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Public health — not political partisanship — must take the lead in COVID-19 vaccination

If lack of trust and confidence causes the failure of a coronavirus vaccination, immeasurable human suffering will continue indefinitely. The stakes could not be higher.

Sisters Maria Harvey (left) and Ashley Makridakis (center) hold signs during a No Mandatory Flu Shot Massachusetts rally held outside of the State House in August to demonstrate against Governor Charlie Baker's order for mandatory influenza vaccinations for all students under the age of 30, an effort to lower the burden on the health care system during the COVID-19 pandemic.Jessica Rinaldi/Globe Staff

As a physician and former public health official for multiple Republican governors and a Democratic president, I have always believed that life-saving vaccination should not be a partisan issue.

But today the future of any COVID-19 vaccine is unclear. Almost 80 percent of Americans believe that politics, not science, is driving its development. The public’s trust in a forthcoming vaccine took yet another hit when Health and Human Services Secretary Alex Azar recently sidelined public health agencies by mandating that he alone can approve new rules on vaccines.

Before the pandemic, vaccine skepticism was regularly fueled by social media and outspoken public figures, including the president — who recently tested positive for COVID-19 — contributing to a host of preventable outbreaks and fewer than half of Americans getting annual flu shots. Regular White House guarantees of an unprecedented “warp speed” COVID-19 vaccine arrival — coupled with multiple pressures from the federal government over its development, including Azar’s announcement — are further compounding distrust. According to the latest Axios-Ipsos polling, 6 in 10 Americans surveyed say they will not take a vaccine as soon as it becomes available.

To assure that the public can welcome, not repudiate, a COVID-19 vaccine, Americans must demand that our leaders:


Uphold the most rigorous scientific standards as part of launching any COVID-19 vaccination campaign. With nine vaccine candidates worldwide in Phase 3 trials, any perception of cutting corners for approval will be disastrous. Instead, it must come only after rigorous review and input from outside data and safety monitoring boards and independent expert groups advising the Food and Drug Administration, Centers for Disease Control and Prevention, and HHS. The public must know that FDA approval reflects the most rigorous and transparent analyses ever. After distribution and dissemination, health officials then must closely track uptake, side effects, and impact in real time to demonstrate that vaccination is safe and effective.


Ensure the success of the seasonal flu vaccination drive. No one will accept a COVID-19 vaccine if ongoing seasonal flu vaccination efforts are botched. Flu, which caused over 400,000 hospitalizations in the United States last season, could easily add to COVID-19 hospitalizations and deaths and overwhelm our already exhausted health care system. With the pandemic currently causing many people to delay critical preventive care and disrupting vaccination sites previously available in workplaces and schools, an “all hands on deck” strategy must involve extra efforts from drive-through and outdoor clinics, pharmacies, supermarkets, barbershops, and faith-based organizations, for example. With doses already being distributed nationwide since July, reaching overall national adult vaccination rates well above 45 percent could provide momentum for a subsequent COVID vaccine campaign. Special efforts must reach communities of color that have long endured lower vaccination rates for flu and other threats.

Synchronize national communication about both vaccination campaigns. Separately promoting flu and COVID-19 vaccines will only heighten the fragmentation that has characterized the pandemic response from the beginning. Strong coordination and communication, through the upcoming $250 million HHS media campaign and otherwise, must send the message that a unified public health system is protecting everyone. The administration and Congress must fund and support state and local health officials, long overloaded and under-resourced, so that they, in turn, can empower front-line health professionals and other community leaders entrusted by patients and the public alike. National experts, like Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, must continue to advise the public daily about masking and social distancing, testing strategies to distinguish the two viruses, a possible two-dose regimen for COVID-19 vaccines, recommendations for adults over 65 to also receive pneumococcal vaccines, and other pressing issues.


Tackle misinformation on social media. Tech services, like Twitter, which have begun to flag and block overt misinformation, should aggressively reject anti-vaccination falsehoods circulating on social media platforms. Health organizations and professionals have joined social media partners to direct people to evidence-based websites for essential vaccination facts.

Assure the world that US vaccines can promote global health, especially in low-income countries. If US vaccines quell the pandemic at home but not abroad, the threat will only recur. The United States should reverse its recent decision not to join COVAX, a global collaboration cosponsored by the World Health Organization, aiming to develop and equitably distribute billions of need-based COVID-19 vaccine doses to participating countries.

If lack of trust and confidence causes the failure of COVID-19 vaccination, immeasurable human suffering will continue indefinitely. The stakes could not be higher. The United States must focus on public health, not partisanship, to put the pandemic behind us once and for all.

Dr. Howard Koh is the former Massachusetts commissioner of public health, former assistant US secretary for health in the Obama administration, and professor of the practice of public health leadership at the Harvard T.H. Chan School of Public Health and the Harvard Kennedy School.