A Successful National COVID-19 Vaccine Program Requires Collaborating Now to Build Public Trust

While much attention has been placed on the global race to produce a safe and effective vaccine for COVID-19, approving a vaccine is not the end goal; a large portion of the population must be willing and able to receive the vaccine in order to realize individual, community, national, and global benefits. We must consider a number of issues associated with vaccine administration now before a vaccine is ready for distribution – if we hope to see widespread participation in a national vaccine program.

Large-scale implementation of the national vaccine program will require public trust. Recent polling by Gallup suggests that 35% of Americans would choose not to get a free, FDA-approved vaccine if it were available today. Another poll conducted by The Associated Press-NORC Center for Public Affairs Research revealed that only 49% of Americans say they plan to get vaccinated if a vaccine becomes available to the public, while 20% say they will not, and 31% are not sure. Some Americans have expressed concerns about the safety and/or efficacy of vaccines that are being developed so rapidly. Some distrust scientific experts, public health officials, and/or vaccines in general. Others do not trust those responsible for manufacturing, approving, and regulating vaccines. It is clear that building confidence in the national vaccine program will require transparency around the process for developing, approving, and distributing vaccines.

Another significant challenge is deciding who gets vaccinated first. It will take time and significant financial resources to produce enough doses to vaccinate the global population, and the reality is that some portions of the population will receive the vaccine sooner than others. Thus, the national vaccine program must deliver a transparent and equitable plan that explains who will be prioritized to receive a COVID-19 vaccine, why they will be prioritized, how the plan will be implemented, and the approach to updating the plan if changes are needed over time. This plan must be publicly available before vaccinations begin.

Decision makers should provide space for gathering and incorporating diverse public input into the vaccine allocation plan since public acceptance and cooperation will be instrumental in the success of a national vaccine program. The Crisis Standards of Care (CSC) model offers an effective approach. As explained by the National Academies of Sciences, Engineering, and Medicine (NASEM), CSC are “guidelines developed before disaster strikes to help healthcare providers decide how to provide the best possible medical care when there are not enough resources to give all patients the level of care they would receive under normal circumstances.” A key component of the CSC model is to gather public input to inform the approach to allocating scarce life-sustaining resources. RESOLVE has worked with Maryland, Illinois, and Washington to design and facilitate statewide community engagement initiatives to help ensure that the development and implementation of each state’s CSC guidelines are informed by and aligned with residents’ values and priorities. I have facilitated more than three dozen community meetings on this topic and have seen firsthand how this kind of proactive public discourse can strengthen decision making and build public confidence in planning processes. The national vaccine program should build on this model and incorporate opportunities for the public to provide input into the approach to vaccine prioritization and distribution.

The NASEM recently invited public comment on its Discussion Draft of the Preliminary Framework for Equitable Allocation of COVID-19 Vaccine (which was commissioned by the Centers for Disease Control and Prevention and the National Institutes of Health). This is a positive step, but the opportunity for public input and dialogue should not stop here. Robust and thoughtful public engagement should be a cornerstone of both the development and implementation of the national vaccine program and should include the following elements:

·        Strong, united support for the planning and implementation of the national vaccine program and vaccine allocation plan from national, regional, state, and local officials;

·        Consistent, deliberate, structured engagement with key stakeholders (e.g., healthcare providers, civil society leaders) at the national, state, and local levels that occurs early and often to ensure that the program guidance and implementation plans are reflective of the diverse needs and perspectives of the American public; and

·        Consistent and transparent implementation of the vaccine allocation plan, with regular feedback loops throughout to ensure the program is responsive to the needs and concerns of American communities.

Fortunately, many experts are already thinking about these important considerations. For example, the Johns Hopkins Center for Health Security recently published some resources that can aid efforts to build confidence and trust in the national vaccine program:

·        The Public’s Role in COVID-19 Vaccination – A report outlining a number of steps that should be taken now to advance public understanding of, access to, and acceptance of COVID-19 vaccines, including: using rapid social and behavioral science research to inform the vaccine program; understanding and informing public expectations about the risks, benefits, and supply of COVID-19 vaccines; gaining the public’s confidence in an equitable vaccine allocation and distribution plan; making the vaccine available in safe, familiar, and convenient places; establishing independent public oversight committees to instill public ownership of the vaccine program; and communicating in meaningful, relevant, and personal terms to counteract misinformation.

·        Interim Framework for COVID-19 Vaccine Allocation and Distribution in the United States – An ethical framework for making decisions about COVID-19 vaccine allocation in the United States, which emphasizes the importance of treating individuals fairly, promoting social equity, and the need for “the promotion of legitimacy, trust, and a sense of community ownership over vaccine policy—while respecting the diversity of values and beliefs in our pluralist society.”

These important recommendations and resources should be considered now by decision makers and those planning the national vaccine program.

Public trust will be the foundation of a successful national vaccine program, and it is imperative that we make this program a success. To do so, we must match the unprecedented level of collaboration it has taken to get this far in the vaccine development process with a comprehensive and collaborative effort – at the national, state, and local level – to build a program that the public can ultimately trust. We must rise to meet this moment, and we must begin now.

Beth Weaver
September 26, 2020

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