger people are a subgroup that can be resistant to vaccination.

“That is a group that generally feels invincible and like they don’t need a vaccine,” she said. “That will be a particularly tough project but important ones because we know they can carry the virus asymptomatically and spread it to older people.”

Levine said that for public health departments, finding out the concerns of younger people will be essential to communicate effectively with them about the importance of being vaccinated.

But England said he thinks that bitter experience may be what gets enough people to agree to be vaccinated.

“This is going to be one horrific winter,” he said of the current wave of infections. “I think experience is going to speak more than facts on some website. People are going to see enough misery this winter. And even if the vaccine has some side effects, like making you feel run down, for most people, that will be nothing compared to what we are living through right now.”



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