We eradicated polio in America, largely because of a vaccine licensed by the FDA in 1955. Since then, vaccines have changed the landscape of communicable disease control. We hope that unprecedented fast track development of a COVID-19 vaccine will change our landscape again, this time, so we can return to normalcy. We may have a vaccine as soon as 2021, right? Perhaps, but I am skeptical.
It’s not that I don’t believe in vaccines. I recall getting all the routine childhood immunizations, and I believe they protected me. I was also vaccinated against smallpox, cholera, malaria and typhoid as a youngster, to travel overseas as a military child. I was vaccinated against Hepatitis B as a young adult, because I had a job that required me to do phlebotomy. I get flu vaccines annually. COVID-19 is a different animal.
Vaccines typically take years to develop. Early in the HIV epidemic, HHS Secretary Margaret Heckler said a vaccine will be ready for testing “in approximately two years.” That was 1984. It has yet to happen. How is it possible that a safe and effective vaccine will be available for widespread use in early 2021 for a disease that was all but unknown at the end of 2019? It will be perfectly reasonable for people to question whether a vaccine developed in record time is safe and effective. Who will want to be the first in line?
That’s not our biggest problem, however. I wonder about people who question the efficacy of masks, and claim a constitutional right not to wear one, even while surrounded by unquestionable and unprecedented illness and death. How many people who can’t fathom the value of mask-wearing in this context will value the notion of vaccination? There is significant demographic variability in mask-wearing and other attitudes about COVID-19 prevention, according to Ipsos, a research firm specializing in public opinion polls. For example, Republicans were more likely than Democrats to report skepticism of the COVID-19 death toll, and Democrats were more likely to report mask-wearing.
In addition, substantial numbers in African American populations cite distrust of public health research, citing the Tuskegee Study, conducted in Macon County, Alabama, between 1932 and 1972. Here, treatment for syphilis was withheld from a large cohort of poor African men with Syphilis for “research purposes,” even after penicillin was widely available. That was a long time ago. Its ending was within the lifetime of people over 49. For some, that, along with negative experiences with the “medical establishment” is enough to foment skepticism of research that is critical to drug development.
This, too, is problematic, in my view. What happens if effective preventive or therapeutic treatment becomes available and people refuse it? George Washington University epidemiologist Dr. Amanda Castel talks about the importance of diverse participation in clinical trials. “Given how disproportionately impacted persons of color are with respect to COVID-19, it is imperative that our communities are included in vaccine trials in a thoughtful and meaningful way. That helps to dispel the myths around vaccines, highlights their potential benefits, and seeks ways to increase vaccine trust and uptake amongst these populations.”
Manige Blackburn Giles is a Denver-based health care administrator and activist who participated in an HIV vaccine clinical trial. She’s also my niece, and tells me, “as a Black person I want to be sure that we are represented in a sphere where we have historically been ignored. With the existing health disparities we face as Black Americans, I am committed to being a part of solution that preserves Black families.”
Certainly, those of us who work in public health can more easily have confidence in public health research, because we have colleagues who involved in research, or serve on consumer advisory boards. Everyone can’t have such an advantage. Therefore, I emphasize the importance of having a good relationship with one’s health care provider. You may not have confidence in new treatments because they are lauded on CNN. Hopefully, you know your doctor well enough to know she or he would not advise you on a treatment knowing it will harm you. Of course, many people do not have such a relationship with a provider or don’t have medical insurance to facilitate such a relationship. That’s a huge problem for another conversation.
In any event, COVID-19 is real. It won’t be ending any time soon. Someone in your family may become infected. At some point, we will all be required to make decisions about vaccines or medication. How can we make informed choices? At the end of the day, the task is much easier if you have a provider that you trust. If you don’t have one, it’s time to start looking if you have access to health care. You’ll need expert advice from someone you trust if a COVID-19 vaccine becomes available in 2021. In addition, someone needs to be thinking about the community engagement aspect of vaccine distribution. The science of vaccine development is only half the battle.
Guy Weston is a retired public health professional that worked in HIV programs for 31 years.