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Eddie Rice is a believer in vaccines. The Melbourne locksmith has received jabs in the past and understands that they go through rigorous testing before they’re rolled out. This time, as researchers sprint ahead with potential shots to protect the world against COVID-19, he’s not so sure.

“This is a pretty unique one, just because it’s going to be so quick,” said Rice, 29. “I don’t know enough of the science to know 100% that it’s safe.”

Governments and drugmakers have long faced skepticism, and even hostility, from a small but vocal group of anti-vaccination campaigners. In the battle against the coronavirus, they may also run into reluctance from a broader swath of the population — people like Rice who would normally be on board.

Fading trust in governments, political interference and the dash to create a shot in record time are sowing doubts. Temporary halts to studies because of unexplained illnesses in volunteers — a part of vaccine development that doesn’t usually make headlines — add to the anxiety. These misgivings could hobble the high-stakes quest to slow a pathogen that’s killed 1.1 million people.

Assuming immunizations can be successfully developed, mass produced and deployed, vaccine advocates will need to convince enough people the shots are key to ending the crisis. In a survey of 20,000 people conducted over the summer, more than a quarter of respondents said they wouldn’t get a COVID-19 shot. Russia, Poland, Hungary and France had the lowest support, the World Economic Forum and Ipsos study showed.

The effort to overcome that sentiment will start with health workers. Medical staff are at heightened risk of catching the virus and spreading it to others, and will likely be among the first to get immunized. Any worries they have about the quality of a vaccine could hamper wider acceptance.

Nor should their support be taken for granted. Medical workers would be careful not to damage the trust they’ve earned by promoting a product they don’t have faith in, said Sara Gorton, head of health at Unison, a union in the U.K. representing nurses, paramedics and others in the field.

“If health care workers are going to be expected to advocate for the vaccine, then their natural concerns will have to be addressed in advance,” she said. “It’s not going to help with take-up if you go to have your jab and the person who gives it to you isn’t able to say reassuring things.”

A study in Hong Kong earlier this year found that only 63% of nurses expressed a willingness to get a potential COVID-19 shot. It cited uncertainty over effectiveness, side effects and how long protection would last. Support was higher as cases surged, but slipped as infections ebbed, according to researchers including Kin On Kwok, an epidemiologist at the Chinese University of Hong Kong.

If less than two thirds of nurses during an outbreak intend to get immunized, “we anticipate that promoting the vaccine to the general public in the post-pandemic period will be much more challenging,” they wrote.

Anxiety over China’s growing influence in the former British colony may be another factor behind the lack of conviction. A mainland-backed effort that offered free tests to all Hong Kong residents saw only a quarter of them come forward. Chinese vaccine developers have been at the forefront of the race. Though the final stage of trials is not complete, thousands in China have already received doses under expansive emergency-use provisions.

Syringes of a SARS CoV-2 vaccine for COVID-19 produced by Sinovac | AP
Syringes of a SARS CoV-2 vaccine for COVID-19 produced by Sinovac | AP

One of the main concerns among doubters is that critical steps to demonstrate safety and efficacy could be carried out in haste, despite reassurances — like the pledge in September by nine U.S. and European developers — to avoid shortcuts on science.

Vaccines led by AstraZeneca PLC and the University of Oxford, Pfizer Inc. and BioNTech SE and Moderna Inc. are among those in the final stage of tests, and pivotal data could come before the end of the year, clearing the way for emergency approvals. That feat would be achieved by compressing into just months a development process that normally takes up to a decade. Public confidence in vaccines that haven’t been extensively tested could be low, according to analysts at HSBC Holdings PLC.

The pursuit of a COVID-19 shot has been increasingly politicized, reducing the number of people who are inclined to get one, according to Scott Ratzan, a doctor and public health specialist at the City University of New York. Officials will need to demonstrate why an immunization that is proven safe is beneficial to individuals and society, he said.

Among the majority of the public, vaccines are embraced as safe and straightforward ways to prevent diseases, but worries about a COVID-19 shot have escalated in recent months. Americans’ willingness to be vaccinated against the virus dropped to 50% in September from 66% in July, a Gallup poll shows.

“Most people do support vaccines,” said Ratzan, who is part of a group working to boost trust in future COVID-19 immunizations. “We have to find the fence sitters. Are they hesitant? Are they unsure? How do we shore them up?”

Interruptions to trials haven’t helped. While it’s not unusual to pause studies to probe potential side effects, those episodes highlight why the work can’t be rushed. Tests of the AstraZeneca vaccine in the U.S. remain on hold after a volunteer in a U.K. trial became ill more than a month ago. Johnson & Johnson said last week it would pause its study to investigate an ailment, which it didn’t specify, in a participant.

The fast pace of the studies has made people uneasy.

U.S. President Donald Trump has pushed for a vaccine before the Nov. 3 election, although many companies and experts have said it’s unlikely. He acknowledged earlier this month that the goal may not be met, but blamed “politics” after regulators released new standards that could delay an authorization.

As the virus continues to run rampant, pressure to come up with a vaccine has increased. The U.S. effort to accelerate the delivery of a vaccine is named Operation Warp Speed.

“People are scared — in a pandemic one would expect that — and the rush, the political proclamations have made people even more nervous,” said Seth Berkley, chief executive officer of Gavi, the Vaccine Alliance, the nonprofit that works to immunize children in poor countries and is helping to lead a program to deploy future COVID vaccines all over the world.

Fiascos in the past may fuel doubts in some regions. The Philippines in 2016 started a major drive to vaccinate children against dengue, the mosquito-borne illness, but it was suspended after the shot was linked to a higher risk of severe disease in some who hadn’t previously been exposed to the virus.

Some people will also remember a 1976 outbreak of swine flu in the U.S. Then-President Gerald Ford announced a plan to vaccinate everyone in the country, and soon more than 40 million Americans had received shots. But it never turned into a pandemic as feared, and some of those who had been vaccinated developed Guillain-Barre syndrome, which can cause temporary paralysis.

Anti-vaccine activists hold signs in front of the Massachusetts State House in Boston during a protest against a mandate that all Massachusetts schoolchildren receive the flu vaccine this year. | AFP-JIJI
Anti-vaccine activists hold signs in front of the Massachusetts State House in Boston during a protest against a mandate that all Massachusetts schoolchildren receive the flu vaccine this year. | AFP-JIJI

Suspicions that extend beyond the usual anti-vaccine movement pose an additional problem for health advocates already struggling to contain a surge of misinformation. In one example, social media posts pushed a bogus story that seven children had died in Senegal as part of a COVID-19 vaccine trial.

AstraZeneca boss Pascal Soriot issued a statement Friday calling misinformation a “clear risk to public health” and urging the public to stick with reliable sources after reports of a campaign in Russia to undermine the drugmaker’s vaccine with Oxford.

Efforts to track and counter misleading claims are ramping up. Unicef, which focuses on protecting children and is one of the largest vaccine providers, said it forged a digital partnership with the Yale Institute for Global Health and others to create content aimed at taking on falsehoods before they get out of control.

In the past, much of the opposition has revolved around the value of “purity,” and claims that vaccines contain unsafe levels of toxins, said Angus Thomson, senior social scientist at Unicef.

“What we’ve seen is an interesting pivot to liberty,” he said. “Suddenly vaccination is about restricting your freedom.”

Engagement with the public will also need to increase to explain how vaccines are being created and how they will be deployed, said Heidi Larson, who leads the Vaccine Confidence Project, a research group. Many promising COVID-19 shots are relying on novel approaches, such as messenger RNA.

“There hasn’t been much discussion about why these vaccines are able to be made faster, the new technologies being used, how some may have one dose and others two,” she said. “We need to talk about that more.”

Although health officials will confront reluctance, and even “nefarious” behavior from people touting incorrect information, there is reason for optimism, according to Berkley, the Gavi CEO.

Strides have been made on the therapy front to help patients who get severely ill, but a vaccine is still seen as essential to the global exit strategy, especially amid concerns about long-term complications months after initial symptoms.

“I have to believe in my heart of hearts if we follow the processes, if we end up with a safe and effective vaccine that’s gone through stringent regulatory approval, if people start taking it and they can go back to normal or close to normal, that will lead to other people wanting the product,” Berkley said.

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