Trump’s covid vaccine dilemma: how public skepticism threatens to undermine a possible cure

In the race to find a vaccine for the coronavirus, most of the political focus has been on how soon it can be delivered and who gets it first. Meanwhile, scientists are anxious to examine data from the ongoing drug trails to ensure safety and efficacy protocols are being followed.

What about the public?

For months President Donald Trump has raised expectations that a vaccine will be available before the end of the year, “or maybe even sooner,” as he said in his speech to the Republican National Convention last week. “America is a nation of miracles,” added Vice President Mike Pence.

But, skepticism abounds.

Even before the coronavirus hit America, public support for childhood vaccines was falling. In January, a Gallup survey found a 10 % drop in enthusiasm for vaccines in the last 20 years. It found that 84% of Americans felt it was extremely or very important that parents vaccinate their children.

But that number appears to have plummeted in recent months with new polling suggesting that between one third and half of America's population would be unwilling or hesitant to get the covid-19 vaccine if it were available. A Pew poll found that skepticism was higher among Republicans (34%) than among Democrats (21%).

Ironically, Trump’s political future hinges, to some degree, on the response to the virus that has killed 190,000 Americans.

“It is ironic that Republicans are more skeptical,” said Dr. K. ‘Vish’ Viswanath professor of Health Communication at the Harvard T. H. Chan School of Public Health. Viswanath, and other public health experts, point out that Trump’s claims that it will be available very quickly were in contract to his questioning of the mitigation measures, such as social distancing and use of face masks, recommended by scientists.

“You can’t have it both ways. You can’t undermine public health principles and mitigation measures, and now expect the same group of people who have been persuaded to be skeptical to suddenly become open to vaccination,” said Viswanath.

"Vaccine hesitancy"

The World Health Organization considers so-called “vaccine hesitancy” a major threat to global health, and poor uptake would jeopardize the impact of a coronavirus vaccine. The common theory of vaccines is that not only do they protect individuals from infection to certain common diseases, widespread inoculation can also contain global spread and eventually eradicate it.

For decades, vaccines have been considered vital to preventing contagious diseases like measles and polio from spreading in the U.S..

But newer vaccines, including the annual influenza shot, have inspired less faith in the public. That is especially true among African Americans, in part due to a notorious 1947 experiment that used poor, rural Black men as medical guinea pigs during a syphilis study conducted in Alabama.

On July 4, the radical African-American Minister, Louis Farrakhan, delivered an address via webcast reminding Blacks in the United States and Africa about the risks of vaccines. "If they come up with a vaccine be careful,” he said. “Don’t let them vaccinate you with their history of treachery through vaccines, through medication.”

Anti-vax movement

Meanwhile, an ‘anti-vax’ movement, fueled by social media, has questioned the safety of all vaccines, alleging they do more harm than good and only serve to enrich unethical drug companies. The vast majority of public health experts reject such accusations, while recognizing that the health system does have its flaws, and sometimes fails to act swiftly enough when drugs are shown to be unsafe after entering the market.

In the past, Trump has expressed doubt about vaccines, supporting an unfounded campaign that sought to link them to autism.

In 2014 he tweeted “Healthy young child goes to doctor, gets pumped with massive shot of many vaccines, doesn't feel good and changes - AUTISM. Many such cases!”

In January 2017, shortly after his election, Trump met with a leading anti-vaccine campaigner, Robert F. Kennedy Jr, the nephew of President John F Kennedy. “They asked me to run a vaccine safety commission,” according to Kennedy.

But Trump dropped the idea soon after. “We were shut out. That was the end,” Kennedy told Univision.

Kennedy opposes the covid-19 vaccines, calling it a waste of money that would be better spent on developing better therapeutic drugs to treat patients. “That’s a better way to cut the fatality rate. I just don’t think we will ever be able to get a vaccine at all,” he said.

Kennedy has also accused politicians and regulators of being in bed with the pharmaceutical companies, highlighting a 1986 law which exempted drug companies from any legal liability in the manufacture of vaccines. Victims of adverse effects are covered by a National Vaccine Injury Compensation Program (VICP), funded by tax-payers.

The dilemma: efficacy and safety

Public health experts say that while companies may be legally covered, they still have a high degree of interest in showing a vaccine is effective. “For many drugs, trials are oriented to showing efficacy and a minimal level of safety, then our system allows them to be released into the wild, into the marketplace,” said Dr Vikas Saini, president of the Lown Institute, a nonpartisan think tank in Massachusetts that advocates for health care reform.

If any of the current vaccine trials show high efficacy there could be political pressure to rush it to market to save lives and help return the country to normal. “We desperately need a vaccine. It would be a game-changer,” said Saini.

That presents a dilemma for whoever is president. "Trying to time good news results around Election Day for political advantage is not a Trump thing or a Biden thing. That’s what politicians do. And it’s been dirty business long before Trump,” Saini said.

Transparency

To be sure, when it comes to vaccines there are a lot of systems set up to protect the public, said Natalie Dean, assistant professor of Biostatistics at the University of Florida, who specializes in vaccine studies.

“The key is transparency. People want to feel confident that the process is scientifically motivated and not politically motivated. They want to see what is informing the decisions that go into approving a product,” she said.

This week when the Centers for Disease Control and Prevention (CDC) announced it was “rapidly making preparations to implement large-scale distribution of covid-19 vaccines” as soon as November 1, two days before the election. That fueled speculation that the Trump administration was seeking to shorten the regulatory process for political gain. Officials quickly said the Nov. 1 date was for planning only and wasn’t meant to influence the presidential election.

There are four vaccines currently in clinical trials in the U.S, with the one from Moderna furthest along. But it’s not known yet if these vaccines will prove safe and effective for the general public.

Before any vaccine is approved the results of the drug trial are examined by an independent Data and Safety Monitoring Board. But the Food and Drug Administration, which is part of U.S. Department of Health and Human Services has the final say.

The FDA could decide to move ahead under a special’ Emergency Use Authorization’ (EUA), says Jennifer Kates, director of Global Health & HIV Policy with the Kaiser family Foundation. “There’s a lot of risks in doing that. It will be politically perceived, even if it’s not,” she said.

The EUA has only once before being used with a vaccine, in 2005 for the limited use of an anthrax vaccine to protect U.S. troops.

Until a vaccine emerges the public debate remains hypothetical and the level of vaccine hesitancy could vary, according to Mollyann Brodie, Executive Director Public Opinion and Survey Research at the Kaiser Family Foundation.

“Until we hear there actually is a real vaccine and who has blessed it, how it’s talked about, how it was tested and who is it safe for, we’re just not going to really know what level of vaccine hesitancy we are talking about,” she said.

That could also depend on the outcome of the election.

Political strategists also warn that the Trump administration needs to be careful. “The pandemic has unveiled a lot of truths that have already been taking place. For quite some time the general public has had great distrust in the key institutions that we once used to have trust in,” said Matt Terrill, a former Republican Party consultant who now works for Firehouse Strategies, a corporate consulting firm in Washington DC.

“The Trump campaign needs to manage expectations but also show that this is micro-success taking place,” he added.

'Herd immunity'

Public health experts say the consequences of any political mishandling of the covid-19 vaccine could be disastrous for public confidence in taking it. In practical terms, experts say in order for a vaccine to work it needs a large proportion of the population to take it, creating a high enough level of immunity, the so-called herd immunity level, where transmission is so shut-down only sporadic cases occur tat can be easily stamped out.

“If there’s a public perception this this was rushed and you can’t be sure of the evidence … that could hinder the rollout unless there’s some really strong and consistent messaging coming from the leadership,” said Eric Schneider, a New York-based foundation that seeks to promote health care improvements .

“We’re having difficulty right now conveying messaging to people about wearing facemasks. In that context, what’s the likelihood of being engaged in a public health campaign that involves something that’s even higher risk generally than wearing a facemask?” added Schneider.