DukeSciSoc-Ben

Say a vaccine is finally achieved. Is 100% safe and tested for 18 months. What happens next? Is it like Contagion (lottery) or how do we vaccinate the whole world? Will there be some sort of bracelet to identified the vaccinated?

Nita: What happens next depends in part on the data. Has it been tested on children? Who are considered the most vulnerable at that time? What is the safety data on the vaccine? What is the effectiveness of the vaccine?Let’s assume it’s safe and effective. But it’s in limited supply. Principles of bioethics would suggest that we ought to give it first to those that are the most in need (e.g. most likely to be exposed, most likely to become critically ill as a result). We ought also to consider those populations on whom it was tested and ensure that those who exposed themselves to risk to enable the development of the vaccine can also benefit from it.

Buz: First, understand - no vaccine is 100% safe.  many of the side effects may not be revealed until after extensive use.  You ask a question to which we don't yet know the answers.  Will it be paid for by the govt and offered free to all?  Will it be available only to people with insurance?  Are there sub-populations who are more at risk for adverse events?  Will the manufacturers be able to meet demand? Will all of the required ingredients be available in the US or will we be dependent on foreign supply?  Sorry to answer the question with more questions.

Thomas: With respect to the question of identifying the vaccinated, it presents a tricky question. In China, they are now utilizing an app which identifies individuals who have had the disease - this creates a new class system at some level. Those in the green in the color code system are able to go to restaurants, use the subway, etc.; others are subject to monitoring if they violate quarantine orders. Others are denied and may be subject to further monitoring. States have the authority to require immunization to attend schools, and universities create similar policies. We'll have to wait and see what actions are taken when a vaccine comes to market, but this will almost certainly have some variance and poke the bear of inequity in ways that aren't hard to imagine.

To jump on to Nita's train of thought, since we also see this pandemic impact communities on the margins with far greater impact while they have far more limited access to care and appropriate housing, we may also consider those factors as we roll out a vaccine to insure a hotspot there doesn't become an enormous outbreak more generally

Thomas: I don't think it's a simple yes or no regarding support for human challenge trials. Generally, opinion on human challenge trials has been to restrict them to diseases that we have effective treatment for, like cholera, when we want to evaluate new vaccines, but we know we can treat the disease. We still have not engaged in challenge trials for HIV even though it's treatable. COVID has no reliable treatment. And even in pretty young, healthy people new evidence of risk not yet before considered is becoming relevant - such as life-altering strokes in patients in their 30s and 40s. We have to think about what informed consent to engage in that research looks like when we're still learning, and also how we might take care of those who sign up and who might be left disabled because of it - will they be care for for a lifetime? There are also lots of different ways to use challenge trials - are you identifying only the best vaccine options? Are you trying to get something to market immediately or more quickly? The details matter.

Ariana: Part 1- In regards to techniques for scicommers to help educate and inform the public, all good guidelines for science communication are in play and even more critical now. One of the biggest things is making sure that the data and the numbers are explained in a way that is relatable and makes sense. As well as describing things in terms that are familiar. Explanations of things such as "why we need to wear masks" and relating it to things that we encounter or do in our daily lives are helpful. Additionally, there have been some excellent examples of actually explaining the meaning behind the graphs and numbers that are being tossed around. It is important to note that in all likelihood, you have no control over how someone responds. But you can try to understand why they think what they think and respond in kind. For example, there was a recent survey that looked at what activities people felt safe doing, but it is important to understand what safety means to folks as well as why they want to do those activities in the first place, and then describing the science related to those responses.

Part 2 - It is difficult for policy to be effectively responsive to what is currently happening if it is being decided data either because we are still finding the data and doing experiments, or because the results are in doubt. One of the difficulties with science is the need for repetition for confirmation. In this case, since we are still rapidly working to figure out this virus, treatments, vaccines,etc., we are in a realm where we are relying on science moving quickly, expert assessment/analysis of related experiences, what is happening regarding COVID-19 in other places, and models that help us predict what is going to happen given different variables. These models, which are informed by expertise from many areas (public health, economics, behavior) are enabling us to make decisions here. Regarding this data being under suspicion, this is another space where good science communication and science expressed clearly and diligently to policymakers can help us with this. Additionally, as members of the public, you yourselves can get informed from accessing the science about this pandemic that is out there and getting in touch with your governor or congresspeople.

Buz: With a virus as contagious as COVID-19,  no understanding of what level of herd immunity will create community safety, and no effective antigen test which will accurately predict immunity and contagion, people who refuse vaccines will have to be quarantined

Thomas: We do actually require vaccination in some cases - many states impose such requirements with respect to school age children with limited opt-outs, as do employers, universities and other organizations. It's unlikely that everyone would be mandated to do so, but given how novel this is we should also expect novel policy directives and structures at both the state and federal level.

In many other instances we have while not requiring vaccination, had widespread acceptance of vaccination, largely because individuals understood the impact of these diseases first hand. Current generations don't remember measles, whooping cough, you name it. Because of that and relaxing standards based on demands for individual choice we have seen multiple recent outbreaks of diseases like measles which was at one point eradicated in many countries, US included. The public health based social contract seems to be fraying - even further now in light of protests against shelter in place rules. But the only way we can protect the vulnerable is with wider herd immunity. This may be a moment where we strengthen the bonds and responsibilities Americans owe each other, and that may mean reframing what we require of one another, including vaccination. Penalties for not vaccinating might range from limited access to social activities to social shaming, which may be the real force that gets individuals to agree to vaccination. But seeing so much death during this crisis may be the other force that limits resistance.

Ariana: I don't have a full answer to this question in regards to Africa, but the fact that we aren't hearing as much isn't because they are experiencing a lack in cases. There was recently an interesting article in Nature magazine that was written by the head of their CDC (https://www.nature.com/articles/d41586-020-01265-0) and it starts with statistics about what the case count is like there, "The first case of COVID-19 in Africa was reported in Egypt on 14 February 2020. Since then, 52 countries in Africa have reported more than 30,000 cases and about 1,400 deaths from the new coronavirus. This count is likely to be an underestimate..." It goes on to describe the inequities between testing capabilities in Africa compared to other places as a platform to talk about a plan moving forward that brings awareness to what is happening there and brings them into the fold. This is an example of how in general western news coverage is terrible about paying attention and covering things going on in Afria and in the developing world.

Sarah: The initial assumption was that illness from the virus would drop off with the advent of warmer weather in the spring. But from the beginning, as the virus spread out from China and Italy, it became apparent that community spread was rapid even in warm climates.  The National Academy of Sciences has said there is not enough evidence to show that the virus will be less virulent in warmer, more humid climates (as others sometimes are), though we will know more about that over the summer. For now we should assume that lower numbers in Africa have more to do with the  factors that Dr. Eily mentions above.