Much of the world’s hope in controlling the COVID-19 pandemic rests on the creation and distribution of a safe and effective vaccine. While there has been much discussion about the necessity for, and difficulties of, equitable vaccine distribution, less concern has been voiced about vaccine communication and public messaging. Approaches used by healthcare professionals, researchers, and governmental officials to discuss a COVID-19 vaccine will affect vaccine uptake and could influence our ability to control both the current pandemic, as well as global vaccine-preventable diseases, far into the future.

A COVID-19 vaccine could delay containment by reducing the use of preventative measures

Vaccine(s) will likely help to control the pandemic; however, a COVID-19 vaccine is not a magic bullet. Even a vaccine with 100% efficacy will take many months of distribution to achieve herd immunity in a population. Worldwide distribution of the vaccine, if possible, will likely take years. During this time, transmission of the virus is still possible due to a corresponding decrease in precaution-taking if the public perceives that the pandemic is ‘in hand’. It is also very likely that a COVID-19 vaccine will provide incomplete and/or time-limited protection. Given the lengthy time-frame estimated to achieve global herd immunity, countries that have effectively eliminated COVID-19 transmission through vaccination will still be at risk of disease resurgence as immunity wanes and the disease is reintroduced into the country through global travel. Preventing disease resurgence will necessitate continued public health surveillance and protective measures. Without clear messaging it will be very difficult to ensure continued public health investment and public action-taking.

Fears of a rushed vaccine may prolong the pandemic by reducing vaccine uptake

For many, the expedited process of COVID-19 vaccine development underscores concerns that shortcuts are being taken which could compromise vaccine safety. These concerns could be aggravated by approval of a COVID-19 vaccine without full phase-III safety and efficacy data. Unfortunately, the precedent for early vaccine release has already been established. China began vaccinating high-risk groups with one of three different vaccines in July concurrent with beginning their phase-III trials. Over 100,000 people are estimated to have been vaccinated without any published phase-I/II data. Russia also released a vaccine in August before beginning their phase-III trial. The US government is also preparing for an early vaccine release, with the possibility of approving a vaccine by the start of November, again before phase-III trials have been completed ¹. These early vaccine releases are occurring despite the fact that it typically takes several years to collect enough data during phase-III clinical trials to demonstrate vaccine safety and efficacy, with approximately 15% of vaccines failing during phase-III ². It may not take years to collect enough data for a clear safety and efficacy profile; however, the data and rationale for licensing needs to be clearly communicated. Without this messaging, there may be poor public confidence in safety of the COVID-19 vaccine, leading to low vaccine uptake and limiting our ability to contain the pandemic.

Poor messaging may result in low COVID-19 vaccine uptake and possibly long-term increases in vaccine-preventable diseases.

In the US, over 50% of people recently surveyed were hesitant or unwilling to get the COVID-19 vaccine ³. This stems from multiple factors, including safety concerns and distrust of the government and the pharmaceutical industry. COVID-19 vaccination hesitancy/resistance increases to 72% for Black Americans, who are disproportionally affected by the pandemic while also being under-represented in current clinical trials ⁴. Without clear communication about vaccine safety and efficacy for all members of society, the risk of a significant portion of any population remaining unvaccinated increases. This would make achieving adequate herd immunity more difficult and could necessitate public health interventions to be maintained indefinitely. Vaccine hesitancy/resistance may also be enhanced with governmentally-mandated vaccination. Globally, resistance to vaccination and mask mandates have already resulted in protests and disinformation campaigns purporting that vaccines are dangerous, not effective or unnecessary. If early vaccine licensure results in a vaccine with even moderately-poor safety or efficacy, there is a further risk of galvanizing the anti-vax movement. Strengthening the anti-vax movement could reduce public uptake of existing vaccines, withcorresponding increases in vaccine-preventable diseases, such as measles. Decreased public acceptance and low vaccine uptake are global public health issues which could impair investment in future vaccine development and manufacturing, resulting in discontinuation of vaccines for rare/neglected diseases or reduced funding/development of new vaccines.

Providing effective messaging for a COVID-19 vaccine matters. Considering the potential, yet significant, implications for controlling the pandemic and vaccine-preventable diseases long into the future, there is a need for clear, open and resonant COVID-19 vaccine messaging.

Strategies for effective COVID-19 vaccine messaging:

1. Build vaccine demand through consensus and clear guidance. Scientists, medical professionals and elected leaders need to demonstrate consensus on the COVID-19 vaccine. Discordant or divergent vaccine messaging risks damaging public confidence. Instead, we need a unified message that provides clear guidance, including what to expect, why the vaccine is important, what the risks are, what the vaccine will mean for the pandemic and what precautions will still be needed. Messaging should build public demand for the vaccine while avoiding mandates that may further damage public trust.
2. Combat misinformation. Even with clear vaccine messaging, mis/disinformation is inevitable. In the current infodemic, it is not possible to effectively combat misinformation using traditional strategies of information dissemination. Instead, emotive personal stories can be used to personally connect with the public, highlighting the dangers of vaccine-preventable diseases and showing how vaccines are not just about individual safety, but also about protecting others.
3. Discuss vaccine concerns in-person. Healthcare professionals need to hold open and honest conversations with patients about the vaccine, especially those expressing hesitancy. Resources should be developed to support healthcare professionals and to provide guidance on common vaccine hesitancy concerns, how to discuss the importance and risks of vaccines with different age and demographic groups and how to deliver concise and evidence-based messages that resonate with the patient.
4. Approach vaccine licensure with transparency. Transparency during all phases of COVID-19 vaccine clinical trials and licensure is critical. Concomitantly, COVID-19 vaccine(s) should not be approved before enough phase-III trial data is available to establish comprehensive safety and efficacy profiles. Several vaccine manufacturers have pledged not to release their vaccine early, even with mounting political pressure to do so ⁵. While this pledge is encouraging, the early release of additional vaccines is still possible and many medical professionals may not feel comfortable promoting an early vaccine. Lack of support for an early release vaccine by healthcare professionals could compromise public trust in the licensure process and in existing licensed vaccines. This lack of trust also creates a potential challenge of how to switch messaging if a different COVID-19 vaccine with an established safety and efficacy profile is later approved. In this event, evidence-based discussions of the risks and benefits of the specific COVID-19 vaccine, and vaccines in general, will be of critical importance

COVID-19 vaccines offer an opportunity to effectively slow and contain the pandemic. However, that opportunity comes with the need for careful messaging to ensure that we are successful at controlling COVID-19, as well as the myriad of other vaccine-preventable diseases, long into the future.