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The US must build a coronavirus vaccine infrastructure

Misguided pronouncements on treatments and current promises of ‘warp speed’ release of competing COVID vaccines have created deep mistrust of the approval process.

A health worker delivers an injection during clinical trials for a COVID-19 vaccine at Research Centers of America in Hollywood, Fla., on Sept. 9.
A health worker delivers an injection during clinical trials for a COVID-19 vaccine at Research Centers of America in Hollywood, Fla., on Sept. 9.Eva Marie Uzcategui/Bloomberg

According to the Pew Research Center, if a COVID-19 vaccine were available today, only 51 percent of Americans would probably take the vaccine, according to its most recent survey. Five months ago, about 72 percent of Americans said they were likely to do so. While vaccine development has progressed at “warp speed,” public confidence in COVID vaccines has moved in reverse.

The nation’s confused and erratic response to the coronavirus pandemic has clearly contributed to this growing uncertainty. Moreover, underserved populations, such as Black Americans suffering disproportionately from COVID-19, have deeper suspicions and hesitancy regarding vaccine acceptance, probably borne of systemic racism and the racial politics of the 2020 election. Vaccine reluctance will not be overcome unless and until individuals are convinced, most likely by a trusted physician or other health care advisor, that the vaccine is safe and effective. The problem is that the Trump administration has inserted politics into the two federal agencies on which physicians and health care advisors traditionally rely for credible information — the Food and Drug Administration and the Centers for Disease Control and Prevention.

The FDA’s misguided pronouncements on treatments and current promises of so-called warp-speed release of competing COVID vaccines, which vary by the day, have created deep mistrust of the approval process. Indeed, vaccine manufacturers Moderna and Pfizer recognized this in taking the highly unusual step of revealing details about their vaccine trials in advance of the trials’ conclusions. The CDC’s contradictory and confusing messages regarding prevention and testing have similarly generated grave concerns among the nation’s health care providers. This is especially debilitating. It is the CDC which is designated to determine vaccination guidelines, emergency allocation of vaccines, and support for vigorous outreach and communication to underserved populations.


In this environment, only influential stakeholders and organizations outside government can restore needed trust. They must provide truthful, accessible, science-based information about COVID-19 vaccines to the general public, particularly to populations at higher risk. Four tasks are urgent:


Collaborate and clarify. Last week, the nation’s pediatric, internal medicine, and family practice physician societies joined with many other groups in calling on the FDA to uphold its highest standards for review and approval of COVID vaccines. This is a welcome step, but it is time for major medical and public health organizations to speak with one voice directly to the public and not only to government agencies. There is no time to wait for the CDC to reassume its traditional role.

Designate a leader. The multiplicity of private voices needed must be organized; leadership is essential to this task. In prior epidemic or pandemic emergencies (all far less serious than COVID-19), the director of the CDC or a federal “pandemic czar” served as a single, visible public leader and coordinator of communications regarding the virus, vaccine development, and treatment. When federal response to AIDS wavered in the 1980s, the Institute of Medicine (now the National Academies of Sciences, Engineering, and Medicine) played a similar role. NASEM is now playing an important role in COVID immunization preparedness through its task force on equitable allocation of vaccines. It could transition to a more expansive leading role in organizing private sector voices. Time is of the essence.

Demand the resources needed to do the job. Truthful and accessible messaging on COVID vaccines is needed throughout the country, down to the neighborhood level. This is a resource-intensive task. While the CDC routinely funds state immunization programs, funds for communication campaigns are limited. More federal support for COVID vaccination communication is needed, particularly at this point in time, when state revenues have crashed under the impact of COVID-19.


Boost flu and other recommended vaccinations. The coronavirus pandemic has surfaced festering weaknesses in US vaccination efforts and widened disparities in public health. Just last year, the United States came dangerously close to losing its elimination status for measles, exposing the country to a painful and disruptive outbreak. Now the 2020-21 flu season has arrived and may further exacerbate risks to essential workers, the chronically ill, older Americans, and communities of color. Public reluctance to support mass immunization against COVID-19 should serve as an alarm for the United States to improve its overall infrastructure for vaccination and build the public health resilience that is clearly lacking now.

Wendy Warring is president and CEO and Tom Hubbard is vice president of policy research at Network for Excellence in Health Innovation.