Mask use, lockdowns, quarantine requirements and other breaches of once-normal life have drawn heated debate throughout the pandemic. A central question to much of it: Where does one’s freedom end and another’s begin?
Dr. Carlos Espinal of the Robert Stempel College of Public Health & Social Work believes the benefit of widescale vaccination should override individuals’ reasons for saying “no” to the shots.
Espinal, an epidemiologist and the director of the Global Health Consortium, on Tuesday attended the meeting of the Center for Disease Control and Prevention’s Advisory Committee for Immunization Practices. The committee recommended that the initially available doses of a COVID-19 vaccine go to healthcare workers and the elderly living in nursing homes. The Food and Drug Administration is scheduled on Dec. 10 to consider the release of the country’s first vaccine.
Espinal agrees that the two groups must quickly be vaccinated to stem the spread of the disease, safeguard those who are on the frontlines of treating the sick and prevent greater numbers of deaths among the most vulnerable. Beyond them, he encourages everyone to seek immunization once the shots become available to the general public. Already, some 1.5 million people have died from COVID-19 worldwide, among them more than 274,000 Americans (as of Dec. 3).
Population or “herd” immunity against COVID-19—the point at which the virus cannot spread because it encounters too many people who are protected against infection—requires that approximately 70 percent of people be immunized with a vaccine that is highly effective. Recent polls suggest that as many as 61 percent of Americans would accept such a vaccine, still well below the level needed to achieve widespread immunity.
In a country that includes 11 percent of adults who, according to a December 2019 Gallup survey, believe vaccines are “more dangerous than the disease they prevent,” anti-vaxxers could be the most-difficult segment of the population to convince.
“That’s the situation that we have even today with measles,” Espinal says of those who disregard vaccination laws. (All 50 states have legislation requiring specified vaccines for students, and 45 grant exemptions on medical and religious grounds.)
“There have been people refusing the measles vaccination because of many reasons, religion or unwilling to do it or afraid to do it or because they believe in the rumor that measles vaccination is the cause of autism. That has created a large outbreak in Europe and the United States, very extensive child mortality.” (In 2019 the United States reported the greatest number of measles cases in 15 years, largely due to lack of vaccination.) That begs the question, he says: “Where is the limit between the freedom of choice and public health good?”
Espinal suggests that workplaces, universities and even other countries’ governments will impose vaccine requirements that will impact Americans. Even without federal mandates in place, many organizations will seek some kind of “vaccine certification” from individuals before they are allowed, for example, to enter a physical building or to travel internationally, Espinal says. He cites, for example, some African and South American countries’ required proof of yellow fever vaccination for entry to their borders.
With millions of doses of vaccine already shipped to state governments around the country for distribution pending FDA decisions, safety concerns are on the minds of many. Espinal understands that the speed with which the vaccines are coming to market creates some doubts.
“That is one of the concerns,” he agrees. “Normally the development of vaccines could take almost five to eight years.” The severity of the COVID-19 pandemic, however, encouraged the U.S. and other governments to allow pharmaceutical companies and their partners to move quickly and to scale up production even as human trials were still underway. Yet, Espinal believes that the end products are sound.
The leading vaccines are produced by drug makers Pfizer and Moderna, whose vaccines are up for final review by the FDA on Dec. 10 and 17, respectively. “Those are very strong companies worldwide, recognized with experience in vaccine production and new technology,” Espinal says. “I feel very confident with the information that they are providing.”
The companies’ drugs have shown 90-95 percent efficacy and a low percent of adverse events or side effects in clinical trials. Those results as well as the transparency with which the organizations have proceeded have convinced Espinal to encourage vaccination.
“I feel comfortable,” he says, “and I trust what they are doing.”