The Lame-Duck Vaccine

In the end, there was no October surprise. Donald Trump spent months declaring that a COVID-19 vaccine was imminent, a gambit that failed to pressure the FDA into an approval before Election Day but did succeed, nevertheless, in eroding the American public’s confidence in a vaccine. It was only yesterday that Pfizer released very early but very promising results suggesting that its COVID-19 vaccine candidate could be more than 90 percent effective. The company plans to seek emergency authorization from the FDA later this month, when required safety data are complete.

If authorized, the initial rollout of this vaccine will likely begin in the fractious period before the inauguration, under a lame-duck president who claims that the election he lost was stolen. There will be a path to ending the pandemic, but it will be fraught. Joe Biden will have to restore trust in a vaccine that his predecessor has fervently politicized, and Americans will have to be willing to take the vaccine regardless of whom they voted for—if they voted at all. If not, the coronavirus will simply rage on.

The good news, if the preliminary data hold, is that the Pfizer vaccine appears highly effective, which in and of itself could sway hesitant Americans, says Matt Motta, a political scientist at Oklahoma State University. Ninety percent efficacy is far better than the 50 percent bar set by the FDA for authorization and far better, frankly, than scientists had expected, given the type of virus. The closer a COVID-19 vaccine gets to preventing all infections, the stronger the case for it.

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A Biden administration is also a return to the very basics of scientific communication: not openly fighting with agencies, letting scientists rather than politicians speak, and setting realistic timelines on vaccine rollout. The president-elect’s and the president’s reactions to the Pfizer news were a study in contrasts. In his statement, Biden praised the experts involved before pivoting to the importance of masks and social distancing in the many months before widespread vaccination is possible. Trump tweeted, “STOCK MARKET UP BIG, VACCINE COMING SOON. REPORT 90% EFFECTIVE. SUCH GREAT NEWS!”

Biden’s conciliatory political instincts are likely to help too. “If he says, ‘I fully endorse the vaccine put in motion under the Trump administration. Our decisions are made on the science’ … that already would be something,” says Heidi Larson, an anthropologist and the director of the Vaccine Confidence Project. As Trump repeatedly promised a speedy vaccine approval before the election, Democrats especially grew concerned about politics overtaking safety. The percentage of Democrats willing to take the vaccine fell from 83 percent in July to 53 percent in September, according to a Gallup poll. A new administration is a chance to reset. Under the best-case scenario, a Trump administration that wants credit for developing a vaccine and a Biden administration that wants credit for administering it end up doing the same thing: persuading Americans to get vaccinated.

In the worst-case scenario, politics engulfs the vaccine again. Trump certainly isn’t ceding the spotlight, and Republicans are following his lead on the vaccines. “In the next two months, you’re going to have a very loud mouthpiece,” says David Bluestone, a co-founder of ClearPath Strategies, a progressive public-opinion research and strategy firm that has conducted polling on COVID-19 vaccine hesitancy. Yesterday, Republicans rushed to credit Trump after Pfizer initially distanced itself from Operation Warp Speed, the government’s public-private vaccine partnership. (Technically, both are right: Operation Warp Speed did not fund Pfizer’s vaccine, but it did sign a $1.95 billion contract to buy 100 million doses.) But Trump is also now attacking Pfizer for sharing its vaccine data after the election, when such news can no longer benefit him. What if Trump turns on the vaccine, say, if someone gets sick after getting a shot? Imagine, Bluestone told me, that Trump says, “Wait, wait, wait, that wasn’t part of Operation Warp Speed. Only trust Operation Warp Speed.’” The transition of power is already far from smooth, and Trump and his allies are unwilling to give up the vaccine as a political issue.

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As the vaccine reaches people, adverse events are likely to be an especially tricky communications problem. A small number of people will, simply by coincidence, get sick after getting a vaccine. “People will continue to have heart attacks and strokes and accidents and things. And when you overlay a vaccination program on top of that, it may appear that some of these things may be caused by vaccines,” says Bruce Gellin, the former director of the National Vaccine Program Office at the Department of Health and Human Services. When the 2009 H1N1-swine-flu vaccine was rolled out, Gellin says, HHS held roundtables with reporters anticipating this very challenge. “It’s just to realize, with these high numbers”—with millions of Americans getting a vaccine—“every community will have a story like this,” he says. A decade later, the news environment is more fractured and local news is even more depleted, with social media often filling the void. Of course, adverse events actually caused by the vaccine may turn up too, so the FDA and the Centers for Disease Control and Prevention will have to make clear that systems exist for monitoring vaccine safety after a clinical trial.

Politicians won’t be the best messengers to encourage people to get vaccinated, by very dint of the fact they are polarizing figures. Biden will have to turn to other groups to boost confidence in a vaccine. Health-care workers will play a crucial role—both as the likely first recipients of a COVID-19 vaccine under CDC recommendations and as trusted sources of information in their communities. “People [will] ask them, ‘Hey, if you were me, what would you do?’” Gellin says. Larson says she hopes that the CDC, for example, can set up a system for health-care workers to ask questions about a vaccine. “Don’t assume just because people work in the health-care profession or science that they’re just going to line up behind it,” Larson says. During the H1N1 pandemic, she points out, some health-care workers did in fact refuse the vaccine. If health-care workers are hesitant about a COVID-19 vaccine during this initial rollout, that will have knock-on effects for the rest of the public.

Biden’s vaccination campaign will have to look beyond scientists and doctors too. Anthony Fauci has been the face of the COVID-19 response so far, but for people who have been resistant to lockdowns, he’s not the best messenger on a vaccine, Bluestone said. “They will shut him out and, in fact, it might antagonize them,” he told me. Celebrities and even ordinary people, Motta adds, can be good messengers, especially when they share personal stories. One potentially powerful message he’s studied is when people who are immunocompromised and cannot get vaccines themselves say they are relying on others to get vaccinated.

Course-correcting will be difficult, so the first messages about a COVID-19 vaccine are the ones most likely to stick. That the vaccine will likely be rolled out during the lame-duck period is both a potential opportunity to bridge partisanship and a potential liability during this extremely contentious transition of power. Whether the process goes well or goes poorly, the Biden administration will inherit it.