To end the pandemic, we need to make trust contagious

Developing safe and highly effective vaccines for COVID-19 was a monumental scientific achievement.

Now comes the hard part: convincing enough people to be vaccinated to bring the pandemic to an end.

Dr. Rakesh Pai, president of the Metro Health Medical Group and Metro’s chief population health officer, is well aware that some people have doubts. That’s one of the reasons he volunteered for one of the large-scale Phase 3 trials to test the safety and efficacy of a vaccine. 

“I do worry about enough people believing that the vaccines were rushed,” Pai said. “They were not rushed. The processes are rigorous, and I have complete confidence in them.”

Although public enthusiasm for the vaccines appears to be increasing as they undergo independent scientific review, a recent survey by Pew Research Center found that confidence varied by demographics. Overall, 60 percent of Americans told Pew researchers in November they would get a vaccine when available – up from 51 percent in May but short of the generally accepted goal of 70 percent.

Confidence was even lower in some demographic groups, particularly African Americans, with only 42 percent reporting that they intend to be vaccinated.

Pai noted the historical basis for distrust among African Americans. This includes a legacy of medical abuses exemplified by the infamous and unethical Tuskegee Study, when poor Black men were told they were being treated for syphilis but were not – even after an effective treatment was discovered. The study continued for 40 years until a whistleblower came forward in 1972.

That history, Pai said, is why Metro Health is committed to sharing as much information as possible about the vaccine development and approval process.

“We understand that reticence to participate,” Pai said. “We need to talk to those communities we want to serve, explain the processes are rigorous, and the volunteers enrolled in the trials are representative of a broad population.”

Pai noted the diversity documented by studies of vaccines, as well as what he learned about the clinical trial he joined, a Michigan Medicine study of the Janssen vaccine.

Doubt about the vaccine, however, is not limited to African Americans. The Pew study found “complex and interrelated” factors that influence the intent to be vaccinated. Enthusiasm varied by gender, age, education and income.

Pai is especially concerned about rumors and misinformation about the vaccines. The only cure for that is to present the truth, he said.

Trustworthy process

It is important, Pai said, to understand that the drug companies did not design the large-scale Phase 3 trials that collected data about safety and efficacy. These were designed by independent scientists, doctors and experts at the National Institutes of Health and the Biomedical Advanced Research and Development Authority. The results are reviewed by other independent experts and presented to the Vaccines and Related Biological Products Advisory Committee, which is chaired by Arnold Monto, a leading epidemiologist from the University of Michigan’s School of Public Health. That panel makes recommendations in public hearings to the U.S. Food & Drug Administration for final approval.

“There's no single company that are driving these criteria,” Pai said. “The financial interests are set aside or suspended. The federal government is providing this to all its citizens at zero cost to them.”

The Approval Process Was Not Rushed

“Operation Warp Speed" refers to the manufacturing and logistics for vaccine distribution – not the review for safety and efficacy. This innovative approach allowed vaccine makers to begin manufacturing at the same time that vaccines were undergoing painstaking review. The result is that vaccines will be manufactured, packaged and ready for distribution soon after they are proven to be safe and effective.

The Need for Widespread Vaccination

Surveys show many people are taking a wait-and-see approach with the vaccines developed to protect against COVID-19. However, Pai said widespread vaccination will be necessary to return to the activities of modern life.

He noted Qantas airlines already has announced that proof of vaccination will be required for passengers once a vaccine is approved for widespread use. Pai envisions a time when similar proof will be required for summer camps, or to attend a concert. He would like to see vaccination rates approaching 95 percent, which will likely prove challenging.

“I think you're going to need all that to reassure people to do some of the things they'd like to do to come together,” he said.

Science, Technology and Hope

The development of the vaccines was enabled by advances in scientific research that has taken place over decades. This is just glimpse of accelerated medical innovation in coming years, Pai said, as expanding artificial intelligence and machine learning are applied to solve the biggest problems of human health.

“I always will tell anyone who will listen, something to the effect of, ‘There's no better time to be born in this country than today,’” Pai said. “There will be no better time to be born in this country than two weeks from today, or three years from now, or a decade from now. The reason is that we’re all benefitting from massive innovation in genomics, data science, artificial intelligence and robotic and virtual reality assisted technologies.”

Read further articles in this series:

Part 1. COVID vaccine trials need diverse test subjects, so a doctor rolled up his sleeve

Part 2: The process that is bringing COVID-19 vaccines forward