Flu and COVID: Why Public Trust in Vaccines is So Critical

Trio of Duke experts address threat of a 'twindemic' and development of a COVID vaccine

Part of the From Health Care to Child Care, the Impact of COVID-19 Series
Flu and COVID: Why Public Trust in Vaccines is So Critical
Dr. Mark McClellan, Lavanya Vasudevan and Thomas Denny

Not sure whether to get a flu shot this year?

The flu has similar symptoms to COVID-19, and while you don’t want either virus, you certainly don’t want both, three Duke vaccine experts said Friday in urging people to seek out the flu vaccine as it becomes available this fall.

Speaking to reporters in a virtual media briefing, the three scientists discussed flu season, the development of a COVID-19 vaccine, and why public trust in vaccines is so critical.

Watch the briefing on YouTube.

Here are excerpts:

ON WHY THE FLU VACCINE IS PARTICULARLY IMPORTANT THIS YEAR

Thomas Denny, COO, Duke Human Vaccine Institute

“It’s important this year and every year that people take a flu vaccine. Especially this year when you have COVID circulating. Both infections affect the respiratory track and can have serious consequences.”

“If we can have a high vaccine take rate … for influenza, we can help reduce or take that infection, that disease off the table and minimize the consequences that result from flu infections.”

Lavanya Vasudevan, family medicine and community health professor

“We are going into this flu season with both hands tied behind our back. We are contending with a drop in preventive health care visits and a drop in vaccine rates due to COVID-19. We are also working in a climate where trust in vaccines continues to erode.”

“North Carolina actually does much better than most other states, but still, only 1 in 2 in NC get the vaccine each year.”

“The stakes are just much higher because we’re risking a twindemic.”

Dr. Mark McClellan, former U.S. Food and Drug Administration commissioner, current director of the Duke-Margolis Center for Health Policy

“If we can get vaccination right for flu, that’s a great practice, great warmup for doing an effective job on the challenges ahead with a COVID vaccine.”

WHY EMERGENCY AUTHORIZATION USE FOR A VACCINE IS IMPORTANT

Mark McClellan

“It gives the FDA the ability to be flexible to approve a product when they have enough evidence on safety and effectiveness to conclude it’s OK to use it on a select group of people who are relatively high risk.”

“We’re going to have to see a safe and effective vaccine. We’re also going to have to see the vaccine really works in patients who would be in these early use cases.”

“When people talk about vaccines being available later this year, they do not mean for everyone. The groups most likely to benefit are health care workers. They’re on the front lines. So it’s more like a therapeutic for them. We’re not talking about getting to herd immunity here. We’re trying to protect the people most likely to face a COVID-19 infection every day of their lives because of the work that they do.”

“This is going to take some time to get the vaccine out to so many people.”

“It’s very important for people to understand the FDA has put into place a quite effective approach. Using Emergency USA Authorization is a step on the way to broader access to the vaccine.”

“We don’t know the results of the trials yet but there will be a lot of opportunities to learn. I hope people don’t rush to conclusions now about whether they want to get the vaccine, but pay attention to the process that’s ahead so we can all make informed decisions.”

IS THE RUSH TO GET A VACCINE MAKING AMERICANS RETICENT?

Lavanya Vasudevan

“We are seeing people who are normally pro-vaccine express concern about the COVID-19 vaccine and not being comfortable with the way the vaccine is being pushed to market. When people are trying to make decisions about vaccinations, they often make risk-benefit tradeoffs.”

“We don’t know what the vaccine is going to look like. We’re seeing a process that’s happening so fast. But we are not in a position to do science as usual. Science as usual takes decades.”

“We are making adjustments. We are using the tools in our toolbox. We are using our knowledge from related diseases and related vaccines. It doesn’t necessarily mean we are cutting corners. We are being efficient.”

“We really can’t say yet whether one vaccine candidate is better than another. A lot of the concern really stems from the rush to approve the vaccine. The only way to get past that is to reassure the American public that all safety precautions will be followed. The approval process really has to be transparent; it has to be reliable. People are looking for a process that is free from political interference. Any perception of shortcuts will really affect the public’s trust in the vaccine.”

ON WHAT MAKES AN EFFECTIVE FLU VACCINATION SEASON

Mark McClellan

“A good sign would be if we could get flu vaccine rates up. Typically they’re only around 50 percent and not even that high in groups that are at highest risk. That’s one important sign. Another is we’re going to need a lot of new distribution channels. As we get to broader use to more of the public, we’re going to need to bring in a lot of partners.”

“This is true for flu vaccine – not just doctor’s offices but pharmacies, which have really expanded their role in COVID testing. They have good access to flu vaccine support now, too. Special community health centers, maybe special programs set up at workplaces.”

ON COMBATTING VACCINE RELUCTANCE

Lavanya Vasudevan

“We have the challenge that the flu vaccine is not always the most effective vaccine, so a lot of people use that as an excuse.”

“It’s important to remember the flu is a contagious respiratory disease. It can lead to hospitalization or death.”

“It helps to tell people that. Sometimes I use the analogy of wearing a seat belt or a bike helmet. If you’re in an accident, a seat belt or a helmet can prevent serious injuries or death. Even if a flu vaccine doesn’t prevent you from getting the flu, it can reduce serious negative consequences.”

COULD A COVID VACCINE LEAD TO A CURE FOR THE COMMON COLD?

Thomas Denny

“Common cold vaccines have been a challenge for a lot of years because that bug mutates, it drifts, it changes very rapidly. It’s a very hard bug to chase. We are looking to develop what we’re calling a pan-corona vaccine.”

“We may be able to minimize the risk of a number of coronaviruses. The science is not there yet but we’re on an aggressive path.”

ON THE NEED FOR CERTAIN VULNERABLE POPULATIONS TO GET A FLU VACCINE

Lavanya Vasudevan

“(We need to) identify the best interventions. A lot of these communities have a long history of negative experiences with health care and research and distrust in authority. It’s becoming so much worse with the prevalence of misinformation online. That’s just fueling anti-vaccine sentiment. We have a long way to go in terms of regaining their confidence and trust.”

“We really need to work with local community leaders. We need strong partnerships. This isn’t something that will happen if it’s top down. We really need to be at the grassroots level working with the communities identifying the best ways to get the message across.”

ON WHETHER QUARANTINE WILL REDUCE FLU NUMBERS

Thomas Denny

“Absolutely. Australia, for example, has had a very mild season. They’ve been on lockdown,  wearing masks, they’ve been following aggressive social distancing. If we can social distance and mask, we should see some benefit there.”

Lavanya Vasudevan

“There is some false sense of security though. People are not really talking about the second part, which is those countries really enforced social distancing, there was really good mask-wearing. We really haven’t seen that in the U.S. We’ve done really poorly in terms of implementing some of those safety measures.”

“The risk of flu still exists. I’m cautiously optimistic as well. It’s important to recognize there’s a real risk of flu and there’s no guarantee flu season will be mild. If we really want that outcome we have to really enforce those measures.”

ON PUBLIC TRUST AND POLITICIZATION OF VACCINES

Mark McClellan

“It’s a really important topic for public health. We are in peak election season. It is a divided country on many political issues. That does not need to go, though, on how we are developing and using vaccines.”

“Just remember that press spokesmen are not in charge of the process. We have a very well-developed system for clinical trials in this country that has all kinds of integrity steps built in. There’s going to be a lot of speculation about cutting corners. What people need to focus on now is the process. Soon, we will hopefully have some data to show what we’re learning about these vaccines.”

“I know people are concerned because we are in unique times in this pandemic coinciding with this very contentious election. The proof is in the process.”

“I have a lot of confidence in the clinical trial process in this country.”

Thomas Denny

“I have no doubt that group of people (at the FDA) will do their job. The more transparency we have there, the better. It’s going to be contentious. We aren’t even at that point and it’s contentious today.”

“While there is criticism about an [Emergency Use Authorization] process, we are in a war. We have a bug that’s coming after us. We’re having lots of infections and deaths. The traditional path to approve a vaccine … may be two or three years or more.”

“If we knew we had a vaccine that has a level of efficacy we might have coming out of some of these trials and we were not to go down an EUA route, that’d be irresponsible also.”

“We do need some help here. I’d like to see just as much focus on the development of treatments. If we can get a few more treatment options in the toolbox, then the vaccine is another part of it. We can take care of those folks that get infected … and hopefully have an antiviral drug administered early on. Vaccines, masks, there’s a number of tools that we need to deal with this effectively.”

ON WHETHER ATTENTION TO THE VACCINE PROCESS WILL SWAY PEOPLE

Lavanya Vasudevan

“We cannot change everybody’s mind, but where we’re focusing on is people who are on the fence. What they are looking for is a reassurance that the process will have integrity.”

ON WHEN VACCINES WILL BE WIDELY AVAILABLE

Mark McClellan

“It’s too early to say for sure. It’s not just a question of trust the process. It’s trust but verify. It’s a good process, we need to make sure it happens.”

“If the vaccines are reasonably effective, we could have … some access to vaccine, under an emergency use authorization, by the end of the year. But different vaccines are on different timetables. This will be a gradual process. Maybe some use by the end of this year. As many experts have said, including Tony Fauci, probably not broad access to the general public until later in the first quarter or second quarter of 2021. Even then, (there will be) some big challenges in making the vaccine widely available and widely used.”

Meet the experts:

Thomas N. Denny
Thomas Denny is chief operating officer of the Duke Human Vaccine Institute, a professor of medicine and an affiliate member of the Duke Global Health Institute. His administrative oversight includes a research portfolio of more than $400 million. Denny has served on numerous committees for the NIH over the last two decades.

Dr. Mark McClellan
Dr. Mark McClellan is a physician and economist who directs the Duke-Margolis Center for Health Policy, where he works on strategies and policy reforms to improve health care. He was commissioner of the U.S. Food and Drug Administration and administrator of the Centers for Medicare & Medicaid Services.

Lavanya Vasudevan
Lavanya Vasudevan is an assistant professor in the Department of Family Medicine and Community Health and the Global Health Institute at Duke. She is also a faculty affiliate at Duke’s Center for Health Policy and Inequalities Research.

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Duke experts on a variety of topics related to the pandemic can be found here.