While pharma companies and public health bodies around the world scramble to develop a vaccine for COVID-19, one might assume that the fervour around the vaccineas the likely pandemic exit strategy would make everyone desperate to receive it. This is far from the case and the pharmaceutical industry can have a hand in helping.
Vaccine hesitancy is by no means a new movement. But those cautiously optimistic that the worst pandemic since 1918 would dampen its popularity have been left frustrated.
YouGov polling in May found that 55 per cent of US adults said they would receive a COVID-19 vaccine. Two months later this figure had dropped to just 41 per cent.1 This sentiment is echoed in many high-income countries – an Ipsos Mori study in July finding that only 53% of people in the UK would be certain or very likely to take a COVID-19 vaccine.2
The primary objective of a vaccine is to reach herd immunity – for COVID-19, experts estimate that 60-70 per cent vaccination coverage would trigger this phenomenon, leaving the whole of the community immune.3 As it stands, public opinion therefore appears to be capable of compromising a vaccine’s ability to contain the disease.
Those with deep enough concerns to turn down a vaccine fall broadly into two categories according to Vish Viswanath, Professor of Health Communication in the Department of Social and Behavioural Sciences at the Harvard T H Chan School of Public Health4:
- Dogmatic anti-vaxxers, who oppose vaccination as a principle – primarily due to often misplaced safety concerns or resistance to infringements of personal liberty. The Center for Countering Digital Hate (CCDH) research shows anti-vaxxers now have an online following of 58 million, based primarily in the US but with significant numbers in the UK, Canada and Australia too.5 Viswanath claims that these people “are not going to change their views.”6
- The second group, Viswanath says, are people who probably wouldn’t consider themselves ‘anti-vaxxers’ but do have “legitimate questions” about vaccine efficacy and safety7 (e.g. fears that an expedited regulatory process will produce a potentially dangerous vaccine). These people “want to do the right thing, but they have doubts.” This faction makes up what could be called the ‘swing vote’ in terms of the achieving herd immunity. According to Viswanath “this is where we need to be focusing our attention.”8
Indeed, it is with this second group where the pharma industry may have a role to play in making people more positive towards vaccination.
Bobby Duffy, Professor of Public Policy at King’s College London says that there is a clear link between mistrust of the establishment and hostility to a vaccine.9 Distrust in big pharma, perceived to sit within this establishment, is often cited in anti-vax messaging10 and is something that the pharmaceutical industry has historically struggled with. Improving trust relations between the industry and ‘the people’ may therefore have a positive knock-on effect on perceptions of the benefit of vaccines.
The global medical community are firmly on the side of ‘pro-vaxxers’ – vaccine hesitancy was listed by the World Health Organisation as one of the top ten threats to global health in 2019.11 But this argument is not purely moralistic for pharma. The small number of companies involved in vaccines (a number that has risen as a result of the search for a COVID-19 vaccine) should be concerned about what impact a burgeoning anti-vax movement could have on future revenue. If the movement becomes large enough to threaten herd immunity, and as a consequence the viability of vaccines as a whole, then governments may think twice before procuring and rolling out nationwide vaccination programmes. This would place vaccine portfolios and pipelines at risk. This quite extreme hypothesis may not be as far off as it once seemed.
The race for the COVID-19 vaccine represents both a significant risk but also a potential opportunity for the reputation of pharma and consequently the popularity of vaccine hesitancy. If a vaccine is rolled out globally, following a fast-tracked regulatory process, which is either limited in its effectiveness or causes serious, harmful side effects, then the anti-vax movement will likely grow in size and intensity. However, if a COVID-19 vaccine is produced, with little to no side effects, that starts to make a demonstrable impact on the spread of the coronavirus, the “legitimate questions” from the vaccine hesitant community will surely be answered.
In September, chief executives from nine pharmaceutical companies pledged not to submit their coronavirus vaccines for regulatory approval unless large clinical trials have proven them to be safe and effective.12 Concerted efforts like these that display commitments to vaccine safety can go a long way to building trust within the vaccine hesitant community. Much more must be done, however, to ensure people have faith in the benefits of vaccination.
By Chris Melson