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Rolling out a Vaccine for COVID-19: Present Prospects and Lessons from the Past

The Wilson Center’s Maternal Health Initiative, in partnership with the University of Pittsburgh, March of Dimes, and the Jonas Salk Legacy Foundation, hosted a discussion with scientists and researchers on ongoing COVID-19 vaccine development initiatives; current challenges and public trust in the process; crucial lessons from previous vaccine development efforts; and questions about safe and equitable distribution, availability, access, and uptake. 

Date & Time

Oct. 15, 2020
10:00am – 11:30am

Rolling out a Vaccine for COVID-19: Present Prospects and Lessons from the Past

Sixty-five years ago, Dr. Jonas Salk, with his team of scientists at the University of Pittsburgh (Pitt) and support from March of Dimes, developed the first safe and effective vaccine against polio. Today, the world faces the COVID-19 pandemic; and as the number of cases and deaths due to COVID-19 continue to rise, there is an urgent need for a vaccine. Typically, vaccines take years of research and testing before being made available, but the urgency of COVID-19 has pushed scientists to work to compress that process as much as possible without compromising safety and good science to hopefully develop a safe and effective vaccine by early 2021. In the race to meet this urgent need, it is crucial to learn from previous vaccine efforts, like the polio vaccine, to safely and ethically develop and effectively distribute the COVID-19 vaccine(s) to all interested individuals, once available.

On October 15, the Wilson Center’s Maternal Health Initiative, in partnership with Pitt, March of Dimes, and the Jonas Salk Legacy Foundation, hosted a discussion with scientists and researchers on ongoing COVID-19 vaccine development initiatives; current challenges and public trust in the process; crucial lessons from previous vaccine development efforts; and questions about safe and equitable distribution, availability, access, and uptake.

Follow the conversation on Twitter at @Wilson_MHI using the hashtags #COVID19Vaccine and #MHDialogue. Find more coverage of these issues on our blog, NewSecurityBeat.com/dot-mom.

                  

Speaker Quotes

Sarah Barnes

“Globally, there are more than 38 million confirmed cases and more than a million deaths in 198 countries attributed to COVID 19. As the number of cases and deaths continue to rise, there is an increasingly urgent need for a vaccine. While historically, vaccines take years of research and testing before being rolled out to the public – the prior record was four years for the mumps vaccine – the urgency of COVID-19 has pushed scientists to compress this process as much as possible while still preserving the safety and effectiveness of the vaccine.”

Dr. Peter L. Salk

“When my father and his research team at the University of Pittsburgh developed the first successful polio vaccine, a great fear was lifted. In this country as well as around the world epidemics of polio were ravaging communities. Parents were terrified. Everyone wanted to have something [a vaccine]. This went on for decades.”

“It is really important that with the Coronavirus vaccines that are in research stages right now that corners must not be cut, that all attempts be made to be sure that these vaccines are going to be safe when they begin to be applied and in some cases one has to just continue to monitor carefully to be sure that things are going to stay on track the way one wants.”

“It’s vitally important that as this vaccine, or as the first vaccines, or as succeeding vaccines get rolled out, that they be available where needed, where people want them, and where the epidemic is particularly severe.”

“In terms of subgroups of the population, such as in this country, the Black population, the Hispanic population, the Native American population, which are being hit extra hard—we have to be sure that vaccine is appropriately available, so that it can be used effectively.”

“What’s important also is that whatever fears there might be about vaccines that they be handled appropriately because vaccines when appropriately managed will be safe and can be extremely effective.”

Dr. Paul Duprex

“Yes indeed, it is a race, but it also isn’t a race. What we know is vaccines are slow[...]. Yes, we are pushing the vaccine development process through the pipeline fast but what we will not do and what we cannot do is rush that development process - from the creativity of the pre-clinical research and laboratory centers like mine all over the world to the companies that we just talked about who transmit those ideas, protect those ideas, and turn them into products. What is also important…  first may not be best, which is why yes it is a race, yes we are competing in that race, yes it is vital that we have a wide range of different developmental vaccines for COVID to use because we don’t know what is in front of us and which ones will work best.”

“It is understandable and it is not wrong to be hesitant. It is good to ask questions and it is good and important to have trusted messengers in front of you who can answer the questions, who can relate, who can communicate. That is why communication, collaboration, transparency, [and] partnerships right from the beginning of a vaccine development through these phases that we see now are good for individuals who span from molecules right to the person, the man, the woman, who will get the vaccine. Secondly, it’s important to remember that we need to champion these products – we need to show what they have done in the past. That’s why I think it’s wonderful to have discussed the polio virus today, pushed to… the edge of eradication by safe, efficacious vaccines.”

“I think we have to remember not to forget…  what these diseases did in the past and to actively collaborate, to work with each other, and to communicate well that vaccines work.”

Dr. Ruth A. Karron

“As of today, the United States leads the world in COVID-19 cases and deaths, and also has one of the world’s highest COVID-19 associated death rates. In our failure to adhere to basic public health principles, we have, in the words of the editors of the New England Journal of Medicine, ‘taken a crisis and turned it into a tragedy.’ However, we now have an opportunity now to lead in a way that benefits people in our country and all over the world, which is to use the best possible science to guide the evaluation, regulation and deployment of COVID-19 vaccines.”

“We also need to devise a clear plan to meet the needs of pregnant women. Reports indicate that pregnant women, particularly Black and Latina women, may be at increased risk for hospitalization and ICU admission compared to their non-pregnant counterparts. Moreover, many pregnant women suffer from comorbidities such as obesity, diabetes, and hypertension, which are known to increase the risk for severe COVID disease.  Pregnant women are high risk health care workers and first responders, the group proposed for phase 1 allocation by the National Academies, and they are also members of every category proposed as phase 2 by the academies. If we don’t yet have data from carefully conducted trials that deliberately include pregnant women, we will need a plan to protect pregnant women in these priority groups when vaccine becomes available late this year or early next year.  If vaccines are not recommended, other strategies for minimizing workplace risk must be developed and implemented.”

“I think that the partnership with the media as a potential trusted messenger to then inform people in the community is critical. I always point, for example, to the New York Times Vaccine Tracker as an extraordinary source of information for everyone. And I think that if we do this right, we could not only increase confidence in COVID-19 vaccines, but increase confidence in all of the vaccines that we deploy.”

“With respect to reinfection, it is not surprising to those of us who work on respiratory viruses, that reinfections with this virus take place. Nor do I personally expect that any COVID-19 vaccine will protect against – absolutely protect against – reinfection, that is, give you sterilizing immunity. The purpose of these vaccines is really to prevent severe COVID disease. So we could certainly expect that people might be reinfected and have mild symptoms, and I would consider that – myself - a perfectly acceptable outcome.”

“We do have to think carefully about this, about how pregnant women, for all of the reasons that I mentioned, how we care for pregnant women in this pandemic. A few important things just to mention, one is that we are mostly working with novel vaccine platforms… they’re all relatively new. I think there is a consensus opinion, at least among people that I’ve talked to, and I tend to agree, that rather than including pregnant women in ongoing Phase 3 trials, which are large and which are done carefully but not necessarily by people who have clinical investigators who have experience in working with pregnant populations, that it might be best to consider Phase 2 trials, done in parallel by experienced obstetricians and gynecologists, maternal fetal medicine specialists, thinking particularly about individual platforms and their suitability for pregnancy. And having those clinical investigators with experience with these populations who can very carefully and thoughtfully oversee these trials.” 

Dr. Rahul Gupta

“There are about 187 various COVID-19 vaccines candidates across the globe, whether in preclinical development or undergoing clinical trials right now. As one or more vaccine gets approved over the next three to six months, it’s very unlikely that sufficient quantities of the vaccine will be immediately available for us to vaccinate much large portions of the United States, much less the globe. So it becomes very important for us–– an issue of distribution of the initial limited supply in a manner that is evidence based and equitable. And a manner that leads to actually building up the trust across nation–– something… we’re currently lacking. And that is a challenge that is growing by the day.”

“There is a declining confidence in a safe and effective vaccine and thus, we must consider launching as soon as possible, even prior to the availability widely of a vaccine, a COVID-19 vaccine promotion campaign that is done by trusted partners across the country and is apolitical in nature.”

“Vaccine hesitancy is to be expected in a normal circumstance, it’s very different from being what we call “anti-vaccine.” It is normal for average citizens and residents to be questioning the vaccine before they take it into their bodies. That’s where the transparency of the manufacturing process, the regulatory process, the building trust in that system is so critical and important. It is not wrong at all, to be hesitant. What is important is to demand that we have a safe and effective vaccine. We also need to understand that it is, these days, in a polarized and divided world, it is very easy – whether we see it with masks, with social distancing, or other aspects – to view vaccines from a political lens. So it’s very important that we understand that the vaccines are some of the most investigated, documented safety countermeasures and drugs out there, of anything.”

“We have thousands and in some places, tens of thousands of participants of each of these clinical trials, so there is no doubt in my mind that when we take and extrapolate the results from thousands or tens of thousands to hundreds of millions and sometimes billions of people, some side effects will come out. We saw that with the H1N1 vaccine… that is not a reason to doubt the safety and efficacy of a vaccine. That is a reason to have a robust process to be able to discover that, make the appropriate changes, and to do that, what we need is a trust of people in the systems of manufacturing. And then we need policymakers and other officials not to politicize this process, and to trust in science and trust in evidence in order to have success.”

“I don’t want us to think for a minute to think that we’re on the right path, that we just need to make adjustments. We have to make some major changes to the way we’re approaching this pandemic in this nation. Otherwise, it may not be far where… we may have a bifurcated world in a few months where the United States and some of West European countries continue to suffer while the rest of the world has immunized itself.”

Dr. Lisa Waddell

“This is a historic time for our country and our world. The novel coronavirus is the greatest threat of our time to our health and the global economy. It’s a historic time for our families and our communities, for our frontline public health and healthcare workers, it is a historic time for our scientists and our researchers, for our businesses, public and private, for our local and public and national public health system. It’s a historic time for policymakers, at all levels, to really peel back the onion and examine and address the underlying issues that are unfolding right in front of us, and quite frankly, will continue to contribute to the issue of trust.”

“We should absolutely be outraged. We cannot let this time in history end without meaningful and systemic changes to address the underlying inequities that have and continue to define this pandemic. Health inequities are avoidable, unfair, and unjust differences in health, and this is abundantly evident in what we have seen unfold with COVID in our country. The data clearly shows that COVID-19 mortality rates are more than twice as high in Black, Latinx, and Indigenous populations compared to white populations. And nationally, Black Americans account for 13% of the U.S. population, but 24% of the coronavirus deaths, for which we have the racial and ethnic information available. And in some states we all know it’s much worse. And in some states the Black share of COVID-19 deaths exceeds the Black share of the population. Outrageous.”

“We know that there are barriers to accessing care and to accessing vaccines. So as we anticipate the availability of a vaccine to protect against this deadly virus, it is incumbent upon us to identify and acknowledge the barriers and concerns about a new vaccine. The reality is that the World [Health] Organization ranks vaccine hesitancy as one of the top ten global threats to global health. So we know that there are real concerns about vaccines. And the relatively low uptick of the yearly flu vaccine each year is, quite frankly, a signal toward the ongoing challenges that we have with adult vaccinations. But hesitancy is not the only barrier. There are those who may not have access to the vaccine. They may not have insurance, or their insurance may not cover the vaccine. This pandemic reminds us that policy plays an integral role in how individuals and communities respond to recommended actions. This is where not acknowledging and addressing those underlying social determinants of health and the structural and systemic policies that are in place in fact do make a difference.”

“We have to rely on trusted messengers. We need to ensure that we are working with communities of color and that we have effective communication strategies in place to overcome those barriers. We must engage providers and healthcare professionals, we need to ensure that the insurance providers – make sure the vaccine is available at no cost to overcome barriers. And that those who don’t have insurance will have access to the vaccine. And we must ensure that communications are developed with the input of the engaged communities, and developed by persons who they trust like their physicians, who look like them, that live in their communities, and that we collaborate with other partners like the faith communities and others.”

“What we say matters, and how we say it matters. And so, when there are already historical concerns about vaccines and studies and that sort of thing, then I think the last thing that the public probably wants to hear is a perception of something being rushed. And so, that’s why it’s so important to communicate often, early, frequently, what we know, exactly what’s happening, so that the public understands that the process for the development of these vaccines is going to be a safe and appropriate process.”

Dr. Anantha Shekhar

“And much has changed too, in the world in terms of science…the whole field of virology, vaccinology has advanced so much since the time of Dr. Salk, but yet the same principles still are challenging us…the fact that the virus presents itself with [a] variety of host related issues that… could be anywhere from mild symptomatic to totally lethal is still prevalent and in fact that’s been one of the big challenges with COVID-19. The fact that there is concerns about safety of the vaccine, or the process of production of the vaccine, the distribution, even IP [intellectual property] for a vaccine are still major challenges.”

“We had… a much more united world than people from Professor Salk, who essentially did not patent the vaccine, all the way to people who contributed to the distribution and production of the vaccine were dedicated to making sure that everyone got the vaccine. In fact…Dr. Salk’s team was very diverse. It had women. It had minorities. It had a number of representatives of what we would today call a team, a diverse team…There was a lot of local pride and local engagement and diversity involved [in the polio vaccine]. One of the concerns, during the historical discussions, were how do we make sure that children of color accept and get this vaccine. So, imagine in the 1950s they were struggling with the same social challenges that today we still, in fact we may have exacerbated that with our health disparities. So these historical factors are still present today and we should be really much more enlightened” 

“What has changed, on the positive side, is now there is extraordinary commitment and coordination and cooperation across the globe…we have, today in October, as has been said, over 160 vaccine candidates being tried because there is global cooperation. Because there is scientific sharing of information.”

“The idea that some of these highly anticipated vaccine trials are being slowed, are halted, means that science is actually holding court and preventing people from rushing things that aren’t ready yet. Our processes are in place, our science is good and is global and can deliver. The big challenge of course is trust in science, which has been eroded, unfortunately. Trust in facts, which has been eroded. Trust in truth, which has been eroded. All of these challenges have to be in fact addressed before we can successfully make sure that there is an acceptable vaccine and that we have answers for vaccine hesitancy.”

“I think there are a lot of great opportunities, there is a lot of optimism. I’m one of the people that is quite optimistic and feel like the world will be a better place in 2021, definitely by 2022, and I am very proud that Pittsburgh, historically and in the current day, will be a great contributor to this outcome.”


Hosted By

Maternal Health Initiative

Life and health are the most basic human rights, yet disparities between and within countries continue to grow. No single solution or institution can address the variety of health concerns the world faces. By leveraging, building on, and coordinating the Wilson Center’s strong regional and cross-cutting programming, the Maternal Health Initiative (MHI) promotes dialogue and understanding among practitioners, scholars, community leaders, and policymakers.  Read more

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