One year ago, on Dec. 11, the FDA made the Pfizer-BioNTech COVID-19 vaccine available in the United States via emergency use authorization (EUA). Since then, that mRNA vaccine has received full FDA approval, plus vaccines from Moderna and Johnson & Johnson became available under EUAs. Age groups eligible for these shots expanded to everyone but those younger than 5, and now everyone 18 and older can get a booster.
As of this week, more than 72% of the U.S. population had received at least one dose of a COVID-19 shot. Though uptake has been uneven, with white people most likely to get vaccinated, those gaps are shrinking thanks to the work of groups like the Philadelphia-based Black Doctors COVID-19 Consortium, founded by Ala Stanford.
Experts predicted what might happen during the first 12 months of vaccine distribution, but how did it actually go?
“It has been a year, in every meaning of that,” said Penn behavioral scientist Alison Buttenheim, director of engagement for the Leonard Davis Institute of Health Economics (LDI), during a recent panel on the subject. “We knew it would be a wild ride, but I think there were also some things we didn’t quite anticipate.”
To discuss some of these consequences, plus what to expect looking forward, Buttenheim, an associate professor in the School of Nursing, moderated a conversation with Stanford, Penn Medicine’s Florence Momplaisir and Paul Offit, also of the Children’s Hospital of Philadelphia, and Nicole Lurie, strategic advisor to the CEO of the Coalition for Epidemic Preparedness Innovations.
They talked about the vaccine rollout both in the U.S. and globally, as well as vaccine hesitancy, demand, boosters, misinformation, and a whole lot more.
Distribution of 8.6 billion doses around the world has varied significantly, with 1.9 billion going to high-income countries and fewer than 70 million going to low-income countries, according to the global organization ONE.
Lurie noted that evening this out is the best way forward. “We’ve got to get vaccine to the rest of the world, and we desperately need to accelerate it,” she said.
Though locally there’s still work to do, Momplaisir, a Penn infectious disease physician, said Philadelphia is moving in the right direction. “What we’ve done better is being intentional when addressing disparities in vaccine uptake,” she said. “Issues related to racial disparities are complex, and they are rooted in practices of structural racism. It will take a lot of time and persistent, intentional effort to move the needle toward equity. I think we can get there.”
She and Lurie stressed the need for a multipronged strategy that assesses vaccine access and also why people feel hesitant to get a shot, what messaging is out there, and who is saying it. “This is valid for both the U.S. and globally,” Momplaisir said.
Misinformation and misfires
Offit, director of CHOP’s Vaccine Education Center and chair of vaccinology at Penn Medicine, said one of the biggest communications errors of the past year happened after 346 fully vaccinated people who had celebrated July 4 in Provincetown, Massachusetts, got COVID.
Four were hospitalized, meaning a hospitalization rate of just 1.2%. “That’s good. That’s a vaccine that’s working very well,” Offit said. The rest of the cases—primarily asymptomatic and mild—were quickly labeled as “breakthroughs.”
“The term ‘breakthrough’ implies failure, holding this vaccine to a standard that we hold for no other mucosal vaccine,” he said. “If you have an asymptomatic or mildly symptomatic infection after you’ve been vaccinated, you won. That’s what you want. But the term ‘breakthrough’ created an expectation for this vaccine that I think is very, very hard to meet.”
Misfires like that, coupled with misinformation, can negatively affect vaccine uptake, said Momplaisir, an assistant professor and LDI senior fellow. She cited a randomized control trial in which 4,000 people in the U.S. and United Kingdom received either accurate COVID-19 vaccine information or misinformation via social media.
The results showed a 6% decline in intention to get vaccinated among those exposed to misinformation. “You could say, ‘OK, 6% is not a big difference,’” she said. “But when you multiply that at a population level, it really can have a significant impact.”
Combating all of this requires getting creative, particularly on social media, said Stanford, who recently started the Center for Health Equity in Philadelphia. She has used herself and her children as examples, for instance, posting to social media after her twins, who are in 6th grade, received their shots. “Trust is earned,” she said. “You can’t flip a switch to get it.”
Variants and boosters have complicated this already complex situation. “I think omicron was used as an excuse to offer a booster dose,” Offit said.
He doesn’t dispute that boosters should go to those older than 65, those who work in long-term care facilities, and possibly, those older than 50 with medical conditions that put them at high risk from COVID. “But otherwise, we have this war against mild infection for young people that doesn’t make a lot of sense to me,” he said.
Instead, the focus should be on getting the unvaccinated vaccinated, Lurie said. “We’re down to a much more challenging reach-and-convince population.”
Maybe that convincing happens through more emotional or personal appeals coming from trusted community members, according to the panelists. Maybe, they suggested, it’s through vaccine mandates. Perhaps it’s a little of each, or something else altogether. All agreed that it’s impossible to predict where we’ll be a year from now.
“This pandemic humbles everyone because it moves at such a rapid pace,” Momplaisir said. “We have to continue being intentional.”
The full recorded panel discussion is available at https://ldi.upenn.edu/events/covid-19-vaccines-one-year-later/.