The 03 Vaccine Dilemmas

7 min readDec 2, 2020

Health authorities around the world are facing some tough choices

Let’s start with a thought exercise based on a true story: A pandemic is causing havoc all over the world, killing hundreds of thousands of people and paralyzing economies. Humanity is craving a vaccine. One science group, made of one of the most prestigious universities in the world and a well-known pharmaceutical company, has a working vaccine. The effectiveness is debated, but in either case, it surpasses the minimal requirement for approval. The group says they can start rolling out the vaccine in a matter of days.

However, part of the group’s experiment was born out of a mistake. A scientific, and public, discussion arose, questioning the integrity of the experiment and as a result, of the vaccine itself. The company announces it will conduct a new experiment that will hopefully clarify results, but meanwhile, asks for emergency approval for its vaccine based on the data that shows it is working. Toss in some political pressure, billions of dollars at stake, and national prestige on the side.

You are the regulator; what would you do?

Itstarts with approval. As shown in our little thought exercise, it’s not an easy decision. The vaccine most quickly approved in history, until now, was the mumps vaccine; It took four years. Usually, vaccine development takes between 10–15 years.

It’s not only that we are talking about a “super-speedy” timeline, the Covid-19 vaccines awaiting approval are also based on new technology. mRNA is known and being studied for years, but no vaccine based on this method has yet been approved, ever.

It’s a new approach to vaccines, in an unprecedented time frame for development. It’s an incredible feat by the science community. The world is desperately looking toward an end to the pandemic, but emergency approval is not something that should be taken lightly, or for granted.

Aworking and an approved vaccine would be worthless if people refuse to take it. And in that front, there is good news and bad news.

The good news is that more people are willing to take the vaccine than before. According to a recent Gallup poll, 58% of Americans say they would get the vaccine. In September, only 50% of Americans responded positively.

The bad news is that 58% might not be enough. Firstly, there is a difference between saying you will get the vaccine and actually going out and getting it. When looking at data concerning the flu vaccine, surveys always overestimate the number of people who actually get the injection. However, it’s important to note that what people say they will do in a survey doesn’t necessarily indicate what they will do when a vaccine is available. Asking people about a theoretical vaccine without data they can review isn’t the most reliable measure of how people will act when there’s an actual vaccine available with strong safety and effectiveness data.

Saying that you will agree to take the vaccine also doesn’t necessarily mean that you’ll be in the front of the queue waiting for it. In the U.K., 47% of participants in a YouGov survey stated that they would want to wait and see whether the vaccine is safe before taking it. This could take time.

Numbers are absolutely vital in this matter. Although showing very high efficiency rates of 94.5% (Moderna), and 95% (Pfizer), the real efficiency would be lower as fewer people get the vaccine. Professor Stephen Evans from The London School of Hygiene and Tropical Medicine told ITV News that 70% of the population would need to receive the vaccine before the government can consider Covid-19 as a threat of the past.

Looking at the AstraZeneca vaccine, the picture gets more complicated. With 62% efficiency, it will take a massive part of the population to take the vaccine in order for the pandemic to be over. According to a study conducted by the School of Public Health and Health Policy in New York, a vaccine with a 60% efficiency would mean 100% of the population would have to take it. An 80% efficient vaccine will drop the required coverage to 75% of the people getting vaccinated. Still quite a reach, though the fact that there may be multiple vaccines available with high efficacy is a very promising signal.

There’s another dilemma that’s widely debated all over the world. Should the Covid-19 vaccine become mandatory in order to make sure the pandemic will be over?

This question was raised in Israel and caused a huge uproar. It got to the point where the Health Minister was receiving threats and being compared to a Nazi war criminal. Eventually, he tweeted that the vaccine would not be made mandatory. “If you choose to get it — get vaccinated. If you choose not to get it — don’t,” he said.

In Australia, a rule known as “no jab, no pay” was passed in 2015. It prevents parents from receiving state benefits if they refuse to vaccinate their child against certain illnesses. The question of whether to make a Covid-19 mandatory arose with the PM taking a hard stance. It was decided that the vaccine would be optional but that the government could force a two-week quarantine on those who refuse to receive it.

Qantas, the largest Australian airline, says it will make it mandatory for travelers to show they are vaccinated before boarding the plane. Qantas’ boss said that other airlines are planning to work by the same rule as well.

In the U.K., a senior MP said that people might be banned from going to work if they refuse to receive the vaccine. Anti-Vax groups on Facebook were enraged. Eventually, the Health Minister had to clarify that the government would not make the vaccine compulsory.

In the U.S., Dr. Anthony Fauci previously said that a vaccine would not be made mandatory, because such a measure “would be unenforceable and not appropriate,” he explained. And yet, the question still stands. It’s legally possible for states to decide to make the vaccine mandatory. Whether for a specific group like essential workers, children, or for the general public. It is also not unprecedented, a smallpox vaccine was made compulsory (albeit a long time ago), but to this day, in the U.S. army, some vaccines are still mandatory for serving adults.

Many agree that making the Covid-19 mandatory is not a wanted measure, however, the option is still visibly left on the table if there is ever a true need.

The third dilemma is how to distribute the vaccines, and who will get them first. It is an issue being debated as we speak in the U.S., the UK, and other places around the world.

It’s not an easy choice to make as in the near future there won’t be enough vaccines to widely spread around the population. In the U.K., for example, it was first said that older care home residents and care home staff are on the top of the list. Later, however, it was reported that health workers would actually receive the vaccines first.

Both approaches are logically sound. One aspires to protect those who are most vulnerable to the disease due to their age and general health. The other protects those who are taking care of all those who are ill, whether at high risk or others. In other words, would you decide to protect those who might reach the hospital as patients or those who would treat them there?

There are other factors to bear in mind as well. In France, for example, taxi drivers were prioritized for vaccines as they suffer higher death rates even compared to health workers. France will also send vaccinations to French citizens living overseas in territories lacking sufficient intensive care beds.

Considering some of the vaccines are based on different technologies, and are different in their effectiveness, some experts are suggesting giving different groups different types of vaccines.“With multiple vaccines available, I think it’s right for policymakers to think about which vaccines might work best in which populations,” Helen Fletcher, a professor of immunology at the London School of Hygiene & Tropical Medicine, told the Guardian.

Basically, it’s not just a question of *who* gets the vaccine first, but also which vaccine should he/she get.

The vaccines are here. Well, not literally, yet, but it’s getting closer and closer. This is wonderful news that the world has been waiting to hear for the past year. It’s still important to realize that even with the vaccines in hand, the difficult decisions are still very much ahead.

The 03 Vaccine Dilemmas

Health authorities around the world are facing some tough choices

Written by ogamarasesh