Are Vaccines a 'Victim of Their Own Success'?

John Whyte, MD, MPH; Tamera Coyne-Beasley, MD, MPH


September 02, 2020

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  • Vaccines are a victim of their success: Many Americans don't remember the fear and dangers associated with now vaccine-preventable diseases such as smallpox and polio.

  • In a WebMD poll, 27% of respondents said they would not get a COVID-19 vaccine in the first 3 months of its availability; 34% said they would not get a COVID-19 vaccine that was 50% effective and had mild-to-moderate side effects.

  • In that same poll, women were more likely than men to say that they would not get the vaccine, which is troublesome as women are often the healthcare decision-makers in families.

  • To achieve herd immunity, we need 60%-75% of people to get the COVID-19 vaccine.

  • The global Vaccine Confidence Project is evaluating what motivates people to get vaccinated. People want to hear stories and better understand the risks and benefits, not just be presented with facts.

This transcript has been edited for clarity.

John Whyte, MD, MPH: You're watching Coronavirus in Context. I'm Dr John Whyte, chief medical officer at WebMD.

We've been talking a lot about vaccines and when a vaccine might become available for COVID. But will people actually take it? I mean, we have had enough trouble with the flu vaccine.

So, to help provide some insight, I've invited Dr Tamera Coyne-Beasley. She's the endowed chair of adolescent medicine at Children's of Alabama at UAB. Dr Coyne-Beasley, thanks for joining me.

Tamera Coyne-Beasley, MD, MPH: Thank you so much for the invitation.

Whyte: Why is it so hard to get people immunized? We see with the flu vaccine that it's often less than 50%. With human papillomavirus (HPV), we have a lot of challenges in getting kids vaccinated. Is it an anti-science approach? What's the problem that we can learn to help with the COVID vaccination if it comes down the road?

Coyne-Beasley: That's such an important question, and thank you for asking me. I couldn't answer that question without reminding our listeners that August was vaccination month. August is a month that's been designated by the CDC to talk about vaccinations across all ages.

Your question is important because one of the things that we've seen reported, not only through the CDC but worldwide, is more individuals who are hesitant about getting vaccines.

You asked why and how we can use that information to prepare us against COVID. Unfortunately, there are many reasons why, and I'd like to talk a little about some of them.

The very first one is that many of us don't remember the vaccine-preventable diseases such as smallpox, or even something like polio. Therefore, we don't even understand or remember the success of vaccines. They're really a victim of their success; because they've been so effective, we don't remember the diseases that people actually died from.

Second, I think there are people who have questions about the effectiveness and safety of vaccines, even though they are one of the most safe and effective things that we have in the medical market. They're protected and evaluated more than any medications we take or any medical devices.

There's also lots of misinformation that's promulgated not only on the internet but also through social media. You mentioned a little bit about the anti-trust or the anti-vaccinators. They have lots of theories, which some people might call conspiracy theories, about certain things being a hoax, or certain conditions not actually being that significant, or an infringement on people's liberties.

The important thing to do, and what we can learn as we think about providing, hopefully, a COVID-19 vaccine, is look at those things that have caused individuals to be hesitant and work to make sure that we can address those issues.

Whyte: But in fairness, people could say that we work on the flu vaccine every year to try to get people vaccinated, and we barely can crack 50%.

I want to tell you about a poll that we've done at WebMD, where 27% of respondents said they would not get a COVID vaccine in the first 3 months. You know — "Let me see how someone else does. Dr Coyne-Beasley, let me see what your response is." How does that help if we're trying to get people to be vaccinated, have a sense of herd immunity? That's not going to be good enough, is it?

Coyne-Beasley: Right. No. To achieve herd immunity with the COVID vaccine, we need upwards of 60%-75%, and actually more than that, to get herd immunity. We have to work really hard in understanding people's hesitancy.

One thing you already alluded to is that we won't have long-term safety data as we do with most vaccines, and that will be part of the challenge. Hopefully, what we'll be able to demonstrate is that we'll vaccinate some of the people who are at greatest risk first.

I want to make sure that we talk about the flu vaccine, and that's going to be really important. Because as we know, COVID-19 really affects the respiratory system the most or what we understand the most about it.

It'll be important for people to get their flu vaccine because you don't already want a compromised respiratory system. So while the flu vaccine uptake has been less than what we would desire, we really need to work hard to make sure that the uptake is larger to prevent deaths that can come from getting COVID disease among people who aren't vaccinated.

Whyte: We don't want to overload the system. We know that tens of thousands of people die of flu every year; hundreds of thousands are hospitalized. We don't want to superimpose that on a COVID pandemic.

I want to talk a little bit about the FDA threshold for approval; it's 50% effective. Some vaccinations are much more effective (eg, for pneumonia and shingles). In our survey, more than a third of people said that they wouldn't take a vaccine that was 50% effective and has mild side effects. When we think about educating the public about what that means — and Dr Fauci has been talking about 50% effective — do we need better terms? How do we more accurately communicate to patients and the public what's going on? Is 50% good enough?

Coyne-Beasley: Ideally, we'd want something that would be better than 50%. One of the things that we've learned as physicians, and particularly through the Vaccine Confidence Project, is that we have to stop talking about numbers because numbers aren't really tangible to people.

One of the ways anti-vaxxers (people who don't like vaccines) have been able to be effective is by talking about stories. But we want to talk about true stories. We want to talk about the lives that are saved. We want to talk about the grandparents. We want to talk about the baby who was too young to be immunized.

It's talking about and appealing to those things that are important to people — things that they value, like their family members and the things that they do in their community. Not just talking about deaths, but also talking about disabilities, like how it can change their lives in terms of, say, meningococcal disease and meningococcemia and they might lose limbs.

There are various aspects to diseases we need to talk about and humanize more aside from just using the numbers. We need to have strong, consistent messages. As providers, we need to be more actively engaged, and many of us are. It's about even calling them; don't just wait for someone to come in to your office. Call those recall messages.[Tell them to] come in and get the vaccines, give them strong recommendations, and find out what their concerns are, what their hesitancy is about, and try to actually address that.

We want a vaccine as effective as it can be. If the FDA approves it, it will be effective. If you had the choice to save the life of your child, wouldn't you take it, even if it was only 50% effective? I don't want people to misunderstand; 50% effective does not mean it's like flipping a coin. It's actually more effective than that. So it's not like, "Well, I'll take my chances."

Whyte: What about people who say that it seems rushed? In some ways, we're having great success because of innovation. It's just like in baking or cooking: You can't cut down 30 minutes to 22 and you can't cut 2 cups of flour to 1 and 1/2. It's not going to work out. To many people, it seems rushed. Do you think it seems rushed?

Coyne-Beasley: Well, if you call it Operation Warp Speed, it makes it very difficult for it not to seem rushed. And again, that's one of the challenges that we'll face when this vaccine comes out, aside from the fact that there are no long-term safety data.

If you're listening to the scientists, the goal is to make this vaccine produced quicker than normal. The scientists are still very interested in making sure that there are methodical, clinical trials that look at efficacy and safety and don't cut corners.

Yes, it may be faster, and that's because of the urgency of this disease. Already in less than a year, this disease has killed more individuals than during our annual flu epidemics. It's highly contagious and leads to many more deaths. That's the urgency. But you need to balance the urgency by not cutting scientific corners. We are relying on our scientific community to do that, and that is the expectation of what we will do.

Whyte: Referring to the poll, there was a higher percentage of women who said they would not take the vaccine if it's only 50% effective. So how does that play into how we're going to communicate messages? Often, moms, wives, daughters are the ones in the family who bring everyone else to the doctor.

In some ways, do we need a more concerted effort to educate women who seem to be having some concerns about the effectiveness of the vaccine?

Coyne-Beasley: Absolutely. I don't like to do gender bias at all, but the literature actually does show us that women are generally the individuals who bring their children to the doctor and who encourage members of their families to get vaccinated.

One of the first things that will be important is trying to get this efficacy as high as possible, right? The lower it is, the less confident people are going to be. Getting it as high as we can in terms of its efficacy and effectiveness will be really important.

The other thing that will be vital is trying to work with women to find out what are the things that are important to them. The Vaccine Confidence Project is a vaccine program that's being done not only in the United States but also throughout the world. It's really looking at what are the things that actually motivate people.

This is a new time. We can't use the things that we used to use before. As clinicians, we used to say, "Give people the facts. That's what they need." That's not what people want anymore.

Whyte: We're overwhelming them with facts.

Coyne-Beasley: Yes, we're overwhelming them with facts. Don't get me wrong; they want the facts. But how do those facts relate to me and my family? What are the benefits of me doing this, and what are the harms of me not doing it?

I don't think we focus so much on what are the harms that can come to you from not doing this. Then also placing it in a family context — it's not just about you. I'd like to think that we still believe in helping others, although it may not always be evident. What can this do to the teacher that your kid is going to go into school with and be exposed to? What are the potential ramifications of not being vaccinated for your mother, your child's grandmother, and your friends and families?

So, I agree. The first thing I would really like to do is to try to find the most effective vaccine. One of the things that we have working in our favor, hopefully, is that there are many companies that are trying to manufacture this vaccine.

One of the things I have done as part of my career has been being involved and engaged in evaluating vaccines. I do vaccine research as well as creating policies, the vaccine recommendations that come up from the Advisory Committee on Immunization Practices.

Whyte: I'm going to put you on the spot. How optimistic are you that, if and when the COVID vaccine comes out, or multiple of them, that we're going to get to that 65%-70% vaccination rate that we likely need?

Coyne-Beasley: Yeah, you're putting me on the spot, aren't you? I am going to be incredibly optimistic and I'm going to say that we are, because this is what I believe will be the challenge.

We're going to have a very difficult fall and winter. I don't really want to predict this, but there certainly is some evidence to suggest that we may have another surge. Your listeners are probably coming from all around the country. One of the things that we've known or seen as we have reintroduced young people into school, and particularly college students who aren't necessarily social distancing, are clusters of disease pop up all over the place.

Couple that with the normal flu season and an increase in COVID-19 disease, and I suspect that it will appear even more urgent to people that we can get the vaccine uptake higher. I think people will start to see even more urgency. There have been almost 200,000 people who have died, and it is likely to get higher. When people start having that as a personal experience, like it's my child, parent, husband, or partner, it's a different kind of experience.

It's my hope not that those things will happen, but that we will be able to achieve a higher rate of immunization than we would have with flu by itself. Again, coupling flu and other vaccine-preventable diseases as making you healthier and safer against COVID-19, I think, is really important.

Whyte: I want to thank you for sharing your insights today, and I want to share with the audience that you were the very first physician, the first resident, that I ever worked with on day 1 of my internship in internal medicine.

Many years later, I still remember when I see your name, because I was struck by your tactical skills, procedural skills, your overall knowledge of medicine, and your compassion for patients as well.

I'm just delighted that I was able to connect with you today and get your thoughts on what we need to do to get people safe and make them aware of the safety and efficacy of all vaccinations, and hopefully COVID-19 as well.

Coyne-Beasley: Thank you, Dr Whyte. It's a pleasure, once again, to be with you.

Whyte: Thank you for watching Coronavirus in Context.

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