With unprecedented speed, the UK has become the first country to approve emergency use authorization for a COVID-19 vaccine that has been tested in a large-scale clinical trial.1
While this is a welcome milestone, it is important to remember that, as the vaccine is rolled out to millions of people, scientists and the public still have several unanswered questions about it.
A vaccine for COVID-19 has been widely hailed as our best chance for a return to some form of normality. This idealistic notion is perhaps a result of worldwide desperation to return to the freedom that we experienced pre-COVID, but we need to be mindful of the challenges that still remain, including vaccine distribution, hesitancy and long-term prospects.
The field of COVID-19 vaccine development is highly dynamic, with new developments occurring rapidly and excitement building for the roll-out of the first vaccine. It can be difficult to determine the current extent of scientific knowledge, in such a fluid and unpredictable environment, so perhaps it is time to take a closer look at questions that have been left unanswered.
Will a vaccine prove effective?
Tests on more than 43,000 people have shown that the Pfizer/BioNTech vaccine is 95% effective at preventing disease when measured one week after participants were given a second dose.2 However, it is important to realize that so far, the trial has gathered data from only 170 cases of COVID-19 across its control and intervention arms, which means that real-world efficacy may be slightly lower than the figures observed in the trial.3 In fact, as is increasingly recognized these days across different diseases and conditions, it will be important to consider the real-world evidence and implications when it comes to all of these vaccines.
It is also key to remember that any vaccine that is developed will not be 100% effective at protecting everyone. This is because everyone responds to being vaccinated in slightly different ways and each person’s immune system is different. It is also important to remember that not all members of the population can be vaccinated, particularly those with weakened immune systems.
Will a vaccine be effective in vulnerable members of the population?
If a vaccine protects sufficient numbers of the population, this should be enough to ensure that the spread of COVID-19 is contained. It will be a priority to ensure that elderly and vulnerable members of the population receive a vaccination, reducing the severity and impact of the disease.
However, herein lies the paradox, as it is the vulnerable members within the community who need the vaccine urgently, this group are also possibly likely to have different types of responses to the vaccine because their immune responses are often weaker.
Data from the Pfizer clinical trials, for example, are drawn from fewer than 200 people who have contracted COVID-19, therefore it is difficult to extrapolate this data and look at how effective the vaccine is within different age groups. Over time, as the vaccine is distributed, and more data are collected, it will become clear as to what extent different demographics within the population are protected.
At the time of writing, there are no data for vaccine performance in children or pregnant women, as these groups are typically tested on once safety data for other members of the population has been verified.
How long will a vaccine work for?
There is no quick way to determine how long a vaccine will be effective at inducing immunity to COVID-19. Long-term efficacy will only become clear after further months and years of monitoring the results of the roll-out of this vaccine.
Furthermore, data from the Pfizer trial, for example, looks at incidence of COVID-19 one week post-administration of the second vaccination dose, so it is clear that more data on the long-term effects of the vaccine is required.
Can a vaccine stop people from spreading COVID -19?
So far, none of the candidate vaccines have been proven to stop the spread of the virus. So, whilst a vaccine may have been shown to reduce symptoms associated with the virus, there is a possibility that vaccinated people may still be infected but asymptomatic. These individuals could then possibly transmit the infection to members of the population who have not yet been vaccinated.
To determine whether or not a vaccine prevents viral transmission, clinical trial design would have to be altered to ensure frequent monitoring and testing of all trial participants, something that has not been incorporated into trials. Thus far, trials have been designed to prioritize the data needed to ensure approval and roll-out as quickly as possible.
How are vaccines going to be fairly distributed?
As expected, vaccine distribution is currently a contentious topic. The NHS England medical director has said that vaccine distribution will “be a marathon not a sprint.” It has been confirmed that care home residents and staff, those over 80, and NHS and frontline health care staff will be first to get the COVID-19 vaccine. In England, 50 hospitals have been initially chosen to serve as hubs for administering vaccines. So far, the government has ordered a total of 40 million doses of the Pfizer vaccine; enough to vaccinate 20 million people, with two shots each, 21 days apart.4
Despite the approval of the Pfizer vaccine, we must not forget that countries have ordered quantities of different candidate vaccines; some of which may also be licensed soon. This raises the question ‘how do we decide who should receive each vaccine?’ It is possible that different candidate vaccines will be more efficacious within different subpopulations, but these insights are still unknown. (For more information on vaccine distribution considerations, please see: Is the world ready for a COVID-19 vaccine?)
However, giving different people different vaccines has the potential to create nationwide uncertainty and confusion. Evidently, the communication and media response to vaccine distribution needs to be as meticulous as the process of vaccine development itself. This is particularly hard to achieve in the time of a crisis, when politicians are the face of public confidence, rather than experts and communication experts themselves.5 (For more considerations for communications strategies, please see: What can we learn about effective healthcare comms from the current vaccine media frenzy?)
Arguably, a clear and transparent distribution plan for vaccine delivery is going to be as equally important as vaccine development itself.6 If vaccine distribution is not carried out with caution and honesty. then the consequences could be catastrophic, not only causing people to refuse vaccination but also creating a lasting damaging impact on public confidence in vaccination for potential future vaccines.
How could a vaccination campaign ensure public confidence in the vaccine?
Due to the rapid nature of vaccine development, and the current deficits of knowledge around the virus itself, the public may be hesitant to accept a vaccine. The onus of the vaccination program is on the government to protect society; particularly the vulnerable members, without infringing on people’s freedom of choice.
Plausibly, the most effective way of ensuring the highest number of people within the population are protected will be to run a vaccination campaign that inspires people to act for the greater good of the community, while addressing concerns and misconceptions about the vaccine itself. Clearly, this is no mean feat.
Vaccine communication is contentious and complicated, and there is currently no real consensus within the literature7 as to the best way to conduct effective vaccination campaigns, particularly within hesitant subpopulations. A lot of vaccine hesitancy research to date has placed emphasis on ensuring that interventions and campaigns are targeted to individuals’ specific concerns, but this will be impossible to carry out on a national or international scale. (For more on this topic, please see: Understanding people’s fears and concerns relating to COVID-19 vaccines.)
Understandably, there is scoping work to be done to ensure that campaigns have insights into specific misconceptions or concerns within the public domain. In order to produce the most informed campaign, flexibility will be crucial, as the environment is so unpredictable, likely causing concerns to change over time.
The messaging used in the campaign will need to be concise and considered. A particular emphasis for communicators will be to ensure that the campaign is multi-faceted and contains multiple communication strategies and tactics, in order to appeal to the widest range of people possible.8 This may be difficult to achieve given that a lot of research to date has assessed and analyzed only individual communication strategies at one time. Additionally, many current vaccination campaigns are targeted at parents of young children; however, this will be a nationwide campaign, so there will need to be innovative thinking around communicating with all different demographics within the population. There will also be some learnings from flu vaccination campaigns (for more on flu vaccinations, please see: Taking steps to ensure flu vaccinations are a priority in a pandemic).
What should we focus on looking ahead?
It is essential that vaccines are continuously monitored by scientists so that we can obtain data that demonstrates the true efficacy of the vaccines within the general population and so that we can uncover the long-term efficacy, safety and prospects. It is likely that development of multiple candidate vaccines will continue to ensure that future generation vaccines will be as efficacious as possible.
As we continue to receive vaccine related updates on a weekly basis, it is easy to get wrapped up in the complexities and prospects of COVID-19 vaccine roll-out and communicating the true and realistic prospects of first-generation vaccines to the general public is not an enviable task. To ensure the vaccines are received in a confident and accepting manner by the public, it is vital that we begin to probe public perceptions now and ensure that any vaccine is communicated in the most intuitive and considered manner possible.
We have all seen how various communication errors have decreased public trust in the government over the course of lockdown, and it is of crucial importance that lessons are learned for this next stage of the pandemic.
Contact us to explore how we can help you to shape effective communications strategies.
- Gov.uk, COVID-19 vaccine authorised by medicines regulator
- Nature, News, What Pfizer’s landmark COVID vaccine results mean for the pandemic
- Nature, News, The UK has approved a COVID vaccine — here’s what scientists now want to know
- BBC News, Health, Covid-19: Pfizer/BioNTech vaccine judged safe for use in UK
- Peretti-Watel, P. et al. A future vaccination campaign against COVID-19 at risk of vaccine hesitancy and politicisation. The Lancet Infectious Diseases vol. 20 769–770 (2020).
- Dubé, E. & MacDonald, N. E. How can a global pandemic affect vaccine hesitancy? Expert Rev. Vaccines 1–3 (2020).
- Dubé, E. et al. (2015) ‘Strategies intended to address vaccine hesitancy: Review of published reviews’, Vaccine, 33(34), pp. 4191–4203.
- Siciliani, L. et al. (2020) ‘Strengthening Vaccination Programmes and Health Systems in the European Union: A Framework for Action’, Health Policy. doi: 10.1016/j.healthpol.2020.02.015.