Two comments posted yesterday in JAMA and a University of Michigan press release offer ideas from behavioral science and other fields to promote uptake of COVID-19 vaccines in the U.S. and discuss the ethics of continuing placebo weapons in coronavirus vaccine studies that are have already proven effective.
Evidence-based admission strategies
The first comment by Kevin Volpp, MD, PhD, and Alison Buttenheim, PhD, MBA, of the University of Pennsylvania at Philadelphia, and George Loewenstein, PhD, of Carnegie Mellon University, looked at the problem of American reluctance, a COVID to take -19 vaccine.
They found a September poll of 10,093 U.S. adults that found only 51% would definitely or likely be vaccinated, 25% said they likely didn’t want to be vaccinated, and 24% said they probably wouldn’t Will be taking vaccine. Black respondents, those with a high school education or less, and Republicans were particularly suspicious of vaccines. New data released today from the Kaiser Family Foundation’s Vaccine Monitor shows that 71% of adults in the US are now ready to receive the vaccine.
The authors of the comments offered five behavioral science-backed strategies for a national program to promote vaccines, including providing a free and easily accessible vaccine in places such as health centers, doctor’s offices, retail pharmacies, job centers, and long-term care facilities and schools.
‘Given the current reluctance of the vaccine and the complexity of administering some of these vaccines (e.g. requirements to store the vaccine at extremely low temperatures) it is unclear whether simplification is possible and will work, but it is necessary to do so easy to be vaccinated, “they wrote.
Allowing access to valued locations such as medical clinics, long-term care facilities, student dormitories, K-12 schools, workplaces, retail stores, and gyms only after receiving a COVID-19 vaccine can motivate people to comply.
“A long winter of new cases, overcrowded hospitals and more than 2,000 COVID-19 deaths a day can change the perception of what is politically acceptable,” the authors said. “Employers can make vaccination a condition of personal work by law, provided there are exemptions for disability and religious concerns and reasonable alternatives to those who refuse to continue working, such as work by too Home to continue working.“”
Once high-level groups like nursing home residents and healthcare workers are vaccinated, states and cities could first make vaccines available to employers who are publicly vaccinated to set an example for workers. National leaders representing different demographic and political groups can also be role models for vaccination.
Vaccinating people who first sign up before vaccines are available to everyone, which underscores the initial shortage of vaccines, would add to their value, the authors say. And if people who are vaccinated can post their decision, similar to “I voted” stickers, it could motivate others to do the same.
“Social factors can also be used by city and state health departments, civic organizations and employers to promote the benefits of vaccination to the community,” they write. “People who may not be doing anything for themselves will often take the same steps to help other people.”
These recommendations need to be formulated as part of a comprehensive slow containment strategy rather than a panacea, the authors say, and a national panel that includes experts from epidemiology, vaccine science, behavioral science, marketing and other fields will be needed To provide data on the safety and effectiveness of the vaccine and to guide advertising efforts.
“The team should have a range of political views to depoliticize the pandemic response,” they said. “The potential of these vaccines to contain the pandemic will be limited without comparable attention being paid to the behavioral last mile needed to ensure vaccine adoption and uptake.”
Problems with vaccination of all study participants
The second comment from Annette Rid, MD, of the National Institutes of Health; Marc Lipsitch, DPhil from Harvard University; and Franklin Miller, PhD from Weill Cornell Medical College, discusses claims made by vaccine makers Pfizer / BioNTech and Moderna about an ethical obligation to vaccinate all vaccine trial participants who have received placebo, given the positive results of the trials and the important role participants play in the research .
Rid and colleagues argue that due to the limited availability of vaccines, only participants in the COVID-19 vaccine study who receive a placebo and are eligible for the vaccine outside of a study (i.e. members of high priority groups) will be allowed access to the vaccine should be vaccines because continuing on the placebo would not make their situation worse compared to when they would not have participated in the study.
“If, in contrast to the study, the participants were eligible for a vaccination, they would be significantly worse off by continuing the placebo group than they should have been outside of the study,” the authors wrote. “The risks for these participants seem difficult to justify. In any case, they could simply withdraw from the study and get vaccinated outside of the study.”
There would also be less overall health and health benefits from vaccination if all non-priority participants in the placebo arms of the Pfizer / BioNTech and Moderna trials were vaccinated. “This would mean that currently up to 36,828 health care workers or anyone with a higher priority than the participants could not be vaccinated,” said Rid and colleagues. “The resulting loss of performance could be significant.”
Vaccinating study participants who would otherwise have proceeded to a placebo would prevent the collection of valuable long-term safety and efficacy data necessary to support their full licensing and government-funded use. This data includes those about how long the immunity conferred by the vaccine lasts and whether people infected with the coronavirus after immunity wears off have more severe illness.
“First, it would result in a significant loss of valuable research data without excluding undue risks for participants who continue in the placebo group of studies,” they wrote. “Second, health and equity gains would decrease as participants in the placebo group would receive a vaccine even if they weren’t prioritized for vaccination outside of the study.”
The authors called for their recommendations to be reviewed regularly, especially as more vaccine doses and other potential vaccines become available.
Education, memories of the second dose
In the University of Michigan press release, Mark Fendrick, MD, a university researcher and director of the Center for Value-Based Insurance Design, looked at ways to ensure that people received a second dose of COVID-19 vaccine a few weeks after the first one that needed is used to boost immunity.
“Vaccines that require more than one dose create additional behavioral and environmental problems, including reports of side effects, false claims about vaccine safety, logistical obstacles, and the politicization of the program that can deter people from getting vaccinated or for their second Dose return, “said Fendrick. “Studies of other high-quality vaccines and drugs used to treat chronic diseases show that patients take half the time, even if they are provided free of charge.”
A vaccine support program should include information about how the vaccine works, side effects of the vaccine, reminders to schedule a second dose, dates to clear any misinformation about the vaccine, and transportation to the second dose appointment.
In addition to a card that doctors can give to patients receiving their first COVID-19 vaccine dose to educate and encourage them to schedule their second dose, Fendrick recommends creating a smartphone-based program to support vaccine compliance Smartphone base based on research by his team and others. He added that a call or email from a trusted source can also be helpful, especially for underserved groups like the elderly and homeless.
And while the authors of the first comment advised against using monetary incentives, which they said could backfire by making vaccinations seem undesirable or even dangerous, Fendrick suggested a $ 50 gift card after receiving the second dose.
“The good news is that the federal government has created a financial incentive for those who dispose of the vaccine by paying a higher reimbursement rate for the second dose than the first,” he said. “Why not give incentives to patients too?”