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A Social and Behavioral Research Agenda to Facilitate COVID-19 Vaccine Uptake in the United States

Emily K. Brunson, Monica Schoch-Spana, and on behalf of the Working Group on Readying Populations for COVID-19 Vaccine
Date posted:
August 26, 2020
Publication type:
Health Secur 2020;18(4)
Mary Ann Liebert, Inc.
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Since its first appearance in the United States in February 2020, novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has infected over 3.77 million and killed over 140,000 people in the United States (as of July 20, 2020).1 Responses to the virus, including closing venues where person-to-person spread was likely (eg, schools, churches, businesses) and requiring the use of masks and physical distancing measures when person-to-person contact could not be avoided, reduced the spread of SARS-CoV-2. At the same time, these protective actions have also radically transformed social life and upended national and household economies.2,3 As the health crisis continues and pandemic fatigue starts to take hold, political leaders, health officials, and the general public are anxiously searching for solutions.

One of the most promising solutions is vaccines—if they can be successfully developed and deployed—that could provide individual- and population-level immunity and, thus, the conditions for routine social and economic activities to resume. To facilitate the development and dissemination of such medical countermeasures, the US government has committed over $10 billion for Operation Warp Speed—a public–private partnership involving several government agencies, including the Centers for Disease Control and Prevention, the Food and Drug Administration, and the Department of Defense.4 Operation Warp Speed aims to deliver 300 million doses of a safe, effective vaccine by January 2021.4 This timeline is likely overly optimistic. Vaccine development, especially against a pathogen for which no vaccine currently exists, as is the case with coronaviruses, typically takes 10 to 15 years.5 Progress is being made, however. As of May 15, 2020, 14 promising vaccine candidates were in development.4

Despite this promising technological output, Operation Warp Speed nonetheless manifests a key social gap. The program rests upon the compelling yet unfounded assumption that “if we build it, they will come.” Past vaccination experience in routine and crisis contexts demonstrates that not all segments of the public may accept a vaccine due to concerns about safety. Uneven access to vaccines could also amplify social and economic disparities as well as feelings of racial bias. And anti-vaccination (anti-vax) sentiment could be exacerbated if mask and physical distancing opposition converges with the existing anti-vax movement, further eroding trust in public health and government.

Under these conditions, what can be done to close the gap between the technical supply and the social demand for SARS-CoV-2 (coronavirus disease 2019 [COVID-19]) vaccines? With the lag time in vaccine availability, US vaccination planners and implementers can exercise foresight and take proactive steps now to overcome potential hurdles to population uptake. Such steps would allow for evidence-informed policies and practices that would enhance public understandings of, access to, and acceptance of COVID-19 vaccines.



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