The announcement last week by Pfizer that its COVID-19 vaccine has been shown in large-scale clinical trials to be more than 90% effective at preventing symptomatic infection has been much in the news. [After this article was posted, biotechnology firm Moderna, Inc., announced that its vaccine was 94.5% effective.] It is especially welcome news, given the skyrocketing numbers of COVID-19 cases, percentage of positive tests, and hospitalizations in much of the nation.
However, to state the obvious, the vaccine won't work if people don't opt to take it, and surveys have revealed significant reluctance. A Kaiser Family Foundation poll published in September found that only about 42% of Americans would opt for a free COVID-19 vaccination before the presidential election. A similar result emerged from a more recent survey by Morning Consult, which found that only 38% would get a coronavirus vaccine if one became available.
Some of the resistance to the COVID-19 vaccine appears to stem from concerns about the federal government's "Operation Warp Speed" rushing vaccine development, and from the disinformation promulgated by the anti-vaccine crazies, who have shifted into high gear with all sorts of false and even bizarre claims. If the poll numbers hold up, even after vaccines are available, we could see continuing high levels of COVID-19 infections, with sporadic surges above baseline.
That could perpetuate the need to wear masks, for social distancing, avoidance of crowds indoors, and so on. It has been estimated that we will need immunity in roughly 70% of the population, through either natural infection or vaccine administration, in order to achieve "herd immunity," which occurs when a large portion of a community (the herd) becomes immune to a disease, making the spread of disease from person to person unlikely. That protects the whole community — not just those who are immune. Clearly, we will never even approach that if a significant fraction of the population rejects the vaccine: Even with a vaccine that is 90% effective, we would need to vaccinate about 75-80% of the population to attain herd immunity.
Therefore, we need an aggressive campaign to educate the public and to reduce the current worrisome levels of "vaccine hesitancy." The Centers for Disease Control and Prevention (CDC) is supposedly working on a plan to boost "vaccine confidence," Director Robert Redfield told a Senate committee in June, but we've heard nothing more about it since then, and with the Pfizer vaccine perhaps no more than a month or two from beginning distribution, we need an aggressive, multi-faceted plan.
First, the mainstream media and Hollywood establishment must be major collaborators in this effort. The endorsements of celebrities of various stripes – actors, musicians, athletes, thought leaders, social media influencers, columnists, scientists, and prominent politicians from across the spectrum – can alter public opinion. Those who have studied vaccine hesitancy urge a non-judgmental approach that emphasizes story-telling and narrative, rather than simply a litany of scientific findings.
Second, the medical profession – individual practitioners, as well as hospitals and clinics – must play a pivotal role. It should reach out to patients, explain the importance of vaccination, answer their questions, and assuage their concerns. Local social media are also good platforms for informing and interacting with the public.
Third, there will be a role as well for the managers of the major social media platforms; fear-mongering about vaccines that have been shown to be safe and effective is anti-social, and should not be permitted. Twitter and Facebook have already made that commitment.
Fourth, it may even be appropriate for the federal government to issue reward debit cards of perhaps $25 to those who are vaccinated, in addition to covering the actual cost of the vaccine (which the feds have already committed to). Free flu shots are common already, so this would just be one additional step justified by the devastating impacts of the COVID-19 pandemic.
Finally, there might be a need for more coercive actions, with vaccination required in medical facilities, certain other businesses, and schools. There are also precedents for governments mandating widespread vaccination. In 1905, the U.S. Supreme Court (in Jacobson v. Massachusetts) upheld a Massachusetts state statute that during a smallpox epidemic required the entire population to undergo smallpox vaccination or pay a fine. The Court deemed it a valid exercise of a state's police powers that did not violate the U.S. Constitution's 14th Amendment's due process clause, inasmuch as the vaccinations were deemed to be necessary to protect the health of the community.
Absent such a coordinated, multi-faceted effort, it seems doubtful that enough people will, in the short term, seek out one of the new vaccines to make a dent in the pandemic, let alone to approach herd immunity. How tragic it would be if the prodigious efforts to develop the COVID-19 vaccines were for naught, simply because they were rejected by a misguided public. There is not a moment to lose in mounting a campaign to encourage vaccination.
Henry I. Miller, a physician and molecular biologist, is a senior fellow at the Pacific Research Institute. He was the founding director of the FDA's Office of Biotechnology. Andrew I. Fillat spent his career in technology venture capital and information technology companies and is the co-inventor of relational databases. They were undergraduates together at the Massachusetts Institute of Technology.