On March 18, two months after its installation, the new US presidential administration achieved the symbolic mark of 100 million vaccine shots. The vaccines are safe. Associate editors Wendy Parmet, Daniel Tarantola, and Stella Yu have prepared a special section of AJPH showing that the devastation of the COVID-19 pandemic, combined with the scientific and public health successes, open a window of opportunity to change the way society at large and governments assess the cost–benefits of vaccines.
Bloom et al. (p. 1049) stress that, typically, economic evaluation of vaccination focuses on direct health benefits for the immunized, such as avoided deaths or life-years gained or health care cost savings from prevented infections. But when it brutally halted society and the economy at a mindboggling human and material cost, COVID-19 highlighted that getting people vaccinated and achieving herd immunity against COVID-19 can also save jobs, housing, schooling, and more.
The full societal impacts of COVID-19 provide a plethora of positive arguments to convince everyone of the benefit of vaccines. To convince the vaccine hesitant, Broniatowski et al. (p. 1055) propose that social media companies, health agencies, and public health advocates team up to disseminate evidence-based information on social media.
By contrast, in the current context, censoring antivaccine misinformation using imprecise algorithms or enforcing vaccination in the workplace can backfire, and, importantly, “a narrow focus on debunking misinformation,” Larson and Broniatowski write (p. 1058), “will not address the emotions and concerns of those who distrust COVID-19 vaccination.”
Similarly, Rothstein et al. (p. 1061) contrast the risk of hardening vaccine opposition if employers can ask their workers to be vaccinated with the trust-building consequences of workplace campaigns informing employees of the benefits of vaccination and providing time off to get the shot or easy access to it at the workplace.
The long-term success of these trust-building strategies requires not mistaking authorization for approval. As Zuckerman explains (p. 1065), the Food and Drug Administration (FDA) rushed hundreds of tests, personal protection equipment, vaccines, and treatments to the market through Emergency Use Authorizations (EUAs). EUAs should not become the new normal, replacing the gold standard of FDA “approval” and being extended longer than is absolutely necessary.
Equally important to bringing an end to the COVID-19 pandemic is to keep in mind the perspective of rebuilding public health on more equitable foundations. The scientific and technical accomplishments too often obscure the daily resilience of millions of health care (including public health) workers. As Lin (p. 1070) explains, the equitable access to and distribution of vaccines, particularly for disadvantaged US populations, is the responsibility of Federal Health Centers, which operate more than 14 000 primary care clinics and employ nearly 260 000 health care workers.
In their insightful examination of the first weeks of the vaccination campaign, Tewarson et al. (p. 1073) describe the challenges faced by states and territories to cover the “last mile” of COVID-19 vaccine distribution. These challenges of reach, equity, workforce, and communication reveal the structural deficiencies that need to be fixed for the long term.
Yes, the more than 984 US federal, state, and local policies in 13 areas of law can “mess with” an effective national strategy. Operation Warp Speed has constructed a federal database, or “data lake,” to monitor vaccine coverage nationwide. But Benjamin-Chung and Reingold (p. 1078) warn that if the data lake is managed separately from existing and experienced state and local immunization information systems, we may lose an opportunity to create a sustainable monitoring system beyond COVID-19.
One hundred million vaccine shots in two months with no vaccine-related deaths is a formidable achievement that has mobilized millions in the private and public workforces. It is also an opportunity to build trust in sustainable vaccination strategies against infectious scourges.
17 Years Ago
Enhancing Public Confidence in Vaccines Through Independent Oversight of Postlicensure Vaccine Safety
The public must know that vaccine safety concerns are taken seriously and investigated by independent professionals whose primary responsibility is safety, not financial gain, public image, or program goals. . . . [T]he Food and Drug Administration (FDA) lacks the resources for adequate postlicensure surveillance and FDA staff members are potentially biased as [it has been said], “their recommendation for approval involves substantial personal identification with that approval, and it is unlikely that those who recommended a drug for approval could later conduct a dispassionate evaluation of possible harm due to that drug.” . . . [We propose] a board, modeled after the National Transportation Safety Board (NTSB), with sufficient funds to mount its own ongoing studies or hold open public hearings resulting in recommendations to the FDA. . . . The development of an NVSB [National Vaccine Safety Board] could create a vibrant system for ensuring the safest vaccine system possible and maintaining public confidence in the safety of vaccines.
From AJPH, June 2004, 947–949, passim
17 Years Ago
Needing a New Paradigm for Vaccine Development
The biotechnology revolution . . . has allowed the unprecedented rational development of new recombinant vaccines that will hopefully help control infectious diseases, including those that appear most complex. . . . However, despite these new tools, the challenges remain formidable. . . . The world vaccine market is estimated at approximately $6.5 billion, a meager 2% of the global pharmaceutical market, making vaccine research and development considerably less attractive to private investors than drug development. Moreover, many of the diseases for which new vaccines are urgently needed mainly affect developing countries whose market characteristics fail to attract private capital investment. . . . In this context, a new paradigm needs to be developed to include and coordinate the actions of the WHO, international and national funding agencies, the pharmaceutical industry and manufacturers in emerging developing countries, nonprofit foundations, and nongovernmental humanitarian organizations.
From AJPH, November 2004, p. 1935
Biography
