Vaccination policy in times of Covid-19

As multiple COVID-19 vaccines are emerging, what can be done to tackle vaccination hesitancy and ensure rapid and equitable deployment?

The availability of a safe and effective vaccine for COVID-19 is an essential tool to control the pandemic. Thanks to extraordinary research efforts, and funding, at the time of writing there are over 200 vaccine candidates in various stages of preclinical and clinical evaluation. Two of them (BioNTech/Pfizer and Moderna candidates) were already approved and another one (AstraZeneca) is currently being assessed by the European Medicines Agency.

The speed at which these vaccines have been developed, in the space of a few months when it usually takes 10 years or more, and their new approach, using mRNA rather than a weakened or inactivated virus, are cause for optimism. However, as governments turn their attention from vaccine development to large-scale production and deployment, their efforts could be seriously undermined by vaccine hesitancy.

Melinda MillsMelinda Mills, Director of the Leverhulme Centre for Demographic Science at the University of Oxford and lead author of the British Academy and Royal Society report on Vaccine Deployment: There will be multiple vaccines against COVID-19 and people have a legitimate knowledge void and questions that need to be answered” Read the full interview

Groups supporting the anti-vaccination movement are using this time of uncertainty to spread misinformation and fear, causing vaccine hesitancy to rise across the world and threatening public health. Mills has been examining the outlandish messages that assert, without any evidence, that the vaccine will cause illness in children, that they are poisonous, that they cause infertility … and finds striking similarities to the messages used by people who opposed the the first vaccine against smallpox was introduced in the 1800s.

Melinda Mills: It’s almost like there is a playbook of how to do this. Simple and terrifying messages such as ‘an mRNA vaccine changes your genetic material’, which isn’t the case, are exactly the type of thing that anti-vaxxers will focus on and amplify. These vaccines have gone through the same trials and regulation processes to prove their safety and efficacy as other vaccines.”

Mapping the extent of vaccine hesitancy

Ayman El-MohandesAyman El-Mohandes, Dean of City University of New York Graduate School of Public Health and Health Policy (CUNY SPH) has coordinated a global survey on potential hesitancy to accept a proven, safe and effective COVID-19 vaccine: We found a very broad range of acceptance, with a high of 88% in China and a low of 55% in Russia. Countries like France and Poland were also quite low on the spectrum of acceptance.”Read the full interview

Many factors influence people’s response to the survey. The study shows that females, people over 65 years old and those with a higher level of education are more likely to accept a COVID-19 vaccine. In addition, people with a higher level of trust in their government and in countries with a high incidence and mortality rate were also more likely to accept a vaccine.

Despite finding an overall global acceptance rate of 71%, he doesn’t belive that this is high enough to halt the pandemic and that it could lead to a false sense of security.

Ayman El-Mohandes: Governments need to be aware of the acceptance rates in their own country. Countries such as Sweden, Nigeria, France, Poland and Russia all have acceptance rates below 65% and the interventions required in each of them will be different since the reasons why their populations are not as enthusiastic about taking the vaccine are not the same.”

Further analyses of the factors that are most strongly correlated to vaccine acceptance in each country will help tailor public health messages on vaccines to the most relevant audiences. “A vaccine won’t make much difference to the spread of disease if less advantaged people in overpopulated urban communities, who are more likely to take public transport and less likely to be working from home, are not accepting of it.”

Increasing vaccine acceptance

Tackling people’s distrust in the new COVID-19 vaccines requires transparency and open dialogue. “We need to respect people’s emotions and understand their concerns rather than be reactive and provide one-way communication,” says Mills.

El-Mohandes laments not seeing more clear and engaging information about the new vaccines. Working with local communities and reaching diverse populations will be key to motivate people to get vaccinated. Political and community leaders also have an important role in promoting public health behaviours. “By showing that they are willing to take the vaccine, they can help instil confidence,” he says.

Interestingly, El-Mohandes saw acceptance rates drop when survey participants were asked if they would take a COVID-19 vaccine if it were recommended by their employer. This finding suggests that people should be allowed to exercise their own judgement, and that making vaccination mandatory may be met with resistence.

Similarly, legislating against those who spread misinformation, could backfire. Mills recommends empowering the public to spot and report misinformation, and raising the accountability of media companies.

Melinda Mills: Helping people understand that if they get a vaccine they can protect themselves, their families and communities so we can get back to normal sooner, is probably a more powerful tactic than legislation”

The EU has drawn up a vaccination strategy for deploying the COVID-19 vaccines, which recommends giving priority to healthcare workers, people over 60 and to those with underlying health problems.  Until wider vaccination programmes are rolled out, it will be crucial to keep complying with measures to mitigate transmission such as wearing a mask and social distancing.

Ayman El-Mohandes: As months go on, we may see a loosening of self-monitoring, as ‘covid fatigue‘ sets in, and manifestations of discomfort with the limitations on our personal freedoms. We need to maintain vigilance and keep people motivated to remain engaged with the recommendations”

Useful link:
European Vaccination Information Portal : an initiative of the European Union
Coronavirus: Commission unveils EU vaccines strategy
European joint action on vaccination
• European Centre for Disease Prevention and Control
COVID-19 vaccines: development, evaluation, approval and monitoring
Authorising COVID-19 vaccines: MEPs to debate with European Medicines Agency
WHO: Coronavirus disease (COVID-19): Vaccines
Safe COVID-19 vaccines for Europeans ( information in all EU languages)


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