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Implementation Will Contribute More to the Success of a Vaccine Against SARS-CoV-2 Than Vaccine Efficacy
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Using mathematical modeling of population benefits of a vaccine against COVID-19 by including vaccines with varying degrees of transmission benefit and disease-modifying benefit, different assumptions regarding the pace and coverage of implementation, and different background epidemic severities, factors related to implementation were found to contribute more to the success of vaccination programs than a vaccine's efficacy as determined in clinical trials. Managing and reducing the reproduction number of the virus are dependent on sustained commitment to public health practices and tools which reduce the spread of COVID-19 (masks, hand-washing, and social distancing). Investment in these strategies is crucial not just until the arrival of a vaccine but throughout the prolonged period during which the vaccine is being deployed.
- The effectiveness of a COVID-19 vaccine will be influenced by the success or failure of efforts to deliver a trusted vaccine quickly to the public. The pace of vaccination will be decided by a combination of various factors including manufacturing capacity, the development of distribution systems and infrastructure, the creation of mass vaccination clinics in diverse locations accessible to all communities, and related logistical considerations. Vaccine coverage is dependent on efforts to encourage widespread public enthusiasm for vaccination and identify and respond to hesitancy for the vaccine. Finally, state and local health officials require adequate federal funding to design and carry out much of the on-the-ground work related to COVID-19 vaccination.
abstract
This abstract is available on the publisher's site.
Access this abstract nowThe global effort to develop a coronavirus disease 2019 (COVID-19) vaccine is likely to soon produce one or more authorized vaccines. We examine how different definitions and thresholds of vaccine efficacy, coupled with different levels of implementation effectiveness and background epidemic severity, translate into outcomes including cumulative infections, hospitalizations, and deaths. Using a mathematical simulation of vaccination, we find that factors related to implementation will contribute more to the success of vaccination programs than a vaccine's efficacy as determined in clinical trials. The benefits of a vaccine will decline substantially in the event of manufacturing or deployment delays, significant vaccine hesitancy, or greater epidemic severity. Our findings demonstrate the urgent need for health officials to invest greater financial resources and attention to vaccine production and distribution programs, to redouble efforts to promote public confidence in COVID-19 vaccines, and to encourage continued adherence to other mitigation approaches, even after a vaccine becomes available. [Editor's Note: This Fast Track Ahead Of Print article is the accepted version of the peer-reviewed manuscript. The final edited version will appear in an upcoming issue of Health Affairs.].
Additional Info
Clinical Outcomes of a COVID-19 Vaccine: Implementation Over Efficacy
Health Aff (Millwood) 2020 Nov 19;[EPub Ahead of Print], AD Paltiel, JL Schwartz, A Zheng, RP WalenskyFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.