Issue 3 • 2021
Congress 2021 – COVID-19 Vaccine: Reflections on the cost (and promise) of speed
What influences the decision to get vaccinated? The five As:
  • Awareness
  • Acceptance
  • Activation
  • Access
  • Affordability
Vaccination against COVID-19 has never been more important. The development of vaccines to mitigate the risks of the virus have been welcome, but they have also been scrutinised. At RACP Congress 2021 ‘COVID-19 Vaccine: Reflections on the cost (and promise) of speed’ explored three viewpoints involving the race for a COVID-19 vaccine, and what lessons we’ve learned along the way.
Facilitated by University of Queensland Honorary Associate Professor Peter Hill, the session was presented by University of Queensland Associate Professor Simon Reid, Director of Public Health at Wide Bay Hospital and Health Service Dr Margaret Young, and University of Sydney Professor of Public Health Julie Leask.
Why being prepared can make all the difference Professor Reid opened the Congress session emphasising the need for preparedness when it comes to managing a country’s response to a global pandemic.
The first wave of COVID-19 in Australia and Aotearoa New Zealand was largely spurred by international travel, and in both countries we were able to quell the spread by tight border restrictions, hotel quarantine arrangements and lockdowns.
The second wave was dominated by our national capacity to respond to the evolving virus. Professor Reid explained that nations with fragile health systems and limited vaccine supply faced more difficulty in controlling outbreaks than those with strong and strategic preparation systems in place.
For example, a country with limited vaccine supply will experience greater health challenges in the event of a major or aggressive outbreak. This is what we are currently seeing in Australia following the emergence of the highly infectious Delta variant.
Here is where preparedness is key
Preparedness is currently envisaged as a function of implementing the international health regulations (IHR). Increased compliance is seen as the avenue to increase preparedness and prevent and/or mitigate future pandemics. However, global preparedness is dependent on all nations implementing the IHR fully. Strong implementation will maximise preparedness within a country, but can it prevent a future pandemic? Global funding towards supporting an International Health Regulation Implementation is crucial, but not sufficient to prevent the next pandemic that will likely arise from an animal reservoir.
“Currently 50 per cent of funding globally is going to immunisation and emergency response efforts as main prevention measures,” said Professor Reid.
“Redirecting funding towards lesser areas such as biosecurity and environmental factors may assist in moving the paradigm so that we can begin to focus on slowing down the emergence of new diseases,” explained Professor Reid.
The perfect vaccine Dr Young’s presentation delved into Australia’s own management of COVID-19 and the impact of vaccines on emerging response measures.
At the time of Congress, Australia was cruising through limited local community transmission. State, territory and federal governments carefully used extraordinary powers under public health legislation to implement border restrictions, extensive social measures and public health responses, including isolation and quarantine.
If we view the impact of these measures through a social determinants of health lens, it is clear that health and well-being have been implemented from all angles, including income, working conditions, job security, food security, housing, access to quality education and healthcare, and social and cultural perspectives.
The development of an effective vaccine for administration at a population level is a requisite for transitioning to the lives we knew before. People yearned for fewer barriers to social engagement, unrestricted travel, and a sense of social and economic stability. Investment in vaccine development, healthy global competition and speed, not haste, have been absolutely critical in the response to COVID-19. When Australia finally received its first deliveries of Pfizer and AstraZeneca, there were some reservations, but many believed these vaccines meant a new normal was on the horizon.
The perfect vaccine is safe, effective, affordable, easily administered, thermally stable, and multivalent with a long duration of effect. The COVID-19 vaccines presented some challenges in relation to these qualities, but had been extensively used globally and had growing safety and efficacy credentials. Although the community desired a return to normal, low rates of COVID-19 removed urgency around vaccination. The vaccine rollout was failing to pick up speed, falling victim to vaccine hesitancy and, perhaps, this notion of ‘the perfect vaccine’.
“With other vaccines, most people don’t know the brand name, like the Hepatitis vaccine. You just go and get it because you trust that it’s gone through the regulatory process. People are also focusing on efficacy without realising that program effectiveness is more important than the efficacy in a clinical trial,” said Dr Young.
Discussions about efficacy pitched COVID-19 vaccines against each other, negatively impacting the balance between supply and demand. Then the emergence of serious adverse events, albeit rare, heightened anxiety. The need to communicate well and address hesitancy was clear.
Communication to address hesitancy Instances of thrombosis with thrombocytopenia syndrome (TTS) in patients who received the Oxford AstraZeneca vaccine increased hesitancy, contributing to Australia’s slow rollout.
A 2020 report by the National Centre for Immunisation Research and Surveillance (NCIRS) on factors influencing the decision to accept and receive a COVID-19 vaccine showed that new vaccines were trusted less. Sentiment tracking by the Australian government in November showed 23 per cent of respondents were unsure of the long-term side-effects.
Prior to the identification of TTS as a rare serious side-effect of the AstraZeneca vaccine, YouGov and the Imperial College London COVID-19 behaviour tracker showed that 65 per cent of Australians were willing to get vaccinated. However, this fell to 59 per cent in their subsequent report in May 2021. The main reasons given by respondents were “concerns about side effects” and “concerns that there has not been enough testing of vaccines”. This has since recovered in other studies.
Supply and access were also points of concern. A large rollout requires complex strategies to ensure everyone has access to the vaccine, that vaccines are administered in a timely manner, and that there is also global equity of supply. So far, as Professor Leask explains, this has been difficult.
“The cost of speed is that new vaccines tend to be trusted less. Rapid development of vaccines is affecting the public’s willingness to receive them. We have the prospect of people being protected from COVID-19 but supply and confidence in safety are ongoing challenges,” said Professor Leask.
To boost confidence and address public concerns, vaccination communications must balance respect for autonomy with the beneficence that vaccines bring and address global equity of access. They must also be adaptable to different groups such as older people, Aboriginal and Torres Strait Islander communities, those with a disability, culturally and linguistically diverse populations, those who may have pre-existing medical conditions and other special risk populations.
Professor Leask co-wrote the Communications chapter of the World Health Organization’s (WHO) 'Safety Surveillance Manual' which provides practical guidance for navigating vaccine safety communications. The goals of such communication are to:
  • Empower people to make evidence-informed choices about
  • COVID-19 vaccination
  • Encourage trust in health authorities and those delivering the vaccine
  • Facilitate access to timely, accurate and credible information about COVID-19 vaccination safety via trusted channels
  • Provide people with a means of asking questions and having their concerns addressed.
This Congress session remains topical as Australia’s vaccination rollout continues. We now have the tools to identify the shortcomings and prepare for the next steps, especially following the Therapeutic Goods Administration’s approval of the Moderna vaccine for use, beginning in September.
© 2021 The Royal Australasian College of Physicians