The U.S. government has spent more than $10 billion creating vaccines to protect against COVID-19 but so far little encouraging Americans to take them.
Public health officials say that’s a mistake.
“This needed to happen yesterday. It’s like watching a train wreck happen,” said Daniel Salmon, director of the Institute for Vaccine Safety at Johns Hopkins Bloomberg School of Public Health.
Now, even before any vaccines are approved, is the time to start telling America straight-up what to expect, more than a dozen public health and medical experts told USA TODAY.
That includes warning that a COVID-19 vaccine likely won’t be 100% effective, getting it will make a substantial number of people “feel like crud” for a day or two,and two shots will be required, not just one.
And they question if the best messenger is a brand-new entity called Operation Warp Speed, which they fear screams: “We’re cutting corners.”
Who’s in charge?
Part of the concern is the U.S. Centers for Disease Control and Prevention has been sidelined by the Trump administration when it comes to communicating with and educating the public about the importance of receiving a coronavirus vaccine.
In almost every other major public health emergency since World War II, the agency, long touted as the world’s premier public health agency, has taken the communications lead.
in this pandemic, however, that crucial work is being spearheaded by Operation Warp Speed, a Trump-administration-created and -appointed task force, and the Department of Health and Human Services.
That puzzles public health experts.
“The CDC should be leading the charge and coordinating, as they always have in the past,” said Anne Rimoin, a professor of epidemiology at the University of California-Los Angeles School of Public Health. “Instead, what’s happened is most people are getting their public health messages from CNN and MSNBC.”
During COVID-19, the CDC has been diminished by the White House, which makes its ability to get clear messages out more difficult.
Thus far the largest Health and Human Services expenditure on communication has been a $40 million Office of Minority Health partnership initiative with Morehouse School of Medicine to deliver education and information on resources to help fight the pandemic, including vaccines, in racial and ethnic minority and vulnerable communities.
According to an HHS spokesperson, various agencies and offices at the Department of Health and Human Services are working with Operation Warp Speed and other groups on a robust public health information campaign that focuses on vaccine safety, efficacy and hesitancy.Specifics, however were not provided.
Briefings to the point of boredom
Experts ticked off specific actions health officials should be taking now, well ahead of when an actual COVID-19 vaccine is authorized. Top among them: public briefings.
There has been confused, chaotic and intermittent communication to the public about the pandemic and what it will take to end it. Daily briefings should immediately start, led by the same person every day, so the public has a face they can get to know and trust, experts say.
“This is textbook crisis communications. Pull out the rulebook and follow it,” said Dr. Kelly Moore, associate director of immunization education at the Immunization Action Coalition, a national vaccine education and advocacy nonprofit.
Early on in the pandemic, the CDC held several briefings. These were ended and the White House Coronavirus Task Force began daily public updates in March, often led by President Donald Trump. These ended in late April, and public briefings have been only held sporadically since then.
For COVID-19 vaccines, public health leaders should go into excruciating detail about how they’re developed, how they are tested for safety and efficacy and how the review process works, said Dr. Paul Offit, director of the Vaccine Education Center at Children’s Hospital of Philadelphia.
The information needs to be repeated so often the public could almost give the briefings themselves, Moore said. “There should be documentaries on television about this stuff.”
Your arm will hurt, you’ll feel like crud
Even without an FDA approved vaccine, anecdotal information from the five Phase 3 clinical trials now underway for COVID-19 vaccines indicates this is not a painless vaccine.
“This is a nasty vaccine to get,” said Dr. William Schaffner, a vaccine expert and professor of infectious diseases at Vanderbilt University. “It really makes your arm sore. It can make you feel crummy for 24 hours. And remember, it’s a two-dose vaccine. Well, guess what – the second dose is worse than the first.”
The last thing the vaccination campaign needs is the first groups of people who get the shots to show up on TV saying they felt like “crud” for a day or two, said Dr. Eric Toner, a senior scholar with the Johns Hopkins Center for Health Security.
“That would really impact others further down the list,” he said. People need to know what is expected and that it means the vaccine is working.
Ditch the nod-to-Star-Trek monicker
One of the first things many of the experts interviewed suggested was backing off the name Operation Warp Speed because it sends the wrong message.
“Just choosing the name Operation Warp Speed has set people’s teeth on edge,” Schaffner said.
While it was named with all good intentions to communicate hard work and speed, “what people heard was ‘They’re cutting corners,'” he said.
It’s a bad name for what is actually a good process, said Marla Dalton, CEO of the National Foundation for Infectious Diseases.
“What we’re doing is compressing the timeline; we’re not skipping steps,” she said. “Unfortunately, Operation Compressed Timeline isn’t as catchy.”
It hasn’t helped that Operation Warp Speed has been largely silent on how it functions and what it’s doing, not just in terms of talking to the public but also the medical community, Schaffner said.
“They’ve been given no insight into this newly created government entity that’s been given billions in taxpayer dollars,” he said. “The public health community has been in the dark about exactly how they function.”
Invite the news media to play a role
News stories about how vaccines work, how they’re made and the hurdles they must pass to be approved should be everywhere now, experts said.
“The first thing would be to really open up the process. Have news cameras following the researchers and the regulators. Interview the scientists, look at the labs,” said UCLA’s Rimoin who worked on polio eradication and Ebola vaccination campaigns.
“I don’t see anyone talking to the media right now to walk them through the steps of the process and why they should trust it at all,” said Tony Fratto, deputy press secretary for the administration of George W. Bush from 2006 to 2009.
Be brutally honest about expectations
News Monday that the candidate vaccine from Pfizer and its collaborator BioNTech prevented more than 90% of infections with the virus that causes COVID-19 was very positive.
Even so, expectations need to be managed, experts say. The public needs to remember the vaccine will not be immediately available and even when it is it will take months, if not a year, to immunize the entire nation.
A vaccine is not an magic bullet, said Monica Schoch-Spana, a senior scholar with the Johns Hopkins Center for Health Security. It may not be equally effective for all ages and some people can’t, or won’t, get vaccinated.
“Just because a vaccine shows up doesn’t mean we can throw our masks away and stop washing our hands and social distancing,” she said. There’s a tremendous amount of work that must happen before that day comes. “It was a mistake by the (Trump) administration to suggest that a vaccine was going to be a be-all and end-all.”
Communicate the potential risks
The first impulse of many governments is to downplay bad news out of concern the public will react negatively. Trump told journalist Bob Woodward he was playing down the risk of coronavirus because he didn’t want to create panic.
But lying always goes badly, said Maya Goldenberg, a professor at the University of Guelph in Canada and author of the forthcoming book, “Vaccine Hesitancy: Public Trust, Expertise, and the War on Science.”
She pointed to United Kingdom in the 1990s, when the government played down the risk of getting mad cow disease from beef. More than 170 people died and 4.4 million cattle were slaughtered, leading to decades-long distrust of government scientists in Britain.
For a vaccine to succeed, officials need to be crystal-clear about the risks and the benefits, and what they know and don’t know.
Address people’s fears up front, Rimoin said. “You can’t go wrong with more public health messaging,” she said. “Explain what the public health risks are. Explain what the side effects might be.”
Honesty about potential bad side effects from a vaccine also is important.
Dr. Richard Jackson, an emeritus professor at UCLA’s Fielding School of Public Health, worked on the swine flu vaccination campaign in 1976. He spent hundreds of hours talking with the public, elected officials and reporters about what could happen when people got the shots.
“We knew some people would literally pass out because of the shot and smash their face on the floor,” he said, not because of the vaccine itself, but because of a fear of needles.Because of the time he had spent with reporters, they were able to make the distinction clearly, he said.
Embrace independent review
So far five states and aBlack doctors’ group have announced they will conduct independent reviews of any COVID-19 vaccines approved by the FDA. The moves came in response to perceived political interference in the vaccine approval process but have shifted more toward adding another set of eyes on a complex system and communicating that to the public.
That is excellent, Goldenberg said. Having independent reviews of decisions made by the FDA and CDC will only increase public trust.
“The public wants to hear an honest and transparent account, even if the message isn’t as delightful as we want it to be. These review groups can help provide another voice,” she said.
Have trust in the public
The American public doesn’t want to be preached to, talked down to or persuaded to be vaccinated, said Salmon of Johns Hopkins. The goal is to understand people’s values and concerns and honestly address them.
The truth doesn’t need to be sugarcoated, Goldenberg said.
“It turns out the public can handle uncertainty,” she said. “We can manage ambiguity.”
Decades of public health work has shown experts the right communication strategies are not marketing or sales pitches, Moore said.
“It’s about getting people good information they can relate to so they can make up their own minds,” she said.