Globed hand holding a vial makred COVID-19 Vaccine with a syringe drawing liquid, photo by Ridofranz/Getty Images

commentary

(The RAND Blog)

It's Going to Be the Vaccination, Stupid!

Photo by Ridofranz/Getty Images

by Robert H. Brook and John J. Rydzewski

August 21, 2020

The increasingly positive news on COVID-19 vaccine development is also bringing growing alarm over whether Americans will trust these vaccines when they become available. Indeed, as the possibility for a vaccine increases, so too may rise tensions and protests.

As a former head of RAND Health (Brook) and as the current chair of the RAND Health Board of Advisors (Rydzewski), we are part of a small group of RAND, UCLA, and Stanford researchers who are attempting to tackle the logistical challenges of opening schools and the economy without negative health consequences. Here is what we know, and what we would propose to increase public acceptance of widespread vaccination.

In the United States, there are 5.8 million cases and 180,000 deaths confirmed to date, with a case fatality rate of about three to four percent. However, based on antibody testing, results in peer-reviewed medical journals, and newspaper reporting of the epidemic, the best estimate of the number of Americans who have had COVID-19 is between 50 million and 60 million, and the number of deaths from this disease is clearly north of 225,000. Globally, the number of cases is probably multiples of ten times the reported 23 million cases and 800,000 deaths.

While we were clearly not prepared for this virus, we now need to understand how we are going to roll out any proven vaccine.

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While we were clearly not prepared for this virus, we now need to understand how we are going to roll out any proven vaccine. Here are some ideas about approaching vaccine distribution strategically in this environment:

  1. First, we need to establish enough acceptance of the vaccine to let it do what it is supposed to do—protect the population. A crash effort in vaccine literacy should include the federal government, including the president, cabinet, Congress, and Supreme Court, and all federal employees whether they are Republicans or Democrats should publicly get the vaccine together. Social media platforms should not be allowed to function as unfiltered vectors of anti-vax falsehoods.
  2. Second, we need an equitable distribution plan that reflects social realities. The vaccine should go first to health workers, essential workers, teachers, the elderly, and people whose living circumstances—from prisons to apartments—make it impossible to self-isolate if they get the disease. We need to ensure there is no discrimination, racial or otherwise, in the distribution process. And vaccinating teachers is particularly important because we cannot expect them to risk their lives to teach their students. There is broad agreement that keeping the schools closed will increase the gap between advantaged and disadvantaged children; a generation is at stake.
  3. We should consider whether and how to provide, at the time of vaccination, an electronic readable card confirming that the person had been vaccinated.
  4. We should also consider whether it is good policy—or even legal—to require employees, guests, students, or others to present a readable card proving they have been vaccinated if they want to work, fly, eat at a restaurant, study in a classroom, go to the opera, take a cruise ship, etc.

It would be tragic if the opening of schools were delayed because we did not plan now how to distribute a vaccine properly, or if there were newspaper reports of racism in rolling it out. It would be a disgrace if supply chain problems made it impossible to administer the vaccine to the people who needed it most. If we do this right, schools, sports, museums, travel, and, not the least, family gatherings could return to normal more quickly.

History will judge the role that America played as the world grappled with this epidemic. Currently, that judgment would be harsh. But if all segments of society work together, we can address our country's crisis while also lending clinical expertise, financial support, and technical skills to help vaccinate the globe.


Robert H. Brook is distinguished chair in Health Care Services and a senior principal physician policy researcher at the nonprofit, nonpartisan RAND Corporation, professor emeritus of medicine at the David Geffen School of Medicine, University of California, Los Angeles, and professor emeritus of health services at the UCLA School of Public Health. John J. Rydzewski is chair of the RAND Health Board of Advisors and a senior advisor at PJ Solomon.

Commentary gives RAND researchers a platform to convey insights based on their professional expertise and often on their peer-reviewed research and analysis.