The science and healthcare community wowed the world with the development of the Covid-19 vaccine in record-breaking time. But, what is it going to take to get this lifesaving technology into hundreds of millions of arms — a critical step in reaching herd immunity?
As an internal medicine doctor and infectious disease expert with decades of experience developing population-specific care models, I’ve seen large scale vaccination efforts with variable levels of impact. To get populations vaccinated in large numbers requires educational and community-based efforts that prioritize inclusion and impact on diverse communities. For example, polio eradication efforts showed that approximately 80% of the population needed to be immunized to prevent outbreaks, and due to similar “hesitancy” issues that we face today, took over a decade to get worldwide adoption and near eradication. Still, we continue to see outbreaks in communities in Asia where vaccination rates dip below the 80% threshold. Measles, which is more contagious, needs 93-95% of communities immunized to protect from outbreaks — there have been several notable outbreaks in the U.S. and abroad as a result of vaccination rates falling. History and tenets of vaccination suggest we need each of our “micro” communities succeeding in vaccination thresholds to reach the global “macro” level of herd immunity that we so desire.
Achieving herd immunity from Covid-19 will be even more challenging — due to its high R-naught (how we measure contagion), current ubiquitous presence across the globe, recent mutations exacerbating contagiousness, and perhaps most of all, unprecedented levels of distrust and division that pose significant challenges to adoption. With people under the age of 16 not yet eligible for the vaccine (20% of the population), we will need 100% of eligible adults to get vaccinated if we are to have any sensible shot at herd immunity in 2021.
With 40% of Americans currently “on the fence” — or “vaccine-hesitant” — our challenge is not only supply and distribution; it’s changing minds. If 4 out of 10 Americans remain unconvinced and refuse the vaccine, the efficacy of this lifesaving technology will radically erode.
So what do we need to do to overcome the barriers inherent to vaccine hesitancy?
First, we need to shift from a “one-size-fits-all” approach to hyper-targeted strategies for different populations — especially for those who have been “burned” by the healthcare system, namely women and BIPOC (black, indigenous and people of color) communities.
Women control more than 80% of healthcare decisions and dollars in the U.S. and are the de facto “Chief Medical Officers” of their families. Accordingly, women will often make the vaccination decisions not only for themselves but also on behalf of their partners and parents (and once the vaccine is approved for children, women will choose for them, too!).
Looking at the public opinion polls, women are 20% less likely than men to get vaccinated. Of reproductive-aged women 18-49, 42% are “hesitant” due to concerns about all side effects, including the implications for fertility, pregnancy, and breastfeeding — and this is in spite of the public recommendations from the American College of Obstetrics and Gynecologists on the vaccine’s safety.
Reaching into these pockets of hesitancy will require nuanced tailored education and counseling from authentic messengers who can speak to the community’s unique reservations and communicate candidly. It also means that we need to account and acknowledge the concerns for the lived experience of female patients as well as persons of all races, ethnicity, language, and sexual orientation — especially amongst Black and Latinx women.
It may mean that the scientific community engages earnestly with an Oprah Winfrey or a Kardashian, but also a local college student and a neighbor. Vaccine advocates may come in the form of a church pastor, a PTA mom, a trusted local store owner, a leading YouTuber, or a friend showing the world she trusts big pharma enough to take the shot in the arm for the health of herself, her family, and her community.
We need to get our information from trusted sources — recognize and avoid reckless misinformation — and spread the right information, backed by science, translated for the layperson. We can earn this trust with honest discourse. This means acknowledging what we do and do not know, while also addressing the specific concerns raised by groups who have experienced less than stellar, sometimes even mistreatment by our healthcare system.
Second, we need to design integrated and local vaccine education and distribution efforts that go hand in hand.
Sports stadiums, hospitals, and mass-market retailers like CVS & Walgreens have macro reach and distribution but lack the resources to deliver personalized education and outreach needed to assuage the groups questioning the vaccine. Ask a pregnant woman where she feels safe getting the vaccine and a packed sports stadium with 10,000 other people is a place to avoid, not seek out.
To counter vaccine hesitancy, especially dominant in at-risk communities, we need hyper-local and population-specific vaccine programs. We need to combine education and distribution at local clinics, pop-ups in our schools and markets, churches, community centers – even inside our own homes. The more entrenched and “small scale” these vaccine sites are, the more trusted they will be. Large scale distribution will vaccinate the half of the population ready to offer their arm now, but we must leverage the power of our neighborhood via local, authentic messengers to get to those most at-risk and “on the fence.”
Finally, we need to spend less time criticizing the process for roll out — chiefly supply and prioritization concerns — and more time on driving participation in the rollout itself. Based on the current rate of vaccinations in the U.S., it will take 10 years to reach herd immunity. Yes, we need the best and the brightest focusing on the rapidly increasing supply of vaccines. In parallel, we need to shift the public discourse — from politicians and healthcare leaders — to education and vaccine safety, now.
Despite the noble efforts to ensure ethical distribution of the vaccine, the emphasis on who should get it and if there is enough supply has slowed down efforts for anyone to get it all. As such, some people in the eligible tiers “turn down the vaccine” due to ethical concerns that someone else should get it first. Not only are rigid tiers operationally problematic, contributing to overly complex sign up processes and vaccine waste, they inadvertently exacerbate the central trust and vaccine hesitancy concerns most critical to solve.
We cannot wait until supply at scale is secured to educate and drive rollout. We must be comfortable getting needles in a few “lower priority” arms ahead of “higher priority” arms — knowing that if we do, the community as a whole will benefit. By reorienting public discourse, we can shift resources towards education and participation to change the minds of “fence-sitters” who are critical to mass market adoption and protecting those most vulnerable.
While it may seem counterintuitive to think “micro” given the “macro” nature of this problem, population-specific approaches are critical to cultivating trust at a time of unprecedented distrust — key for driving vaccine adoption, achieving herd immunity, and returning to normalcy.
Photo: User7565abab_575, Getty Images
