By Jeremy Schafer PharmD, MBA
Senior Vice President
By Deborah Lotterman
Chief Creative Officer
Vaccination is often considered one of the greatest achievements in medicine. A series of injections that confers decades, if not a lifetime, of protection from a myriad of deadly or disabling diseases, including polio, diphtheria, measles, chicken pox, and more. In some cases, vaccines have been so effective that they wiped out the disease in question entirely. However, vaccines have become a topic of controversy. A now widely debunked study by Wakefield et al published in The Lancet (retracted in 2010) in 1998 claimed to find a connection between the MMR vaccine and autism.1,2 Media attention and panic followed, leading to a drop in vaccination rates and a resurgence of vaccine preventable illness. Healthcare professionals and vaccine advocates have fought back with published data proving vaccine safety, public awareness campaigns, and even state mandates.
Still, optimal vaccination rates prove elusive.
The challenge may be that the harm of not being vaccinated is not as real to vaccine detractors as the rumored side effects associated with vaccines. An individual, vaccinated or not, is unlikely to ever encounter a case of measles, polio, or rubella. However, most parents are likely to encounter a case of autism, seeing for themselves the life-changing nature of the disease. The result is a person willing to forgo a vaccine in his/her child because the fear of a hypothetical, but relatable, disease outweighs the risk of a real, but ultimately, unknown disease. So the question to the healthcare community is how do you make the impact of not vaccinating more relatable and real?
We suggest we have been handed the answer with COVID-19.
COVID-19’s origins are still unknown, but the disease began in China late in 2019.3 The virus rapidly spread and is now responsible for hundreds of thousands of cases and thousands of deaths.4 Many of the deaths have occurred in the same population most at risk of poor outcomes with influenza—individuals with preexisting health conditions and the elderly. The World Health Organization declared COVID-19 a pandemic in early March, acknowledging that the virus is likely to spread across the globe.5 The world is now faced with an easily transmitted virus, deadly in vulnerable populations, and zero proven treatment options or vaccines.
The response is the only option the world has – lockdown.
To say COVID-19 has been disruptive to daily life would be an understatement of immense proportions. Many states and cities have closed schools, including New York City, a change impacting more than 1.1 million students.6 Major sporting events, including the NHL season, NBA season, and college basketball’s March Madness were all canceled or indefinitely postponed as well. Even those without children, or an appetite for sports, feel the pinch. Air travel is significantly reduced, nixing exotic vacations. Many states have closed bars and restaurants, furloughing workers and disrupting social patterns and connections. Movie theaters are closed and big motion picture releases delayed (we may never see how Emily Blunt will persevere in A Quiet Place 2 and we may find her plight much less horrific if we do). Retailers have limited how many customers could be in a store at a given time to reduce risk of transmission in the store (instead risking transmission in the line outside). In Italy, the situation became so dire that individuals were restricted from going outside.7 The limits on social gatherings canceled or postponed scores of conferences, parties, events, and weddings. Social distancing became part of our lexicon and is practiced by millions across the world. Many have felt the pain of COVID-19 when the stock market cratered and approached recession levels. In short, COVID-19 changed the lives of just about everyone.
The rationale for the lockdown is multifaceted. Minimizing the number of cases will reduce the strain on an overtaxed healthcare system. Limited travel has the potential to block transmission of the disease to new countries and territories. Perhaps most persuasive of all, limited social contact is portrayed as a sacrifice by the less vulnerable to protect those at highest risk of death by COVID-19. Some, like spring break revelers in Florida, were forced to comply, but many more viewed the lockdown as an opportunity to help those in need. This legacy of significant life disruption combined with a willingness to sacrifice, should not be forgotten. Instead, it should serve as the foundation of a new script for how healthcare practitioners educate hesitant patients on the value of vaccines. After COVID, many will remember what they gave up to protect those that were most vulnerable. That recent memory can underwrite a message that all that sacrifice is avoidable, with just a quick shot and a band-aid.
Everyone is impacted by COVID-19, meaning that everyone can relate to messaging based on it. For counseling patients, healthcare practitioners can start simple. “Do you remember when you were stuck in your house for months to not get sick with COVID-19. A vaccine is a way of protecting yourself without wanting to throttle your spouse or the tedium of reorganizing your Tupperware.” Provider messaging could focus on relatable events and metrics. The missed sporting events, social gatherings, and shopping options will resonate to broad sections of patients. “COVID-19, an illness without a vaccine, led to the cancellation of the NHL, NBA, and March Madness. Don’t miss another game due to a runaway illness, vaccinate today.” Highlighting individuals with conditions that exclude them from vaccination could also be effective. “For some people, every day is as dangerous as the COVID-19 pandemic. Get a vaccination to protect them and yourself.”
The CDC, healthcare organizations, and payers could collaborate on a broader campaign. A mixture of COVID-19 references and data on vaccine safety could be an effective one-two punch. Messages and programmatic content could focus on how disruptive COVID-19 was and how this was largely due to the lack of vaccine. The information could be enriched by data on how many years different vaccines have been available, the limited safety issues, and the number of patients treated. Pair these messages with case studies on the resurgence of measles to reinforce that consistent vaccination is an ongoing need to prevent outbreaks. The result is education that is both relatable and scientific.
The COVID-19 pandemic will come to an end eventually. The lessons and experiences of COVID-19 should not.
Let’s use this moment to fuel healthcare messaging and education on how important vaccination is to public health. In COVID-19, everyone will experience what life is like in the absence of vaccines and the steps that must be taken to protect the health of those most vulnerable. Reminding patients of the sacrifices to daily life, combined with the latest scientific data on vaccines, may help put anti-vaccination concerns to rest.
1. Wakefield AJ, Murch SH, Anthony A, Linnell J, Casson DM, Malik M, et al. Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children. Lancet. 1998;351(9103):637-641.
2. Eggertson L. Lancet retracts 12-year-old article linking autism to MMR vaccines. CMAJ. 2010; 182(4):E199-E200.
3. BBC. Who is ‘patient zero’ in the coronavirus outbreak? February 23, 2020. https://www.bbc.com/future/article/20200221-coronavirus-the-harmful-hunt-for-covid-19s-patient-zero. Accessed March 27, 2020.
4. WorldOMeter. COVID-19 coronavirus pandemic. https://www.worldometers.info/coronavirus/. Accessed March 27, 2020.
5. STAT. WHO declares the coronavirus outbreak a pandemic. https://www.statnews.com/2020/03/11/who-declares-the-coronavirus-outbreak-a-pandemic/ March 11, 2020. Accessed March 2, 2020.
6. FoxNews. New York City closes public schools amid coronavirus outbreak, affecting over 1.1 million students. https://www.foxnews.com/us/new-york-city-closes-public-schools-coronavirus-outbreak March 15, 2020. Accessed March 27, 2020.
7. Wall Street Journal. Italy tightens quarantine as it battles world’s deadliest coronavirus outbreak. https://www.wsj.com/articles/italy-tightens-quarantine-as-it-battles-worlds-deadliest-coronavirus-outbreak-11584880383. March 22, 2020. Accessed March 27, 2020.