Dr. Heidi Larson, Director, Vaccine Confidence Project
While the COVID-19 pandemic is not likely to end soon, many public health experts are optimistic that vaccinations will help dramatically reduce the human toll of the coronavirus. Vaccination is being hailed, as a key mechanism — although not the silver bullet — to winning the battle against COVID-19. Each day, the world is getting closer to herd immunity, the state when enough people in a community are protected from a disease, either through vaccination or previous infection, that the virus can no longer spread easily.
Currently, demand for COVID-19 vaccines is far outpacing supply. Vaccine rollouts globally have been marked by long waits, inconsistent guidance on eligibility, limited supply, and wasted doses — in addition to inequitable access. These barriers to vaccination contribute to a rising health threat from dangerous variants and their spread.
At the same time, these challenges are compounded by growing vaccine hesitancy — the reluctance or refusal to vaccinate despite the availability of vaccines. The rates of vaccine hesitancy continue to fluctuate around the world, with millions of people unwilling to receive a COVID-19 vaccine.
Hesitancy stems from a confluence of factors, including safety concerns given the unprecedented speed in developing these vaccines, discomfort with injections, uncertainty around the cost and time required for vaccination, and deep-seated mistrust of the healthcare system, especially historical medical racism, among many other reasons. Adding to these fears are conflicting reports about the safety and efficacy of certain COVID-19 vaccines. All these anxieties — and associated issues like vaccine equity — must be addressed to ensure that communities around the world achieve herd immunity, the lynchpin in saving lives.
This week’s edition of Rabin Martin’s COVID-19 Briefing examines vaccine hesitancy’s impact on COVID-19 vaccination globally. Will hesitancy prolong the pandemic? What factors are fueling this hesitancy? Our earlier COVID-19 Briefings are available here.
The U.S. accounts for about a quarter of global cases, reporting 30,042,191 cases and 545,726 deaths. The U.S. continues to forge ahead with mass vaccination campaigns: more than one in four and 70 percent of those 65 and older have received at least one dose.
Global pandemic spread (Johns Hopkins University)
COVID-19 has revealed and exacerbated the inequities and fault lines in healthcare systems around the world. Systemic challenges have arisen at both micro (e.g., transportation to vaccination sites) and macro levels (e.g., rich countries have elbowed out low- and middle-income countries to purchase vaccine supply). While countries are working to overcome these barriers to administration and access, many are also battling misinformation and mistrust about vaccination.
Vaccine hesitancy is not localized to certain countries or communities. In 2019, the World Health Organization (WHO) counted vaccine hesitancy as one of the top ten greatest public health threats globally. A recent study from Imperial College London found that hesitancy around COVID-19 vaccination could lead to thousands of extra deaths over the next two years.
In France, hesitancy rates are particularly high, with 40 percent of respondents in a December 2020 poll noting they would refuse a COVID-19 vaccine. In Russia, which authorized the Sputnik V vaccine in August 2020, prior to the completion of Phase 3 studies, vaccine hesitancy — including disbelief in the coronavirus — is a massive obstacle to vaccination. Though the vaccine is free, only 3.5 percent of Russians had received at least one shot, as of March 8. “We were on par with everybody else in developing the vaccine, but we’re now behind in administering it,” said Anton Gopka, Dean of Faculty of Technological Management and Innovations, St. Petersburg’s ITMO University.
The challenge is also serious in the U.S., where an estimated 30 percent of adults do not plan to receive or are undecided about receiving a COVID-19 vaccine. As more people become eligible to receive a vaccine, the reality of vaccine hesitancy is becoming more apparent: vaccine appointments are going unfilled or being skipped in certain regions. People who report vaccine hesitancy reside largely in rural areas, and, according to a recent poll, Republicans are more than three times as likely as Democrats (33 percent vs. 10 percent) to say they will not get a COVID-19 vaccine when it becomes available to them. Even among staff working in healthcare delivery settings, hesitancy looms. For example, at Harlem Hospital in New York City, only half of the eligible staff have accepted a COVID-19 vaccine. Similarly, a December 2020 national study by Kaiser Family Foundation reported that 30 percent of those who work in a healthcare delivery setting said they probably or definitely would not get a COVID-19 vaccine even if it were available for free and deemed safe by scientists.
Fears around specific vaccines are also growing, due to miscommunication and misunderstanding about the vaccine development process. In the first week of March, the mayor of Detroit refused to distribute Johnson & Johnson’s vaccine, citing lower efficacy rates compared to other COVID-19 vaccines. (He has since recanted the assertion and has endorsed the vaccine.) Just last week, alarm about blood clots caused many countries to suspend the approval or distribution of the AstraZeneca/University of Oxford vaccine. Despite assurances by WHO and the European Medicines Agency that the “benefits of the AstraZeneca vaccine outweigh its risks,” many remain skeptical. This week has given rise to even more concerns about the safety and efficacy of the vaccine due to questions around the company’s representation of trial data (reissued on Wednesday, March 24).
Apprehension about this particular vaccine is especially problematic for countries relying on WHO’s COVAX Facility to gain access to vaccines, as AstraZeneca’s pledge (336 million doses) accounts for the overwhelming majority of supply. In Africa, where hesitancy levels are already high, the confusion has generated further mistrust. Dr. John Nkengasong, Director, Africa Centers for Disease Control and Prevention, commented that the situation is “clearly not…helpful for our public confidence… and trust on the use of that particular vaccine and other vaccines.”
From the Experts
“We don’t really know what that magical point of herd immunity is, but we do know that if we get the overwhelming population vaccinated, we’re going to be in good shape.”
Dr. Anthony Fauci, Director, NIAID
Thursday, March 18
“[The slow U.S. response to COVID-19] takes me back to my experience with the Ebola response, and the Zika response, and previous influenza response[s]. I really hope that this is the last time that we have to learn this lesson.”
Dr. Rick Bright, former Director, U.S. Biomedical Advanced Research and Development Authority
Friday, March 19
“We must act now, and I am worried that if we don’t take the right actions now, we will have another avoidable surge – just as we are seeing in Europe.”
Dr. Rochelle Walensky, Director, CDC
Monday, March 22
“I’m afraid we’re all trying to grasp at straws. We’re trying to find the golden solution: just get enough vaccine and we push enough vaccine to people and that’s going to take care of it. I’m sorry, it’s not. There aren’t enough vaccines in the world, and they’re distributed terribly [inequitably].”
Dr. Michael Ryan, Executive Director, Health Emergencies Programme, WHO
Monday, March 22
“Vaccines are coming, but they are still several months away for most people in our region… Although scale-up has begun, we know it’s not enough. We do not yet have the vaccines we need to protect everyone. It’s what happens when the whole world must rely on too few manufacturers. We must also find ways to share vaccines more equitably among countries.”
Dr. Carissa Etienne, Director, Pan American Health Organization
Tuesday, March 23
What We’re Reading
- Stop Blaming Tuskegee, Critics Say. It’s Not An ‘Excuse’ For Current Medical Racism – KQED, National Public Radio
- The Saga of Mishaps and Miscommunications Overshadowing AstraZeneca’s COVID Vaccine – Andrew Joseph and Lev Facher, STAT News
- E.U. Will Curb COVID Vaccine Exports for 6 Weeks – Matina Stevis-Gridneff, The New York Times
- Brazil Is Looking Like the Worst Place on Earth For COVID-19 – Philip Reeves, National Public Radio
- Clinical Trials of COVID-19 Treatments Aim to Bridge Income Gaps – Andrew Green, Devex
- The Curious Case of Florida’s Pandemic Response – Derek Thompson, The Atlantic
- They Had Mild COVID. Then Their Serious Symptoms Kicked In. – Pam Belluck, The New York Times
- Pandemic Whistleblower: We Need A Non-Political Way to Track Viruses – Amy Maxmen, Nature
- COVID: The Countries That Nailed It, And What We Can Learn from Them – Jane Corbin, BBC
Reports from International Governments and Bodies
- WHO COVID-19 Information and Guidance
- WHO Weekly Epidemiological Update: March 23
- WHO Weekly Operational Update: March 22
- CDC Coronavirus Resource Page
- COVID-19 Health Systems Response Monitor
- NCD Alliance COVID resources relevant to NCDs
Funding and Policy Trackers
- International Monetary Fund Policy Tracker
- Kaiser Family Foundation Coronavirus Policy Tracker
- U.S. Chamber of Commerce Foundation Corporate Aid Tracker
- Devex Interactive Funding Tracker
Resource Pages and Market Research Literature
- JAMA Resource Center
- The Lancet COVID-19 Resource Centre
- 2019 Novel Coronavirus Research Compendium (NCRC)
- National Academy of Medicine COVID-19 News and Resources
- WIPO COVID-19 IP Policy Tracker
- The COVID Tracking Project
- PharmaIntelligence: Coronavirus – What will the Impact Be?
- Health Affairs Resource Center
- STAT News COVID-19 Tracker
- Global Health NOW’s COVID-19 Expert Reality Check
- International Association of National Public Health Institutes COVID-19 Resources
- Center for Strategic and International Studies The Reopening and Take as Directed Coronavirus Crisis Update Podcast
- Primary Health Care Performance Initiative Forum
- U.S. Global Leadership Coalition COVID-19 Issue Briefs
- Prevent Epidemics Weekly Science Review
- COVID-19 Watch Weekly Updates
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About Rabin Martin
Rabin Martin is a global health strategy firm working at the intersection of private sector capabilities and unmet public health needs. Rooted in our mission to improve health for underserved populations, we design strategies, programs and partnerships that both deliver public health impact and drive business results. We leverage our deep knowledge and networks across a wide range of geographies and health areas to develop tailored solutions for every client engagement. We have helped many clients create bold global health initiatives and innovative multi-sector partnerships. Our specific areas of expertise include infectious disease and vaccines, non-communicable diseases, rare diseases, maternal and child health, and universal health coverage. Our clients and partners include multinational health care companies, multilateral institutions, government agencies, large foundations and leading NGOs. Rabin Martin is part of the Omnicom Public Relations Group.
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