COVID-19 vaccine effectiveness to be affected heavily by infrastructure, public attitudes

November 19, 2020

BOSTON - The success of a COVID-19 vaccine will depend not only on its efficacy, but will hinge at least as much on how fast and widely it can be delivered, the severity of the pandemic, and the public's willingness to be immunized, according to a study published in Health Affairs. The authors, who include investigator and senior author Rochelle Walensky, MD, MPH, chief of the Division of Infectious Diseases at Massachusetts General Hospital (MGH), demonstrate that far more investment is needed in ensuring that approved COVID-19 vaccines can be produced and distributed efficiently, and that more must be done to promote the public's trust in immunization and willingness to continue practices that slow the spread of the novel coronavirus.

Billions of dollars have been spent on developing COVID-19 vaccines, and preliminary evidence suggests that several candidates appear to be extraordinarily effective. "But there are lots of ways to think about the effectiveness of a vaccine," says Walensky. She teamed up with A. David Paltiel, PhD, a professor of Public Health (Health Policy) at the Yale School of Public Health (YSPH), and several other colleagues to create a mathematical model that assessed how other factors beyond a COVID-19 vaccine's efficacy might influence how well it thwarts the disease. Those factors included:

- How fast and broadly can the vaccine be produced and administered? Some candidate vaccines pose logistical challenges, such as needing to be stored in ultra-cold freezers or requiring two doses, spaced weeks apart.

- What portion of the population is willing to be vaccinated? National surveys suggest that as few as 50% of Americans say they will receive a COVID-19 vaccine.

- The severity of the pandemic when a vaccine is rolled out. The proportion of infections a vaccine is able to avert is directly related to the public's willingness to engage in mitigation behaviors, such as wearing masks and social distancing.

The mathematical model considered how these factors would influence the impact of vaccines of varying levels of efficacy. "We found that infrastructure will contribute at least as much to the success of the vaccination program as will the vaccine itself," says Paltiel. "The population benefits of vaccination will decline rapidly in the face of manufacturing or deployment delays, significant vaccine hesitancy, or greater epidemic severity."

To help ensure a vaccination program's success, Walensky says that significantly greater investment is needed in an infrastructure to deliver COVID-19 vaccines. Moreover, powerful public messages and on-the-ground implementation strategies at the local level are also necessary to help overcome skepticism about vaccines, especially in underserved populations.

Likewise, the Health Affairs study showed that even a highly effective vaccine will struggle to control COVID-19 if infection rates continue to rise. "If I have a cup of water, I can put out a stove fire. But I can't put out a forest fire, even if that water is 100% potent," says Walensky, emphasizing the public's role in keeping the infection rate low by mask wearing and social distancing. "We'll get out of this faster if you give the vaccine less work to do."
Walensky is also co-director of the Medical Practice Evaluation Center at MGH and a professor of Medicine at Harvard Medical School (HMS). Paltiel is also professor of Management, professor in the Institution for Social and Policy Studies, and co-director of the Public Health Modeling Concentration at Yale. Coauthors of the study were Jason L. Schwartz, PhD, assistant professor of Public Health (Health Policy) at YSPH; and Amy Zheng, a medical student at HMS.

About the Massachusetts General Hospital

Massachusetts General Hospital, founded in 1811, is the original and largest teaching hospital of Harvard Medical School. The Mass General Research Institute conducts the largest hospital-based research program in the nation, with annual research operations of more than $1 billion and comprises more than 9,500 researchers working across more than 30 institutes, centers and departments. In August 2020, Mass General was named #6 in the U.S. News & World Report list of "America's Best Hospitals."

Massachusetts General Hospital

Related Public Health Articles from Brightsurf:

COVID-19 and the decolonization of Indigenous public health
Indigenous self-determination, leadership and knowledge have helped protect Indigenous communities in Canada during the coronavirus disease 2019 (COVID-19) pandemic, and these principles should be incorporated into public health in future, argue the authors of a commentary in CMAJ (Canadian Medical Association Journal)

Public health consequences of policing homelessness
In a new study examining homelessness, researchers find that policy such a lifestyle has massive public health implications, making sleeping on the street even MORE unhealthy.

Electronic health information exchange improves public health disease reporting
Disease tracking is an important area of focus for health departments in the midst of the COVID-19 pandemic.

Pandemic likely to cause long-term health problems, Yale School of Public Health finds
The coronavirus pandemic's life-altering effects are likely to result in lasting physical and mental health consequences for many people--particularly those from vulnerable populations--a new study led by the Yale School of Public Health finds.

The Lancet Public Health: US modelling study estimates impact of school closures for COVID-19 on US health-care workforce and associated mortality
US policymakers considering physical distancing measures to slow the spread of COVID-19 face a difficult trade-off between closing schools to reduce transmission and new cases, and potential health-care worker absenteeism due to additional childcare needs that could ultimately increase mortality from COVID-19, according to new modelling research published in The Lancet Public Health journal.

The Lancet Public Health: Access to identification documents reflecting gender identity may improve trans mental health
Results from a survey of over 20,000 American trans adults suggest that having access to identification documents which reflect their identified gender helps to improve their mental health and may reduce suicidal thoughts, according to a study published in The Lancet Public Health journal.

The Lancet Public Health: Study estimates mental health impact of welfare reform, Universal Credit, in Great Britain
The 2013 Universal Credit welfare reform appears to have led to an increase in the prevalence of psychological distress among unemployed recipients, according to a nationally representative study following more than 52,000 working-age individuals from England, Wales, and Scotland over nine years between 2009-2018, published as part of an issue of The Lancet Public Health journal on income and health.

BU researchers: Pornography is not a 'public health crisis'
Researchers from the Boston University School of Public Health (BUSPH) have written an editorial in the American Journal of Public Health special February issue arguing against the claim that pornography is a public health crisis, and explaining why such a claim actually endangers the health of the public.

The Lancet Public Health: Ageism linked to poorer health in older people in England
Ageism may be linked with poorer health in older people in England, according to an observational study of over 7,500 people aged over 50 published in The Lancet Public Health journal.

Study: Public transportation use linked to better public health
Promoting robust public transportation systems may come with a bonus for public health -- lower obesity rates.

Read More: Public Health News and Public Health Current Events is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to