Vaccines have helped to change the course of the global COVID-19 pandemic which was declared on 11 March 2020. Now, as we enter the third year of the outbreak, experts are beginning to reflect not only on how vaccination affected the pandemic, but on how the pandemic affected vaccination. We asked several members of our Editorial Board for their views.
While more than 10 billion doses of COVID-19 vaccine have been administered, the disruption to global immunisation programmes against measles, polio and tetanus, has plunged routine vaccine uptake into decline. The WHO and UNICEF are warning of a lost decade as more than 30 million children missed their basic vaccines in 2020. As a result, hard-earning gains made over several years have been lost, with uptake for key vaccines falling to 2009 levels. In short, the pandemic exacerbated pre-existing inequalities in global health and created large gaps in basic preventative care.
‘The ripple effects of COVID-19 on routine immunisation is something which keeps me awake at night,’ says Dr Angus Thomson, senior social scientist at UNICEF. ‘In addition to having to rebuild immunisation rates back, we have cohorts of lost children around the world who were missed during the pandemic, some of whom may have had zero doses of vaccine.’ Addressing this will take significant commitment and investment, he added.
When it comes to vaccine acceptance, COVID-19 vaccination campaigns have brought vaccines to people of all ages. In some cases, people were offered vaccines for the first time in decades. Research suggests that willingness to take COVID-19 vaccines is much higher in low and middle-income countries than in the US and Russia. In Europe, the picture is mixed, with some countries (including France, Portugal, Ireland, Denmark and Malta) vaccinating well in excess of 90% of adults, while others (such as Romania, Bulgaria and Slovakia) struggling to vaccinate half of their populations.
Dr Peter English, a UK-based public health doctor, says the decision to vaccinate against a highly contagious disease should be presented not as a choice between taking action and doing nothing. Instead, it can be viewed as a choice between getting vaccinated and getting the disease while unvaccinated ‒ an option that carries maximum risk of negative outcomes.
For some people, this concept has become well understood as the pandemic progressed. ‘People understand a lot more about vaccination [than pre-pandemic],’ says Dr English. COVID-19 vaccines are viewed as a way to prevent hospitalisation, long COVID and death, rather than a way to eliminate the chances of infection. This may shift perceptions of vaccine effectiveness against other diseases. ‘Effectiveness of flu vaccines has often been measured in terms of effectiveness against any infection rather than against the most severe outcomes,’ he says. ‘Understanding the impact on severity might encourage more people to accept the flu vaccine.’
Dr Dirk Poelaert, a medical doctor working at GSK Vaccines in Belgium, says the pandemic has been an unprecedented opportunity for the public to ‘follow science in action’. ‘We witnessed the whole process, the struggles, the hypotheses that were wrong or right; the statements that needed correction,’ he says. ‘This pandemic taught us the importance of science communication. Explaining science is extremely difficult but also extremely important.’
Dr Poelaert also highlighted the impact of breakthroughs in vaccine technology, including mRNA vaccines, and the value of investing in good healthcare systems. It also revealed humanity’s resilience in the fact of adversity, and the antagonistic approach that some people adopted on social media. ‘The voices of the trolls on social media were louder than ever before. I was shocked that many scientists in Europe have been severely threatened.’
Silvia Romeo, an EU health consultant at Acumen Public Affairs, says that while the growth in social media conversations on vaccines allowed the spread of misinformation, it also increased overall knowledge of vaccines among all segments of the population. ‘I think it would be important to stress the fact that the COVID-19 pandemic has raised awareness on the topic of vaccines ‒ especially among young people,’ she says.
In the near term, she emphasises the need to get routine vaccination back on track but, looking further ahead, uptake could reach higher levels than before the pandemic. ‘Unfortunately, routine immunisation has been negatively impacted by the pandemic across Europe, but vaccine awareness and the perception of the value of vaccines could be positively impacted in the medium and long term,’ Romeo adds. ‘The pandemic stressed the benefits of vaccines in preventing diseases among the general population.’
Dr Hugues Bogaerts, a medic specialising in the development and licensing of vaccines, says it may be too soon to tell whether the COVID-19 pandemic will permanently change attitudes to vaccination. However, he sees real advances in production and research which give the world far better capacity to develop and deliver vaccines.
‘On the vaccine manufacturing front, I see more permanent changes: the new players will continue to lead innovation as their deep pockets will allow them to accelerate the development of their pipelines,’ Dr Bogaerts says. ‘Secondly, the increased third-party manufacturing capacity and the shared knowhow will consolidate the pre-Covid trend of local manufacturing.’
However, he is unsure whether the current ‘fascination for vaccination’ will persist as the immediate impact of the pandemic begins to fade and attention turns to other global crises: ‘People have short memories for disaster.’
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