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
RESOLVE
September 26, 2020