Vaccine Views

"The speed with which vaccines were developed for COVID-19 was astonishing, and scientists even managed to harness a new technology in the process. The rollout of the vaccines has been impressive as well, but not without its problems and shortcomings. A range of experts at the Yale School of Public Health provide their views on what went right, what wasn’t handled so well, or the challenges posed by a mass vaccination campaign that still remain.

The deployment of a public-private partnership in vaccine development was a remarkable success, including the conduct of an expedited, yet thorough, review by the Food and Drug Administration. The national and global narrative also made clear the need to revitalize public health infrastructure, workforce, procedures and planning."

BUT...

"Many government leaders failed to lead by example, eschewing mask use and flaunting guidance as to small groups or stay-at-home mandates. Public health departments had been chronically undercapacitated, a disadvantage when a rapid response was needed."

Dean Sten H. Vermund, M.D., P.H.D.,
Yale School of Public Health

"The fact that even one safe and effective COVID-19 vaccine exists is extraordinary, not to mention having multiple vaccines, all developed at record speed. COVID-19 vaccines are a testament to the power of science, human ingenuity and public-private cooperation."

BUT...

"But, as the saying goes: Vaccines don’t save people, vaccination does. Despite monumental efforts by companies, national governments and the international COVID Vaccines Facility (COVAX), there remains a dangerous, worldwide vaccination divide. Much more must still be done to achieve higher, faster, more equitable vaccination coverage for everyone, everywhere—lives and the global economy depend on it."

Anant Shah, M.P.H. ’07,
Vaccine Expert in Private Industry

"Developing a new vaccine for an emerging pathogen and completing regulatory review and assessment for safety and efficacy over months without skipping any steps necessary was an absolute success. I received the same vaccine in my arm in less than nine months after consenting to my first participation in an mRNA-1273 phase 1 trial. This reinforces our trust of the scientific community."

BUT...

"Communication in everything related to this pandemic could have been better. This includes the vaccine messages, but also other mitigation measures. As a pediatrician, I think the delay in initiation of the pediatric vaccine trials contributed to anxiety that we all share around having our children back in school. High-income countries, including the United States, need also to be more active in increasing vaccine production and supply to vulnerable populations in the world. Until we resolve the disparity between rich and poor countries, we all are susceptible to more transmissible and dangerous variants. "

Inci Yildirim, M.D., PH.D., M.SC.,
Associate Professor, Yale School of Medicine; Associate Professor, Yale School of Public Health

"Connecticut has been a leader in communicating updates regularly and often to its residents. The now-defunct daily COVID-19 updates provided timely guidance and information to those with access to Connecticut Network."

BUT...

"Equity, particularly racial equity, remains an issue! This pandemic disproportionately impacted people who are African American/Black, Latina/o and Native American. We were slow to respond and adapt our testing strategies to account for this, and the same is true for our vaccination strategies. Now as we see variants on the rise, we are still working on finding exactly what does and does not work to increase vaccine confidence in communities that lack trust in the government and in health care. Connecticut has a ways to go on building trust, increasing vaccine confidence and advancing health equity."

Tekisha Dwan Everette, PH.D., Is in the Advanced Professional M.P.H. Program at YSPH and is Executive Director of Health Equity Solutions.

"The development, evaluation and approval of safe and effective vaccines within one year of the SARS-CoV-2 emergence is the public health success story. The rapid implementation of vaccination in Connecticut as well as in wealthy parts of the world is another, as evidenced by the large numbers of estimated lives saved in these regions."

BUT...

"The major failure has been the inability to translate the public health benefit of vaccines globally and especially in the most vulnerable segments at risk for COVID-19 in our country and the world. Unless we do so, we are a highly interconnected world and will have continued threats due to the spread of new variants that may compromise the benefit afforded by vaccines and the gains made in countries privileged to have implemented vaccination."

Albert Ko, M.D.,
Raj and Indra Nooyi Professor of Public Health

"My focus is on the challenges that we still face. I’ll mention just two. The first is the global catastrophe. Nobody on the planet is safe until we are all safe. How do we share the benefits of vaccine development—a miracle paid for and owned by U.S. taxpayers and their investment in basic research for the last 30 years—with the rest of the world? The second is children. How do we keep them safe and in school while accelerating the pediatric vaccine development and approval process?"

A. David Paltiel, MBA, PH.D.,
Professor, Yale School of Public Health

"The Pfizer and Moderna vaccines target the spike protein of SARS-CoV-2, which presents a surface that antibodies will easily encounter. It was a good target for the first vaccines, which had to be developed and deployed quickly. However, the surface region of the spike has evolved in the zoonotic reservoir—and now in humans—to easily proffer divergent structures with each mutation. In fact, it surely has evolved to be an evolvable structure that rapidly evades previous immunity with one or a few mutations. Therefore, the next generation of vaccine development should include as targets the membrane and envelope proteins. These proteins also feature external surfaces that are somewhat shielded by the spike and evolve at a much slower rate than the spike. It would be more challenging to devise an efficacious vaccine that targets these shielded proteins, but such a vaccine could provide much more general—perhaps even lifelong—protection, instead of the shorter duration of protection that we can count on from a spike-targeting vaccine."

Jeffrey Townsend, P.H.D.,
Elihu Professor of Biostatistics, Yale School of Public Health & Professor of Ecology and Evolutionary Biology.

"To support the global response to COVID-19, the dynamism and diversity of R&D efforts in the United States and other countries (including China, Russia and Europe as a whole) by dozens of teams incentivized by the prospect of attractive markets have driven unprecedented success in the design, development, testing and licensing of multiple COVID-19 vaccines of good efficacy in record time. This has created the potential for rapid distributions and uptake of vaccines everywhere."

BUT...

"Tragically, despite the technology successes, our efforts to plan and finance rapid production scale up so that all countries could distribute and administer vaccines to their population have been a colossal failure. Narrow vaccine nationalism, lack of technology transfer agreements in advance of the pandemic that could be quickly activated (vaccines are complex biological products that cannot be easily copied, even when patents are waived), and the total absence of global leadership and coordination to expand manufacturing to the needed scale and offer suppliers clear and predictable payment have led to today’s situation, where less than 5% of the population is vaccinated in many African and Asian countries, despite high demand from the people. This is fueling repeated surges of infection and cycles of illness and death that are entirely avoidable and is also promoting the spread of new virus variants and prolonging the travel bans and other forms of paralysis of our global system. We must fix this before the next pandemic strikes."

Robert Hecht, P.H.D.,
Professor, Yale School of Public Health

"The vaccines in use in the United States have benefited from a rigorous, transparent, independent and science-based review process from the scientists at the Food and Drug Administration and their expert advisers. These regulatory processes—free from political interference—were essential to the unprecedented pace of vaccination in the months following their authorization."

Jason L. Schwartz, P.h.D.,
Associate Professor, Yale School of Public Health