A coronavirus vaccine could end this agonizing pandemic. But two new polls out last week revealed startling numbers on how many Coloradans actually want to receive one.
The first, from the Colorado Health Foundation, found nearly one-third of Coloradans surveyed said they would likely not step up to get vaccinated for coronavirus when a vaccine becomes available. Fewer than half of the people in the survey said they are very likely to get the vaccine.
And that was actually the more optimistic of the two polls. An AARP poll found that, if a free coronavirus vaccine were available today, more Coloradans would choose not to get it than would choose to receive it.
To Jennifer Reich, a professor of sociology at the University of Colorado Denver who has spent years studying why people refuse vaccines, the numbers weren’t that surprising. Colorado has long struggled with near-bottom vaccination rates for kids, and the combination of a strong anti-vaccination movement and a deeply entrenched libertarian ethos makes it logical that the state will also likely struggle to persuade people to get a coronavirus vaccine, Reich said.
“The COVID vaccine is leaving people who are already uncomfortable with vaccines and vaccine safety with new questions,” she said.
But the polls also contain a deeper revelation: Even the modest support that exists in Colorado for a coronavirus vaccine exists on a fragile foundation that could be eroded if approval for the vaccines becomes politicized.
In both polls, people who identify as liberal are most likely to say they want the coronavirus vaccine. Among Democrats in the Colorado Health Foundation poll, 85% say they are likely to get the vaccine, compared with 52% of Republicans and 63% of independents. In the AARP poll, Democrats were the only political group in which more than half of people surveyed said they would agree to be vaccinated.
This sets up a nightmare scenario for Colorado health leaders. What if the Trump administration circumvents the normal approval process for a new vaccine to meet President Donald Trump’s stated goal of having one available before the election? What if the approval looks similar to the administration’s controversial approval for another coronavirus-fighting tool, convalescent plasma? What if politics muddies the most basic questions — Does it work? Is it safe? — and makes the one group of people most likely to get the vaccine suddenly reluctant?
“Whether it’s true or not,” said Dr. Anuj Mehta, a National Jewish Health pulmonologist who is helping the state create fair allocation protocols for the future vaccine, “it’s all about perception.”
Added Reich: “I would say I don’t think having a politically established deadline is creating confidence that science is leading this effort.”
The question of politics adds an unwelcome wrinkle to the state’s planning for how to distribute vaccine supplies, once available.
Health care workers are expected to be first in line to receive the vaccine. But Mehta said, if the approval process is rushed, nontransparent or outside the usual procedures, even health care workers would likely be hesitant to receive it. And that could have a ripple effect, building distrust throughout the rest of the population.
By contrast, Mehta said, if health care workers trust in the vaccine’s approval and turn up en masse to receive it, that could reassure the public that the vaccine is safe. It all depends on how political the process is, and it’s why Mehta said regulators like the Food and Drug Administration need to go out of their way to show they are separate from political considerations.
“An independent FDA is a critical part of the medical system in the United States,” he said.
There have already been worrying signals in this area, though.
Trump was an early proponent for using the drug hydroxychloroquine to treat coronavirus, and, despite shaky supporting research and evidence of political involvement, the FDA issued an emergency authorization for the drug to be used against COVID-19. As study after study has subsequently shown that the drug is not effective, the FDA revoked its authorization.
A similar pattern repeated, though, when the FDA issued an emergency authorization for a different coronavirus treatment, convalescent plasma. The authorization for the treatment, which many scientists say is likely helpful but not a cure, was announced at a news conference where the FDA presented misleading data justifying its efficacy that didn’t appear in any of the supporting studies. FDA Commissioner Stephen Hahn later apologized.
Despite the criticism, Trump has not been shy about tying politics to approval for COVID-19 treatments. Last month, the president tweeted that the “deep state” at the FDA is slowing the approval process for coronavirus vaccines and treatments.
“Obviously, they are hoping to delay the answer until after November 3rd,” Trump wrote, referencing Election Day. “Must focus on speed, and saving lives!”
He tagged Hahn, a former top executive at The University of Texas M.D. Anderson Cancer Center whom Trump appointed to the role of FDA commissioner, in the tweet.
Diminished faith in health leaders
Likely as a result of these kinds of controversies and others, polls in recent months have consistently found Americans distrustful of government health officials and their work. Both Republicans and Democrats are losing trust in the nation’s top disease-fighters, according to a Kaiser Family Foundation poll released earlier this month. A poll released last month found that substantial majorities in both parties believe the coronavirus vaccine approval process is being driven by politics, not science.
National polls have found large numbers of people plan not to receive a coronavirus vaccine, though perhaps not as great of a percentage as in Colorado. A Pew Research Center survey from May found 72% of people said they would get vaccinated. A Gallup poll last month found a smaller number — only 65% of people surveyed would get the vaccine.
In a truly extraordinary move to counter this growing distrust, a group of nine leading pharmaceutical companies last week issued a joint statement promising to uphold scientific rigor and caution in moving forward with vaccine development, making, “the safety and well-being of vaccinated individuals our top priority.”
“We believe this pledge will help ensure public confidence in the rigorous scientific and regulatory process by which COVID-19 vaccines are evaluated and may ultimately be approved,” the statement read.
Colorado health leaders widely agree that it will take more than a promise from drug manufacturers to restore public trust. Instead, they talk about the need for transparency and accountability. This means clinical trials must be robust and followed through to completion. Data from that research needs to be published publicly. Officials need to be honest about any potential risks and place them in context.
And then, once a vaccine is proved safe, a broad public-messaging campaign should be undertaken that enlists everyone from the most prominent people in the state down to family doctors.
“You use leaders, whether they be sports leaders, actors, other community leaders to convey messages because people will respect them and will follow the norm,” said Dr. Jon Andrus, an internationally renowned immunization specialist who is an adjunct professor with the Colorado School of Public Health and has worked on vaccination campaigns for polio across the globe.
“Transparency is critical,” he added.
Potential ripple effects
But, as with many in Colorado’s health community, there is a palpable anxiety in the way Andrus talks about the coming rollout of a coronavirus vaccine.
Andrus has experience working with both the federal Centers for Disease Control and Prevention and for an arm of the World Health Organization. He said he’s never seen U.S. public health institutions in such disarray. He calls it “mind-boggling” that national health officials haven’t been able to fully take the lead in the response to the pandemic. And now, with a vaccine likely on its way, the nation’s entire health system could be headed for a reckoning.
“Will we get it right?” he asked. “A lot is riding on that.”
He paused to talk about the need to make sure the initial allocation systems for the vaccine are fair and ethical, another way to build public trust. Then, he added: “All I can say is that I hope we get it right.”
This has become a pervasive thought among many health leaders. Andy Slavitt, a former Obama administration health official who lives in Minnesota, earlier this month gave succinct voice to the worries that getting it wrong will hurt all public health efforts.
“Done right,” Slavitt wrote, “vaccines end pandemics. Done wrong, pandemics end vaccines.”
Reich, the University of Colorado Denver sociologist, expressed her own version of this fear. Botching the coronavirus vaccine because of politics might have consequences far beyond the current pandemic — and harm those who have mostly escaped the worst of COVID-19.
“If this vaccine is handled badly and circumvents the normal safety processes, that could undermine confidence in all vaccines,” she said. “And the outcomes of that for children’s health would be devastating.”
But she also knows that the antidote to vaccine concerns can’t be as simple as signing up a few celebrities to get the shot. Vaccines are unique among medical treatments in that they are given to healthy people with the promise of warding off sickness. Everybody has a limit to how much they are willing to trust that promise, based on the evidence available.
Asked whether she will get the coronavirus vaccine when it is approved, Reich started by talking about how her research has taught her all the ways existing vaccines have been checked and rechecked. They are commonly referred to as the safest pharmaceutical product on the market.
“I’ve become really impressed that vaccines normally have exceptionally strong post-license safety monitoring,” she said.
But, returning to the question, she chose her words carefully.
“I would have to know,” she said, “that it meets the standards that already exist.”