Like Ryan, the World Health Organization’s health emergencies director, had a conversation recently with his mother, the kind that lots of public health people are having these days, much to their dismay. Ryan’s mother was concerned about one of the Covid-19 vaccines in use in Ireland, where she lives. The one made by AstraZeneca.
Clinical trials had shown the vaccine offered protection against the disease, but less than the vaccine made by Moderna or the one made by Pfizer and BioNTech. Ryan’s mother was worried the vaccine might not be good enough.
Ryan, never one to mince words, decided it was time for a come-to-Jesus chat with his 80-year-old mother. “Whatever vaccine they show up with, you take it,” he told her. “Because that is the best decision you can make on that day for your health.”
That’s a message Ryan and other public health officials are trying to deliver to everyone — but it’s not necessarily one that is being well-received. News coverage and social media posts about clinical trial results are creating a hierarchy of Covid vaccines in the minds of much of the public: “good vaccines” and “bad vaccines.” The former you might try to seek out; the latter might even prompt you to step out of line.
That, health officials say, is a problem.
The concern isn’t just that people will get picky about which vaccine they want, slowing down the task of inoculating enough of the population to blunt the impact of Covid-19. Public health experts also worry a simplified narrative overlooks essential facts — say, that AstraZeneca’s and Johnson & Johnson’s vaccines were being tested in clinical trials after variants of the SARS-CoV-2 virus started to circulate widely, likely reducing their efficacy more than was the case with Pfizer’s and Moderna’s vaccines, the first to be cleared.
The vaccines perceived to be less effective also happen to be ones that may be the best option in rural America or in low-income countries because they don’t require the ultra-cold freezers and complex delivery systems more commonly found in or near major cities.
“I worried that we’re going to have that kind of consumer-driven ‘Oh, is it Moderna? Great! Is it [Johnson & Johnson]? No, thank you, I’ll wait,’” said Alison Buttenheim, an associate professor of nursing and health policy at the University of Pennsylvania, whose research focuses on vaccine acceptance. “That’s just going to delay getting to the coverage that we want to get to.”
In truth, the phenomenon is already playing out, even among some who understand the caveats around when the studies were conducted and the operational benefits of these easier-to-deploy vaccines. STAT asked Emory University immunologist Rafi Ahmed if he would specify a preference should his mother ask for advice about Covid vaccines. Ahmed replied without hesitation: He’d tell her to get one of the messengerRNA, or mRNA, vaccines made by Pfizer or Moderna. “It’s human nature,” he insisted. “It’s common sense.”
Experts say that the problem is likely to worsen with the authorization of more vaccines, each with varying efficacy, dosing regimens (one dose or two), and dose intervals (21 days, 28 days, up to 12 weeks in some cases and places). They also say there are only limited messaging strategies to do something about it.
“I think, right now, the message really has to be that the vaccines that are authorized for use are authorized for use because they will provide significant protection against Covid-19 illness. And if you’re not vaccinated, you have no protection against Covid-19 illness,” said Glen Nowak, director of the Center for Health and Risk Communication at Grady College of Journalism and Mass Communication in Athens, Ga.
Kasisomayajula “Vish” Viswanath, a professor of health communication at the Harvard T.H. Chan School of Public Health, said he is deeply concerned that decisions about where to use some of the vaccines that appear less effective will be viewed through a lens of racial or socio-economic inequality, even if the reasons to offer those vaccines in certain settings make sense from a public health point of view and gets vaccine to those places faster.[…]
Continue reading: The myth of ‘good Covid vaccines’ and ‘bad Covid vaccines’