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President-elect Joe Biden faces many grave challenges. The one we believe to be paramount is that the lack of coherent, national leadership to date in the face of the Covid-19 pandemic has left Americans to respond to it in their own ways instead of responding together in a logical, coordinated fashion.

By letting individuals’ decisions revert to America’s “red versus blue” mold, we imperil our strongest national strategic asset in this fight: safe and effective vaccines against Covid-19.

Unless we increase people’s confidence in Covid-19 vaccines, we will fail to reach the protection that comes from community-wide immunity. What’s needed is a national plan to build confidence that is led by science and experts, heavily rooted in the community and grassroots, and not an extension of political campaigns or tempted by the false hope of a national celebrity campaign or public service ad campaigns offering special vaccine deals to Santa Claus performers.

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A national confidence-building plan cannot be monolithic. It must be tailored to different segments of the American public, each with different reasons for skepticism, different levels of trust in different people and institutions, and different attitudes and behaviors toward how they protect themselves today. Getting back to normal requires getting this plan right. Getting it wrong puts our recovery — and people’s lives — at risk.

To better understand Americans’ attitudes toward Covid-19 vaccines, ClearPath Strategies, the company two of us (Bluestone and Garrett) founded, recently conducted a nationally representative poll of 1,015 U.S. adults. Instead of showing a red vs. blue divide, it showed that the collective American response to the pandemic has a bell curve distribution. At one extreme, 16% would do nothing and simply want Covid-19 to run its course. At the other extreme, 19% believe their states must employ radical measures like lockdowns. Most Americans, though — 65% — are in the middle, advocating some combination of targeted interventions, personal behavior change, and sheltering in place.

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The poll showed that 67% of Americans believe that getting back to some form of normal requires safe and effective vaccines. Yet public confidence in Covid-19 vaccines is low. Only 38% of respondents said they would be willing to take a vaccine within the first three months after it became available, while 33% said they would be willing to take it after three months and 29% said they would wait at least one year. These results are reflected in other national surveys, such as those conducted by the Pew Research Center and Gallup, showing a troubling trend toward lower confidence in Covid-19 vaccines.

So most Americans are in a wait-and-see mode regarding Covid-19 vaccines. They lack confidence in the speed of vaccine development and the diligence of the clinical trials. For some, the risk of the pandemic is not enough to warrant taking what they view as a rushed — and therefore risky — vaccine. Others have faith in vaccines and the scientists producing them, but question whether the speed of development is influenced by political motivations at the expense of scientific rigor.

Fortunately, these wait-and-see Americans are persuadable. Their confidence in the vaccine and the process can be boosted. They are receptive to messages that offer details on the rigor of clinical trials processes and about how Covid-19 vaccines will help protect everyone and get us back to normal.

But the time for doing this is short.

By Inauguration Day, the wait-and-see majority may no longer be sitting on the fence. In the time between the election and the inauguration, politics will remain omnipresent and rhetoric between the outgoing and incoming president over taking credit for the vaccine and distribution effort may even sharpen. If politics continues to infiltrate the vaccine conversation, it will further erode confidence in a vaccine, putting our national recovery at risk.

Our country needs a national vaccine confidence project. If vaccines are to pave the road back to normal, this project serves as the road map for them.

During the Oct. 30 meeting of the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices, a vague project on vaccine confidence was presented. It didn’t go far enough.

A vaccine confidence project should be created and led by the best public health experts from academia with full support and collaboration from the private sector. Participants should be drawn from local, state, federal, and international levels. A vaccine confidence project must be nonpolitical if it has any hope of persuading the wait-and-see group to get the vaccine in a timely way. It fails if it is perceived as a political effort, such as a presidential directive, resulting from a political event like the election.

Instead, this effort, which requires a significant private-sector component, must focus on the safety and efficacy of the vaccine as well as on the fairness and equity of its distribution.

A vaccine confidence project should be based on sound principles of public health communication:

  • Rely on sound science and engage in evidence-based decision-making.
  • Be honest about what is known and not known.
  • Protect people from harm.
  • Assure full and fair access to vaccines.
  • Allocate and prioritize vaccine supplies and distribution based on transparency and equity, and account for the need to protect health workers, essential workers, and vulnerable populations.

Who is the audience for this project? The various segments of the wait-and-see majority who lack confidence in Covid-19 vaccines but who are open to them. The goal is to maintain that openness and reduce the time before they are willing to get vaccinated.

Doing that requires addressing the greatest sources of hesitation cited in the ClearPath poll, all of which are interrelated: the speed of the process, potential side effects from the vaccine, and politicization of the process.

Public opinion research provides clear guidance on addressing these concerns, such as educating people on the rigorous and transparent trials that put science first, involve tens of thousands of volunteers — including people who “look like me” — and benefit from industry-wide collaboration across pharmaceutical companies.

This effort must heavily message key groups of skeptics to assuage concerns and persuade them be vaccinated. Three groups the survey identified are Black Americans, individuals who have not attended college, and young adults under age 30. These populations respond very differently to key influencers. For example, Black Americans trust Dr. Anthony Fauci more than their places of worship or federal government agencies. For non-college graduates and especially for 18-to 29-year-olds, local influencers as well as institutions like the FDA, CDC, and Mayo Clinic are all more trusted than Fauci, who actually ranks last for the under-30 crowd.

The vaccine confidence project will require a multichannel communications program that features these entities and individuals with the highest trust levels according to research for each of these groups, from the grassroots (personal doctors, pharmacists, church leaders, and the like) to advertising featuring national figures and agencies (such as Fauci, the FDA, and medical experts).

Such a project must operate in the context where demand for the vaccine will not be a flip of a switch, but will be a cascade, with ebbs and surges. As more people get vaccinated against Covid-19 and the pandemic becomes less severe, and as consistency in communication breeds confidence, we will see waves of people crossing the invisible threshold to embrace a Covid-19 vaccine.

The road to a new normal will have twists, detours, and setbacks. The vaccine trials will have successes and failures. Medical experts will learn and update protocols. On this journey, all of us will still need to apply the best tools and practices we have to date, such as social distancing, wearing masks, and washing hands. We will also need better treatments and enough medical personnel, personal protective equipment, and hospital beds.

No setback would be greater to the country’s efforts to control the devastating coronavirus pandemic than Americans’ broad refusal to take a safe and effective vaccine. That means no effort can be more important than improving their confidence that vaccines will be safe, will be effective, and will put us on the smoothest road to a new normal.

David Bluestone is a founding partner of ClearPath Strategies, a public opinion research and strategy firm. John Garrett is a founding partner of ClearPath Strategies who specializes in the firm’s public health and pharmaceutical research. David Beier is a managing director of Bay City Capital, a San Francisco venture firm, and former chief domestic policy adviser to Vice President Al Gore.

  • Inclusion of public health expertise is absolutely critical in a confidence effort – but this commentary left me wondering what about social scientists? Vaccine acceptance is not a “flipped switch” but is a complex spectrum of behavior and perceptions. If we want a confidence project to be successful in all subgroups in the United States, we must grasp the social drivers of vaccination, and social scientists must be included and advise.

  • I appreciate your use of the phrase “community wide immunity” instead of “herd immunity”. Along these same lines I recommend that you change the phrase “social distancing” to physical distancing. This will fit better with your messaging goal:
    TO COMMUNICATE WITH CLARITY AND DISCIPLINE. The discipline of which I speak here stems from the ancient Chinese philosophy of called “rectification of names”.

  • I believe the lack of urgency demonstrated by the regulatory agencies to approve a vaccine (being careful not to approve a “harmful” vaccine) has had an affect on the public who are increasingly mirroring the agencies caution to accept a vaccine. Note the U.S. 5 week delay in phase 3 from one unexplained event. Yet, how many people died of COVID-19 during those 5 weeks? The risk vs benefit doesn’t appear to be worth it to the regulators – why should be worth it to them?

  • Since this article is mostly about politics I wish to point out, there is a good chance Biden will not have to do anything with the epidemic. A safe and effective vaccine will likely be distributed pretty widely in December, even more widely in January, along with 100,000 mAb treatments. Instead of 3,000 deaths per day as some predicted, it may be more like 300 and steadily declining.

    • Agreed. The FDA, HHS, and private sector have laid the foundation for the effective end of the pandemic, although there is still significant work to be done on Jan 20th regarding access. Of bigger concern is tracking mutations and updating vaccines and mAb’s with the latest antigens should the need arise.

    • I also agree. Trump secured advance purchases ahead of most all other countries of vaccines from AstraZeneca, Moderna, J&J, etc. Biden need do nothing, Trump laid the groundwork. Biden can go back to the basement and, please, don’t do anything for the next 4 years to screw up the Trump bump.

  • I want the epidemic to end but from a personal benefit standpoint, if a lot of people will not take the vaccine, that may mean I am able to get it sooner. Since I am at medium risk and very tired of trying to avoid Wuhan, (almost every other recently identified disease has been named for the place it was found, why does China get to change that tradition?) I am kind of happy if people turn it down and let me get my shot.

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