This article was originally written for the March 2021 issue of ForeSight, a newsletter distributed by the Arizona Council of the Blind.
Authors: Drs. Vanessa Saunders, Rebecca Fein, Killian Kleffner, and Dean Colston
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COVID-19 captured the world by storm, changing the way we live through social distancing, stay-at-home orders, travel restrictions, and the acceleration of telehealth, remote work, and remote learning. The devastating impact of COVID-19 on population health and livelihood spurred a race to develop a COVID-19 vaccine. This opened the door for unprecedented collaborations between academic institutes and pharmaceutical companies to investigate new and established vaccine technology.
The winner of the 2020 vaccine race was a messenger RNA (mRNA) vaccine produced by Pfizer, Inc. and BioNTech. mRNA vaccines interact with a person’s DNA to instruct cells to produce a part of the coronavirus protein called a “spike protein” that will be recognized by the immune system. The cells then respond to these spike proteins by producing life-saving antibodies that drastically reduce or prevent the symptoms caused by COVID-19 infection. The Pfizer-BioNTech vaccine is given as a series of 2 shots, 21 days apart. Close on the heels of the Pfizer-BioNTech vaccine was another mRNA vaccine developed by ModernaTX, Inc. This vaccine is also given as a series of 2 shots, one month (28 days) apart.
In early 2021, a third vaccine was made available in the U.S. from Johnson and Johnson (Janssen COVID-19 vaccine) which uses a viral vector to stimulate the immune response. A viral vector is a modified virus that is rendered essentially harmless to most people and is combined with genetic material from the COVID-19 virus. This vaccine also produces spike protein that triggers the body to produce antibodies against COVID-19. Unlike the mRNA vaccines, viral vectors do not integrate into a person’s DNA; instead, the body reacts to the viral vector as it would to a normal infection. The Janssen COVID-19 vaccine is provided in a single dose.
All three vaccines were approved through a process known as an emergency use authorization (EUA). An EUA means that the expectations for safety and effectiveness of the three vaccines were deemed acceptable by the FDA. The speed of EUA, while necessary to battle COVID-19 infections, has made some people concerned about the safety of the vaccines—even though clinical trials have shown that COVID-19 vaccines are safe and effective. Some individuals fear vaccines while others distrust science, government, and the pharmaceutical industry. In reality, there's been more than a decade of behind-the-scenes research on new vaccine technology, which helped us get a head start. In fact, scientists and vaccine makers have been preparing for new coronavirus vaccines for years.
When in doubt, we always advise following the science. Unfortunately, it’s a difficult time for the mantra “follow the science.” Much of it has not been made publicly available, and therefore cannot be evaluated.
What happens if someone cannot be vaccinated for medical reasons, or chooses not to be vaccinated? There has been an online flux of pictures of vaccination cards and memes around vaccine passports. These vaccine cards have the potential danger of creating a system where those who cannot or will not vaccinate become second-class citizens—barred from travel, grocery stores, restaurants, etc. While this possibility is getting push-back from professionals and the general public alike, it is troubling because it is in direct violation of the Nuremberg Code (refer to Reference 1).
There are 10 principles to the Nuremberg Code, but the most significant one here is informed consent. The code states that a requirement for experimentation involving humans is that the human subject is informed of the risks and has a good understanding of the procedures, risks, etc. In other words, one cannot be forced to take an experimental drug or be treated unequally for refusing an experimental drug. The concerns are also addressed in the Geneva Conventions and other international law documents.
The lack of information makes it difficult to believe that informed consent is a priority. Choosing to vaccinate or not vaccinate should not create a two-tiered system. Ethically speaking, if you’re uncomfortable with the vaccines, don’t get one...but do continue to take precautions, such as masking, good hygiene, and social distancing to protect those around you and yourself. To be clear, the authors are not anti-vaccine, but believe informed consent and understanding your available options is an ethical right.
Yet, even with knowledge and informed consent, one obstacle that public health providers continue to face is vaccine hesitancy. Vaccine hesitancy is a multifaceted, complex topic. The World Health Organization identified vaccine hesitancy as a major threat to global health (refer to Reference 2). As we know, a vaccine is only effective if the public is willing to receive it. But why are some people more hesitant about vaccines than others?
We're finding that vaccine hesitancy is easier to be understood as a belief system rooted in specific moral values (i.e., liberty, purity, and anti-authority), not just attitudes (refer to Reference 3). And that's where the focus may be more beneficial. Designing interventions that use the moral foundations that underlie people's attitudes and judgments—instead of focusing strictly on safety and efficacy—may be key. This understanding may help modify behaviors and attitudes when it comes to vaccine hesitancy.
We argue that one key antidote to fear during the pandemic is accurate science communication. Plus, widespread educational campaigns can be targeted towards populations at risk of vaccine hesitancy. Notably, these public health campaigns have been increasingly turning to social media. Scientists, health care providers, and medical communicators can use social media to improve health literacy and foster public trust in vaccination. They are in an ideal position to take this complex medical information and make it understandable to the masses with plain language. By playing a larger role in public education and discourse, they will empower the public with facts. It can also help ease uncertainty and quiet misinformation that is circulating about COVID-19 and the various vaccines.
Cutting through the noise is imperative to calm the public's fears of the unknown. Still, more evidence-based research into vaccine hesitancy is paramount in curbing the rise of vaccine-preventable diseases.
A final concern is vaccine supply and distribution.
Because the initial supply of the vaccine is limited, vaccination decisions at the local, state, federal, and international levels have been full of difficult choices. The CDC issued general recommendations; ultimately each state makes its own vaccination plan. By necessity, vaccine eligibility is organized in phased distributions, with the earliest eligibility reserved for healthcare workers, residents in long-term facilities, and sometimes other groups (e.g., tribal health programs).
In Arizona, the second phase of vaccination prioritizes Education & Childcare Workers, Protective Services Occupations, Adults 65 (75 in some jurisdictions), which is comparable to other states. Unfortunately, Arizona is falling behind in terms of procedural compliance—10-20% of first-dose recipients do not show up for their second (refer to Reference 4). This high rate of “dose ghosting” is concerning since one dose of the Pfizer or Moderna vaccine is much less effective (50-60%). The freshly-approved single-dose J&J vaccine has made Arizona health authorities hopeful that the State’s vaccination statistics will improve.
With new shipments of Pfizer and Moderna arriving and no current timeline for the J&J vaccine, Arizona’s Vaccine and Antiviral Prioritization Advisory Committee is strategizing new ways to reduce the access barriers for eligible recipients. For blind and visually impaired communities, barriers include poorly-developed websites that violate disability laws and create access inequity (refer to Reference 5). The Arizona Governor’s Council on Blindness and Visual Impairment COVID Vaccine Workgroup has been working with the Arizona Department of Health Services (ADHS) to ensure the Vaccination Finder is accessible on their website with mixed results, including poor compatibility with JAWS. The council Facebook page includes county-specific numbers for scheduling appointments, but this alternative comes with the issues of busy lines, office hours, and appointment unavailability due to time slots being rapidly snatched online.
With the announcement from Governor Ducey (as of March 2, 2021) that Arizonians as young as 55 who want the vaccine are now eligible, we trust a similar commitment will be made to ensure accessibility equity for already-eligible Arizonians. If and when you do get your COVID-19 vaccine, be sure to voluntarily participate in the CDC V-safe program, which is a smartphone-based tool that allows people who have been immunized to report potential side effects using text messages and web surveys.
The more we know, the better decisions we can make.
This article was written by A Flock of Scientists, LLC. We are a group of scientists, educators, and medical communicators with a passion for bringing science to everyone. Learn more about us at flockofscientists.com
References
[1] Hancock, L. & Fein, R., personal communication, February 27, 2021
[2] World Health Organization. (2019). Ten Threats to Global Health in 2019. (2019). Retrieved from https://www.who.int/news-room/spotlight/ten-threats-to-global-health-in-2019
[3] Amin, A.B., Bednarczyk, R.A., & Ray, C.E. et al. Association of moral values with vaccine hesitancy. Nature Human Behaviour 1, 873–880 https://doi.org/10.1038/s41562-017-0256-5
[4] Hay, K. (2021, February 26). Arizona one of the worst states in the country for people getting second vaccine dose | Coronavirus in Arizona | azfamily.com. https://www.azfamily.com/news/continuing_coverage/coronavirus_coverage/arizona-one-of-the-worst-states-in-the-country-for-people-getting-second-vaccine-dose/article_837f0496-78ac-11eb-ab1b-4fd5dd831c88.html
[5] Weber, L., & Recht., H. (2021, February 25). Covid Vaccine Websites Violate Disability Laws, Create Inequity for the Blind. Kaiser Health News. https://khn.org/news/article/covid-vaccine-websites-violate-disability-laws-create-inequity-for-the-blind/
Further Reading
For information on ethical rights and vaccination:
For information from the CDC on the COVID-19 vaccines:
Pfizer-BioNTech https://www.cdc.gov/coronavirus/2019-ncov/vaccines/different-vaccines/Pfizer-BioNTech.html
Moderna https://www.cdc.gov/coronavirus/2019-ncov/vaccines/different-vaccines/Moderna.html
Johnson & Johnson (Janssen) https://www.cdc.gov/vaccines/covid-19/info-by-product/janssen/janssen-faqs.html
CDC V-Safe vaccine side effect tracker https://www.cdc.gov/coronavirus/2019-ncov/vaccines/safety/vsafe.html