By R. M. Seaa Shyin Vibi
While the rapid development of vaccines against COVID‑19 is an extraordinary achievement, successfully vaccinating the global population presents many challenges, from production to distribution, deployment, and importantly, acceptance. Trust in the vaccines is vital, and is critically dependant on the ability of governments to communicate the benefits of vaccination, and to deliver the vaccines safely and effectively. This article addresses the importance ofCOVID‑19 vaccines, efficacy and the role of public and safety through effective communication. While only a small minority of the population holds strong anti-vaccination views, hesitancy about COVID‑19 vaccination is evident in many countries. Recognising that vaccination campaigns of the magnitude needed are unprecedented, government actions to garner trust will be essential to their success and to the emergence of more resilient societies after the crisis.
Since the World Health Organization (WHO) declared the COVID-19 outbreak a pandemic back in March 2020, the virus has claimed more than 2.5 million lives globally with upwards of 113 million cases being confirmed by laboratory tests (March 2021). The pandemic has impacted almost every corner of life, causing global economies to stall, changing the way we work and interact with our loved ones, and stretching healthcare systems to the limit. Governments around the world have been forced to implement harsh restrictions on human activity to curb the spread of the virus .
COVID-19 vaccination is now offering a way to transition out of this phase of the pandemic. Without them, many scientists believe that natural herd immunity would not have been sufficient to restore society to its normal status quo and that it would have resulted in extreme fatality . This is something that has been echoed by many health organizations including the WHO. In a scenario without access to vaccines, strict behavioural measures may have had to remain for the foreseeable future.Fortunately, the beginning of 2021 saw numerous vaccines given emergency approval and begins their roll out in countries across the world. As of March 2021, just shy of 300 million vaccine doses had been administered worldwide. However, global COVID-19 vaccination faces several challenges which may impact its success.
Efficacy of COVID-19 Vaccination
Currently, a total of seven COVID-19 vaccines available across three platforms have been approved and are being rolled out across the globe. However, some question the efficacy of these vaccines, especially given the emergence of new strains of the virus. Vaccines must be effective at significantly reducing the spread of the virus for them to be successful. Research has demonstrated that the Moderna and the mRNA-based Pfizer vaccines are 94 to 95% effective, and these figures have proven true even in trials studying those at high risk and the elderly .
It is a common misconception that this means 95% who get the vaccine are protected from the disease, leaving 5% unprotected. If this were true, in a population of 100,000 were vaccinated this would lead to 5,000 people contracting the virus and developing the disease over three months. This rate is similar to the current UK COVID-19 case rate. The 95% effectiveness actually means that people with the vaccine have a 95% lower risk of COVID-19 when compared to a control group. Without the vaccine, we would expect roughly 1% of the population to get the disease, and with the vaccine, this reduces to 0.05%. At such low rates, the vaccines will allow society to get back to ‘normal’ and for restrictions to be permanently eased.
Evolution of SARS-CoV-2 Virus
While the current vaccines have proven to be highly effective against the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) strain that has caused the pandemic, recent data has highlighted the emergence of several mutational strains. There has been uncertainty as to whether the current vaccines will protect against these variants. Recently, the WHO has eased concerns, stating that current vaccinations have at least some protection against new variants. They also stress that data is being collected and analyzed on new variants, and as our knowledge grows, as will our ability to modify the already approved vaccines to be more effective against emerging variants. As more data is collected, researchers will understand how to amend the current COVID-19 vaccinations so that in the future, to protect against the various strains, booster shots may be administered to maintain the level of protection required curbing the spread of the virus.What is clear is that it is necessary to achieve herd immunity through vaccination globally in order to prevent SARS-CoV-2 from continuing to mutate, becoming more resistant to current vaccines and causing more periods of mass fatality .
Production, Affordability, and Allocation of COVID-19 Vaccinations
One challenge that has been increasingly discussed is that of offering the vaccine to those who need it most and preventing disparities in vaccination access. Some research is showing that those in well-off regions are more likely to have access to vaccination, with those in poorer communities at greater risk of having less accessibility. For the vaccines to work to the highest of their ability, access should not be dictated by wealth. Ideally, those at high-risk should be vaccinated first, as they are doing in the UK, with less vulnerable groups receiving their vaccine last.
The world needs more doses of the COVID-19 vaccine than it ever has for any disease in history. This, therefore, requires significant production efforts to ensure that needs are met. While the vaccine itself is effective, its impact will be compromised if not enough doses can be produced in a timely fashion. Fortunately, COVID-19 vaccinations have not suffered from underinvestment like so many others and this investment looks likely to continue to support the need for modified vaccines that address the newer COVID-19 variants.
Public Opinion of COVID-19 Vaccination
One major potential barrier to the success of COVID-19 vaccinations is a negative public opinion of the vaccine. A June 2020 survey found that 71.5% of people would be very or somewhat likely to take a COVID-19 vaccine, leaving almost a third less accepting of the vaccine. If significant portions of the population were to reject the vaccine, this could have a serious impact on the vaccine’s potential efficacy at controlling the spread of COVID-19. Some populations, in particular, have low acceptance rates; in Russia, for example, less than 55% of those surveyed would accept the vaccine.
This challenge can be overcome by educating the public about the importance of COVID-19 vaccination and being transparent about the development of the vaccine along with the prevalence of potential adverse events. Educating people helps to build trust in the decision to offer vaccinations, without which, the world will not be able to overcome the pandemic and return to ‘normal’ life.
In a 2019 paper, describing adverse events after the influenza H1N1 pandemic vaccination, Edwards et al conclude .
“..one of the lessons learned from the 2009 pandemic was that there is a need for an internationally coordinated vaccine safety infrastructure so that the safety of pandemic vaccines, which are rapidly deployed in large numbers, can be rapidly evaluated. We know another pandemic is coming, but we do not know when.”
Where People Are Most Optimistic About the Vaccine Race
Russia is gearing up to bring its Sputnik V Covid-19 vaccine to the market at some stage this month, despite concerns that it has not gone through a proper testing process. Final Phase III tests involving 400,000 people only began last Wednesday. Sputnik V is already mandatory for military personnel while a small independent teachers’ union has urged its members to avoid being coerced into accepting shots of the vaccine during back-to-school season. Even though it seems Russia is almost certain to carry out mass vaccinations over the coming weeks, a recent Ipsos MORI poll found that only 57 percent of Russians think a Covid-19 vaccine will be available by the end of 2020. It may well be that a large swathe of the public is holding out to see how the final trials pan out before taking their chances on Sputnik V. Similarly, China has also developed a vaccine; obliging members of its military to take the CanSino innoculation before testing for its commercial sale are complete. CanSino Biologics has already announced positive trials and this may have resonated with the public, 87 percent of who agree that a Covid-19 vaccine will be available in China by the end of the year. In the United States and Germany, the share in agreement is far lower at just 34 percent and 24 percent, respectively .
The Public’s Role in COVID-19 Vaccination: Best Practices
To ensure a successful COVID-19 vaccination campaign, it is necessary for sponsors to invest in time-critical investigations on human factors related to vaccine acceptance, and for public health authorities and other stakeholders to act on the social and behavioural findings of this research. Such efforts include:
- Reconfiguring existing research investments to include social, behavioural, and communication science.
- Embedding rapid social, behavioural, and communication science within the COVID-19 response, helping to deliver timely data and empirically based advice.
- Transforming the vaccine research enterprise by involving communities as active partners’ not passive subjects.
- Applying Human-Centered Design principles to the planning and implementation of the COVID-19 vaccination program.
Table 1:Summary of Working Group Recommendations, Best Practices for Implementation, and Tasks for Specific Entities 
|Recommendation||Best Practice||Action Items|
|Value social science as key to the success of COVID-19 vaccination||Reconfigure existing research investments to include social, behavioural, and communication scienceEmbed rapid social, behavioural, and communication science in the response, delivering timely data and empirically based adviceTransform the vaccine research enterprise by involving communities as active partners, not passive subjectsApply human centered design (HCD) principles to COVID-19 vaccination program planning and implementation||Joined by foundations, Operation Warp Speed should commit a portion of its budget, and work through the National Institutes of Health (NIH), National Science Foundation (NSF), and Centers for Disease Control and Prevention (CDC) to support rapid response research into COVID-19 vaccination’s human factors.NIH’s ACTIV model should include social/behavioral research and recognize minority serving institutions as well-placed partners to study community-specific vaccine access and acceptance issues.With university social scientists, SLTT health officials should partner with grassroots groups to learn how their communities are thinking about, and wanting to learn more about, SARS-CoV-2 vaccines.|
|Inform public expectations bout COVID-19 vaccination benefits, risks, and supply||Temper expectations of vaccines as a “quick fix”Forecast a range of vaccine possibilities, from best case to works case scenarios regarding vaccine supply and effectivenessPersist in transparency around vaccine safety systems; actively work to protect their integritySeek the input of communities of color that may have historic reticence toward public health||Pre-vaccine rollout, federal health agencies should develop a coordinated national promotion strategy, using HCD-informed interventions that enable a broad network of champions to communicate about risks, benefits, allocation, and availability.CDC, with support from Congress, should fund state, local, tribal and territorial (SLTT) health departments, via Public Health Emergency Preparedness (PHEP) grants, to partner with grassroots-level groups, practitioners, and others to engage early and often with communities around COVID-19 vaccination.|
|Communicate in meaningful ways, crowding out misinformation||Put public well-being at the center of vaccine communication, rejecting any political trappingsInvest in qualitative research to identify specific community concerns and hopes about vaccinationUsing surveys, identify the prevalence of attitudes and beliefs across the US population, among specific subgroups, and over timeEngage a broad network of trusted spokespersons to deliver and reinforce a unified message||United States Government (USG) should sponsor rapid efforts for public and stakeholder engagement, formative research, and message development for SARS-CoV-2 vaccines. Longitudinal efforts will permit strategic adjustments if attitudes or beliefs evolve over time.CDC should apply capabilities in risk communication and community engagement with broader local coalitions involving SLTT departments, universities, and community organizations.Trusted community spokespersons should be engaged in communication efforts to amplify vaccine-affirming, personally relevant messages.|
|Earn the public’s confidence that allocation and distribution are evenhanded||USG, take active steps to make the vaccine available at no cost to all residents; publicly pledge vaccines to all who desire themDevelop objective allocation and distribution strategies and provide concrete proof that the processes are apoliticalTake racial, ethnic, and social factors into account when developing allocation and distribution strategies||With stakeholder and public feedback, and facilitation by a neutral third party, the CDC should reassess its pandemic vaccine allocation and targeting strategy, using multiple forms of widespread public engagement.Operation Warp Speed, US Department of Health and Human Services (HHS), CDC, and SLTT health officials should develop operational systems that involve nontraditional civilian partners and instill public confidence that vaccine distribution is evenhanded.CDC should develop consistent guidelines and rubrics for evaluating operational systems on principles of effectiveness and equity.|
|Make vaccination available in safe, familiar, and convenient places||Implement allocation and distribution guidelines consistently across providers and locations; provide timely explanations in dynamic scenariosUse nontraditional sites: e.g., schools, pharmacies, places of worship, workplaces, grocery stores, health departments, senior centers, home visitsPrepare, in advance, necessary educational materials and training for those tasked with vaccination at nontraditional sitesAnticipate hesitancy among marginalized populations toward historically fear-inducing sites and develop contingency plans to assure accessFoster interagency and nongovernmental collaborations to make vaccination available alongside provision of other safety net servicesStrengthen partnerships between health departments and media news sources to communicate about availability and access||CDC and relevant professional organizations should consolidate evidence on what has worked well at SLTT health departments for making vaccines widely accessible and locally acceptable.SLTT health departments should collaborate with interagency and nongovernment partners to use nontraditional vaccination sites and explore bundling vaccination with other safety net services.HHS and CDC should work together with SLTT health authorities to develop clear communication strategies for describing where vaccines are available and who should be seeking them.|
|Establish independent representative bodies to instill public ownership of the vaccination program||Establish public oversight committees to review and report on systems affecting public understanding, access to, and acceptance of COVID-19 vaccines||USG should sponsor a national panel convened by a neutral entity (e.g., NASEM) to review, synthesize, and report on best practices for engaging communities in vaccine allocation, deployment, and communication systems to achieve equity, solidarity, and good health outcomes.Each state (and the most populous cities) should stand up a committee that is demographically representative and incorporates diverse sectors of society including business and faith communities.|
In my point of view, Covid-19 vaccine will be more important to cure from the deadliest disease. And the pattern of giving vaccine based on the accompanying points: COVID-19 vaccine will be offered first to healthcare workers, frontline workers and population above 50 years of age, followed by population below 50 years of age with associated comorbidities based on the evolving pandemic situation, and finally to the remaining population based on the disease epidemiology and vaccine availability. The priority group of above 50 years may be further subdivided into those above 60 years of age and those between 50 to 60 years of age for the phasing of roll out based on pandemic situation and vaccine availability.Overall, the success of vaccination campaigns will largely be influenced by the extent to which people trust the effectiveness and safety of the vaccines, the competence and reliability of the institutions that deliver them, and the principles that guide government decisions and actions.
 J. Lazarus et al., “A global survey of potential acceptance of a COVID-19 vaccine”, Nature Medicine, vol. 27, no. 2, pp. 225-228, 2020. Available: 10.1038/s41591-020-1124-9.
 E. Mahase, “Covid-19: Where are we on vaccines and variants?”, BMJ, p. n597, 2021. Available: 10.1136/bmj.n597.
 P. Olliaro, “What does 95% COVID-19 vaccine efficacy really mean?”, The Lancet Infectious Diseases, vol. 21, no. 6, p. 769, 2021. Available: 10.1016/s1473-3099(21)00075-x.
 Annavajhala, M., Mohri, H., Zucker, J., Sheng, Z., Wang, P., Gomez-Simmonds, A., Ho, D. and Uhlemann, A., 2021. A Novel SARS-CoV-2 Variant of Concern, B.1.526, Identified in New York. https://www.medrxiv.org/content/10.1101/2021.02.23.21252259v1
 K. Edwards, P. Lambert and S. Black, “Narcolepsy and Pandemic Influenza Vaccination”, Pediatric Infectious Disease Journal, vol. 38, no. 8, pp. 873-876, 2019. Available: 10.1097/inf.0000000000002398.
M. Schoch-Spana et al., “The public’s role in COVID-19 vaccination: Human-centered recommendations to enhance pandemic vaccine awareness, access, and acceptance in the United States”, Vaccine, 2020. Available: 10.1016/j.vaccine.2020.10.059 [Accessed 4 June 2021].
 Niall McCarthy, “Where People Are Most Optimistic About the Vaccine Race”, 2020.