How do we Ensure Appropriate Access to the COVID-19 Vaccine and Ensure Success for this Unprecedented Public Health Challenge?

An interesting commentary in The Lancet published December 10, 2020 by Peter Hotez and Walter Orenstein looks at this issue. They offer a staged approach to this important subject.

First, they suggest that the uptake of COVID-19 vaccine must be monitored on a daily basis to ensure proper distribution and minimise geographic gaps.

Second, they suggest that the capacity of the healthcare system to deliver the vaccine to everyone needs to be monitored.

For example, when are the vaccines available?

Where are supplies of vaccine?

If there is a gap, how soon might it be filled?

Therefore building out surveys for local health departments across all countries to assess their vaccine delivery readiness is suggested.

A growing body of scientific literature shows that COVID-19 disproportionately affects minorities and a plan tailored to meet the challenges of ensuring vaccine access for all these communities is imperative.

Third, the geographic distribution of vaccine delivery needs to be considered. The experience with the virus thus far has revealed it ebbs and flows.

As a result of this, there are hotspots, for example in America in early 2020, the Northeast and Western coastal states were hotspots. During the summer months, however, high cases and deaths appeared in the southern states. At this year’s end the Midwest together with West Texas and New Mexico became the hardest hit regions. It is required to estimate and to model the level of transmission and to identify regions where the epidemic is accelerating.

Fourth, the safety and efficacy of each vaccine is paramount

Possible side effects or adverse reactions to vaccinations need to be tracked and monitored. Do they occur in specific subpopulations, for whom vaccines could be contraindicated or in the general population?

What, if any, risk factors are identified?
Determining whether these are isolated cases, misdiagnosis, or part of a larger problem – causally or coincidentally related – will not only help to survey the vaccine but also develop responsive communication strategies. With every new vaccine, the FDA and CDC has robust vaccine safety monitoring networks, including the vaccine adverse effect reporting system, vaccine safety data link, and the clinical immunisation safety assessment. The capacity of these must be increased so that an analysis of the reports of any events can be ready to be responded, especially since the first vaccine used new technologies.

Fifth they suggest an effective message is needed to ensure the public’s confidence in the vaccine.

Overcoming vaccine hesitancy is no small task in the current political and cultural climate. Honing a message across media to impart to the public trust in the process will help determine vaccination rates. The scientific community needs to show that the fresh to market vaccines are safe, effective and necessary.

Popular public figures and trusted institutions need to promote vaccinations to accelerate herd immunity. In parallel, it needs to be recognised the pervasive aspects of anti-vaccine messaging across the Internet, including social media and E-commerce platforms.

Anti vaccination rumours, misinformation and conspiracy theories swirl in a fractured media universe; their origins are diverse and include dedicated anti-vaccine organisations, political extremist groups and even the Russian government.

Sixth, effectiveness needs to be monitored – one approach is to have serological monitoring of random samples of vaccine recipients to gauge whether there is a decline in antibody over time and presumed immunity by vaccine type and segments of the population.

This will help to answer those who might need more doses and when and the long term effectiveness of the vaccines or their durability for protection.

It is also needed to better understand the performance characteristics of these new vaccines in terms of their ability to interrupt virus shedding. This is critical for understanding whether widespread vaccination achieves herd immunity and the thus leads to a halt in virus transmission.

Although this was written from an American perspective, the same ideology exists here in the United Kingdom.

The London General Practice believes that the vaccine should be available to all who require it and it should be provided by the government rather than within private practice.

Dr Paul Ettlinger
BM, DRCOG, MRCGP, FRIPH, DOccMed