National Post (Latest Edition)
Vaccine’s efficacy ‘comes down to trust’
Vaccines will be the best shot at liberating the globe from COVID-19, but will enough people co-operate? Or be willing to go first?
“In the long run, the best way to end this pandemic is with a safe and effective vaccine,” reads the transcript from the throne speech in Ottawa. While the country’s strategy “is all about ensuring that Canadians will be able to get a vaccine once it is ready,” anti- vaccine sentiment could present problems.
“We’ve had discussions at the task force, we’ve had presentations by experts in this area, about vaccine hesitancy,” said Dr. Alan Bernstein, a member of Canada’s COVID-19 vaccine task force tasked with advising the government on “the most promising” vaccine options.
“It’s not the extreme anti- vaxxers we’re talking about — it’s people who I think quite reasonably will have a ‘ I’ll wait a little bit and see what my friends say,’ kind of thing,” Bernstein said.
“And I would say, in a word, this comes down to trust.”
He is referring to trust not just in the vaccines themselves, but in the regulatory process, political leaders and scientific bodies. “A lot of people have been concerned because it seems to be going so fast.”
Surveys are revealing that nervousness: A Statistics Canada survey released in July found that while a majority ( 68 per cent) of crowd- sourced participants said they were very likely to voluntarily get vaccinated, about 12 per cent said they were somewhat, or very unlikely to do so, while five per cent said they didn’t know.
An Ipsos survey released at the end of August of nearly 20,000 adults from 27 countries on behalf of the World Economic Forum found that 74 per cent polled would get a vaccine, but only 37 per cent strongly agreed, while 37 per cent somewhat agreed, though the agreeable, the pollsters reported, outnumbered those who disagreed by a significant margin in most countries.
The World Health Organization last year declared vaccine hesitancy one of the top 10 global health threats. While most vaccine safety scares aren’t supported by scientific evidence, “without substantial global investment in active vaccine safety surveillance, continuous monitoring of public perceptions and development of rapid and flexible communication strategies, there is a risk of SARS- COV-2 vaccines never reaching their potential due to a continued inability to quickly and effectively respond to public vaccine safety concerns, real or otherwise,” doctors with the Institute for Vaccine Safety at Johns Hopkins Bloomberg School of Public Health warned in The Lancet.
Canada has signed pre- order deals with several drug companies, the most recent with Astrazeneca, the British firm that is manufacturing a vaccine with Oxford University. The government has spent about $ 1 billion so far to access more than 150 million doses from five different countries, set to be delivered beginning early next year, assuming one or more are successful.
The choice whether or not to be vaccinated is one most people won’t have to face for months, “if not a year or more,” Arthur Caplan, founding head of the division of medical ethics at NYU School of Medicine, recently wrote. “The supply just won’t be there for the general public.”
While staring down a possibly fearsome fall and winter surge of COVID, and the possibility that vaccines “can liberate everyone from the constraints on liberty” imposed by lockdowns and quarantining, some people are going to say, “count me out,” he wrote.
“They don’t trust vaccines or they don’t trust the government to provide a safe one.”
U. S. President Donald Trump’s politicization of a COVID-19 vaccine is seriously undermining public confidence, critics say. Trump said the White House may or may not approve more stringent FDA standards for emergency authorization of a COVID vaccine. “Because when you have Pfizer, Johnson and Johnson, Moderna, these great companies, coming up with the vaccines, and they’ve done testing and everything else ... why would they have to be adding great length to the process?” Trump said.
What kind of uptake would be needed to achieve herd immunity? “The honest answer is, we don’ t know,” Bernstein said. “Obviously, the higher the number, the better.” It depends on two variables, Bernstein said: the uptake, and how effective the vaccine is.
Bernstein understands the uneasiness some may be feeling. Several of the front- runner candidates are RNA- based vaccines, which use specific parts of the SARS- COV- 2 virus’ genetic code to trigger an immune response. They’re a whole new ball game. “It would be unwise to say, ‘ Gee there won’t be any side effects.’ We don’t know that,” Bernstein said. “We just don’t know the answer to that question until we do the Phase III trials.”
But “one has to remember we’re in the middle of a pandemic. So you have to weigh — we all have to weigh — the risks of taking a vaccine against the risk of getting COVID.”
It’s now known, for example, that stroke can be the first symptoms of COVID- 19 in younger people.
It normally takes 10 to 15 years to develop a vaccine. Everyone is trying to do this in one. But Bernstein, president and CEO of the global research organization CIFAR, said corners aren’t being cut. And unlike in the U. S., “there is no evidence whatsoever of political interference, or any other kind of compromising on safety. So I think we’re quite lucky in this country that we can trust our regulator.”
Still, times of pandemic throughout history have been a rich source of information — and disinformation. George Washington University physicist Neil Johnson has been mapping online vaccine conversations in 100 million Facebook users. Before COVID hit, the “undecided” were becoming more entangled with hard- core anti- vaxxers, a phenomenon that has only blossomed since March.
Part of the problem is that the science keeps shifting, evolving. Is COVID airborne or not? What’s the size of a particle, a droplet? “Should you be six feet away, should it be three feet, should it be 2,000?” Johnson said. “It’s not wrong, it just looks like science doesn’t know.”
Safety, need, big- pharma conspiracies and does- science- actually- know- whatit’s- doing are the main features that appear among the “not-sure’s,” Johnson said.
“But we also see it — and I think this is even more scary — in the yes’s, the ones that say ‘ they would get a vaccine,’ who then inside are thinking, ‘ yeah, but I wouldn’t be first in line. I’m going to wait until my whole street, everybody I know has it, and if they’re still standing a few months later I’ll get one.’”
Among the narratives he’s read: What happens if you have the first shot at the same time as the flu shot? What happens if I’ve already had antibodies in me and I have the vaccine, is that bad? “These are the things occurring to them.”
Dozens of vaccines are now being tested in humans. It’s not clear which strategy will be the most successful. The best vaccines are the ones that most closely mimic a natural infection, without making the person sick, or killing them.
Vaccines use parts of the virus — in the case of most of the front-runner vaccines, the spike protein the virus uses to attach to and enter cells — to goad the body into making an immune response.
A COVID vaccine doesn’t have to be as good as vaccines against highly infectious viruses like the measles, said Mcmaster University’s Dr. Matthew Miller, an infectious diseases researcher.
A vaccine that’s even partially effective, in the 60- to 70- per cent range, would probably make a meaningful impact, he said. The less effective the vaccine, the more people needed to be vaccinated to reach herd immunity.
But just how long vaccine- induced immunity will last is still a wild card. Months? A year? Longer? The vaccines are likely to be most effective in the people that need them the least — young, healthy people, the same group driving current infection rates. Older people and those with weakened immune systems — the people at highest risk of dying from COVID — tend not to respond well to vaccines.
If one or more of Canada’s bets pans out, Canadians could expect to see vaccines in the first quarter of 2021, the second quarter at the latest, Bernstein said.
In the meantime, a vaccine communications strategy is needed, he said. “Public health is all about transparency, communication, earning the public’s trust.”
But we also need to adjust expectations. “This will not necessarily be a magic bullet,” he said. “It’ll be part of the public health armamentarium: wearing a mask, washing our hands, keep a distance and the vaccine.
“We will eventually get rid of this virus. But it won’t happen the day after you are immunized.”
IT WOULD BE UNWISE TO SAY, ‘GEE THERE WON’T BE ANY SIDE EFFECTS.’